Minnesota Legislature
HF 2128
1st Unofficial Engrossment - 92nd Legislature (2021 - 2022) Posted on 05/04/2021 09:41am
3.39 3.40
3.41 3.42 3.43 3.44 3.45 3.46 3.47 3.48 4.1 4.2 4.3 4.4
4.5 4.6 4.7
4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22
4.23 4.24 4.25
4.26 4.27 4.28 4.29 4.30 4.31 4.32 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24
5.25 5.26 5.27
5.28 5.29 5.30 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24
6.25 6.26 6.27
6.28 6.29 6.30 6.31 6.32 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32
8.1 8.2 8.3
8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2
9.3 9.4 9.5
9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13
12.14 12.15 12.16
12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30
13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19
13.20
13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 14.1 14.2 14.3 14.4
14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24
14.25
14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 15.1 15.2
15.3
15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23
15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29
17.30 17.31 17.32 17.33 17.34 18.1 18.2 18.3
18.4 18.5 18.6
18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 19.1 19.2 19.3
19.4 19.5 19.6
19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28
19.29
19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 24.1 24.2 24.3 24.4 24.5
24.6 24.7 24.8
24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 24.34 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30
25.31 25.32 25.33 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19
26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28
26.29 26.30 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21
28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10
29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29
29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24
31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10
32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 32.35 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 34.35 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19
35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17
36.18
36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14
37.15 37.16 37.17 37.18 37.19
37.20 37.21 37.22
37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30
39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33
40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14
40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27
41.28 41.29 41.30 41.31 41.32 41.33 41.34 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15
42.16 42.17 42.18
42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9
44.10 44.11 44.12
44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 45.35 45.36 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14
47.15 47.16 47.17
47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13
49.14 49.15 49.16 49.17
49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32
50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10
50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18
51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 53.1 53.2 53.3 53.4 53.5 53.6 53.7
53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 54.1 54.2
54.3 54.4 54.5 54.6 54.7
54.8
54.9 54.10 54.11 54.12
54.13
54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25
54.26
54.27 54.28 54.29 54.30 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32
55.33 55.34
56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31
56.32 56.33 56.34
57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26
58.27 58.28
58.29 58.30 58.31 59.1 59.2 59.3 59.4 59.5 59.6
59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17
60.18
60.19 60.20 60.21 60.22
60.23
60.24 60.25 60.26 60.27 60.28 60.29 60.30 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10
61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21
61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30
62.1 62.2 62.3 62.4 62.5 62.6
62.7
62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23
62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 63.1 63.2
63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10
63.11 63.12 63.13 63.14 63.15
63.16 63.17 63.18
63.19 63.20
63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30
64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30
65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22
65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28
67.29 67.30 67.31 67.32 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24
71.25 71.26 71.27 71.28 71.29 71.30 71.31 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2 77.3
77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16
81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18
82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 83.1 83.2 83.3 83.4
83.5
83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9
84.10 84.11 84.12 84.13 84.14 84.16 84.15 84.18 84.17 84.19 84.20 84.21 84.22 84.24 84.23 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 84.35 84.36 84.37 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.9 85.8 85.11 85.10 85.12 85.13 85.15 85.14 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 85.34 85.35 85.36 85.37 85.38 85.39 85.40 85.41 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.14 86.13 86.15 86.16 86.17 86.18 86.19 86.20 86.22 86.21 86.23 86.24 86.26 86.25 86.27 86.28 86.29 86.30 86.31 86.32 86.34 86.33 86.35 86.36 86.37 86.38 86.39 86.40 86.41 86.42 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9
87.10 87.11 87.12 87.13 87.15 87.14 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 87.33 87.34 87.35 87.36 87.37 87.38 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.17 88.16 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 88.33 88.34 88.35 88.36 88.37 88.38 88.39 88.40 89.1 89.2 89.3 89.4 89.5 89.6
89.7 89.8 89.9 89.10 89.11 89.12
89.13 89.14 89.15 89.16 89.17 89.18 89.19
89.20 89.21 89.22 89.23 89.24
89.25 89.26 89.27 89.28 89.29 89.30 89.31 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11
90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26
90.27 90.28 90.29 90.30 90.31 90.32 90.33 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9
91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8
92.9 92.10 92.11 92.12 92.13 92.14 92.15
92.16
92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27
92.28
93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8
93.9
93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27
94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11
95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 96.1 96.2 96.3 96.4 96.5
96.6
96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 100.34 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10
101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31
101.32
102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 103.33 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13
104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22
106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 108.1 108.2 108.3 108.4 108.5 108.6 108.7
108.8
108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23
108.24 108.25 108.26 108.27 108.28 108.29 108.30 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 111.1 111.2 111.3
111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24
111.25 111.26 111.27 111.28
111.29 111.30 111.31 111.32 112.1 112.2 112.3 112.4
112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12
112.13 112.14 112.15 112.16
112.17 112.18
112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26
113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8
117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17
117.18 117.19 117.20 117.21 117.22 117.23 117.24
117.25 117.26 117.27 117.28 117.29 117.30 117.31 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18
119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27
119.28 119.29 119.30 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13
121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20
122.21 122.22 122.23 122.24 122.25 122.26 122.27
122.28 122.29 122.30 122.31 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12
123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11
124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24
124.25 124.26 124.27 124.28 124.29 124.30 125.1 125.2
125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11
125.12 125.13 125.14 125.15 125.16 125.17
125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26
126.27 126.28 126.29 126.30 126.31 126.32 126.33 127.1 127.2
127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12
127.13 127.14 127.15 127.16 127.17
127.18 127.19 127.20 127.21 127.22
127.23 127.24 127.25 127.26 127.27 127.28 127.29 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26
130.27 130.28 130.29 130.30 130.31
131.1 131.2 131.3
131.4 131.5
131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27
132.28
132.29 132.30 132.31 132.32 132.33 132.34 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12
134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10
135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 136.1 136.2 136.3 136.4 136.5
136.6
136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 137.1
137.2
137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13
137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16
138.17
138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31
139.32
140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9
141.10
141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29
141.30
142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9
142.10
142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4 143.5 143.6
143.7
143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24
143.25
143.26 143.27
143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28
144.29
144.30 144.31 144.32 144.33 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11
145.12
145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9
146.10 146.11
146.12 146.13 146.14 146.15 146.16 146.17
146.18 146.19
146.20 146.21
146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10
147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33 148.34 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12
149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 150.1 150.2
150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8
151.9
151.10 151.11 151.12 151.13 151.14 151.15
151.16 151.17 151.18 151.19 151.20
151.21 151.22 151.23 151.24 151.25 151.26
151.27 151.28 151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25
152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34 154.1 154.2 154.3 154.4 154.5 154.6 154.7
154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15
155.16
155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13
156.14
156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4
157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16
157.17 157.18 157.19 157.20 157.21 157.22
157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30
160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 162.1 162.2 162.3 162.4 162.5 162.6 162.7
162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14
164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11
166.12
166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26
166.27 166.28 166.29 166.30 166.31 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27
167.28 167.29 167.30 167.31 167.32
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11
168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21
168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9
169.10 169.11 169.12 169.13 169.14 169.15
169.16
169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31
171.1 171.2 171.3 171.4 171.5 171.6 171.7
171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29
171.30
172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31
173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25
174.26 174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23
175.24
175.25 175.26 175.27 175.28 175.29 175.30 176.1 176.2
176.3
176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12
176.13 176.14 176.15 176.16 176.17 176.18 176.19
176.20 176.21 176.22 176.23 176.24 176.25
176.26 176.27 176.28 176.29 176.30 176.31 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25
177.26
177.27 177.28 177.29 177.30 177.31 177.32 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 178.35 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 179.34 179.35 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17
181.18
181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25
182.26
182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 184.1 184.2 184.3 184.4
184.5
184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19
184.20
184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30
184.31
185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18
185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30
186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17
186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21
188.22
188.23 188.24 188.25 188.26 188.27 188.28
188.29
188.30 188.31 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7
190.8
190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23
190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31
190.32
191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9
191.10
191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 193.1 193.2 193.3 193.4
193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12
195.13 195.14
195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24
195.25 195.26 195.27 195.28 195.29 195.30
196.1 196.2 196.3 196.4 196.5
196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32 197.1 197.2
197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15
197.16 197.17 197.18 197.19 197.20 197.21 197.22
197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 198.1 198.2 198.3 198.4
198.5
198.6 198.7 198.8 198.9 198.10 198.11 198.12
198.13 198.14 198.15 198.16 198.17 198.18
198.19 198.20 198.21 198.22 198.23 198.24
198.25 198.26 198.27 198.28 198.29 198.30 198.31
199.1 199.2
199.3 199.4
199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 200.1 200.2 200.3
200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24
201.25 201.26 201.27 201.28
202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28
202.29 202.30 202.31 202.32 202.33 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16
203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 203.34 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 204.34 204.35 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 205.34 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14
206.15 206.16 206.17 206.18 206.19 206.20 206.21
206.22 206.23 206.24 206.25 206.26 206.27 206.28
206.29 206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18
207.19 207.20 207.21 207.22 207.23 207.24 207.25
207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17
208.18 208.19 208.20 208.21 208.22
208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30
208.31 208.32 208.33 209.1 209.2 209.3 209.4 209.5 209.6
209.7 209.8 209.9 209.10 209.11 209.12
209.13 209.14 209.15 209.16 209.17 209.18
209.19 209.20 209.21 209.22 209.23 209.24
209.25 209.26 209.27 209.28 209.29 209.30 209.31 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23
210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13
211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26
211.27 211.28 211.29 211.30 211.31 211.32
212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 212.34 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13
213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 213.33
214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10
214.11 214.12 214.13 214.14 214.15 214.16
214.17 214.18 214.19 214.20 214.21
214.22 214.23 214.24 214.25 214.26 214.27
214.28 214.29 214.30 215.1 215.2 215.3 215.4 215.5
215.6 215.7
215.8 215.9
215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 216.34 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11
219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30
220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 220.33 220.34 220.35 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33
223.1
223.2 223.3 223.4 223.5
223.6 223.7 223.8 223.9 223.10 223.11
223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31
224.1 224.2 224.3 224.4
224.5 224.6 224.7
224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13
227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26
227.27 227.28 227.29 227.30 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 229.33 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 230.33 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30
232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 233.34 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27
234.28 234.29 234.30 234.31 234.32 234.33 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15
235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 236.33 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12
237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 237.33 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 238.33 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 240.1 240.2
240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27
241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5
242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 242.33 242.34 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31
244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 244.33 244.34 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17
245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 248.34 248.35 249.1 249.2
249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 251.1 251.2 251.3 251.4 251.5
251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14
253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2
254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12
254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 255.1 255.2 255.3 255.4 255.5 255.6
255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31
258.1 258.2 258.3 258.4 258.5
258.6 258.7 258.8
258.9 258.10
258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21
258.22
258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 259.33 259.34 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21
261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13
262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26
262.27
262.28 262.29 262.30 262.31 262.32 263.1 263.2
263.3
263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22
263.23
263.24 263.25 263.26 263.27 263.28
263.29
264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20
264.21
264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9
265.10
265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28
265.29
266.1 266.2 266.3 266.4
266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24
267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 267.33 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21
268.22
268.23 268.24 268.25 268.26 268.27 268.28 268.29 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12
269.13
269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25
269.26 269.27 269.28 269.29 269.30 269.31 270.1 270.2 270.3 270.4 270.5
270.6
270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23
270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 271.1 271.2 271.3
271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11
271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30
273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9
275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30
276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15
276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 276.32 277.1 277.2 277.3 277.4
277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21
277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 278.1 278.2 278.3 278.4
278.5 278.6 278.7 278.8 278.9 278.10
278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18
279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 280.33
281.1 281.2 281.3 281.4 281.5
281.6
281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15
281.16
281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10
282.11
282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 283.1 283.2 283.3 283.4 283.5 283.6 283.7
283.8
283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12
284.13
284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31
285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18
285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 286.1 286.2
286.3 286.4 286.5 286.6
286.7 286.8 286.9 286.10
286.11 286.12 286.13 286.14 286.15 286.16
286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28
287.1 287.2 287.3 287.4
287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16
287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2
288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14
288.15 288.16 288.17 288.18 288.19 288.20 288.21
288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 289.1 289.2 289.3 289.4
289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16
289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 289.33 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 291.34 291.35 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22
294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13
296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 297.1 297.2
297.3 297.4 297.5 297.6 297.7 297.8
297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16
298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23
299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 299.33 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23
301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 302.33 303.1 303.2 303.3 303.4 303.5 303.6 303.7
303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32
304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23
304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 305.1 305.2 305.3 305.4 305.5
305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19
305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 306.1 306.2 306.3 306.4 306.5
306.6 306.7 306.8 306.9 306.10 306.11
306.12 306.13 306.14
306.15 306.16
306.17 306.18
306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 307.33 307.34 307.35 308.1 308.2 308.3 308.4
308.5
308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14
309.15
309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 309.33 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 311.1 311.2 311.3 311.4 311.5 311.6 311.7
311.8 311.9
311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25
311.26
311.27 311.28 311.29 311.30 311.31 312.1 312.2
312.3 312.4
312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25
312.26
312.27 312.28 312.29 312.30 312.31 312.32 312.33 313.1 313.2 313.3 313.4 313.5 313.6 313.7
313.8
313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 313.33 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 314.33 314.34 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13
315.14
315.15 315.16 315.17 315.18 315.19 315.20
315.21
315.22 315.23 315.24 315.25 315.26
315.27
316.1 316.2 316.3 316.4 316.5
316.6
316.7 316.8 316.9 316.10 316.11
316.12
316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21
316.22
316.23 316.24 316.25 316.26 316.27
316.28
317.1 317.2 317.3 317.4 317.5
317.6
317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16
317.17
317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 321.32 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23
327.24
327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11
330.12
330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21
331.22
331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 332.1 332.2 332.3 332.4 332.5 332.6
332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19
332.20
332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 333.33 333.34 333.35 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2
335.3
335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 335.34 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30
336.31
337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29
337.30
338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26
338.27
338.28 338.29 338.30 338.31 338.32 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26
339.27 339.28 339.29 339.30 339.31 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 343.1 343.2 343.3 343.4 343.5 343.6 343.7
343.8
343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19
345.20
345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16
347.17
347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 349.1 349.2
349.3
349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20
351.21
351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15
352.16
352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32
353.1
353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 354.33 354.34 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27
355.28
355.29 355.30 355.31 355.32 355.33 356.1 356.2 356.3 356.4
356.5
356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20
358.21
358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17
361.18
361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13
362.14
362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32
363.1
363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9
363.10
363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25
363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8
364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25
364.26 364.27 364.28 364.29 364.30 364.31 364.32 364.33 364.34 365.1 365.2 365.3
365.4 365.5
365.6
365.7 365.8
365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18
365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27
365.28 365.29 365.30 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17
366.18 366.19 366.20 366.21 366.22 366.23
366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16
367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29
367.30 367.31 367.32 367.33 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22
368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 371.33 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26
372.27
372.28 372.29 372.30 372.31 372.32 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8
374.9
374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32
375.1
375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26
375.27
375.28 375.29 375.30 375.31 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.16 376.15 376.18 376.17 376.20 376.19 376.22 376.21 376.24 376.23 376.26 376.25 376.28 376.27 376.30 376.29 376.32 376.31 376.34 376.33 376.36 376.35 376.38 376.37 376.40 376.39 376.42 376.41 376.44 376.43 377.2 377.1 377.4 377.3 377.6 377.5 377.8 377.7 377.10 377.9 377.12 377.11 377.14 377.13 377.16 377.15 377.18 377.17 377.20 377.19 377.22 377.21 377.24 377.23 377.26 377.25 377.28 377.27 377.30 377.29 377.32 377.31 377.34 377.33 377.36 377.35 377.38 377.37 377.40 377.39 377.42 377.41 377.44 377.43 377.46 377.45 378.2 378.1 378.4 378.3 378.6 378.5 378.8 378.7 378.10 378.9 378.12 378.11 378.14 378.13 378.16 378.15 378.18 378.17 378.20 378.19 378.22 378.21 378.24 378.23 378.26 378.25 378.28 378.27 378.30 378.29 378.32 378.31 378.34 378.33 378.36 378.35 378.38 378.37 378.40 378.39 378.42 378.41 378.44 378.43 378.46 378.45 379.2 379.1 379.4 379.3 379.6 379.5 379.8 379.7 379.10 379.9 379.12 379.11 379.14 379.13 379.16 379.15 379.18 379.17 379.20 379.19 379.22 379.21 379.24 379.23 379.26 379.25 379.28 379.27 379.30 379.29 379.32 379.31 379.34 379.33 379.36 379.35 379.38 379.37 379.40 379.39 379.42 379.41 379.44 379.43 379.46 379.45 380.2 380.1 380.4 380.3 380.6 380.5 380.8 380.7 380.10 380.9 380.12 380.11 380.14 380.13 380.16 380.15 380.18 380.17 380.20 380.19 380.22 380.21 380.24 380.23 380.26 380.25 380.28 380.27 380.30 380.29 380.32 380.31 380.34 380.33 380.36 380.35 380.38 380.37 380.40 380.39 380.42 380.41 380.44 380.43 380.46 380.45 381.2 381.1 381.4 381.3 381.6 381.5 381.8 381.7 381.10 381.9 381.12 381.11 381.14 381.13 381.16 381.15 381.18 381.17 381.20 381.19 381.22 381.21 381.24 381.23 381.26 381.25 381.28 381.27 381.30 381.29 381.32 381.31 381.34 381.33 381.36 381.35 381.38 381.37 381.40 381.39 381.42 381.41 381.44 381.43 381.46 381.45 382.2 382.1 382.4 382.3 382.6 382.5 382.8 382.7 382.10 382.9 382.12 382.11 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 382.34 382.35 382.36 382.37 382.38 382.39 382.40 382.41 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28
383.29
383.30 383.31 383.32 383.33 383.34 383.35 383.36
384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19
384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17
385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 385.33 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28
386.29
387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9
387.10
387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 388.1 388.2 388.3 388.4 388.5
388.6
388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 391.1 391.2
391.3
391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8
393.9
393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 393.32 393.33 394.1 394.2
394.3
394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13
394.14
394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24
394.25
394.26 394.27 394.28 394.29 394.30
394.31
395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 396.33 396.34 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12
397.13
397.14 397.15
397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 399.1 399.2
399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 399.32 399.33 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 401.33 401.34 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15
402.16 402.17 402.18 402.19
402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29
403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8
403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18
404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23
405.24 405.25 405.26
405.27 405.28 405.29 405.30 405.31 405.32 405.33 405.34 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32 406.33 406.34 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10
409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21
410.22 410.23 410.24 410.25
410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31
411.32 411.33 412.1 412.2
412.3 412.4 412.5 412.6 412.7 412.8
412.9
412.10 412.11 412.12 412.13 412.14 412.15
412.16
412.17 412.18 412.19 412.20 412.21
412.22
412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 413.1 413.2
413.3
413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 413.33 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22
415.23 415.24 415.25 415.26 415.27 415.28 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11
416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21
418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24
420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25
421.26 421.27 421.28 421.29 421.30 421.31 421.32 421.33 421.34 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14
422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 422.33
423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17
423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27
423.28
423.29 423.30 423.31 423.32 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28
424.29 424.30 424.31 424.32 424.33 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15
425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27
425.28 425.29 425.30 425.31 425.32 426.1 426.2 426.3 426.4 426.5 426.6
426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21
426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 426.33 427.1 427.2
427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11
427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 428.1 428.2 428.3 428.4 428.5 428.6
428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17
428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29
429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13
429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30
430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16
430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33
431.1 431.2 431.3 431.4 431.5
431.6 431.7
431.8
431.9 431.10
431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19
432.20 432.21
432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 434.1 434.2
434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11
434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 435.33 435.34 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 436.34 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 437.33 437.34 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9
438.10
438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28
439.29 439.30 439.31 439.32 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 440.33 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18
441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8
442.9 442.10 442.11 442.12 442.13 442.14 442.15
442.16 442.17 442.18
442.19 442.20 442.21 442.22 442.23 442.24 442.25
442.26 442.27 442.28
442.29 442.30 442.31 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 443.32 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21
444.22 444.23 444.24
444.25 444.26 444.27 444.28 444.29 444.30 444.31 444.32 445.1 445.2 445.3 445.4
445.5 445.6 445.7
445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24
447.25 447.26 447.27 447.28 447.29 447.30 447.31 447.32 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33 448.34 448.35 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 451.33 451.34 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22
452.23 452.24
452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 452.33 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 453.33 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9
454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28
454.29 454.30 454.31 454.32 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 456.1 456.2 456.3 456.4 456.5 456.6 456.7
456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17
456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 457.1 457.2
457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17
458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25
458.26 458.27 458.28 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32 459.33 459.34 460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9
460.10 460.11 460.12
460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 460.31 460.32 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9
462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28
462.29 462.30 462.31
463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13
463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21
463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 463.31 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28
465.29 465.30 465.31 465.32 466.1 466.2 466.3 466.4 466.5 466.6
466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20
466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28
467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16
467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24
467.25 467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19
468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27
468.28 468.29 468.30 468.31 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23
469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8
472.9 472.10 472.11
472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 474.32 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31
479.32 479.33 480.1 480.2
480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 483.1 483.2 483.3 483.4
483.5 483.6 483.7 483.8
483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19
485.20 485.21 485.22 485.23
485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 485.32 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14
487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22
487.23 487.24 487.25 487.26 487.27 487.28 487.29 487.30 487.31 487.32 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27
489.28 489.29 489.30 489.31
490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11
490.12 490.13 490.14
490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 492.1 492.2
492.3 492.4 492.5
492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13
492.14 492.15 492.16
492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9
493.10 493.11 493.12
493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22
493.23 493.24 493.25
493.26 493.27 493.28 493.29 493.30 493.31 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17
495.18 495.19 495.20
495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30
497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12
497.13
497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 498.33 498.34 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20
499.21
499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 499.33 499.34 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22
500.23
500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 500.33 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29
501.30 501.31
502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15
502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24
502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 502.33
503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10
503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18 503.19
503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 503.31 503.32 503.33 504.1 504.2
504.3
504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22
504.23
504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8
505.9
505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20
505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27
506.28 506.29 506.30 506.31
507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13
507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 507.32 507.33 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20
509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29 509.30 509.31 510.1 510.2 510.3
510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13
510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22
510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17
511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27
511.28 511.29 511.30 511.31 511.32 511.33 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9
512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17
512.18 512.19 512.20 512.21 512.22 512.23
512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 512.32
513.1 513.2 513.3
513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26 513.27
513.28 513.29 513.30 513.31 513.32 513.33 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 515.32 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 516.31 516.32 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 517.32 517.33 517.34 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17
518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28 518.29 518.30
518.31
519.1 519.2 519.3 519.4 519.5 519.6 519.7
519.8
519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17
519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 520.1 520.2 520.3
520.4 520.5 520.6 520.7 520.8 520.9
520.10 520.11
520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 521.32 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30
523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 524.1 524.2 524.3 524.4
524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21
524.22
524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9
525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19
525.20 525.21 525.22 525.23
525.24 525.25 525.26 525.27 525.28 525.29 525.30 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11
526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 527.1 527.2 527.3
527.4 527.5 527.6 527.7 527.8
527.9 527.10 527.11 527.12
527.13 527.14 527.15 527.16 527.17 527.18 527.19
527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 528.1 528.2
528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17
528.18 528.19 528.20 528.21 528.22
528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 529.1 529.2 529.3
529.4 529.5 529.6 529.7 529.8
529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16
529.17 529.18 529.19 529.20 529.21 529.22 529.23
529.24 529.25 529.26 529.27 529.28 529.29 529.30 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13
530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23
530.24 530.25 530.26 530.27 530.28
531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8 531.9 531.10
531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18
531.19 531.20 531.21 531.22
531.23 531.24 531.25 531.26 531.27 531.28
532.1 532.2 532.3 532.4
532.5 532.6 532.7 532.8 532.9 532.10
532.11 532.12 532.13 532.14
532.15 532.16 532.17 532.18 532.19
532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 533.1 533.2 533.3 533.4 533.5 533.6 533.7
533.8 533.9 533.10 533.11 533.12 533.13
533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23
533.24 533.25 533.26 533.27 533.28 533.29 533.30
534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9
534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18
534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 535.1 535.2
535.3 535.4 535.5 535.6 535.7 535.8 535.9 535.10 535.11
535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27 535.28 535.29
536.1 536.2 536.3 536.4 536.5 536.6 536.7
536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20
536.21 536.22 536.23 536.24
536.25 536.26 536.27 536.28 536.29
537.1 537.2 537.3 537.4 537.5
537.6 537.7 537.8 537.9 537.10 537.11
537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32 537.33 538.1 538.2 538.3 538.4
538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13
538.14 538.15 538.16 538.17
538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31 538.32 538.33 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27
539.28 539.29 539.30 539.31 539.32 539.33
540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17
540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17
541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29
542.1 542.2 542.3 542.4 542.5 542.6
542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23
542.24 542.25 542.26 542.27 542.28 542.29 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 543.32 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27
544.28 544.29 544.30 544.31 544.32 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11
545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 545.34 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 546.32 546.33 546.34 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 547.33 547.34 547.35 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 548.33 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16
549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 549.31 549.32 549.33 549.34 550.1 550.2 550.3 550.4
550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 553.32 553.33 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 554.32 554.33 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27
555.28 555.29 555.30 555.31 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16
556.17 556.18 556.19 556.20
556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12 557.13 557.14 557.15 557.16 557.17
557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 557.33 557.34 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11
559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15
560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21 561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13
562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 562.30 563.1 563.2 563.3 563.4 563.5 563.6 563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17
563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24 564.25 564.26 564.27 564.28 564.29 564.30 564.31 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8 566.9 566.10
566.11 566.12 566.13 566.14 566.15 566.16 566.17 566.18 566.19 566.20 566.21 566.22 566.23 566.24 566.25 566.26 566.27 566.28 566.29 566.30 566.31 567.1 567.2 567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23
567.24 567.25 567.26 567.27 567.28 567.29 567.30 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26
568.27 568.28 568.29 568.30 568.31 568.32 569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17 569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26
569.27 569.28 569.29 569.30 569.31 570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9 570.10 570.11 570.12 570.13 570.14 570.15 570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 570.31 570.32 571.1 571.2 571.3 571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12 571.13 571.14 571.15 571.16 571.17 571.18 571.19 571.20 571.21 571.22 571.23 571.24 571.25 571.26 571.27 571.28 571.29 571.30 571.31 572.1 572.2 572.3 572.4 572.5 572.6
572.7 572.8 572.9 572.10 572.11 572.12 572.13 572.14 572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24 572.25 572.26
572.27 572.28 572.29 572.30 572.31 572.32 573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10 573.11 573.12 573.13 573.14 573.15 573.16 573.17 573.18 573.19 573.20 573.21 573.22 573.23 573.24
573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 574.1 574.2 574.3 574.4 574.5 574.6 574.7 574.8 574.9 574.10 574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21 574.22 574.23 574.24 574.25 574.26 574.27 574.28 574.29 574.30 574.31 574.32 575.1 575.2 575.3 575.4 575.5 575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15 575.16 575.17 575.18 575.19 575.20 575.21 575.22
575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 576.1 576.2 576.3 576.4 576.5 576.6 576.7 576.8 576.9 576.10 576.11 576.12 576.13 576.14 576.15 576.16 576.17 576.18 576.19 576.20 576.21 576.22 576.23 576.24 576.25 576.26 576.27 576.28 577.1 577.2 577.3 577.4 577.5 577.6 577.7 577.8 577.9 577.10 577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20 577.21 577.22 577.23 577.24 577.25 577.26 577.27 577.28 577.29 577.30 577.31 578.1 578.2
578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17 578.18 578.19 578.20 578.21 578.22 578.23 578.24 578.25 578.26 578.27 578.28 578.29 578.30 579.1 579.2 579.3 579.4 579.5 579.6 579.7 579.8 579.9
579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29 579.30 579.31 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12
580.13 580.14 580.15 580.16 580.17 580.18 580.19 580.20 580.21 580.22 580.23 580.24 580.25 580.26 580.27 580.28 580.29 581.1 581.2 581.3 581.4 581.5 581.6 581.7 581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16 581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24
581.25 581.26 581.27 581.28 581.29 581.30 581.31 582.1 582.2 582.3 582.4 582.5 582.6 582.7 582.8 582.9 582.10 582.11 582.12 582.13 582.14 582.15 582.16 582.17 582.18
582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 582.30 582.31 582.32 583.1 583.2 583.3 583.4 583.5 583.6 583.7 583.8 583.9 583.10
583.11 583.12 583.13 583.14 583.15 583.16 583.17 583.18 583.19 583.20 583.21 583.22 583.23 583.24 583.25 583.26 583.27 583.28 583.29 583.30 583.31 583.32 583.33 584.1 584.2 584.3 584.4 584.5 584.6 584.7 584.8 584.9 584.10 584.11 584.12 584.13 584.14 584.15 584.16
584.17 584.18 584.19 584.20 584.21 584.22 584.23 584.24 584.25 584.26 584.27 584.28 584.29 584.30 584.31 584.32
585.1 585.2 585.3 585.4 585.5 585.6 585.7 585.8 585.9 585.10 585.11 585.12 585.13 585.14 585.15 585.16
585.17 585.18 585.19 585.20
585.21 585.22
585.23 585.24
585.25 585.26 585.27 585.28 585.29 585.30 585.31 586.1 586.2
586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18 586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29 586.30 587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8 587.9 587.10 587.11 587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19 587.20 587.21 587.22 587.23 587.24 587.25 587.26 587.27 587.28 587.29
588.1 588.2 588.3 588.4 588.5 588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26 588.27 588.28 588.29 588.30 588.31 588.32 589.1 589.2 589.3 589.4 589.5 589.6 589.7 589.8 589.9 589.10 589.11 589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27 589.28 589.29 589.30 589.31 589.32 589.33 589.34 590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10 590.11 590.12 590.13 590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22 590.23 590.24 590.25 590.26 590.27 590.28 590.29 590.30 590.31 590.32 591.1 591.2 591.3 591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19 591.20 591.21 591.22 591.23 591.24 591.25 591.26 591.27 591.28 591.29 591.30 591.31 591.32 592.1 592.2 592.3 592.4 592.5 592.6 592.7 592.8 592.9 592.10 592.11 592.12
592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21 592.22 592.23 592.24 592.25 592.26 592.27 592.28 592.29 592.30 592.31 592.32 592.33 593.1 593.2 593.3 593.4 593.5 593.6 593.7 593.8 593.9 593.10 593.11 593.12 593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22 593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 593.31 593.32 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28 594.29 594.30
595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12 595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23 595.24 595.25 595.26 595.27 595.28 595.29 595.30 595.31 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11 596.12 596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24 596.25 596.26 596.27 596.28 596.29 596.30 596.31 597.1 597.2 597.3 597.4 597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14 597.15 597.16 597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 597.30 597.31 597.32 597.33 598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21 598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 599.1 599.2 599.3 599.4 599.5 599.6 599.7 599.8 599.9 599.10 599.11 599.12 599.13 599.14 599.15 599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24 599.25 599.26 599.27 599.28 599.29 599.30 600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8 600.9 600.10 600.11 600.12 600.13 600.14 600.15 600.16 600.17 600.18 600.19 600.20 600.21 600.22 600.23
600.24 600.25 600.26 600.27 600.28 600.29 600.30 600.31 600.32 601.1 601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13 601.14 601.15 601.16 601.17 601.18 601.19 601.20 601.21 601.22 601.23 601.24 601.25 601.26 601.27 601.28 601.29 601.30 602.1 602.2 602.3 602.4 602.5 602.6 602.7 602.8 602.9 602.10 602.11 602.12 602.13 602.14 602.15 602.16 602.17 602.18 602.19 602.20 602.21 602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 602.30 603.1 603.2 603.3 603.4 603.5 603.6 603.7 603.8 603.9 603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23 603.24 603.25 603.26 603.27 603.28 603.29 603.30
604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 604.31 605.1 605.2 605.3 605.4 605.5 605.6 605.7 605.8 605.9 605.10 605.11 605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24
605.25 605.26 605.27 605.28 605.29 605.30 605.31 606.1 606.2 606.3 606.4 606.5 606.6 606.7 606.8 606.9 606.10 606.11 606.12 606.13 606.14
606.15 606.16 606.17 606.18 606.19 606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 606.31 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15 607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25 607.26 607.27 607.28 607.29 607.30 607.31 608.1 608.2
608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10 608.11 608.12 608.13 608.14 608.15 608.16 608.17 608.18 608.19 608.20 608.21 608.22 608.23 608.24 608.25 608.26 608.27 608.28 608.29 608.30 608.31 608.32 609.1 609.2 609.3 609.4 609.5 609.6 609.7 609.8 609.9
609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28 609.29 609.30 609.31 610.1 610.2 610.3 610.4 610.5 610.6 610.7 610.8 610.9 610.10 610.11 610.12 610.13 610.14 610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 611.1 611.2 611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14 611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30 611.31 611.32 611.33 612.1 612.2 612.3 612.4 612.5 612.6 612.7 612.8 612.9 612.10 612.11 612.12 612.13 612.14 612.15 612.16 612.17 612.18 612.19 612.20 612.21 612.22 612.23 612.24 612.25 612.26 612.27 612.28 612.29 612.30 613.1 613.2 613.3 613.4 613.5 613.6 613.7 613.8 613.9 613.10 613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21 613.22 613.23 613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32 614.1 614.2 614.3 614.4 614.5 614.6 614.7 614.8 614.9 614.10 614.11 614.12 614.13 614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26 614.27 614.28 614.29 614.30 614.31 615.1 615.2 615.3 615.4 615.5 615.6 615.7 615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15 615.16 615.17 615.18 615.19 615.20 615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 615.31 615.32 615.33 616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15 616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25
616.26 616.27 616.28 616.29 616.30 617.1 617.2 617.3 617.4 617.5 617.6 617.7 617.8 617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 617.31 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11 618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 618.30 618.31 618.32 619.1 619.2 619.3 619.4 619.5 619.6 619.7
619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 619.31 619.32 620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8 620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21 620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 620.31 620.32 621.1 621.2 621.3 621.4 621.5 621.6 621.7
621.8 621.9 621.10 621.11 621.12 621.13
621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28 621.29 621.30 621.31 622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8 622.9 622.10 622.11 622.12 622.13 622.14 622.15 622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27 622.28 622.29 622.30 622.31 622.32 623.1 623.2 623.3 623.4 623.5 623.6 623.7 623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17 623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 623.33 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11 624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 624.30 624.31 624.32 625.1 625.2 625.3 625.4 625.5 625.6 625.7 625.8 625.9 625.10 625.11 625.12 625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 625.31 625.32 625.33 625.34 626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16 626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 627.1 627.2 627.3 627.4 627.5 627.6 627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21 627.22 627.23 627.24 627.25 627.26 627.27 627.28 627.29 627.30 627.31 627.32 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 628.32 628.33
629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 629.32 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 632.1 632.2 632.3 632.4 632.5 632.6 632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16 632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 632.32 632.33 632.34 632.35 633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22 633.23 633.24 633.25 633.26 633.27 633.28 633.29 633.30 633.31 633.32 634.1 634.2 634.3 634.4 634.5 634.6 634.7 634.8 634.9 634.10 634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19 634.20 634.21 634.22 634.23 634.24 634.25 634.26 634.27 634.28 634.29 634.30 634.31 635.1 635.2 635.3 635.4 635.5 635.6 635.7 635.8 635.9 635.10 635.11 635.12 635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20 635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28 635.29 635.30 635.31 635.32 635.33 636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26 636.27 636.28 636.29 636.30 636.31 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16 637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 638.31 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 640.1 640.2 640.3 640.4 640.5 640.6 640.7 640.8 640.9 640.10 640.11 640.12 640.13 640.14 640.15 640.16 640.17 640.18 640.19 640.20 640.21 640.22 640.23 640.24 640.25 640.26 640.27 640.28 640.29 640.30 640.31 640.32 640.33 641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16
641.17 641.18 641.19 641.20 641.21 641.22 641.23 641.24 641.25 641.26 641.27 641.28 641.29 641.30 641.31 642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17 642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26 642.27 642.28 642.29 642.30 642.31 642.32 643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 643.31 644.1 644.2 644.3 644.4 644.5 644.6 644.7 644.8 644.9 644.10 644.11 644.12 644.13 644.14 644.15 644.16 644.17 644.18 644.19 644.20 644.21 644.22 644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 644.32 645.1 645.2 645.3 645.4 645.5 645.6 645.7 645.8 645.9 645.10 645.11 645.12 645.13 645.14 645.15 645.16 645.17 645.18 645.19 645.20 645.21 645.22 645.23 645.24 645.25 645.26 645.27 645.28 645.29 645.30 645.31 645.32 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18 646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28 646.29 646.30 646.31 647.1 647.2 647.3 647.4 647.5 647.6 647.7 647.8 647.9 647.10 647.11 647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 647.31 647.32 647.33 648.1 648.2 648.3 648.4 648.5 648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14 648.15 648.16 648.17 648.18 648.19 648.20 648.21 648.22 648.23 648.24 648.25 648.26 648.27 648.28 648.29 648.30 648.31 649.1 649.2 649.3 649.4 649.5 649.6 649.7 649.8 649.9 649.10 649.11 649.12 649.13 649.14 649.15 649.16 649.17 649.18 649.19 649.20 649.21 649.22 649.23 649.24 649.25 649.26 649.27 649.28 649.29 649.30 650.1 650.2 650.3 650.4 650.5 650.6 650.7 650.8 650.9 650.10 650.11 650.12 650.13 650.14 650.15 650.16 650.17 650.18 650.19 650.20 650.21 650.22 650.23 650.24 650.25 650.26 650.27 650.28 650.29 650.30 651.1 651.2 651.3 651.4 651.5 651.6 651.7 651.8 651.9 651.10 651.11 651.12 651.13 651.14 651.15 651.16 651.17 651.18 651.19 651.20 651.21 651.22 651.23 651.24 651.25 651.26 651.27 651.28 651.29 651.30 651.31 651.32 651.33 651.34 652.1 652.2 652.3 652.4 652.5 652.6 652.7 652.8 652.9 652.10 652.11 652.12 652.13 652.14 652.15 652.16 652.17 652.18 652.19 652.20 652.21 652.22 652.23 652.24 652.25 652.26 652.27 652.28 652.29 652.30 652.31 652.32 652.33 652.34 653.1 653.2 653.3
653.4 653.5 653.6 653.7 653.8 653.9 653.10 653.11 653.12 653.13
653.14 653.15 653.16
653.17 653.18
653.19 653.20 653.21 653.22 653.23 653.24 653.25 653.26 653.27 653.28 653.29 653.30 653.31 654.1 654.2 654.3 654.4 654.5 654.6 654.7 654.8 654.9 654.10
654.11 654.12 654.13 654.14 654.15 654.16 654.17 654.18 654.19 654.20 654.21 654.22 654.23 654.24 654.25 654.26 654.27 654.28 654.29 654.30 655.1 655.2 655.3 655.4 655.5 655.6 655.7 655.8 655.9 655.10 655.11 655.12 655.13 655.14 655.15 655.16 655.17 655.18
655.19 655.20 655.21 655.22 655.23 655.24 655.25 655.26 655.27 655.28 655.29 655.30 655.31 655.32 656.1 656.2 656.3 656.4 656.5 656.6
656.7 656.8 656.9 656.10 656.11 656.12 656.13 656.14 656.15 656.16 656.17 656.18 656.19 656.20 656.21 656.22 656.23 656.24 656.25 656.26 656.27 656.28 656.29 656.30 657.1 657.2 657.3 657.4 657.5 657.6 657.7 657.8 657.9 657.10 657.11 657.12 657.13 657.14 657.15 657.16 657.17 657.18 657.19 657.20 657.21 657.22 657.23 657.24 657.25 657.26 657.27 657.28 657.29 657.30 657.31 657.32 658.1 658.2 658.3 658.4 658.5 658.6 658.7 658.8 658.9 658.10 658.11 658.12 658.13 658.14 658.15 658.16 658.17 658.18 658.19 658.20 658.21 658.22 658.23 658.24 658.25 658.26 658.27 658.28 658.29 658.30 658.31 658.32 659.1 659.2 659.3 659.4 659.5 659.6 659.7 659.8 659.9 659.10 659.11 659.12 659.13 659.14 659.15 659.16 659.17 659.18 659.19 659.20 659.21 659.22 659.23 659.24 659.25 659.26 659.27 659.28 659.29 659.30 659.31 660.1 660.2 660.3 660.4 660.5 660.6 660.7 660.8 660.9 660.10 660.11 660.12 660.13 660.14 660.15 660.16 660.17 660.18 660.19 660.20 660.21 660.22 660.23 660.24 660.25 660.26 660.27 660.28 660.29 660.30 660.31 661.1 661.2 661.3 661.4 661.5 661.6 661.7 661.8 661.9 661.10 661.11 661.12 661.13 661.14 661.15 661.16 661.17 661.18 661.19 661.20 661.21 661.22 661.23 661.24 661.25 661.26 661.27 661.28 661.29 661.30 661.31 662.1 662.2 662.3 662.4 662.5 662.6 662.7 662.8 662.9 662.10 662.11 662.12 662.13 662.14 662.15 662.16 662.17 662.18 662.19 662.20 662.21 662.22 662.23 662.24 662.25 662.26 662.27 662.28 662.29 662.30 662.31 662.32 662.33 663.1 663.2 663.3 663.4 663.5 663.6 663.7 663.8 663.9 663.10 663.11 663.12 663.13 663.14 663.15 663.16 663.17 663.18 663.19 663.20 663.21 663.22 663.23 663.24 663.25 663.26 663.27 663.28 663.29 663.30 663.31 664.1 664.2 664.3 664.4 664.5 664.6 664.7 664.8 664.9 664.10 664.11 664.12 664.13 664.14 664.15 664.16 664.17 664.18 664.19 664.20 664.21 664.22 664.23 664.24 664.25 664.26 664.27 664.28 664.29 664.30 664.31 664.32 664.33 664.34 665.1 665.2 665.3 665.4 665.5 665.6 665.7 665.8 665.9 665.10 665.11 665.12 665.13 665.14 665.15 665.16 665.17 665.18 665.19 665.20 665.21 665.22 665.23 665.24 665.25 665.26 665.27 665.28 665.29 665.30 665.31 665.32 665.33 666.1 666.2 666.3 666.4 666.5 666.6 666.7 666.8 666.9 666.10 666.11 666.12 666.13 666.14 666.15 666.16 666.17 666.18 666.19 666.20 666.21 666.22 666.23 666.24 666.25 666.26 666.27 666.28 666.29 666.30 666.31 666.32 666.33 667.1 667.2 667.3 667.4 667.5 667.6 667.7 667.8 667.9 667.10 667.11 667.12 667.13 667.14 667.15 667.16 667.17 667.18 667.19 667.20 667.21 667.22 667.23 667.24 667.25 667.26 667.27 667.28 667.29 667.30 667.31 667.32 668.1 668.2 668.3 668.4 668.5 668.6 668.7 668.8 668.9 668.10 668.11 668.12 668.13 668.14 668.15 668.16 668.17 668.18 668.19 668.20 668.21 668.22 668.23 668.24 668.25 668.26 668.27 668.28 668.29 668.30 669.1 669.2 669.3 669.4 669.5 669.6 669.7 669.8 669.9 669.10 669.11 669.12 669.13 669.14 669.15 669.16 669.17 669.18 669.19 669.20 669.21 669.22 669.23 669.24 669.25 669.26 669.27 669.28 669.29 669.30 669.31 670.1 670.2 670.3 670.4 670.5 670.6 670.7 670.8 670.9 670.10 670.11 670.12 670.13 670.14 670.15 670.16 670.17 670.18 670.19 670.20 670.21 670.22 670.23 670.24 670.25 670.26 670.27 670.28 670.29 670.30 670.31
671.1 671.2 671.3
671.4 671.5
671.6 671.7 671.8 671.9 671.10 671.11 671.12 671.13 671.14 671.15 671.16
671.17 671.18 671.19 671.20 671.21 671.22 671.23 671.24 671.25 671.26 671.27 671.28 671.29 671.30 671.31
672.1 672.2 672.3 672.4 672.5 672.6 672.7 672.8 672.9 672.10 672.11 672.12 672.13 672.14
672.15 672.16 672.17 672.18 672.19 672.20 672.21 672.22 672.23 672.24 672.25 672.26 672.27 672.28 672.29 672.30 672.31 672.32 672.33
673.1 673.2 673.3 673.4 673.5 673.6 673.7 673.8 673.9 673.10 673.11 673.12 673.13 673.14 673.15 673.16 673.17 673.18 673.19 673.20 673.21 673.22 673.23 673.24 673.25 673.26 673.27 673.28 673.29 673.30 673.31 674.1
674.2 674.3 674.4 674.5 674.6 674.7 674.8 674.9 674.10 674.11 674.12 674.13 674.14 674.15 674.16 674.17 674.18 674.19 674.20 674.21 674.22 674.23 674.24 674.25 674.26 674.27 674.28 674.29 674.30 674.31 674.32 675.1 675.2 675.3 675.4 675.5 675.6 675.7 675.8 675.9 675.10
675.11 675.12 675.13 675.14 675.15 675.16 675.17 675.18 675.19 675.20 675.21 675.22 675.23 675.24 675.25 675.26 675.27 675.28 675.29 675.30 675.31 676.1 676.2 676.3 676.4
676.5 676.6 676.7 676.8 676.9 676.10 676.11 676.12 676.13 676.14 676.15 676.16 676.17 676.18 676.19 676.20 676.21 676.22 676.23 676.24 676.25 676.26 676.27 676.28 676.29 676.30 676.31 676.32 677.1 677.2 677.3 677.4 677.5 677.6 677.7
677.8 677.9 677.10 677.11 677.12 677.13 677.14 677.15 677.16 677.17 677.18 677.19 677.20 677.21 677.22 677.23 677.24 677.25 677.26 677.27 677.28 677.29 677.30 677.31 677.32 677.33 678.1 678.2
678.3 678.4 678.5
678.6 678.7 678.8 678.9 678.10 678.11 678.12 678.13 678.14 678.15 678.16 678.17 678.18 678.19 678.20 678.21
678.22 678.23 678.24 678.25 678.26 678.27 678.28 678.29 678.30 679.1 679.2 679.3 679.4 679.5 679.6 679.7 679.8 679.9 679.10 679.11
679.12 679.13 679.14 679.15 679.16 679.17 679.18 679.19 679.20 679.21 679.22 679.23 679.24 679.25 679.26 679.27 679.28 679.29 679.30 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 680.10 680.11 680.12 680.13 680.14
680.15 680.16 680.17 680.18 680.19 680.20 680.21 680.22 680.23
680.24 680.25 680.26 680.27 680.28
680.29 680.30 680.31 680.32 681.1 681.2 681.3 681.4 681.5 681.6 681.7 681.8 681.9 681.10 681.11 681.12 681.13 681.14 681.15 681.16 681.17 681.18 681.19 681.20 681.21 681.22 681.23 681.24 681.25 681.26 681.27 681.28 681.29 681.30 681.31 681.32 682.1 682.2 682.3 682.4 682.5 682.6 682.7 682.8 682.9 682.10 682.11 682.12 682.13 682.14 682.15 682.16 682.17 682.18 682.19 682.20 682.21 682.22 682.23 682.24 682.25 682.26 682.27 682.28 682.29 682.30 682.31 682.32 683.1 683.2 683.3 683.4 683.5 683.6 683.7 683.8
683.9 683.10 683.11 683.12 683.13 683.14 683.15 683.16 683.17 683.18 683.19 683.20 683.21 683.22 683.23 683.24 683.25 683.26 683.27 683.28 683.29 683.30 683.31 684.1 684.2 684.3 684.4 684.5 684.6 684.7 684.8 684.9 684.10 684.11
684.12 684.13 684.14 684.15 684.16 684.17 684.18
684.19 684.20 684.21 684.22 684.23 684.24 684.25
684.26 684.27 684.28 684.29
685.1 685.2 685.3 685.4 685.5 685.6 685.7 685.8 685.9 685.10 685.11 685.12 685.13 685.14 685.15
685.16 685.17 685.18 685.19 685.20 685.21 685.22 685.23 685.24 685.25 685.26 685.27
685.28 685.29 685.30 685.31 686.1 686.2 686.3 686.4 686.5 686.6 686.7 686.8 686.9 686.10 686.11
686.12 686.13 686.14 686.15 686.16 686.17 686.18 686.19 686.20 686.21 686.22 686.23 686.24 686.25 686.26 686.27 686.28 686.29 686.30
686.31 686.32 686.33 686.34 687.1 687.2 687.3 687.4 687.5 687.6 687.7 687.8 687.9 687.10 687.11 687.12 687.13 687.14 687.15 687.16 687.17 687.18 687.19 687.20
687.21 687.22 687.23 687.24 687.25 687.26 687.27 687.28 687.29 687.30 687.31 688.1 688.2 688.3 688.4 688.5 688.6 688.7 688.8 688.9 688.10 688.11 688.12 688.13 688.14 688.15 688.16 688.17 688.18
688.19 688.20 688.21 688.22 688.23 688.24 688.25 688.26 688.27
688.28 688.29 688.30 688.31 689.1 689.2 689.3 689.4 689.5 689.6 689.7 689.8 689.9 689.10 689.11 689.12 689.13 689.14 689.15 689.16 689.17 689.18 689.19 689.20 689.21 689.22 689.23 689.24 689.25
689.26 689.27 689.28 689.29 689.30 689.31 689.32 689.33 690.1 690.2 690.3 690.4 690.5 690.6 690.7 690.8 690.9 690.10
690.11 690.12 690.13 690.14 690.15 690.16 690.17 690.18 690.19 690.20 690.21 690.22 690.23 690.24 690.25 690.26 690.27 690.28 690.29 690.30 690.31 690.32 690.33 691.1 691.2 691.3
691.4 691.5 691.6 691.7 691.8 691.9 691.10 691.11 691.12 691.13 691.14 691.15 691.16 691.17 691.18 691.19 691.20 691.21 691.22 691.23 691.24 691.25 691.26 691.27 691.28 691.29 691.30 691.31 692.1 692.2
692.3 692.4 692.5 692.6 692.7 692.8 692.9 692.10 692.11 692.12 692.13 692.14 692.15 692.16 692.17 692.18 692.19 692.20 692.21 692.22
692.23 692.24 692.25 692.26 692.27 692.28 692.29 692.30 693.1 693.2 693.3
693.4 693.5 693.6 693.7
693.8 693.9 693.10 693.11 693.12 693.13 693.14 693.15 693.16 693.17 693.18 693.19 693.20 693.21 693.22 693.23 693.24 693.25 693.26 693.27 693.28 693.29 693.30 693.31 693.32 694.1 694.2 694.3 694.4 694.5 694.6 694.7 694.8 694.9 694.10 694.11 694.12 694.13 694.14
694.15 694.16 694.17 694.18 694.19 694.20 694.21
694.22 694.23 694.24 694.25 694.26 694.27 694.28 694.29 694.30 694.31 694.32 694.33 695.1 695.2 695.3 695.4
695.5 695.6 695.7 695.8 695.9 695.10 695.11
695.12 695.13 695.14 695.15 695.16 695.17 695.18
695.19 695.20 695.21 695.22
695.23 695.24 695.25 695.26 695.27 695.28 695.29 695.30 695.31 696.1 696.2 696.3 696.4 696.5 696.6
696.7 696.8 696.9 696.10 696.11 696.12 696.13 696.14 696.15 696.16 696.17 696.18 696.19 696.20 696.21 696.22 696.23 696.24 696.25 696.26 696.27 696.28 696.29
696.30 696.31 696.32 696.33 696.34 697.1 697.2 697.3 697.4 697.5 697.6 697.7 697.8 697.9 697.10 697.11 697.12 697.13 697.14 697.15 697.16 697.17 697.18 697.19 697.20
697.21 697.22 697.23 697.24 697.25 697.26 697.27 697.28 697.29 697.30 698.1 698.2 698.3 698.4 698.5
698.6 698.7 698.8 698.9
698.10 698.11 698.12 698.13 698.14 698.15 698.16 698.17 698.18 698.19 698.20 698.21 698.22 698.23 698.24 698.25 698.26 698.27 698.28 698.29 698.30 698.31 698.32 699.1 699.2 699.3 699.4 699.5 699.6 699.7 699.8 699.9 699.10 699.11 699.12 699.13 699.14 699.15 699.16 699.17 699.18 699.19 699.20 699.21 699.22 699.23 699.24 699.25 699.26 699.27 699.28 699.29 699.30 699.31 699.32 700.1 700.2 700.3 700.4 700.5 700.6 700.7 700.8 700.9 700.10 700.11 700.12 700.13 700.14 700.15 700.16 700.17 700.18 700.19 700.20 700.21 700.22 700.23 700.24 700.25 700.26 700.27 700.28 700.29 700.30 700.31 700.32 700.33 700.34 701.1 701.2 701.3 701.4 701.5 701.6 701.7
701.8 701.9 701.10 701.11 701.12 701.13 701.14 701.15 701.16 701.17 701.18 701.19 701.20 701.21 701.22 701.23 701.24 701.25 701.26 701.27 701.28 701.29 701.30 701.31 701.32
702.1 702.2 702.3 702.5 702.4 702.6 702.7 702.8 702.9 702.10 702.11 702.12 702.13 702.14 702.15 702.16 702.17 702.18 702.19 702.20 702.21 702.22 702.23 702.24 702.25 702.26 702.27 702.28 702.29 702.30 702.31 702.32 702.33 702.34 702.35 702.36 702.37 702.38 702.39 703.1 703.2 703.3 703.4 703.5 703.6 703.7 703.8 703.9 703.10 703.11 703.12 703.13 703.14 703.15 703.16 703.17 703.18 703.19 703.20 703.21 703.22 703.23 703.24 703.25 703.26 703.27 703.28 703.29 703.30 703.31 703.32 703.33 703.34 703.35 703.36 703.37 703.38 703.39 703.40 703.41 703.42 703.43 703.44 703.45 704.1 704.2 704.3 704.4 704.5 704.6 704.7 704.8 704.9 704.10 704.11 704.12 704.13 704.14 704.15 704.16 704.17 704.18 704.19 704.20 704.21 704.22 704.23 704.24 704.25 704.26 704.27 704.28 704.29 704.30 704.31 704.32 704.33 705.1 705.2 705.3 705.4 705.5 705.6 705.7 705.8 705.9 705.10 705.11 705.12 705.13 705.14 705.15 705.16 705.17 705.18 705.19 705.20 705.21 705.22 705.23 705.24 705.25 705.26 705.27 705.28 705.29 705.30 705.31 705.32 705.33 705.34 706.1 706.2 706.3 706.4 706.5 706.6 706.7 706.8 706.9
706.10 706.11 706.12 706.13 706.14 706.15 706.16 706.17 706.18 706.19 706.20 706.21 706.22 706.23 706.24 706.25 706.26 706.27 706.28 706.29 706.30 706.31 706.32 706.33 707.1 707.2 707.3 707.4 707.5 707.6 707.7 707.8 707.9 707.10 707.11 707.12 707.13 707.14 707.15 707.16 707.17 707.18 707.19 707.20 707.21 707.22 707.23 707.24 707.25 707.26 707.27 707.28 707.29 707.30 707.31 707.32 707.33
708.1 708.2 708.3 708.4 708.5
708.6 708.7 708.8 708.9 708.10 708.11 708.12 708.13 708.14 708.15 708.16 708.17 708.18 708.19 708.20 708.21 708.22 708.23 708.24 708.25 708.26 708.27 708.28 708.29 708.30 708.31 709.1 709.2 709.3 709.4 709.5 709.6 709.7 709.8 709.9 709.10 709.11 709.12 709.13 709.14 709.15 709.16 709.17 709.18 709.19 709.20 709.21 709.22 709.23 709.24 709.25 709.26 709.27 709.28 709.29 709.30 710.1 710.2 710.3 710.4 710.5 710.6 710.7 710.8 710.9 710.10 710.11 710.12 710.13 710.14 710.15 710.16 710.17 710.18 710.19 710.20 710.21 710.22 710.23 710.24 710.25 710.26 710.27 710.28 710.29 710.30 710.31 710.32 711.1 711.2 711.3 711.4 711.5 711.6 711.7 711.8 711.9 711.10 711.11 711.12 711.13
711.14 711.15 711.16 711.17 711.18 711.19
711.20 711.21 711.22 711.23 711.24 711.25 711.26 711.27 711.28 711.29
711.30 711.31 711.32 712.1 712.2 712.3 712.4 712.5
712.6 712.7 712.8 712.9
712.10 712.11 712.12 712.13 712.14 712.15 712.16 712.17 712.18 712.19 712.20
712.21 712.22 712.23 712.24 712.25 712.26 712.27 712.28 712.29 712.30 712.31
713.1 713.2 713.3 713.4 713.5 713.6 713.7 713.8 713.9 713.10 713.11 713.12 713.13 713.14 713.15 713.16 713.17 713.18 713.19 713.20 713.21 713.22 713.23 713.24 713.25 713.26 713.27 713.28 713.29 713.30 713.31 713.32 713.33 714.1 714.2 714.3 714.4 714.5 714.6 714.7 714.8 714.9 714.10 714.11 714.12 714.13 714.14 714.15 714.16 714.17 714.18 714.19 714.20 714.21 714.22 714.23 714.24 714.25 714.26 714.27 714.28 714.29 714.30 714.31 714.32 714.33 714.34 714.35 715.1 715.2 715.3 715.4 715.5 715.6 715.7 715.8 715.9 715.10 715.11 715.12 715.13 715.14 715.15 715.16 715.17 715.18 715.19 715.20 715.21 715.22 715.23 715.24 715.25 715.26 715.27 715.28 715.29 715.30 715.31 716.1 716.2 716.3 716.4 716.5 716.6 716.7 716.8 716.9 716.10 716.11 716.12 716.13 716.14 716.15 716.16 716.17 716.18 716.19 716.20 716.21 716.22 716.23 716.24
716.25 716.26 716.27 716.28 716.29 716.30 716.31 716.32 717.1 717.2 717.3 717.4 717.5 717.6 717.7 717.8 717.9 717.10 717.11 717.12 717.13 717.14 717.15 717.16 717.17 717.18 717.19 717.20 717.21 717.22 717.23 717.24 717.25 717.26 717.27 717.28
718.1 718.2 718.3 718.4 718.5 718.6 718.7 718.8 718.9 718.10 718.11 718.12 718.13 718.14 718.15 718.16 718.17 718.18 718.19 718.20 718.21 718.22
718.23 718.24 718.25 718.26 718.27 718.28 718.29 718.30 718.31 718.32 719.1 719.2 719.3 719.4 719.5 719.6 719.7 719.8 719.9 719.10 719.11 719.12 719.13 719.14 719.15 719.16 719.17 719.18 719.19 719.20 719.21 719.22 719.23 719.24 719.25 719.26 719.27 719.28 719.29 719.30 719.31 719.32 719.33 720.1 720.2 720.3 720.4 720.5 720.6 720.7 720.8 720.9 720.10 720.11 720.12 720.13 720.14 720.15 720.16 720.17 720.18 720.19 720.20 720.21 720.22 720.23 720.24 720.25 720.26 720.27 720.28
720.29 720.30 720.31 720.32 721.1 721.2 721.3 721.4 721.5 721.6 721.7 721.8 721.9 721.10 721.11 721.12 721.13 721.14 721.15 721.16 721.17 721.18 721.19 721.20 721.21 721.22 721.23 721.24 721.25 721.26 721.27 721.28 721.29 721.30 721.31 721.32 721.33 722.1 722.2 722.3 722.4 722.5 722.6 722.7 722.8 722.9 722.10 722.11 722.12 722.13 722.14 722.15 722.16 722.17 722.18 722.19 722.20 722.21 722.22 722.23 722.24 722.25 722.26 722.27 722.28 722.29 722.30 722.31 722.32 722.33 723.1 723.2 723.3 723.4 723.5 723.6 723.7 723.8 723.9 723.10 723.11 723.12 723.13 723.14 723.15 723.16 723.17 723.18 723.19 723.20 723.21 723.22 723.23 723.24 723.25 723.26 723.27 723.28 723.29 723.30 723.31 723.32 724.1 724.2 724.3 724.4 724.5 724.6 724.7 724.8 724.9 724.10 724.11 724.12 724.13 724.14 724.15 724.16 724.17 724.18 724.19 724.20 724.21 724.22 724.23 724.24 724.25 724.26 724.27 724.28
724.29 724.30 724.31 724.32 725.1 725.2 725.3 725.4 725.5 725.6 725.7 725.8 725.9 725.10 725.11 725.12 725.13 725.14 725.15 725.16 725.17 725.18 725.19 725.20 725.21 725.22 725.23 725.24 725.25 725.26 725.27 725.28 725.29 725.30 725.31 725.32 725.33 726.1 726.2 726.3 726.4 726.5 726.6 726.7 726.8 726.9 726.10 726.11 726.12 726.13 726.14 726.15 726.16 726.17 726.18 726.19 726.20 726.21 726.22 726.23 726.24 726.25 726.26 726.27 726.28 726.29 726.30 726.31 726.32 727.1 727.2 727.3 727.4 727.5 727.6 727.7 727.8 727.9 727.10 727.11 727.12 727.13 727.14 727.15 727.16 727.17 727.18 727.19
727.20 727.21 727.22 727.23 727.24 727.25 727.26 727.27 727.28 727.29 727.30 728.1 728.2 728.3 728.4 728.5 728.6 728.7 728.8 728.9 728.10 728.11 728.12 728.13 728.14 728.15 728.16 728.17 728.18 728.19 728.20 728.21 728.22 728.23 728.24 728.25 728.26 728.27 728.28 728.29 728.30 728.31 728.32 728.33 729.1 729.2 729.3 729.4 729.5 729.6 729.7 729.8 729.9 729.10 729.11 729.12 729.13 729.14 729.15 729.16 729.17 729.18 729.19 729.20 729.21 729.22 729.23 729.24 729.25 729.26 729.27 729.28
729.29 729.30 729.31 729.32 729.33 730.1 730.2 730.3 730.4 730.5 730.6
730.7 730.8 730.9 730.10 730.11 730.12 730.13 730.14 730.15 730.16 730.17 730.18 730.19 730.20 730.21 730.22 730.23 730.24 730.25 730.26 730.27 730.28 730.29 730.30 730.31 730.32 731.1 731.2 731.3 731.4 731.5
731.6 731.7 731.8 731.9 731.10 731.11 731.12 731.13 731.14 731.15 731.16 731.17
731.18 731.19 731.20 731.21 731.22 731.23 731.24 731.25 731.26 731.27 731.28 731.29 731.30 731.31 732.1 732.2 732.3 732.4 732.5 732.6 732.7 732.8 732.9 732.10 732.11 732.12 732.13 732.14 732.15 732.16 732.17 732.18 732.19 732.20 732.21 732.22 732.23 732.24 732.25 732.26 732.27 732.28 732.29 732.30 732.31 733.1 733.2 733.3 733.4 733.5 733.6 733.7 733.8 733.9 733.10
733.11 733.12 733.13 733.14 733.15 733.16 733.17 733.18 733.19 733.20 733.21 733.22 733.23 733.24 733.25 733.26 733.27 733.28 733.29 733.30 733.31 734.1 734.2 734.3 734.4 734.5 734.6 734.7 734.8 734.9 734.10 734.11 734.12 734.13 734.14 734.15 734.16 734.17 734.18 734.19 734.20 734.21 734.22 734.23 734.24 734.25 734.26 734.27 734.28 734.29 734.30 735.1 735.2 735.3 735.4 735.5 735.6 735.7 735.8 735.9 735.10 735.11 735.12 735.13 735.14 735.15 735.16 735.17 735.18 735.19
735.20 735.21 735.22 735.23 735.24 735.25 735.26 735.27 735.28 735.29 735.30 735.31 735.32 736.1 736.2 736.3 736.4 736.5 736.6 736.7 736.8 736.9 736.10 736.11 736.12 736.13 736.14 736.15 736.16 736.17 736.18 736.19 736.20 736.21 736.22 736.23 736.24 736.25 736.26 736.27 736.28 736.29 736.30 736.31 736.32 736.33 737.1 737.2 737.3 737.4 737.5 737.6 737.7 737.8 737.9 737.10 737.11 737.12 737.13 737.14 737.15 737.16 737.17 737.18 737.19 737.20 737.21 737.22 737.23 737.24 737.25
737.26 737.27 737.28 737.29 737.30 737.31 737.32 738.1 738.2 738.3 738.4 738.5 738.6 738.7
738.8 738.9 738.10 738.11 738.12 738.13 738.14 738.15 738.16 738.17 738.18 738.19 738.20 738.21 738.22 738.23 738.24 738.25 738.26 738.27 738.28 738.29 738.30 738.31 738.32 738.33 739.1 739.2 739.3 739.4 739.5 739.6 739.7
739.8 739.9 739.10 739.11 739.12 739.13 739.14 739.15 739.16 739.17 739.18 739.19 739.20 739.21 739.22 739.23 739.24 739.25 739.26 739.27 739.28 739.29 739.30 739.31 739.32 740.1 740.2 740.3 740.4 740.5 740.6 740.7 740.8 740.9 740.10 740.11 740.12 740.13 740.14 740.15 740.16 740.17 740.18 740.19 740.20 740.21 740.22 740.23 740.24 740.25 740.26 740.27 740.28 740.29 740.30 740.31 740.32 740.33 741.1 741.2 741.3
741.4 741.5 741.6 741.7 741.8 741.9 741.10 741.11 741.12 741.13 741.14 741.15 741.16 741.17 741.18 741.19 741.20 741.21 741.22 741.23 741.24 741.25 741.26 741.27 741.28 741.29 741.30 741.31 742.1 742.2 742.3 742.4 742.5 742.6 742.7 742.8 742.9 742.10 742.11 742.12 742.13 742.14 742.15 742.16 742.17 742.18 742.19 742.20 742.21 742.22 742.23 742.24 742.25 742.26 742.27
742.28 742.29
742.30 742.31 742.32 742.33 743.1 743.2 743.3 743.4 743.5 743.6 743.7 743.8
743.9 743.10 743.11 743.12 743.13 743.14 743.15 743.16 743.17 743.18 743.19 743.20 743.21 743.22
743.23 743.24 743.25 743.26 743.27 743.28
743.29 743.30 743.31 743.32 744.1 744.2 744.3 744.4 744.5 744.6 744.7 744.8 744.9
744.10 744.11 744.12 744.13 744.14 744.15 744.16 744.17 744.18 744.19 744.20 744.21 744.22 744.23 744.24 744.25 744.26 744.27 744.28 744.29 744.30
745.1 745.2 745.3 745.4 745.5 745.6 745.7 745.8 745.9 745.10 745.11 745.12 745.13 745.14 745.15 745.16 745.17 745.18 745.19 745.20 745.21 745.22 745.23 745.24 745.25 745.26 745.27 745.28 745.29 745.30 746.1 746.2 746.3 746.4 746.5 746.6 746.7 746.8 746.9 746.10 746.11 746.12 746.13 746.14 746.15 746.16 746.17 746.18 746.19 746.20
746.21 746.22 746.23 746.24 746.25 746.26 746.27 746.28 746.29 746.30 746.31 747.1 747.2 747.3 747.4 747.5 747.6 747.7 747.8 747.9 747.10 747.11 747.12 747.13 747.14 747.15 747.16 747.17 747.18
747.19 747.20 747.21 747.22 747.23 747.24 747.25 747.26 747.27 747.28 747.29 747.30 747.31 748.1 748.2 748.3 748.4 748.5 748.6 748.7 748.8 748.9 748.10 748.11 748.12 748.13 748.14 748.15 748.16 748.17 748.18
748.19 748.20 748.21 748.22 748.23 748.24 748.25 748.26 748.27 748.28 748.29 748.30 748.31 748.32 749.1 749.2 749.3 749.4 749.5 749.6 749.7 749.8 749.9 749.10 749.11 749.12 749.13 749.14 749.15 749.16 749.17 749.18 749.19 749.20 749.21 749.22 749.23 749.24 749.25 749.26 749.27 749.28 749.29 749.30 749.31 749.32 749.33 750.1 750.2 750.3 750.4 750.5 750.6 750.7 750.8 750.9 750.10 750.11 750.12 750.13 750.14 750.15 750.16 750.17 750.18 750.19 750.20 750.21 750.22 750.23 750.24 750.25 750.26 750.27 750.28 750.29 750.30 750.31 750.32 750.33 750.34 751.1 751.2 751.3 751.4 751.5 751.6 751.7 751.8 751.9 751.10 751.11 751.12 751.13 751.14 751.15 751.16 751.17 751.18 751.19 751.20 751.21 751.22 751.23 751.24 751.25 751.26 751.27 751.28 751.29 751.30 751.31 751.32 751.33 751.34 752.1 752.2 752.3 752.4 752.5 752.6 752.7 752.8 752.9 752.10 752.11 752.12 752.13 752.14 752.15
752.16 752.17 752.18 752.19 752.20 752.21 752.22 752.23 752.24 752.25 752.26 752.27 752.28 752.29 752.30 752.31 752.32 753.1
753.2 753.3 753.4 753.5 753.6 753.7 753.8 753.9 753.10 753.11 753.12 753.13 753.14 753.15 753.16 753.17 753.18 753.19 753.20 753.21 753.22 753.23 753.24 753.25 753.26 753.27 753.28 753.29
753.30 753.31 753.32 754.1 754.2 754.3 754.4 754.5 754.6 754.7 754.8 754.9 754.10 754.11 754.12 754.13 754.14 754.15
754.16 754.17 754.18 754.19 754.20 754.21 754.22 754.23 754.24 754.25 754.26 754.27 754.28 754.29 754.30 754.31 754.32 754.33 755.1 755.2 755.3 755.4 755.5 755.6 755.7 755.8 755.9 755.10 755.11 755.12 755.13 755.14 755.15 755.16 755.17 755.18 755.19 755.20 755.21 755.22 755.23 755.24
755.25 755.26 755.27 755.28 755.29
756.1 756.2 756.3 756.4 756.5 756.6 756.7 756.8 756.9 756.10 756.11 756.12 756.13 756.14 756.15 756.16 756.17 756.18 756.19 756.20 756.21 756.22 756.23 756.24 756.25 756.26 756.27 756.28 756.29 756.30 756.31 756.32 756.33 757.1 757.2 757.3 757.4 757.5 757.6 757.7 757.8 757.9 757.10 757.11 757.12 757.13 757.14 757.15 757.16 757.17 757.18 757.19 757.20 757.21 757.22 757.23 757.24 757.25 757.26 757.27 757.28 757.29 757.30 757.31 757.32 757.33 758.1 758.2 758.3 758.4 758.5 758.6 758.7 758.8 758.9 758.10 758.11 758.12 758.13 758.14 758.15 758.16 758.17 758.18 758.19 758.20 758.21 758.22 758.23 758.24 758.25 758.26 758.27 758.28 758.29 758.30 758.31 758.32 758.33 758.34 759.1 759.2 759.3 759.4 759.5 759.6 759.7 759.8 759.9 759.10 759.11 759.12 759.13 759.14 759.15 759.16 759.17 759.18 759.19 759.20 759.21 759.22 759.23 759.24 759.25 759.26 759.27 759.28 759.29 759.30 759.31 759.32 759.33
760.1 760.2 760.3 760.4 760.5 760.6 760.7 760.8 760.9 760.10 760.11 760.12 760.13 760.14 760.15 760.16 760.17 760.18 760.19 760.20 760.21 760.22 760.23 760.24 760.25 760.26 760.27 760.28 760.29
761.1 761.2 761.3 761.4 761.5 761.6 761.7 761.8 761.9 761.10 761.11 761.12 761.13 761.14 761.15 761.16 761.17 761.18 761.19 761.20 761.21 761.22 761.23 761.24 761.25 761.26 761.27 761.28 761.29 761.30 761.31 761.32 761.33 761.34 762.1 762.2 762.3 762.4 762.5 762.6 762.7 762.8 762.9 762.10 762.11 762.12 762.13 762.14 762.15 762.16 762.17 762.18 762.19 762.20 762.21 762.22 762.23 762.24 762.25 762.26 762.27 762.28 762.29 762.30 762.31 762.32 762.33 763.1 763.2 763.3 763.4 763.5 763.6 763.7 763.8 763.9 763.10 763.11 763.12 763.13 763.14 763.15 763.16 763.17 763.18 763.19 763.20 763.21 763.22 763.23 763.24 763.25 763.26 763.27 763.28 763.29 763.30 763.31 763.32 763.33 763.34 764.1 764.2 764.3 764.4 764.5 764.6 764.7 764.8 764.9 764.10 764.11 764.12 764.13 764.14 764.15 764.16 764.17 764.18 764.19 764.20 764.21 764.22 764.23 764.24 764.25 764.26 764.27 764.28 764.29 764.30 764.31 764.32 764.33 765.1 765.2 765.3 765.4 765.5 765.6
765.7 765.8 765.9 765.10 765.11 765.12 765.13 765.14 765.15 765.16 765.17 765.18 765.19 765.20 765.21 765.22 765.23 765.24 765.25 765.26 765.27 765.28
765.29 765.30 765.31 766.1 766.2 766.3 766.4 766.5 766.6 766.7 766.8 766.9 766.10 766.11 766.12 766.13 766.14 766.15 766.16 766.17 766.18 766.19 766.20
766.21 766.22 766.23 766.24 766.25 766.26 766.27 766.28 766.29 766.30 766.31 766.32 767.1 767.2 767.3 767.4 767.5 767.6 767.7 767.8 767.9 767.10 767.11 767.12 767.13 767.14 767.15 767.16 767.17 767.18 767.19 767.20 767.21 767.22 767.23 767.24 767.25 767.26 767.27 767.28 767.29 767.30 767.31 767.32 768.1 768.2 768.3 768.4 768.5 768.6 768.7 768.8 768.9 768.10 768.11 768.12 768.13 768.14 768.15 768.16 768.17 768.18 768.19 768.20 768.21 768.22 768.23 768.24 768.25 768.26 768.27
768.28 768.29 768.30 768.31 768.32 769.1 769.2 769.3 769.4 769.5 769.6 769.7 769.8 769.9 769.10 769.11 769.12 769.13 769.14 769.15 769.16 769.17 769.18 769.19 769.20 769.21 769.22 769.23 769.24 769.25 769.26 769.27
769.28 769.29 769.30 769.31 769.32 769.33 770.1 770.2 770.3 770.4 770.5 770.6 770.7 770.8 770.9 770.10
770.11 770.12 770.13 770.14 770.15 770.16 770.17 770.18 770.19 770.20 770.21 770.22 770.23 770.24 770.25 770.26 770.27 770.28 770.29 770.30 771.1 771.2 771.3 771.4 771.5 771.6 771.7 771.8 771.9 771.10 771.11 771.12 771.13 771.14 771.15 771.16 771.17 771.18 771.19 771.20 771.21 771.22 771.23 771.24 771.25 771.26 771.27 771.28 771.29 771.30
772.1 772.2 772.3 772.4 772.5 772.6 772.7 772.8 772.9 772.10 772.11 772.12 772.13 772.14 772.15 772.16 772.17 772.18 772.19 772.20 772.21 772.22
772.23 772.24 772.25 772.26 772.27 772.28 772.29
773.1 773.2 773.3 773.4 773.5 773.6 773.7 773.8 773.9 773.10 773.11 773.12 773.13 773.14 773.15 773.16 773.17 773.18 773.19 773.20 773.21 773.22 773.23 773.24 773.25 773.26 773.27 773.28 773.29 773.30 773.31 773.32 773.33 774.1 774.2 774.3 774.4 774.5 774.6 774.7 774.8 774.9 774.10 774.11 774.12 774.13 774.14 774.15 774.16 774.17 774.18 774.19 774.20 774.21 774.22 774.23 774.24 774.25 774.26 774.27 774.28 774.29 774.30 775.1 775.2 775.3 775.4 775.5 775.6 775.7 775.8 775.9 775.10 775.11 775.12 775.13 775.14 775.15 775.16 775.17 775.18 775.19 775.20 775.21 775.22 775.23 775.24
775.25 775.26 775.27 775.28 775.29 775.30 776.1 776.2 776.3 776.4 776.5 776.6 776.7 776.8 776.9 776.10 776.11 776.12 776.13
776.14 776.15 776.16 776.17 776.18 776.19 776.20 776.21 776.22 776.23 776.24 776.25 776.26 776.27 776.28 776.29 776.30 776.31 776.32 777.1 777.2 777.3 777.4 777.5 777.6 777.7 777.8 777.9 777.10 777.11 777.12 777.13 777.14 777.15 777.16 777.17 777.18 777.19 777.20 777.21 777.22 777.23 777.24 777.25 777.26 777.27 777.28 777.29 777.30
778.1 778.2 778.3 778.4 778.5 778.6 778.7 778.8 778.9 778.10 778.11 778.12 778.13 778.14 778.15 778.16 778.17 778.18 778.19 778.20 778.21 778.22 778.23 778.24 778.25 778.26 778.27 778.28 778.29 778.30 778.31 778.32 779.1 779.2 779.3 779.4 779.5 779.6 779.7 779.8 779.9 779.10 779.11 779.12 779.13 779.14 779.15 779.16 779.17 779.18 779.19 779.20 779.21 779.22 779.23 779.24 779.25 779.26 779.27 779.28 779.29 779.30 779.31 779.32 780.1 780.2 780.3 780.4 780.5 780.6 780.7 780.8 780.9 780.10 780.11 780.12
780.13 780.14 780.15 780.16 780.17 780.18 780.19 780.20 780.21 780.22 780.23 780.24 780.25 780.26 780.27 780.28 780.29 780.30 780.31 781.1 781.2 781.3 781.4 781.5 781.6 781.7 781.8 781.9 781.10 781.11 781.12 781.13 781.14 781.15 781.16 781.17 781.18 781.19 781.20 781.21 781.22 781.23 781.24 781.25 781.26 781.27 781.28 781.29 781.30 781.31 782.1 782.2 782.3 782.4 782.5 782.6 782.7 782.8 782.9 782.10 782.11 782.12 782.13 782.14 782.15 782.16 782.17 782.18 782.19 782.20 782.21
782.22 782.23 782.24 782.25 782.26 782.27 782.28 782.29 782.30 782.31 782.32 782.33 782.34 783.1 783.2 783.3 783.4 783.5 783.6 783.7 783.8
783.9 783.10 783.11 783.12 783.13 783.14 783.15 783.16 783.17 783.18 783.19 783.20 783.21 783.22 783.23 783.24 783.25 783.26 783.27 783.28 783.29 783.30 783.31 784.1 784.2 784.3 784.4 784.5 784.6 784.7 784.8 784.9 784.10 784.11 784.12 784.13 784.14 784.15 784.16 784.17 784.18 784.19 784.20 784.21 784.22 784.23 784.24 784.25 784.26 784.27 784.28 784.29 784.30 784.31 785.1 785.2 785.3 785.4 785.5 785.6 785.7 785.8 785.9 785.10 785.11 785.12 785.13 785.14 785.15 785.16
785.17 785.18 785.19 785.20 785.21 785.22 785.23 785.24 785.25 785.26 785.27 785.28 785.29
786.1 786.2 786.3 786.4 786.5 786.6 786.7 786.8 786.9 786.10 786.11 786.12 786.13 786.14
786.15 786.16 786.17 786.18 786.19 786.20 786.21 786.22 786.23 786.24 786.25 786.26
786.27 786.28 786.29 786.30 786.31 787.1 787.2 787.3 787.4 787.5 787.6 787.7 787.8 787.9 787.10 787.11 787.12 787.13 787.14 787.15 787.16 787.17 787.18 787.19 787.20 787.21 787.22 787.23 787.24 787.25
787.26 787.27 787.28 787.29 787.30 787.31 788.1 788.2 788.3 788.4 788.5 788.6 788.7 788.8 788.9 788.10 788.11 788.12 788.13 788.14 788.15 788.16 788.17 788.18 788.19 788.20 788.21 788.22 788.23 788.24 788.25 788.26 788.27 788.28 788.29 788.30 788.31 788.32 788.33 789.1 789.2 789.3 789.4 789.5 789.6
789.7 789.8 789.9 789.10 789.11 789.12 789.13 789.14 789.15 789.16 789.17 789.18 789.19 789.20 789.21 789.22
789.23 789.24 789.25 789.26 789.27 789.28 789.29 789.30 790.1 790.2 790.3 790.4 790.5 790.6 790.7 790.8 790.9 790.10 790.11 790.12 790.13 790.14 790.15 790.16 790.17 790.18 790.19 790.20 790.21 790.22 790.23 790.24 790.25 790.26 790.27 790.28 790.29 790.30 790.31 791.1 791.2 791.3 791.4 791.5 791.6 791.7 791.8 791.9
791.10 791.11 791.12 791.13 791.14 791.15 791.16 791.17 791.18 791.19 791.20 791.21 791.22 791.23 791.24 791.25 791.26 791.27 791.28 791.29 791.30 791.31 791.32 792.1 792.2 792.3 792.4 792.5 792.6 792.7 792.8 792.9 792.10 792.11 792.12 792.13 792.14 792.15 792.16 792.17 792.18 792.19 792.20 792.21 792.22 792.23 792.24 792.25 792.26 792.27 792.28 792.29 792.30 792.31
793.1 793.2 793.3 793.4 793.5 793.6 793.7 793.8 793.9 793.10 793.11 793.12
793.13 793.14 793.15 793.16
793.17 793.18
793.19 793.20 793.21 793.22 793.23 793.24 793.25 793.26 793.27 793.28 793.29 793.30 793.31 794.1 794.2 794.3 794.4 794.5 794.6 794.7 794.8 794.9 794.10 794.11 794.12 794.13 794.14 794.15 794.16 794.17 794.18
794.19 794.20 794.21 794.22 794.23 794.24 794.25 794.26 794.27 794.28 794.29 794.30 794.31 794.32 795.1 795.2 795.3 795.4 795.5 795.6 795.7 795.8 795.9 795.10 795.11 795.12 795.13 795.14 795.15
795.16 795.17 795.18 795.19 795.20 795.21 795.22 795.23 795.24 795.25 795.26 795.27 795.28 795.29 795.30 795.31 795.32 796.1 796.2 796.3 796.4 796.5 796.6 796.7 796.8 796.9 796.10 796.11
796.12 796.13 796.14 796.15 796.16 796.17 796.18 796.19 796.20 796.21 796.22 796.23 796.24 796.25 796.26 796.27 796.28 796.29 796.30 796.31 797.1 797.2 797.3 797.4 797.5 797.6 797.7 797.8 797.9 797.10 797.11 797.12 797.13 797.14 797.15 797.16 797.17 797.18 797.19 797.20 797.21 797.22 797.23 797.24 797.25 797.26 797.27 797.28 797.29 797.30 797.31 797.32 798.1 798.2 798.3 798.4 798.5 798.6 798.7 798.8 798.9 798.10 798.11 798.12 798.13 798.14 798.15 798.16 798.17 798.18 798.19 798.20 798.21 798.22 798.23 798.24 798.25
798.26 798.27 798.28 798.29 798.30 798.31 798.32 799.1 799.2 799.3 799.4 799.5 799.6 799.7 799.8 799.9 799.10 799.11 799.12 799.13 799.14 799.15 799.16 799.17 799.18 799.19 799.20 799.21 799.22 799.23 799.24 799.25 799.26 799.27 799.28 799.29 799.30 799.31 799.32 800.1 800.2 800.3 800.4 800.5 800.6 800.7 800.8 800.9 800.10 800.11 800.12 800.13
800.14 800.15 800.16 800.17 800.18 800.19 800.20 800.21 800.22 800.23 800.24 800.25 800.26 800.27 800.28 800.29 800.30 800.31 801.1 801.2 801.3 801.4 801.5 801.6 801.7 801.8 801.9 801.10 801.11 801.12 801.13 801.14 801.15 801.16 801.17 801.18 801.19 801.20 801.21 801.22 801.23 801.24 801.25 801.26 801.27 801.28 801.29 801.30 801.31 801.32 802.1 802.2 802.3 802.4 802.5 802.6 802.7 802.8 802.9 802.10 802.11 802.12 802.13 802.14 802.15 802.16 802.17 802.18 802.19 802.20 802.21 802.22
802.23 802.24 802.25 802.26 802.27 802.28 802.29 802.30 802.31
803.1 803.2 803.3 803.4 803.5 803.6 803.7 803.8 803.9 803.10 803.11 803.12 803.13 803.14 803.15 803.16 803.17 803.18 803.19 803.20 803.21 803.22 803.23 803.24 803.25 803.26 803.27 803.28 803.29 803.30 803.31 804.1 804.2 804.3 804.4 804.5 804.6 804.7 804.8 804.9 804.10 804.11 804.12 804.13 804.14 804.15 804.16 804.17 804.18 804.19 804.20 804.21 804.22 804.23 804.24 804.25 804.26 804.27 804.28 804.29 804.30 805.1 805.2 805.3 805.4 805.5 805.6 805.7 805.8 805.9 805.10 805.11 805.12 805.13 805.14 805.15
805.16 805.17 805.18 805.19 805.20 805.21 805.22 805.23 805.24 805.25 805.26 805.27 805.28 805.29 805.30 805.31 806.1 806.2 806.3 806.4 806.5 806.6 806.7 806.8 806.9 806.10 806.11 806.12 806.13 806.14 806.15 806.16 806.17 806.18 806.19
806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28 806.29 806.30 806.31 806.32 807.1 807.2 807.3 807.4 807.5 807.6 807.7 807.8 807.9 807.10 807.11 807.12 807.13 807.14 807.15 807.16 807.17 807.18 807.19 807.20 807.21 807.22 807.23 807.24 807.25 807.26 807.27 807.28 807.29 807.30 807.31 807.32
808.1 808.2 808.3 808.4 808.5 808.6 808.7 808.8
808.9 808.10 808.11 808.12 808.13 808.14 808.15 808.16 808.17 808.18 808.19
808.20 808.21 808.22 808.23 808.24 808.25 808.26 808.27 808.28 808.29 808.30 808.31 808.32 808.33 809.1 809.2 809.3 809.4 809.5 809.6 809.7
809.8 809.9 809.10 809.11 809.12 809.13 809.14
809.15 809.16 809.17 809.18 809.19 809.20 809.21 809.22 809.23 809.24 809.25 809.26 809.27 809.28 809.29 809.30 809.31 809.32 810.1 810.2
810.3 810.4 810.5 810.6 810.7 810.8 810.9 810.10 810.11 810.12 810.13 810.14 810.15 810.16
810.17 810.18 810.19 810.20 810.21 810.22 810.23 810.24 810.25 810.26 810.27 810.28 810.29 810.30 810.31 810.32 810.33 811.1 811.2
811.3 811.4 811.5 811.6 811.7 811.8 811.9
811.10 811.11 811.12 811.13 811.14 811.15 811.16 811.17 811.18 811.19 811.20 811.21 811.22 811.23 811.24
811.25 811.26
811.27 811.28 811.29 811.30 811.31 811.32 811.33 812.1 812.2 812.3 812.4
812.5 812.6 812.7 812.8 812.9 812.10 812.11 812.12 812.13 812.14 812.15 812.16 812.17 812.18 812.19 812.20 812.21 812.22 812.23 812.24 812.25 812.26 812.27 812.28 812.29 812.30 812.31 812.32 812.33 812.34 813.1 813.2 813.3 813.4 813.5 813.6
813.7 813.8
813.9 813.10
813.11 813.12 813.13 813.14 813.15 813.16 813.17 813.18 813.19 813.20 813.21 813.22
813.23 813.24 813.25 813.26 813.27 813.28 813.29 813.30 813.31 814.1 814.2 814.3 814.4 814.5 814.6 814.7 814.8 814.9 814.10 814.11 814.12 814.13 814.14 814.15 814.16 814.17 814.18 814.19 814.20 814.21 814.22 814.23 814.24 814.25 814.26 814.27 814.28 814.29 814.30 814.31 814.32 814.33 814.34 815.1 815.2 815.3 815.4 815.5 815.6 815.7 815.8 815.9 815.10 815.11 815.12 815.13 815.14 815.15 815.16 815.17 815.18 815.19 815.20 815.21 815.22 815.23 815.24 815.25 815.26 815.27 815.28 815.29 815.30 815.31 815.32 815.33 816.1 816.2 816.3 816.4 816.5 816.6 816.7 816.8 816.9 816.10 816.11 816.12 816.13 816.14 816.15 816.16 816.17 816.18 816.19 816.20 816.21 816.22 816.23 816.24 816.25 816.26 816.27 816.28 816.29 816.30 816.31 816.32 816.33 816.34 817.1 817.2 817.3 817.4 817.5 817.6 817.7 817.8 817.9 817.10 817.11 817.12 817.13 817.14 817.15 817.16 817.17 817.18 817.19 817.20 817.21 817.22 817.23 817.24 817.25 817.26 817.27 817.28 817.29 817.30 817.31 817.32 817.33 817.34 817.35 818.1 818.2 818.3 818.4 818.5 818.6 818.7 818.8 818.9 818.10 818.11 818.12 818.13 818.14 818.15 818.16 818.17 818.18 818.19 818.20 818.21 818.22 818.23 818.24 818.25 818.26 818.27 818.28 818.29 818.30 818.31 818.32 819.1 819.2 819.3 819.4 819.5 819.6 819.7 819.8 819.9 819.10 819.11 819.12 819.13 819.14 819.15 819.16 819.17 819.18 819.19 819.20 819.21 819.22 819.23 819.24 819.25 819.26 819.27 819.28 819.29 819.30 819.31 819.32 819.33 819.34 819.35 820.1 820.2 820.3 820.4 820.5 820.6 820.7 820.8 820.9 820.10 820.11 820.12 820.13 820.14 820.15 820.16 820.17 820.18 820.19 820.20 820.21 820.22 820.23 820.24 820.25 820.26 820.27 820.28 820.29 820.30 820.31 820.32 820.33 820.34 821.1 821.2 821.3 821.4 821.5 821.6 821.7 821.8 821.9 821.10 821.11 821.12 821.13 821.14 821.15 821.16 821.17 821.18 821.19 821.20 821.21 821.22 821.23 821.24 821.25 821.26 821.27 821.28 821.29 821.30 821.31 821.32 821.33 821.34 821.35 822.1 822.2 822.3 822.4 822.5 822.6 822.7 822.8 822.9 822.10 822.11 822.12 822.13 822.14 822.15 822.16 822.17 822.18 822.19 822.20 822.21 822.22 822.23 822.24 822.25 822.26 822.27 822.28 822.29 822.30 822.31 822.32 822.33 822.34 822.35 823.1 823.2 823.3 823.4 823.5 823.6 823.7 823.8 823.9 823.10 823.11 823.12 823.13 823.14 823.15 823.16 823.17 823.18 823.19 823.20 823.21 823.22 823.23 823.24 823.25 823.26 823.27 823.28 823.29 823.30 823.31 823.32 823.33 823.34 823.35 824.1 824.2 824.3 824.4 824.5 824.6 824.7 824.8 824.9 824.10 824.11 824.12 824.13 824.14 824.15 824.16 824.17 824.18 824.19 824.20 824.21 824.22 824.23 824.24 824.25 824.26 824.27 824.28 824.29 824.30 824.31 824.32 824.33 824.34 825.1 825.2 825.3 825.4 825.5 825.6 825.7 825.8 825.9 825.10 825.11 825.12 825.13 825.14 825.15 825.16 825.17 825.18 825.19 825.20 825.21 825.22 825.23 825.24 825.25 825.26 825.27 825.28 825.29 825.30 825.31 825.32 825.33 825.34 825.35 826.1 826.2 826.3 826.4 826.5 826.6 826.7 826.8 826.9 826.10 826.11 826.12 826.13 826.14 826.15 826.16 826.17 826.18 826.19 826.20 826.21 826.22 826.23 826.24 826.25 826.26 826.27 826.28 826.29 826.30 826.31 826.32 826.33 826.34 827.1 827.2 827.3 827.4 827.5 827.6 827.7 827.8 827.9 827.10 827.11 827.12 827.13 827.14 827.15 827.16 827.17 827.18 827.19 827.20 827.21 827.22 827.23 827.24 827.25 827.26 827.27 827.28 827.29 827.30 827.31 827.32 827.33 827.34 828.1 828.2 828.3 828.4 828.5 828.6 828.7 828.8 828.9 828.10 828.11 828.12 828.13 828.14 828.15 828.16 828.17 828.18 828.19 828.20 828.21 828.22 828.23 828.24 828.25 828.26 828.27 828.28 828.29 828.30 828.31 828.32 828.33 828.34 829.1 829.2 829.3 829.4 829.5 829.6 829.7 829.8 829.9 829.10 829.11 829.12 829.13 829.14 829.15 829.16 829.17 829.18 829.19 829.20 829.21 829.22 829.23 829.24 829.25 829.26 829.27 829.28 829.29 829.30 829.31 829.32 830.1 830.2 830.3 830.4 830.5 830.6 830.7 830.8 830.9 830.10 830.11 830.12 830.13 830.14 830.15 830.16 830.17 830.18 830.19 830.20 830.21 830.22 830.23 830.24 830.25 830.26 830.27 830.28 830.29 830.30 830.31 830.32 830.33 830.34 830.35 830.36 831.1 831.2 831.3 831.4 831.5 831.6 831.7 831.8 831.9 831.10 831.11 831.12 831.13 831.14 831.15 831.16 831.17 831.18 831.19 831.20 831.21 831.22 831.23 831.24 831.25 831.26 831.27 831.28 831.29 831.30 831.31 831.32 831.33 831.34 832.1 832.2 832.3 832.4 832.5 832.6 832.7 832.8 832.9 832.10 832.11 832.12 832.13 832.14 832.15 832.16 832.17 832.18 832.19 832.20 832.21 832.22 832.23 832.24 832.25 832.26 832.27 832.28 832.29 832.30 832.31
832.32 832.33 833.1 833.2 833.3 833.4 833.5 833.6 833.7 833.8 833.9 833.10 833.11 833.12 833.13 833.14 833.15 833.16 833.17 833.18 833.19 833.20 833.21 833.22 833.23 833.24 833.25 833.26 833.27 833.28 833.29 833.30 833.31 833.32 833.33 833.34 833.35 834.1 834.2 834.3 834.4 834.5 834.6 834.7 834.8 834.9 834.10 834.11 834.12 834.13 834.14 834.15 834.16 834.17 834.18 834.19 834.20 834.21 834.22 834.23 834.24 834.25 834.26 834.27 834.28 834.29 834.30 834.31 834.32 834.33 834.34 835.1 835.2 835.3 835.4 835.5 835.6 835.7 835.8 835.9 835.10 835.11 835.12 835.13 835.14 835.15 835.16 835.17 835.18 835.19 835.20 835.21 835.22 835.23 835.24 835.25 835.26 835.27 835.28 835.29 835.30 835.31 835.32 835.33 835.34 836.1 836.2 836.3 836.4 836.5 836.6 836.7 836.8 836.9 836.10 836.11 836.12 836.13 836.14 836.15 836.16 836.17 836.18 836.19 836.20 836.21 836.22 836.23 836.24 836.25 836.26 836.27 836.28 836.29 836.30 836.31 836.32 836.33 836.34 837.1 837.2 837.3 837.4 837.5 837.6 837.7 837.8 837.9 837.10 837.11 837.12 837.13 837.14 837.15 837.16 837.17 837.18 837.19 837.20 837.21 837.22 837.23 837.24 837.25
837.26 837.27 837.28 837.29 837.30 837.31 837.32 837.33 837.34 838.1 838.2 838.3 838.4 838.5 838.6 838.7 838.8 838.9 838.10 838.11 838.12 838.13 838.14 838.15 838.16 838.17 838.18 838.19 838.20 838.21 838.22 838.23 838.24 838.25 838.26 838.27 838.28 838.29 838.30 838.31 838.32 838.33 838.34 838.35 839.1 839.2 839.3 839.4 839.5 839.6 839.7 839.8 839.9 839.10 839.11 839.12 839.13 839.14 839.15 839.16 839.17 839.18 839.19 839.20 839.21 839.22 839.23 839.24 839.25 839.26 839.27 839.28 839.29 839.30 839.31 839.32 839.33 839.34 839.35 840.1 840.2 840.3 840.4 840.5 840.6 840.7 840.8 840.9 840.10 840.11 840.12 840.13 840.14 840.15 840.16
840.17 840.18 840.19 840.20 840.21 840.22 840.23 840.24
840.25
840.26 840.27 840.28 840.29 840.30 840.31 840.32 840.33
840.34
841.1 841.2 841.3 841.4 841.5 841.6 841.7 841.8 841.9 841.10 841.11 841.12 841.13 841.14
841.15
841.16 841.17 841.18 841.19 841.20 841.21 841.22 841.23
841.24 841.25 841.26 841.27 841.28 841.29 841.30 841.31 841.32 842.1 842.2 842.3 842.4 842.5 842.6 842.7 842.8
842.9
842.10 842.11 842.12 842.14 842.13 842.15 842.16 842.17 842.18 842.19 842.20 842.21 842.22 842.23 842.24 842.25 842.26 842.27 842.28 842.29 842.30 842.31 842.32 842.33 842.34 843.1 843.2 843.3 843.4 843.5 843.6 843.7 843.8 843.9 843.10 843.11 843.12 843.13 843.14 843.15 843.16 843.17 843.18 843.19 843.20 843.21 843.22 843.23 843.24 843.25 843.26 843.27 843.28 843.29 843.30 843.31 843.32 843.33 843.34 844.1 844.2 844.3 844.4 844.5 844.6 844.7 844.8 844.9 844.10 844.11 844.12 844.13 844.14 844.15 844.16 844.17 844.18 844.19 844.20 844.21 844.22 844.23 844.24 844.25 844.26 844.27 844.28 844.29 844.30 844.31 844.32 844.33 844.34 845.1 845.2 845.3 845.4 845.5 845.6 845.7 845.8 845.9 845.10 845.11 845.12 845.13 845.14 845.15 845.16 845.17 845.18 845.19 845.20 845.21 845.22 845.23 845.24 845.25 845.26 845.27 845.28 845.29 845.30 845.31 845.32 845.33 845.34 846.1 846.2 846.3 846.4 846.5 846.6 846.7 846.8 846.9 846.10 846.11 846.12 846.13 846.14 846.15 846.16 846.17 846.18 846.19 846.20 846.21 846.22 846.23 846.24 846.25 846.26 846.27 846.28 846.29 846.30 846.31 846.32 847.1 847.2 847.3 847.4 847.5 847.6 847.7 847.8 847.9 847.10 847.11 847.12 847.13 847.14 847.15 847.16 847.17 847.18 847.19 847.20
847.21 847.22
847.23 847.24 847.25 847.26 847.27 847.28 847.29 847.30 847.31 847.32 847.33
848.1
848.2 848.3 848.4 848.5 848.6 848.7 848.8 848.9 848.10 848.11
848.12
848.13 848.14 848.15 848.16 848.17 848.18 848.19
848.20
848.21 848.22 848.23
848.24
848.25 848.26 848.27 848.28 848.29
848.30
849.1 849.2 849.3 849.4 849.5
849.6 849.7 849.8 849.9 849.10 849.11
849.12
849.13 849.14 849.15 849.16 849.17 849.18 849.19 849.20 849.21 849.22 849.23
849.24 849.25 849.26 849.27 849.28
850.1 850.2 850.3 850.4 850.5 850.6 850.7
850.8
850.9 850.10 850.11 850.12 850.13 850.14 850.15 850.16 850.17 850.18 850.19 850.20 850.21 850.22
850.23 850.24 850.25 850.26 850.27 850.28 850.29 850.30 850.31 850.32 851.1 851.2 851.3 851.4 851.5 851.6 851.7 851.8
851.9 851.10 851.11
851.12 851.13 851.14
851.15 851.16 851.17
851.18 851.19
A bill for an act
relating to state government; modifying provisions governing health, health care,
human services, human services licensing and background studies, the Minnesota
Higher Education Facilities Authority, health-related licensing boards, prescription
drugs, health insurance, telehealth, children and family services, behavioral health,
direct care and treatment, disability services and continuing care for older adults,
community supports, and chemical and mental health services; implementing
mental health uniform services standards; establishing a budget for health and
human services; making forecast adjustments; making technical and conforming
changes; requiring reports; making appointments; transferring money; appropriating
money; amending Minnesota Statutes 2020, sections 3.732, subdivision 1; 10A.01,
subdivision 35; 16A.151, subdivision 2; 62A.152, subdivision 3; 62A.3094,
subdivision 1; 62J.495, subdivisions 1, 2, 3, 4; 62J.498; 62J.4981; 62J.4982; 62J.81,
subdivisions 1, 1a; 62J.84, subdivision 6; 62Q.096; 62V.05, by adding a
subdivision; 62W.11; 119B.09, subdivision 4; 119B.11, subdivision 2a; 119B.13,
subdivisions 1, 6; 122A.18, subdivision 8; 136A.25; 136A.26; 136A.27; 136A.28;
136A.29, subdivisions 1, 3, 6, 9, 10, 14, 19, 20, 21, 22, by adding a subdivision;
136A.32, subdivision 4; 136A.33; 136A.34, subdivisions 3, 4; 136A.36; 136A.38;
136A.41; 136A.42; 136F.67, subdivision 1; 144.05, by adding a subdivision;
144.057, subdivision 1; 144.0724, subdivision 4; 144.1205, subdivisions 2, 4, 8,
9, by adding a subdivision; 144.125, subdivisions 1, 2; 144.1481, subdivision 1;
144.216, by adding subdivisions; 144.218, by adding a subdivision; 144.223;
144.225, subdivision 7; 144.226, subdivision 1; 144.551, subdivision 1; 144.651,
subdivision 2; 144A.073, subdivision 2, by adding a subdivision; 144D.01,
subdivision 4; 144E.001, by adding a subdivision; 144E.27; 144E.28, subdivisions
1, 3, 7, 8; 144E.283; 144E.285, subdivisions 1, 2, 4, by adding subdivisions;
144G.08, subdivision 7, as amended; 145.32, subdivision 1; 145.902; 147.033;
148.995, subdivision 2; 148.996, subdivisions 2, 4, by adding a subdivision;
148B.5301, subdivision 2; 148E.120, subdivision 2; 148F.11, subdivision 1; 151.01,
subdivision 29, by adding subdivisions; 151.065, subdivisions 1, 3, 7; 151.066,
subdivision 3; 151.37, subdivision 2; 151.555, subdivisions 1, 7, 11, by adding a
subdivision; 157.22; 245.462, subdivisions 1, 6, 8, 9, 14, 16, 17, 18, 21, 23, by
adding a subdivision; 245.4661, subdivision 5; 245.4662, subdivision 1; 245.467,
subdivisions 2, 3; 245.469, subdivisions 1, 2; 245.470, subdivision 1; 245.4712,
subdivision 2; 245.472, subdivision 2; 245.4863; 245.4871, subdivisions 9a, 10,
11a, 17, 21, 26, 27, 29, 31, 32, 34, by adding a subdivision; 245.4874, subdivision
1; 245.4876, subdivisions 2, 3; 245.4879, subdivision 1; 245.488, subdivision 1;
245.4882, subdivision 1; 245.4885, subdivision 1; 245.4889, subdivision 1;
245.4901, subdivision 2; 245.62, subdivision 2; 245.697, subdivision 1; 245.735,
subdivisions 3, 5, by adding a subdivision; 245A.02, by adding subdivisions;
245A.03, subdivision 7, by adding a subdivision; 245A.04, subdivision 5;
245A.041, by adding a subdivision; 245A.043, subdivision 3; 245A.05; 245A.07,
subdivision 1; 245A.08, subdivisions 4, 5; 245A.10, subdivision 4; 245A.14,
subdivisions 1, 4; 245A.16, subdivision 1, by adding a subdivision; 245A.50,
subdivisions 1a, 7; 245A.65, subdivision 2; 245C.02, subdivision 4a; 245C.03, by
adding subdivisions; 245C.05, subdivisions 2c, 2d, 4, 5; 245C.08, subdivisions 1,
3; 245C.10, by adding subdivisions; 245C.14, subdivision 1; 245C.15, by adding
a subdivision; 245C.24, subdivisions 2, 3, 4, by adding a subdivision; 245C.32,
subdivision 1a; 245D.02, subdivision 20; 245E.07, subdivision 1; 245F.03; 245F.04,
subdivision 2; 245G.01, subdivisions 13, 26; 245G.02, subdivision 2; 245G.03,
subdivision 2; 245G.06, subdivisions 1, 3; 245G.11, subdivision 7; 246.54,
subdivision 1b; 252.27, subdivision 2a; 252.43; 252A.01, subdivision 1; 252A.02,
subdivisions 2, 9, 11, 12, by adding subdivisions; 252A.03, subdivisions 3, 4;
252A.04, subdivisions 1, 2, 4; 252A.05; 252A.06, subdivisions 1, 2; 252A.07,
subdivisions 1, 2, 3; 252A.081, subdivisions 2, 3, 5; 252A.09, subdivisions 1, 2;
252A.101, subdivisions 2, 3, 5, 6, 7, 8; 252A.111, subdivisions 2, 4, 6; 252A.12;
252A.16; 252A.17; 252A.19, subdivisions 2, 4, 5, 7, 8; 252A.20; 252A.21,
subdivisions 2, 4; 254A.19, subdivision 5; 254B.03, subdivision 2; 254B.05,
subdivisions 1, 5, by adding a subdivision; 256.01, subdivisions 14b, 28, by adding
a subdivision; 256.0112, subdivision 6; 256.042, subdivision 4; 256.043,
subdivisions 3, 4; 256.477; 256.741, by adding subdivisions; 256.969, by adding
a subdivision; 256.9695, subdivision 1; 256.983; 256B.051, subdivisions 1, 3, 5,
6, 7, by adding a subdivision; 256B.055, subdivision 6; 256B.056, subdivision 10;
256B.057, subdivision 3; 256B.06, subdivision 4; 256B.0615, subdivisions 1, 5;
256B.0616, subdivisions 1, 3, 5; 256B.0621, subdivision 10; 256B.0622,
subdivisions 1, 2, 3a, 4, 7, 7a, 7b, 7d; 256B.0623, subdivisions 1, 2, 3, 4, 5, 6, 9,
12; 256B.0624; 256B.0625, subdivisions 3b, 3c, 3d, 3e, 5, 5m, 9, 13, 13c, 13e,
13g, 13h, 19c, 20, 20b, 28a, 42, 46, 48, 49, 56a, by adding subdivisions; 256B.0638,
subdivisions 3, 5, 6; 256B.0653, by adding a subdivision; 256B.0654, by adding
a subdivision; 256B.0659, subdivisions 11, 13, 17a; 256B.0757, subdivision 4c;
256B.0759, subdivisions 2, 4, by adding subdivisions; 256B.0911, subdivisions
1a, 3a, 6, by adding a subdivision; 256B.092, subdivision 1b; 256B.0924,
subdivision 6; 256B.094, subdivision 6; 256B.0941, subdivision 1; 256B.0943,
subdivisions 1, 2, 3, 4, 5, 5a, 6, 7, 9, 11; 256B.0946, subdivisions 1, 1a, 2, 3, 4, 6;
256B.0947, subdivisions 1, 2, 3, 3a, 5, 6, 7; 256B.0949, subdivisions 2, 4, 5a, 13,
by adding a subdivision; 256B.097, by adding subdivisions; 256B.14, subdivision
2; 256B.19, subdivision 1; 256B.196, subdivision 2; 256B.25, subdivision 3;
256B.49, subdivision 23, by adding a subdivision; 256B.4905, by adding
subdivisions; 256B.4912, subdivision 13; 256B.4914, subdivisions 2, 5, 6, 7, 8,
9; 256B.5012, by adding a subdivision; 256B.5013, subdivisions 1, 6; 256B.5015,
subdivision 2; 256B.69, subdivisions 5a, 6d, by adding a subdivision; 256B.6928,
subdivision 5; 256B.75; 256B.761; 256B.763; 256B.85, subdivisions 1, 2, 3, 4, 5,
6, 7, 7a, 8, 9, 10, 11, 11b, 12, 12b, 13, 13a, 15, 16, 17a, 18a, 20b, 23, 23a, by
adding subdivisions; 256D.051, by adding subdivisions; 256E.30, subdivision 2;
256E.34, subdivision 1; 256I.04, subdivision 3; 256I.05, subdivisions 1a, 1c, 1q,
11, by adding subdivisions; 256I.06, subdivision 8; 256J.08, subdivision 21;
256J.09, subdivision 3; 256J.30, subdivision 8; 256J.35; 256J.45, subdivision 1;
256J.626, subdivision 1; 256J.95, subdivision 5; 256L.01, subdivision 5; 256L.03,
subdivision 1; 256L.04, subdivision 7b; 256L.05, subdivision 3a; 256L.15,
subdivision 2, by adding a subdivision; 256N.02, subdivisions 16, 17; 256N.22,
subdivision 1; 256N.23, subdivisions 2, 6; 256N.24, subdivisions 1, 8, 11, 12, 14;
256N.25, subdivision 1, by adding a subdivision; 256P.01, subdivision 6a; 256P.02,
subdivisions 1a, 2; 256P.04, subdivision 4; 256P.05; 256P.06, subdivision 3;
256S.203; 259.22, subdivision 4; 259.241; 259.35, subdivision 1; 259.53,
subdivision 4; 259.73; 259.75, subdivisions 5, 6, 9; 259.83, subdivision 1a;
259A.75, subdivisions 1, 2, 3, 4; 260C.007, subdivisions 22a, 26c, 31; 260C.157,
subdivision 3; 260C.163, subdivision 3; 260C.212, subdivisions 1, 1a, 2, 13, by
adding a subdivision; 260C.215, subdivision 4; 260C.219, subdivision 5;
260C.4412; 260C.452; 260C.503, subdivision 2; 260C.515, subdivision 3;
260C.605, subdivision 1; 260C.607, subdivision 6; 260C.609; 260C.615; 260C.704;
260C.706; 260C.708; 260C.71; 260C.712; 260C.714; 260D.01; 260D.05; 260D.06,
subdivision 2; 260D.07; 260D.08; 260D.14; 260E.06, subdivision 1, by adding a
subdivision; 260E.20, subdivision 2; 260E.31, subdivision 1; 260E.36, by adding
a subdivision; 295.50, subdivision 9b; 295.53, subdivision 1; 297E.02, subdivision
3; 325F.721, subdivision 1; 326.71, subdivision 4; 326.75, subdivisions 1, 2, 3;
354B.20, subdivision 7; 466.03, subdivision 6d; 518.157, subdivisions 1, 3; 518.68,
subdivision 2; 518A.29; 518A.33; 518A.35, subdivisions 1, 2; 518A.39, subdivision
7; 518A.40, subdivision 4, by adding a subdivision; 518A.42; 518A.43, by adding
a subdivision; 518A.685; 548.091, subdivisions 1a, 2a, 3b, 9, 10; 549.09,
subdivision 1; Laws 2008, chapter 364, section 17; Laws 2019, First Special Session
chapter 9, article 5, section 86, subdivision 1, as amended; article 14, section 3,
as amended; Laws 2020, First Special Session chapter 7, section 1, as amended;
proposing coding for new law in Minnesota Statutes, chapters 62A; 62J; 62Q;
119B; 144; 145; 145A; 148; 151; 245A; 245G; 254B; 256; 256B; 256S; 363A;
518A; proposing coding for new law as Minnesota Statutes, chapter 245I; repealing
Minnesota Statutes 2020, sections 16A.724, subdivision 2; 62A.67; 62A.671;
62A.672; 136A.29, subdivision 4; 144E.27, subdivisions 1, 1a; 151.19, subdivision
3; 245.462, subdivision 4a; 245.4871, subdivision 32a; 245.4879, subdivision 2;
245.62, subdivisions 3, 4; 245.69, subdivision 2; 245.735, subdivisions 1, 2, 4;
252.28, subdivisions 1, 5; 252A.02, subdivisions 8, 10; 252A.21, subdivision 3;
256B.0615, subdivision 2; 256B.0616, subdivision 2; 256B.0622, subdivisions 3,
5a; 256B.0623, subdivisions 7, 8, 10, 11; 256B.0625, subdivisions 5l, 35a, 35b,
61, 62, 65; 256B.0943, subdivisions 8, 10; 256B.0944; 256B.0946, subdivision
5; 256B.097, subdivisions 1, 2, 3, 4, 5, 6; 256B.4905, subdivisions 1, 2, 3, 4, 5, 6;
256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b, 6c, 7, 8, 9, 18; 256D.052,
subdivision 3; 259A.70; Laws 2019, First Special Session chapter 9, article 5,
section 90; Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010;
9520.0020; 9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080;
9520.0090; 9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150;
9520.0160; 9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230;
9520.0750; 9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810;
9520.0820; 9520.0830; 9520.0840; 9520.0850; 9520.0860; 9520.0870; 9530.6800;
9530.6810.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
HEALTH CARE; DEPARTMENT OF HUMAN SERVICES
Section 1.
Minnesota Statutes 2020, section 245F.03, is amended to read:
245F.03 APPLICATION.
(a) This chapter establishes minimum standards for withdrawal management programs
licensed by the commissioner that serve one or more unrelated persons.
(b) This chapter does not apply to a withdrawal management program licensed as a
hospital under sections 144.50 to 144.581. A withdrawal management program located in
a hospital licensed under sections 144.50 to 144.581 that chooses to be licensed under this
chapter is deemed to be in compliance with section 245F.13.new text begin This chapter does not apply
when a license holder is providing pre-treatment coordination services under section 254B.05,
subdivision 4a.
new text end
(c) Minnesota Rules, parts 9530.6600 to 9530.6655, do not apply to withdrawal
management programs licensed under this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245G.02, subdivision 2, is amended to read:
Subd. 2.
Exemption from license requirement.
This chapter does not apply to a county
or recovery community organization that is providing a service for which the county or
recovery community organization is an eligible vendor under section 254B.05. This chapter
does not apply to an organization whose primary functions are information, referral,
diagnosis, case management, and assessment for the purposes of client placement, education,
support group services, or self-help programs. This chapter does not apply to the activities
of a licensed professional in private practice. A license holder providing the initial set of
substance use disorder services allowable under section 254A.03, subdivision 3, paragraph
(c), to an individual referred to a licensed nonresidential substance use disorder treatment
program after a positive screen for alcohol or substance misuse is exempt from sections
245G.05; 245G.06, subdivisions 1, 2, and 4; 245G.07, subdivisions 1, paragraph (a), clauses
(2) to (4), and 2, clauses (1) to (7); and 245G.17.new text begin This chapter does not apply when a license
holder is providing pretreatment coordination services under section 254B.05, subdivision
4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245G.06, subdivision 3, is amended to read:
Subd. 3.
Documentation of treatment servicesnew text begin and pretreatment servicesnew text end ; treatment
plan review.
(a) A review of all treatment services must be documented weekly and include
a review of:
(1) deleted text begin caredeleted text end new text begin treatmentnew text end coordination activitiesnew text begin , including any pretreatment coordination
servicesnew text end ;
(2) medical and other appointments the client attended;
(3) issues related to medications that are not documented in the medication administration
record; and
(4) issues related to attendance for treatment services, including the reason for any client
absence from a treatment service.
(b) A note must be entered immediately following any significant event. A significant
event is an event that impacts the client's relationship with other clients, staff, the client's
family, or the client's treatment plan.
(c) A treatment plan review must be entered in a client's file weekly or after each treatment
service, whichever is less frequent, by the staff member providing the service. The review
must indicate the span of time covered by the review and each of the six dimensions listed
in section 245G.05, subdivision 2, paragraph (c). The review must:
(1) indicate the date, type, and amount of each treatment service provided and the client's
response to each service;
(2) address each goal in the treatment plan and whether the methods to address the goals
are effective;
(3) include monitoring of any physical and mental health problems;
(4) document the participation of others;
(5) document staff recommendations for changes in the methods identified in the treatment
plan and whether the client agrees with the change; and
(6) include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.
(d) Each entry in a client's record must be accurate, legible, signed, and dated. A late
entry must be clearly labeled "late entry." A correction to an entry must be made in a way
in which the original entry can still be read.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245G.11, subdivision 7, is amended to read:
Subd. 7.
Treatment coordination provider qualifications.
(a) Treatment coordination
must be provided by qualified staff. An individual is qualified to provide treatment
coordination if the individual meets the qualifications of an alcohol and drug counselor
under subdivision 5 or if the individual:
(1) is skilled in the process of identifying and assessing a wide range of client needs;
(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) has successfully completed 30 hours of classroom instruction on treatment
coordination for an individual with substance use disorder;
(4) has either:
(i) a bachelor's degree in one of the behavioral sciences or related fields; or
(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and
(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.
(b) A treatment coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor, or a mental health
professional who has substance use treatment and assessments within the scope of their
practice, on a monthly basis.
new text begin
(c) County staff who conduct chemical use assessments under Minnesota Rules, part
9530.6615, and are employed as of January 1, 2022, are qualified to provide treatment
coordination under section 245G.07, subdivision 1, paragraph (a), clause (5). County staff
who conduct chemical use assessments under Minnesota Rules, part 9530.6615, and are
employed after January 1, 2021, are qualified to provide treatment coordination under section
245G.07, subdivision 1, paragraph (a), clause (5), if the county staff person completes the
classroom instruction in paragraph (a), clause (3).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 5.
Minnesota Statutes 2020, section 254B.05, subdivision 1, is amended to read:
Subdivision 1.
Licensure required.
(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, deleted text begin ordeleted text end outpatient treatment
services, and are licensed by tribal government are eligible vendors.new text begin American Indian
programs are eligible vendors of peer support services according to section 245G.07,
subdivision 2, clause (8). An alcohol and drug counselor as defined in section 245G.11,
subdivision 5, must be available to recovery peers for ongoing consultation, as needed.
new text end
(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment and assessment summary provided according to
section 245G.05, and treatment services provided according to sections 245G.06 and
245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses
(1) to (6).
(c) A county is an eligible vendor for a comprehensive assessment and assessment
summary when provided by an individual who meets the staffing credentials of section
245G.11, subdivisions 1 and 5, and completed according to the requirements of section
245G.05. A county is an eligible vendor of deleted text begin caredeleted text end new text begin treatmentnew text end coordination services when
provided by an individual who meets the staffing credentials of section 245G.11, subdivisions
1 and 7, and provided according to the requirements of section 245G.07, subdivision 1,
paragraph (a), clause (5).new text begin A county is an eligible vendor of peer recovery support services
according to section 245G.07, subdivision 2, clause (8). An alcohol and drug counselor as
defined in section 245G.11, subdivision 5, must be available to recovery peers for ongoing
consultation, as needed.
new text end
(d) new text begin Nonresidential programs licensed under chapter 245G, withdrawal management
programs licensed under chapter 245F, American Indian programs described in paragraph
(a), and counties are eligible vendors of pretreatment coordination services as defined under
section 254B.05, subdivision 4a, when the individual providing the services meets the
staffing credentials in section 245G.11, subdivisions 1 and 7.
new text end
new text begin (e) new text end A recovery community organization that meets certification requirements identified
by the commissioner is an eligible vendor of peer support services.
deleted text begin (e)deleted text end new text begin (f)new text end Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 6.
Minnesota Statutes 2020, section 254B.05, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Pretreatment coordination services. new text end
new text begin
(a) An enrolled provider may provide
pretreatment coordination services to an individual prior to the individual's comprehensive
assessment under section 245G.05, to facilitate an individual's access to a comprehensive
assessment. The total pretreatment coordination services must not exceed 36 units per
eligibility determination.
new text end
new text begin
(b) An individual providing pretreatment coordination services must meet the staff
qualifications in section 245G.11, subdivision 7. Section 245G.05 and Minnesota Rules,
parts 9530.6600 to 9530.6655, do not apply to pretreatment coordination services.
new text end
new text begin
(c) To be eligible for pretreatment coordination services, an individual must screen
positive for alcohol or substance misuse using a screening tool approved by the commissioner.
The provider may bill the screening as a pretreatment coordination service.
new text end
new text begin
(d) Pretreatment coordination services include:
new text end
new text begin
(1) assisting with connecting an individual with a qualified comprehensive assessment
provider;
new text end
new text begin
(2) identifying barriers that might inhibit an individual's ability to participate in a
comprehensive assessment; and
new text end
new text begin
(3) assisting with connecting an individual with resources to mitigate an individual's
immediate safety risks.
new text end
new text begin
(e) A license holder is authorized to provide up to 36 units of pretreatment coordination
services, excluding travel time, and must document the following information in the client's
case file:
new text end
new text begin
(1) the dates, number of units, and description of pretreatment coordination services
provided;
new text end
new text begin
(2) identifying an individual's safety concerns and developing a plan to address those
concerns;
new text end
new text begin
(3) assisting an individual with scheduling an appointment for a comprehensive
assessment and confirming that the individual and provider keep the appointment; and
new text end
new text begin
(4) assisting an individual with accessing resources for obtaining a comprehensive
assessment authorizing substance use disorder treatment services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 7.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) deleted text begin caredeleted text end new text begin treatmentnew text end coordination services provided according to section 245G.07,
subdivision 1, paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; deleted text begin and
deleted text end
(12) room and board facilities that meet the requirements of subdivision 1anew text begin ; and
new text end
new text begin (13) pretreatment coordination services provided according to subdivision 4anew text end .
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256.01, subdivision 28, is amended to read:
Subd. 28.
Statewide health information exchange.
(a) The commissioner has the
authority to join and participate as a member in a legal entity developing and operating a
statewide health information exchange new text begin or to develop and operate an encounter alerting
service new text end that shall meet the following criteria:
(1) the legal entity must meet all constitutional and statutory requirements to allow the
commissioner to participate; and
(2) the commissioner or the commissioner's designated representative must have the
right to participate in the governance of the legal entity under the same terms and conditions
and subject to the same requirements as any other member in the legal entity and in that
role shall act to advance state interests and lessen the burdens of government.
(b) Notwithstanding chapter 16C, the commissioner may pay the state's prorated share
of development-related expenses of the legal entity retroactively from October 29, 2007,
regardless of the date the commissioner joins the legal entity as a member.
Sec. 9.
Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 42. new text end
new text begin Expiration of report mandates. new text end
new text begin
(a) If the submission of a report by the
commissioner of human services to the legislature is mandated by statute and the enabling
legislation does not include a date for the submission of a final report, the mandate to submit
the report shall expire in accordance with this section.
new text end
new text begin
(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1,2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end
new text begin
(c) Any reporting mandate enacted on or after January 1, 2021 shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report unless the enacting legislation provides for a different
expiration date.
new text end
new text begin
(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over human services by February 15 of each
year, beginning February 15, 2022, of all reports set to expire during the following calendar
year in accordance with this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256.042, subdivision 4, is amended to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report deleted text begin of the
grants proposed by the advisory council to be awarded for the upcoming fiscal yeardeleted text end to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance, by March 1 of each year, beginning March
1, 2020new text begin , describing the priorities and specific activities the advisory council intends to
address for the upcoming fiscal year based on the projected funds available for grant
distributionnew text end .
(b) deleted text begin The commissioner of human services shall award grants from the opiate epidemic
response fund under section 256.043.deleted text end The grants shall be awarded to proposals selected by
the advisory council that address the priorities in subdivision 1, paragraph (a), clauses (1)
to (4), unless otherwise appropriated by the legislature. new text begin The advisory council shall determine
grant awards and funding amounts based on the funds appropriated to the commissioner
under section 256.043, subdivision 3, paragraph (e). The commissioner shall award the
grants from the opiate epidemic response fund and administer the grants in compliance with
section 16B.97. new text end No more than three percent of the grant amount may be used by a grantee
for administration.
Sec. 11.
Minnesota Statutes 2020, section 256.043, subdivision 4, is amended to read:
Subd. 4.
Settlement; sunset.
(a) If the state receives a total sum of $250,000,000 either
as a result of a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or resulting from a court order in litigation brought by the
attorney general of the state on behalf of the state or a state agency, against one or more
opioid manufacturers or opioid wholesale drug distributors new text begin or consulting firms working for
an opioid manufacturer or opioid wholesale drug distributor new text end related to alleged violations of
consumer fraud laws in the marketing, sale, or distribution of opioids in this state, or other
alleged illegal actions that contributed to the excessive use of opioids, or from the fees
collected under sections 151.065, subdivisions 1 and 3, and 151.066, that are deposited into
the opiate epidemic response fund established in this section, or from a combination of both,
the fees specified in section 151.065, subdivisions 1, clause (16), and 3, clause (14), shall
be reduced to $5,260, and the opiate registration fee in section 151.066, subdivision 3, shall
be repealed.
(b) The commissioner of management and budget shall inform the Board of Pharmacy,
the governor, and the legislature when the amount specified in paragraph (a) has been
reached. The board shall apply the reduced license fee for the next licensure period.
(c) Notwithstanding paragraph (a), the reduction of the license fee in section 151.065,
subdivisions 1 and 3, and the repeal of the registration fee in section 151.066 shall not occur
before July 1, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision
to read:
new text begin Subd. 2f. new text end
new text begin Alternate inpatient payment rate. new text end
new text begin
Effective January 1, 2022, for a hospital
eligible to receive disproportionate share hospital payments under subdivision 9, paragraph
(d), clause (6), the commissioner shall reduce the amount calculated under subdivision 9,
paragraph (d), clause (6), by 99 percent and compute an alternate inpatient payment rate.
The alternate payment rate shall be structured to target a total aggregate reimbursement
amount equal to what the hospital would have received for providing fee-for-service inpatient
services under this section to patients enrolled in medical assistance had the hospital received
the entire amount calculated under subdivision 9, paragraph (d), clause (6).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256.9695, subdivision 1, is amended to read:
Subdivision 1.
Appeals.
A hospital may appeal a decision arising from the application
of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would
result in a change to the hospital's payment rate or payments. Both overpayments and
underpayments that result from the submission of appeals shall be implemented. Regardless
of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge
ratios, and policy adjusters shall not be changed. The appeal shall be heard by an
administrative law judge according to sections 14.57 to 14.62, or upon agreement by both
parties, according to a modified appeals procedure established by the commissioner and the
Office of Administrative Hearings. In any proceeding under this section, the appealing party
must demonstrate by a preponderance of the evidence that the commissioner's determination
is incorrect or not according to law.
To appeal a payment rate or payment determination or a determination made from base
year information, the hospital shall file a written appeal request to the commissioner within
60 days of the date the preliminary payment rate determination was mailed. The appeal
request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or
rule upon which the hospital relies for each disputed item; and (iii) the name and address
of the person to contact regarding the appeal. Facts to be considered in any appeal of base
year information are limited to those in existence deleted text begin 12deleted text end new text begin 18new text end months after the last day of the
calendar year that is the base year for the payment rates in dispute.
Sec. 14.
Minnesota Statutes 2020, section 256.983, is amended to read:
256.983 FRAUD PREVENTION INVESTIGATIONS.
Subdivision 1.
Programs established.
Within the limits of available appropriations, the
commissioner of human services shall require the maintenance of budget neutral fraud
prevention investigation programs in the counties new text begin or tribal agencies new text end participating in the
fraud prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other counties
new text begin or tribal agencies new text end provided the expansion is budget neutral to the state. Under any expansion,
the commissioner has the final authority in decisions regarding the creation and realignment
of individual countynew text begin , tribal agency,new text end or regional operations.
Subd. 2.
County new text begin and tribal agency new text end proposals.
Each participating county new text begin and tribal
new text end agency shall develop and submit an annual staffing and funding proposal to the commissioner
no later than April 30 of each year. Each proposal shall include, but not be limited to, the
staffing and funding of the fraud prevention investigation program, a job description for
investigators involved in the fraud prevention investigation program, and the organizational
structure of the county new text begin or tribal new text end agency unit, training programs for case workers, and the
operational requirements which may be directed by the commissioner. The proposal shall
be approved, to include any changes directed or negotiated by the commissioner, no later
than June 30 of each year.
Subd. 3.
Department responsibilities.
The commissioner shall establish training
programs which shall be attended by all investigative and supervisory staff of the involved
county new text begin and tribal new text end agencies. The commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms, which shall be used by the involved countynew text begin
or tribalnew text end agencies. An individual's application or redetermination form for public assistance
benefits, including child care assistance programs and medical care programs, must include
an authorization for release by the individual to obtain documentation for any information
on that form which is involved in a fraud prevention investigation. The authorization for
release is effective for six months after public assistance benefits have ceased.
Subd. 4.
Funding.
(a) County new text begin and tribal new text end agency reimbursement shall be made through
the settlement provisions applicable to the Supplemental Nutrition Assistance Program
(SNAP), MFIP, child care assistance programs, the medical assistance program, and other
federal and state-funded programs.
(b) The commissioner will maintain program compliance if for any three consecutive
month period, a county new text begin or tribal new text end agency fails to comply with fraud prevention investigation
program guidelines, or fails to meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county new text begin or tribal new text end agency shall be required to submit a corrective
action plan to the commissioner within 30 days of receipt of a notice of noncompliance.
Failure to submit a corrective action plan or, continued deviation from standards of more
than ten percent after submission of a corrective action plan, will result in denial of funding
for each subsequent month, or billing the county new text begin or tribal new text end agency for fraud prevention
investigation (FPI) service provided by the commissioner, or reallocation of program grant
funds, or investigative resources, or both, to other countiesnew text begin or tribal agenciesnew text end . The denial of
funding shall apply to the general settlement received by the county new text begin or tribal new text end agency on a
quarterly basis and shall not reduce the grant amount applicable to the FPI project.
Subd. 5.
Child care providers; financial misconduct.
(a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.
(b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The countynew text begin or tribenew text end must send notice in accordance with the requirements of section
119B.161, subdivision 2. If a provider's payment is suspended under this section, the payment
suspension shall remain in effect until: (1) the commissioner, county,new text begin tribe,new text end or a law
enforcement authority determines that there is insufficient evidence warranting the action
and a county, tribe, or the commissioner does not pursue an additional administrative remedy
under chapter 119B or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and
administrative proceedings related to the provider's alleged misconduct conclude and any
appeal rights are exhausted.
(c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.
(d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).
Sec. 15.
Minnesota Statutes 2020, section 256B.055, subdivision 6, is amended to read:
Subd. 6.
Pregnant women; needy unborn child.
Medical assistance may be paid for
a pregnant woman who meets the other eligibility criteria of this section and whose unborn
child would be eligible as a needy child under subdivision 10 if born and living with the
woman. In accordance with Code of Federal Regulations, title 42, section 435.956, the
commissioner must accept self-attestation of pregnancy unless the agency has information
that is not reasonably compatible with such attestation. For purposes of this subdivision, a
woman is considered pregnant for deleted text begin 60 daysdeleted text end new text begin six monthsnew text end postpartum.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the deleted text begin 60-daydeleted text end new text begin
six monthsnew text end postpartum period to update their income and asset information and to submit
any required income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.057, subdivision 3, is amended to read:
Subd. 3.
Qualified Medicare beneficiaries.
new text begin (a) new text end A person deleted text begin who is entitled to Part A
Medicare benefits, whose income is equal to or less than 100 percent of the federal poverty
guidelines, and whose assets are no more than $10,000 for a single individual and $18,000
for a married couple or family of two or more,deleted text end is eligible for medical assistance
reimbursement of new text begin Medicare new text end Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Actdeleted text begin .deleted text end new text begin
if:
new text end
new text begin
(1) the person is entitled to Medicare Part A benefits;
new text end
new text begin
(2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
new text end
new text begin
(3) the person's assets are no more than (i) $10,000 for a single individual, or (ii) $18,000
for a married couple or family of two or more; or, when the resource limits for eligibility
for the Medicare Part D extra help low income subsidy (LIS) exceed either amount in item
(i) or (ii), the person's assets are no more than the LIS resource limit in United States Code,
title 42, section 1396d, subsection (p).
new text end
new text begin (b)new text end Reimbursement of the Medicare coinsurance and deductibles, when added to the
amount paid by Medicare, must not exceed the total rate the provider would have received
for the same service or services if the person were a medical assistance recipient with
Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until July 1 of each year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.06, subdivision 4, is amended to read:
Subd. 4.
Citizenship requirements.
(a) Eligibility for medical assistance is limited to
citizens of the United States, qualified noncitizens as defined in this subdivision, and other
persons residing lawfully in the United States. Citizens or nationals of the United States
must cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.
(b) "Qualified noncitizen" means a person who meets one of the following immigration
criteria:
(1) admitted for lawful permanent residence according to United States Code, title 8;
(2) admitted to the United States as a refugee according to United States Code, title 8,
section 1157;
(3) granted asylum according to United States Code, title 8, section 1158;
(4) granted withholding of deportation according to United States Code, title 8, section
1253(h);
(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);
(6) granted conditional entrant status according to United States Code, title 8, section
1153(a)(7);
(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
(8) is a child of a noncitizen determined to be a battered noncitizen by the United States
Attorney General according to the Illegal Immigration Reform and Immigrant Responsibility
Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
or
(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.
(c) All qualified noncitizens who were residing in the United States before August 22,
1996, who otherwise meet the eligibility requirements of this chapter, are eligible for medical
assistance with federal financial participation.
(d) Beginning December 1, 1996, qualified noncitizens who entered the United States
on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
chapter are eligible for medical assistance with federal participation for five years if they
meet one of the following criteria:
(1) refugees admitted to the United States according to United States Code, title 8, section
1157;
(2) persons granted asylum according to United States Code, title 8, section 1158;
(3) persons granted withholding of deportation according to United States Code, title 8,
section 1253(h);
(4) veterans of the United States armed forces with an honorable discharge for a reason
other than noncitizen status, their spouses and unmarried minor dependent children; or
(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.
Beginning July 1, 2010, children and pregnant women who are noncitizens described
in paragraph (b) or who are lawfully present in the United States as defined in Code of
Federal Regulations, title 8, section 103.12, and who otherwise meet eligibility requirements
of this chapter, are eligible for medical assistance with federal financial participation as
provided by the federal Children's Health Insurance Program Reauthorization Act of 2009,
Public Law 111-3.
(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter are
eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this subdivision,
a "nonimmigrant" is a person in one of the classes listed in United States Code, title 8,
section 1101(a)(15).
(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of this
chapter, if such care and services are necessary for the treatment of an emergency medical
condition.
(g) For purposes of this subdivision, the term "emergency medical condition" means a
medical condition that meets the requirements of United States Code, title 42, section
1396b(v).
(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment of
an emergency medical condition are limited to the following:
(i) services delivered in an emergency room or by an ambulance service licensed under
chapter 144E that are directly related to the treatment of an emergency medical condition;
(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and
(iii) follow-up services that are directly related to the original service provided to treat
the emergency medical condition and are covered by the global payment made to the
provider.
(2) Services for the treatment of emergency medical conditions do not include:
(i) services delivered in an emergency room or inpatient setting to treat a nonemergency
condition;
(ii) organ transplants, stem cell transplants, and related care;
(iii) services for routine prenatal care;
(iv) continuing care, including long-term care, nursing facility services, home health
care, adult day care, day training, or supportive living services;
(v) elective surgery;
(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as part
of an emergency room visit;
(vii) preventative health care and family planning services;
(viii) rehabilitation services;
(ix) physical, occupational, or speech therapy;
(x) transportation services;
(xi) case management;
(xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
(xiii) dental services;
(xiv) hospice care;
(xv) audiology services and hearing aids;
(xvi) podiatry services;
(xvii) chiropractic services;
(xviii) immunizations;
(xix) vision services and eyeglasses;
(xx) waiver services;
(xxi) individualized education programs; or
(xxii) chemical dependency treatment.
(i) Pregnant noncitizens who are ineligible for federally funded medical assistance
because of immigration status, are not covered by a group health plan or health insurance
coverage according to Code of Federal Regulations, title 42, section 457.310, and who
otherwise meet the eligibility requirements of this chapter, are eligible for medical assistance
through the period of pregnancy, including labor and delivery, and deleted text begin 60 daysdeleted text end new text begin six monthsnew text end
postpartumdeleted text begin , to the extent federal funds are available under title XXI of the Social Security
Act, and the state children's health insurance programdeleted text end .
(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation services
from a nonprofit center established to serve victims of torture and are otherwise ineligible
for medical assistance under this chapter are eligible for medical assistance without federal
financial participation. These individuals are eligible only for the period during which they
are receiving services from the center. Individuals eligible under this paragraph shall not
be required to participate in prepaid medical assistance. The nonprofit center referenced
under this paragraph may establish itself as a provider of mental health targeted case
management services through a county contract under section 256.0112, subdivision 6. If
the nonprofit center is unable to secure a contract with a lead county in its service area, then,
notwithstanding the requirements of section 256B.0625, subdivision 20, the commissioner
may negotiate a contract with the nonprofit center for provision of mental health targeted
case management services. When serving clients who are not the financial responsibility
of their contracted lead county, the nonprofit center must gain the concurrence of the county
of financial responsibility prior to providing mental health targeted case management services
for those clients.
(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
emergency medical conditions under paragraph (f) except where coverage is prohibited
under federal law for services under clauses (1) and (2):
(1) dialysis services provided in a hospital or freestanding dialysis facility;
(2) surgery and the administration of chemotherapy, radiation, and related services
necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission and
requires surgery, chemotherapy, or radiation treatment; and
(3) kidney transplant if the person has been diagnosed with end stage renal disease, is
currently receiving dialysis services, and is a potential candidate for a kidney transplant.
(l) Effective July 1, 2013, recipients of emergency medical assistance under this
subdivision are eligible for coverage of the elderly waiver services provided under chapter
256S, and coverage of rehabilitative services provided in a nursing facility. The age limit
for elderly waiver services does not apply. In order to qualify for coverage, a recipient of
emergency medical assistance is subject to the assessment and reassessment requirements
of section 256B.0911. Initial and continued enrollment under this paragraph is subject to
the limits of available funding.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.0625, subdivision 3c, is amended to read:
Subd. 3c.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end .
(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-memberdeleted text end new text begin 14-membernew text end Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end , which consists of deleted text begin 12deleted text end new text begin 13new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall advise the commissioner regardingnew text begin (1)new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programsdeleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision-making and health care benefit and coverage policies for
MHCP. The Health Services Advisory Council shall consider available evidence regarding
quality, safety, and cost-effectiveness when advising the commissionernew text end . The Health Services
deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end shall annually deleted text begin electdeleted text end new text begin selectnew text end a deleted text begin physiciandeleted text end chair from among its
membersdeleted text begin ,deleted text end who shall work directly with the commissioner's medical directordeleted text begin ,deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall alsodeleted text end new text begin Advisory
Council maynew text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.
(b) The commissioner shall establish a dental deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end to operate under
the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end . The dental deleted text begin subcommitteedeleted text end new text begin
subcouncilnew text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end shall advise the commissioner regarding:
(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;
(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;
(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;
(4) the development of dental delivery models; and
(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
deleted text begin
(c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end The Health Services deleted text begin Policy Committee shalldeleted text end new text begin Advisory Council maynew text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrolleesdeleted text end new text begin health care providers who serve MHCP recipientsnew text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committeedeleted text end new text begin monitoring
and trackingnew text end shall focus on services or specialties for which there is a high variation in
utilization new text begin or quality new text end across deleted text begin physiciansdeleted text end new text begin providersnew text end , or which are associated with high medical
costs. The commissioner, based upon the findings of the deleted text begin committeedeleted text end new text begin Health Services Advisory
Councilnew text end , deleted text begin shall regularlydeleted text end new text begin maynew text end notify deleted text begin physiciansdeleted text end new text begin providersnew text end whose practice patterns indicate
new text begin below average quality or new text end higher than average utilization or costs. Managed care and
county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make deleted text begin thisdeleted text end new text begin thesenew text end
data available to the deleted text begin committeedeleted text end new text begin Health Services Advisory Councilnew text end .
deleted text begin
(e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end
Sec. 20.
Minnesota Statutes 2020, section 256B.0625, subdivision 3d, is amended to read:
Subd. 3d.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end members.
(a) The
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end consists of:
(1) deleted text begin sevendeleted text end new text begin sixnew text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, anddeleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistancedeleted text end new text begin MHCPnew text end recipients;
(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;
(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;
new text begin
(4) one voting member who is a health care or mental health professional licensed or
registered in the member's profession, actively engaged in the practice of the member's
profession in Minnesota, and actively engaged in the treatment of persons with mental
illness;
new text end
deleted text begin (4) one consumerdeleted text end new text begin (5) two consumersnew text end who shall serve as deleted text begin adeleted text end voting deleted text begin memberdeleted text end new text begin membersnew text end ; and
deleted text begin (5)deleted text end new text begin (6)new text end the commissioner's medical director who shall serve as a nonvoting member.
(b) Members of the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall not be
employed by the deleted text begin Department of Human Servicesdeleted text end new text begin state of Minnesotanew text end , except for the medical
director.new text begin A quorum shall comprise a simple majority of the voting members. Vacant seats
shall not count toward a quorum.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 3e, is amended to read:
Subd. 3e.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end terms and
compensation.
deleted text begin Committeedeleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committeedeleted text end new text begin councilnew text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end does not expire as provided in section 15.059, subdivision 6.
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 9, is amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers dental services.
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
(1) comprehensive exams, limited to once every five years;
(2) periodic exams, limited to one per year;
(3) limited exams;
(4) bitewing x-rays, limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
(7) prophylaxis, limited to one per year;
(8) application of fluoride varnish, limited to one per year;
(9) posterior fillings, all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited to root canals on the anterior and premolars only;
(12) removable prostheses, each dental arch limited to one every six years;
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
(14) palliative treatment and sedative fillings for relief of pain; deleted text begin and
deleted text end
(15) full-mouth debridement, limited to one every five yearsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
new text end
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
(1) periodontics, limited to periodontal scaling and root planing once every two years;
(2) general anesthesia; and
(3) full-mouth survey once every five years.
(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar for
children only;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
(f) The commissioner shall not require prior authorization for the services included in
paragraph (e), clauses (1) to (3), and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (e), clauses
(1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
Sec. 23.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9c. new text end
new text begin Uniform prior authorization for dental services. new text end
new text begin
(a) For purposes of this
subdivision, "dental benefits administrator" means an organization licensed under chapter
62C or 62D that contracts with a managed care plan or county-based purchasing plan to
provide covered dental care services to enrollees of the plan.
new text end
new text begin
(b) By January 1, 2022, the commissioner, in consultation with interested stakeholders,
shall develop uniform prior authorization criteria for all dental services requiring prior
authorization. The commissioner shall publish a list of the dental services requiring prior
authorization and the process for obtaining prior authorization on the department's website.
Dental services on the list and the process for obtaining prior authorization approval must
be consistent. The commissioner shall require that dental providers, managed care plans,
county-based purchasing plans, and dental benefit administrators use the dental services on
the list regardless of whether the services are provided through a fee-for-service system or
through a prepaid medical assistance program.
new text end
new text begin
(c) Managed care plans and county-based purchasing plans may require prior
authorization for additional dental services not on the list described in paragraph (b) if a
uniform process for obtaining prior approvals is applied, including a process for
reconsideration when a prior approval request is denied that can be utilized by both the
patient and the patient's dental provider.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9d. new text end
new text begin Uniform credentialing process. new text end
new text begin
(a) For purposes of this subdivision, "dental
benefits administrator" has the meaning given in subdivision 9c.
new text end
new text begin
(b) By January 1, 2022, the commissioner, in consultation with interested stakeholders,
shall develop a uniform credentialing process for dental providers. Upon federal approval,
the credentialing process must be accepted by all managed care plans, county-based
purchasing plans, and dental benefits administrators that contract with the commissioner or
subcontract with plans to provide dental services to medical assistance or MinnesotaCare
enrollees.
new text end
new text begin
(c) The process developed in this subdivision must include a uniform credentialing
application that must be available in electronic format and accessible on the department's
website. The process developed under this subdivision must include an option to submit a
completed application electronically. The uniform credentialing application must be available
to providers for free.
new text end
new text begin
(d) If applicable, a managed care plan, county-based purchasing plan, dental benefits
administrator, contractor, or vendor that reviews and approves a credentialing application
must notify a provider regarding a deficiency on a submitted credentialing application form
no later than 30 business days after receiving the application form from the provider.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.0625, subdivision 13, is amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissionerdeleted text begin .deleted text end new text begin or the drug appears on the 90-day supply list
published by the commissioner. The 90-day supply list shall be published by the
commissioner on the department's website. The commissioner may add to, delete from, and
otherwise modify the 90-day supply list after providing public notice and the opportunity
for a 15-day public comment period. The 90-day supply list may include cost-effective
generic drugs and shall not include controlled substances.
new text end
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
Sec. 26.
Minnesota Statutes 2020, section 256B.0625, subdivision 13c, is amended to
read:
Subd. 13c.
Formulary Committee.
The commissioner, after receiving recommendations
from professional medical associations and professional pharmacy associations, and consumer
groups shall designate a Formulary Committee to carry out duties as described in subdivisions
13 to 13g. The Formulary Committee shall be comprised of four licensed physicians actively
engaged in the practice of medicine in Minnesotanew text begin ,new text end one of whom must be actively engaged
in the treatment of persons with mental illness; at least three licensed pharmacists actively
engaged in the practice of pharmacy in Minnesota; and one consumer representative; the
remainder to be made up of health care professionals who are licensed in their field and
have recognized knowledge in the clinically appropriate prescribing, dispensing, and
monitoring of covered outpatient drugs. Members of the Formulary Committee shall not
be employed by the Department of Human Services, but the committee shall be staffed by
an employee of the department who shall serve as an ex officio, nonvoting member of the
committee. The department's medical director shall also serve as an ex officio, nonvoting
member for the committee. Committee members shall serve three-year terms and may be
reappointed by the commissioner. The Formulary Committee shall meet at least twice per
year. The commissioner may require more frequent Formulary Committee meetings as
needed. An honorarium of $100 per meeting and reimbursement for mileage shall be paid
to each committee member in attendance. The Formulary Committee expires June 30, 2022.
Sec. 27.
Minnesota Statutes 2020, section 256B.0625, subdivision 13e, is amended to
read:
Subd. 13e.
Payment rates.
(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.48deleted text end new text begin $10.77new text end per deleted text begin bagdeleted text end new text begin claimnew text end . The professional dispensing fee for prescriptions filled
with over-the-counter drugs meeting the definition of covered outpatient drugs shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for dispensed quantities equal to or greater than the number of units contained
in the manufacturer's original package. The professional dispensing fee shall be prorated
based on the percentage of the package dispensed when the pharmacy dispenses a quantity
less than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for new text begin specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for new text end all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking members of the legislative committees with
jurisdiction over medical assistance pharmacy reimbursement.
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
Sec. 28.
Minnesota Statutes 2020, section 256B.0625, subdivision 13g, is amended to
read:
Subd. 13g.
Preferred drug list.
(a) The commissioner shall adopt and implement a
preferred drug list by January 1, 2004. The commissioner may enter into a contract with a
vendor for the purpose of participating in a preferred drug list and supplemental rebate
program. The commissioner shall ensure that any contract meets all federal requirements
and maximizes federal financial participation. The commissioner shall publish the preferred
drug list annually in the State Register and shall maintain an accurate and up-to-date list on
the agency website.
(b) The commissioner may add to, delete from, and otherwise modify the preferred drug
list, after consulting with the Formulary Committee and appropriate medical specialists and
providing public notice and the opportunity for public comment.
(c) The commissioner shall adopt and administer the preferred drug list as part of the
administration of the supplemental drug rebate program. Reimbursement for prescription
drugs not on the preferred drug list may be subject to prior authorization.
(d) For purposes of this subdivision, "preferred drug list" means a list of prescription
drugs within designated therapeutic classes selected by the commissioner, for which prior
authorization based on the identity of the drug or class is not required.
(e) The commissioner shall seek any federal waivers or approvals necessary to implement
this subdivision.
new text begin
(f) Notwithstanding paragraph (b), before the commissioner may delete a drug from the
preferred drug list or modify the inclusion of a drug on the preferred drug list, the
commissioner, in consultation with the commissioner of health, shall consider any
implications the deletion or modification may have on state public health policies or
initiatives and any impact the deletion or modification may have on increasing health
disparities in the state. Prior to deleting a drug or modifying the inclusion of a drug, the
commissioner shall also conduct a public hearing. The commissioner shall provide adequate
notice to the public prior to the hearing that specifies the drug the commissioner is proposing
to delete or modify, any medical or clinical analysis that the commissioner has relied on in
proposing the deletion or modification, and evidence that the commissioner has consulted
with the commissioner of health and has evaluated the impact of the proposed deletion or
modification on public health and health disparities.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 13k. new text end
new text begin Eligible providers. new text end
new text begin
(a) To be eligible to dispense prescription drugs under
this section as an enrolled dispensing provider, the dispensing provider must be a:
new text end
new text begin
(1) pharmacy located within the state that is licensed by the Board of Pharmacy under
chapter 151;
new text end
new text begin
(2) physician located in a service area where there is no medical assistance enrolled
pharmacy; or
new text end
new text begin
(3) physician or advanced practice registered nurse employed by or under contract with
a community health board for communicable disease control.
new text end
new text begin
(b) A licensed out-of-state pharmacy may be enrolled as a dispensing provider under
paragraph (a) if the pharmacy is:
new text end
new text begin
(1) a retail pharmacy located within 50 miles of the Minnesota border that serves walk-in
medical assistance enrollees and whose walk-in customers represent at least 75 percent of
the pharmacy's prescription volume;
new text end
new text begin
(2) a retail pharmacy serving foster children enrolled in medical assistance and living
outside of Minnesota;
new text end
new text begin
(3) serving enrollees receiving preapproved organ transplants who require medication
during after-care while residing outside of Minnesota; or
new text end
new text begin
(4) providing products with limited or exclusive distribution channels for which there
is no potential dispensing provider located within the state.
new text end
new text begin
(c) A dispensing provider must attest that they meet the requirements in paragraphs (a)
and (b) before enrolling as a dispensing provider in the medical assistance program. If a
provider is found to be out of compliance with the requirements in paragraphs (a) and (b),
any funds paid to that provider during the time they were out of compliance shall be recovered
under section 256B.064.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 67. new text end
new text begin Pretreatment coordination services. new text end
new text begin
Effective January 1, 2022, or upon
federal approval, whichever is later, medical assistance covers pretreatment coordination
services provided according to section 254B.05, subdivision 4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022. The commissioner of
human services shall notify the revisor of statutes when federal approval is obtained or
denied.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.0638, subdivision 3, is amended to read:
Subd. 3.
Opioid prescribing work group.
(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:
(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;
(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;
(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;
(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;
(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;
(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;
(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;
(8) one member who is a medical examiner for a Minnesota county;
(9) one member of the Health Services Policy Committee established under section
256B.0625, subdivisions 3c to 3e;
(10) one member who is a medical director of a health plan company doing business in
Minnesota;
(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; deleted text begin and
deleted text end
(12) one member representing Minnesota law enforcementdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) two consumer members who are Minnesota residents and who have used or are
using opioids to manage chronic pain.
new text end
(b) In addition, the work group shall include the following nonvoting members:
(1) the medical director for the medical assistance program;
(2) a member representing the Department of Human Services pharmacy unit; deleted text begin and
deleted text end
(3) the medical director for the Department of Labor and Industrydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) a member representing the Department of Health.
new text end
(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.
Sec. 32.
Minnesota Statutes 2020, section 256B.0638, subdivision 5, is amended to read:
Subd. 5.
Program implementation.
(a) The commissioner shall implement the programs
within the Minnesota health care program to improve the health of and quality of care
provided to Minnesota health care program enrollees. The commissioner shall annually
collect and report tonew text begin provider groups the sentinel measures of data showing individualnew text end opioid
deleted text begin prescribers data showing the sentinel measures of theirdeleted text end new text begin prescribers'new text end opioid prescribing
patterns compared to their anonymized peers.new text begin Provider groups shall distribute data to their
affiliated, contracted, or employed opioid prescribers.
new text end
(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:
(1) components of the program described in subdivision 4, paragraph (a);
(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and
(3) appropriate use of the prescription monitoring program under section 152.126.
(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall take one or more of the following steps:
(1) monitor prescribing practices more frequently than annually;
(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or
(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.
(d) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.
Sec. 33.
Minnesota Statutes 2020, section 256B.0638, subdivision 6, is amended to read:
Subd. 6.
Data practices.
(a) Reports and data identifying an opioid prescriber are private
data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber
is subject to termination as a medical assistance provider under this section. Notwithstanding
this data classification, the commissioner shall share with all of the provider groups with
which an opioid prescriber is employednew text begin , contracted,new text end or affiliated, deleted text begin a report identifying an
opioid prescriber who is subject to quality improvement activitiesdeleted text end new text begin the datanew text end under subdivision
5, paragraphnew text begin (a),new text end (b)new text begin ,new text end or (c).
(b) Reports and data identifying a provider group are nonpublic data as defined under
section 13.02, subdivision 9, until the provider group is subject to termination as a medical
assistance provider under this section.
(c) Upon termination under this section, reports and data identifying an opioid prescriber
or provider group are public, except that any identifying information of Minnesota health
care program enrollees must be redacted by the commissioner.
Sec. 34.
Minnesota Statutes 2020, section 256B.0659, subdivision 13, is amended to read:
Subd. 13.
Qualified professional; qualifications.
(a) The qualified professional must
work for a personal care assistance provider agency, meet the definition of qualified
professional under section 256B.0625, subdivision 19c, deleted text begin and enroll with the department as
a qualified professional after clearingdeleted text end new text begin clearnew text end a background studynew text begin , and meet provider training
requirementsnew text end . Before a qualified professional provides services, the personal care assistance
provider agency must initiate a background study on the qualified professional under chapter
245C, and the personal care assistance provider agency must have received a notice from
the commissioner that the qualified professional:
(1) is not disqualified under section 245C.14; or
(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:
(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;
(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;
(3) review documentation of personal care assistance services provided;
(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and
(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.
(c) deleted text begin Effective July 1, 2011,deleted text end The qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.
Sec. 35.
Minnesota Statutes 2020, section 256B.0946, subdivision 1, is amended to read:
Subdivision 1.
Required covered service components.
(a) Effective May 23, 2013,
and subject to federal approval, medical assistance covers medically necessary intensive
treatment services described under paragraph (b) that are provided by a provider entity
eligible under subdivision 3 to a client eligible under subdivision 2 who is placed in a foster
home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or placed in a foster
home licensed under the regulations established by a federally recognized Minnesota tribe.
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to deleted text begin (5)deleted text end new text begin
(6)new text end are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
Rules, part 9505.0371, subpart 5, item C;
(2) crisis assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943;
(3) individual, family, and group psychoeducation services, defined in subdivision 1a,
paragraph (q), provided by a mental health professional or a clinical trainee;
(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
health professional or a clinical trainee; deleted text begin and
deleted text end
(5) new text begin individual treatment plan development as defined in Minnesota Rules, part 9505.0371,
subpart 7; and
new text end
new text begin (6) new text end service delivery payment requirements as provided under subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (o)new text end .
(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
(d) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
diagnostic assessment and team consultation and treatment planning review process.
(e) Each client receiving treatment must be assessed for a trauma history, and the client's
treatment plan must document how the results of the assessment will be incorporated into
treatment.
(f) Each client receiving treatment services must have an individual treatment plan that
is reviewed, evaluated, and signed every 90 days using the team consultation and treatment
planning process, as defined in subdivision 1a, paragraph (s).
(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided in
accordance with the client's individual treatment plan.
(h) Each client must have a crisis assistance plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.
(i) Services must be delivered and documented at least three days per week, equaling at
least six hours of treatment per weekdeleted text begin , unless reduced units of service are specified on the
treatment plandeleted text end new text begin . If the mental health professional, client, and family agree, service units may
be temporarily reduced for a period of no more than 60 days in order to meet the needs of
the client and family, ornew text end as part of transition or on a discharge plan to another service or
level of care. new text begin The reasons for service reduction must be identified, documented, and included
on the treatment plan. Billing and payment are prohibited for days on which no services are
delivered and documented. new text end Documentation must comply with Minnesota Rules, parts
9505.2175 and 9505.2197.
(j) Location of service delivery must be in the client's home, day care setting, school, or
other community-based setting that is specified on the client's individualized treatment plan.
(k) Treatment must be developmentally and culturally appropriate for the client.
(l) Services must be delivered in continual collaboration and consultation with the client's
medical providers and, in particular, with prescribers of psychotropic medications, including
those prescribed on an off-label basis. Members of the service team must be aware of the
medication regimen and potential side effects.
(m) Parents, siblings, foster parents, and members of the child's permanency plan must
be involved in treatment and service delivery unless otherwise noted in the treatment plan.
(n) Transition planning for the child must be conducted starting with the first treatment
plan and must be addressed throughout treatment to support the child's permanency plan
and postdischarge mental health service needs.
new text begin
(o) In order for a provider to receive the daily per-client encounter rate, at least one of
the services listed in subdivision 1, paragraph (b), clauses (1) to (3), must be provided. The
services listed in subdivision 1, paragraph (b), clauses (4) and (5), may be included as part
of the daily per-client encounter rate.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.196, subdivision 2, is amended to read:
Subd. 2.
Commissioner's duties.
(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.
(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.
(c) Beginning January 1, 2010, deleted text begin Hennepin County anddeleted text end Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
deleted text begin $12,000,000 per year from Hennepin County anddeleted text end $6,000,000 per year deleted text begin from Ramsey Countydeleted text end .
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to deleted text begin Hennepin County Medical Center ordeleted text end Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to deleted text begin Hennepin County Medical Center anddeleted text end
Regions Hospital by those plans. For the purposes of this paragraph, "the base amount"
means the total annual value of increased medical assistance capitation payments, including
the voluntary intergovernmental transfers, under this paragraph in calendar year 2017. For
managed care contracts beginning on or after January 1, 2018, the commissioner shall reduce
the total annual value of increased medical assistance capitation payments under this
paragraph by an amount equal to ten percent of the base amount, and by an additional ten
percent of the base amount for each subsequent contract year until December 31, 2025.
Upon the request of the commissioner, health plans shall submit individual-level cost data
for verification purposes. The commissioner may ratably reduce these payments on a pro
rata basis in order to satisfy federal requirements for actuarial soundness. If payments are
reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
increased medical assistance capitation payments under the intergovernmental transfer
described in this paragraph shall increase its medical assistance payments to deleted text begin Hennepin
County Medical Center anddeleted text end Regions Hospital by the same amount as the increased payments
received in the capitation payment described in this paragraph. This paragraph expires
January 1, 2026.
(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County, the
city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center, the city of St. Paul, and other participating governmental entities equal to
the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center, the city of St.
Paul, and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.
(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.
(f) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (e), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.
(g) The payments in paragraphs (a) to (e) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under subdivision 3.
(h) All of the data and funding transactions related to the payments in paragraphs (a) to
(e) shall be between the commissioner and the governmental entities.
(i) For purposes of this subdivision, billing professionals are limited to physicians, nurse
practitioners, nurse midwives, clinical nurse specialists, physician assistants,
anesthesiologists, certified registered nurse anesthetists, dentists, dental hygienists, and
dental therapists.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 31, 2021, or upon federal
approval, whichever is later. The commissioner of human services shall inform the revisor
of statutes when federal approval is obtained.
new text end
Sec. 38.
new text begin
[256B.1973] DIRECTED PAYMENT ARRANGEMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given them.
new text end
new text begin
(b) "Billing professionals" means physicians, nurse practitioners, nurse midwives, clinical
nurse specialists, physician assistants, anesthesiologists, and certified registered anesthetists,
and may include dentists, individually enrolled dental hygienists, and dental therapists.
new text end
new text begin
(c) "Health plan" means a managed care or county-based purchasing plan that is under
contract with the commissioner to deliver services to medical assistance enrollees under
section 256B.69.
new text end
new text begin
(d) "High medical assistance utilization" means a medical assistance utilization rate
equal to the standard established in section 256.969, subdivision 9, paragraph (d), clause
(6).
new text end
new text begin Subd. 2. new text end
new text begin Federal approval required. new text end
new text begin
Each directed payment arrangement under this
section is contingent on federal approval and must conform with the requirements for
permissible directed managed care organization expenditures under section 256B.6928,
subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Eligible providers. new text end
new text begin
Eligible providers under this section are nonstate government
teaching hospitals with high medical assistance utilization and a level 1 trauma center and
the hospital's affiliated billing professionals, ambulance services, and clinics.
new text end
new text begin Subd. 4. new text end
new text begin Voluntary intergovernmental transfers. new text end
new text begin
A nonstate governmental entity that
is eligible to perform intergovernmental transfers may make voluntary intergovernmental
transfers to the commissioner. The commissioner shall inform the nonstate governmental
entity of the intergovernmental transfers necessary to maximize the allowable directed
payments.
new text end
new text begin Subd. 5. new text end
new text begin Commissioner's duties; state-directed fee schedule requirement. new text end
new text begin
(a) For
each federally approved directed payment arrangement that is a state-directed fee schedule
requirement, the commissioner shall determine a uniform adjustment factor to be applied
to each claim submitted by an eligible provider to a health plan. The commissioner shall
ensure that the application of the uniform adjustment factor maximizes the allowable directed
payments and does not result in payments exceeding federal limits, and may use a settle-up
process no less than annually to adjust health plan payments to comply with this requirement.
The commissioner shall apply the uniform adjustment to each submitted claim.
new text end
new text begin
(b) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner must ensure that the total annual amount of
payments equals at least the sum of the annual value of the voluntary intergovernmental
transfers to the commissioner under subdivision 4 and federal financial participation.
new text end
new text begin
(c) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner shall develop a plan for the initial
implementation of the state-directed fee schedule requirement to ensure that the eligible
provider receives the entire permissible value of the federally approved directed payment
arrangement. If federal approval of a directed payment arrangement under this subdivision
is retroactive, the commissioner shall make a onetime pro rata increase to the uniform
adjustment factor and the initial payments in order to include claims submitted between the
retroactive federal approval date and the period captured by the initial payments.
new text end
new text begin Subd. 6. new text end
new text begin Health plan duties; submission of claims. new text end
new text begin
In accordance with its contract,
each health plan shall submit to the commissioner payment information for each claim paid
to an eligible provider for services provided to a medical assistance enrollee.
new text end
new text begin Subd. 7. new text end
new text begin Health plan duties; directed payments. new text end
new text begin
In accordance with its contract, each
health plan shall make directed payments to the eligible provider in an amount equal to the
payment amounts the plan received from the commissioner.
new text end
new text begin Subd. 8. new text end
new text begin State quality goals. new text end
new text begin
The directed payment arrangement and state-directed fee
schedule requirement must align the state quality goals to Hennepin Healthcare medical
assistance patients, including unstably housed individuals, those with higher levels of social
and clinical risk, limited English proficiency patients, adults with serious chronic conditions,
or individuals of color. The directed payment arrangement will maintain quality and access
to a full range of health care delivery mechanisms for these patients, such as behavioral
health, emergent care, preventive care, hospitalization, transportation, interpretation, and
pharmaceutical. In partnership with the Department of Human Services, the Centers for
Medicare and Medicaid Services, and Hennepin Healthcare, mutually agreed upon measures
to demonstrate access to care must be identified and measured.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, unless the federal approval provides for an effective date after July 1,
2021, but before the date of federal approval, in which case the federally approved effective
date applies.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.69, subdivision 6d, is amended to read:
Subd. 6d.
Prescription drugs.
new text begin (a)new text end The commissioner may exclude or modify coverage
for prescription drugs from the prepaid managed care contracts entered into under this
section in order to increase savings to the state by collecting additional prescription drug
rebates. The contracts must maintain incentives for the managed care plan to manage drug
costs and utilization and may require that the managed care plans maintain an open drug
formulary. In order to manage drug costs and utilization, the contracts may authorize the
managed care plans to use preferred drug lists and prior authorization. This subdivision is
contingent on federal approval of the managed care contract changes and the collection of
additional prescription drug rebates.
new text begin
(b) Managed care plans and county-based purchasing plans or the plan's subcontractor
if the plan subcontracts with a third party to administer pharmacy services, including a
pharmacy benefit manager, must comply with section 256B.0625, subdivision 13k, for
purposes of contracting with dispensing providers to provide pharmacy services to medical
assistance and MinnesotaCare enrollees.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256B.69, is amended by adding a subdivision
to read:
new text begin Subd. 6f. new text end
new text begin Dental fee schedules. new text end
new text begin
(a) A managed care plan, county-based purchasing plan,
or dental benefits administrator as defined under section 256B.0625, subdivision 9c,
paragraph (a), must provide individual dental providers, upon request, the applicable fee
schedules for covered dental services provided under the contract between the dental provider
and the managed care plan, county-based purchasing plan, or dental benefits administrator.
new text end
new text begin
(b) A managed care plan, county-based purchasing plan, or dental benefits administrator
may fulfill this requirement by making the applicable fee schedules available through a
secure web portal for the contracted dental provider to access.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256B.6928, subdivision 5, is amended to read:
Subd. 5.
Direction of managed care organization expenditures.
(a) The commissioner
shall not direct managed care organizations expenditures under the managed care contract,
except deleted text begin indeleted text end new text begin as permitted under Code of Federal Regulations, part 42, section 438.6(c). The
exception under this paragraph includesnew text end the following situations:
(1) implementation of a value-based purchasing model for provider reimbursement,
including pay-for-performance arrangements, bundled payments, or other service payments
intended to recognize value or outcomes over volume of services;
(2) participation in a multipayer or medical assistance-specific delivery system reform
or performance improvement initiative; or
(3) implementation of a minimum or maximum fee schedule, or a uniform dollar or
percentage increase for network providers that provide a particular service. The maximum
fee schedule must allow the managed care organization the ability to reasonably manage
risk and provide discretion in accomplishing the goals of the contract.
(b) Any managed care contract that directs managed care organization expenditures as
permitted under paragraph (a), clauses (1) to (3), must be developed in accordance with
Code of Federal Regulations, part 42, sections 438.4 and 438.5; comply with actuarial
soundness and generally accepted actuarial principles and practices; and have written
approval from the Centers for Medicare and Medicaid Services before implementation. To
obtain approval, the commissioner shall demonstrate in writing that the contract arrangement:
(1) is based on the utilization and delivery of services;
(2) directs expenditures equally, using the same terms of performance for a class of
providers providing service under the contract;
(3) is intended to advance at least one of the goals and objectives in the commissioner's
quality strategy;
(4) has an evaluation plan that measures the degree to which the arrangement advances
at least one of the goals in the commissioner's quality strategy;
(5) does not condition network provider participation on the network provider entering
into or adhering to an intergovernmental transfer agreement; and
(6) is not renewed automatically.
(c) For contract arrangements identified in paragraph (a), clauses (1) and (2), the
commissioner shall:
(1) make participation in the value-based purchasing model, special delivery system
reform, or performance improvement initiative available, using the same terms of
performance, to a class of providers providing services under the contract related to the
model, reform, or initiative; and
(2) use a common set of performance measures across all payers and providers.
(d) The commissioner shall not set the amount or frequency of the expenditures or recoup
from the managed care organization any unspent funds allocated for these arrangements.
Sec. 42.
Minnesota Statutes 2020, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.new text begin
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
new text end
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
Sec. 43.
new text begin
[256B.795] MATERNAL AND INFANT HEALTH REPORT.
new text end
new text begin
(a) The commissioner of human services, in consultation with the commissioner of
health, shall submit a biennial report beginning April 15, 2022, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health policy and
finance on the effectiveness of state maternal and infant health policies and programs
addressing health disparities in prenatal and postpartum health outcomes. For each reporting
period, the commissioner shall determine the number of women enrolled in the medical
assistance program who are pregnant or are in the six months postpartum period of eligibility
and the percentage of women in that group who, during each reporting period:
new text end
new text begin
(1) received prenatal services;
new text end
new text begin
(2) received doula services;
new text end
new text begin
(3) gave birth by primary cesarean section;
new text end
new text begin
(4) gave birth to an infant who received care in the neonatal intensive care unit;
new text end
new text begin
(5) gave birth to an infant who was premature or who had a low birth weight;
new text end
new text begin
(6) experienced excessive blood loss of more than 500 cc of blood;
new text end
new text begin
(7) received postpartum care within six weeks of giving birth; and
new text end
new text begin
(8) received a prenatal and postpartum follow-up home visit from a public health nurse.
new text end
new text begin
(b) These measurements must be determined through an analysis of the utilization data
from claims submitted during each reporting period and by any other appropriate means,
including the use of utilization data under section 62U.04. The measurements for each metric
must be determined in the aggregate and separately for white women, women of color, and
indigenous women.
new text end
new text begin
(c) The commissioner shall establish a baseline for the metrics described in paragraph
(a) using calendar year 2017. The initial report due April 15, 2022 must contain the baseline
metrics and the metrics data for calendar years 2019 and 2021. The following reports due
biennially thereafter must contain the metrics for the preceding two calendar years.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256L.01, subdivision 5, is amended to read:
Subd. 5.
Income.
"Income" has the meaning given for modified adjusted gross income,
as defined in Code of Federal Regulations, title 26, section 1.36B-1, and means a household's
deleted text begin current income, or if income fluctuates month to month, the income for the 12-month
eligibility perioddeleted text end new text begin projected annual income for the applicable tax yearnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 45.
Minnesota Statutes 2020, section 256L.04, subdivision 7b, is amended to read:
Subd. 7b.
Annual income limits adjustment.
The commissioner shall adjust the income
limits under this section annually deleted text begin each July 1deleted text end new text begin on January 1new text end as deleted text begin described in section 256B.056,
subdivision 1cdeleted text end new text begin provided in Code of Federal Regulations, title 26, section 1.36B-1(h)new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256L.05, subdivision 3a, is amended to read:
Subd. 3a.
Redetermination of eligibility.
(a) An enrollee's eligibility must be
redetermined on an annual basisdeleted text begin , in accordance with Code of Federal Regulations, title 42,
section 435.916 (a). The 12-month eligibility period begins the month of application.
Beginning July 1, 2017, the commissioner shall adjust the eligibility period for enrollees to
implement renewals throughout the year according to guidance from the Centers for Medicare
and Medicaid Servicesdeleted text end .new text begin The period of eligibility is the entire calendar year following the
year in which eligibility is redetermined. Eligibility redeterminations shall occur during the
open enrollment period for qualified health plans as specified in Code of Federal Regulations,
title 45, section 155.410(e)(3).
new text end
(b) Each new period of eligibility must take into account any changes in circumstances
that impact eligibility and premium amount. Coverage begins as provided in section 256L.06.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 47.
Minnesota Statutes 2020, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
(c) Paragraph (b) does not apply to:
(1) children 20 years of age or younger; and
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
|
Federal Poverty Guideline Greater than or Equal to |
Less than |
Individual Premium Amount |
| 35% |
55% |
$4 |
| 55% |
80% |
$6 |
| 80% |
90% |
$8 |
| 90% |
100% |
$10 |
| 100% |
110% |
$12 |
| 110% |
120% |
$14 |
| 120% |
130% |
$15 |
| 130% |
140% |
$16 |
| 140% |
150% |
$25 |
| 150% |
160% |
$37 |
| 160% |
170% |
$44 |
| 170% |
180% |
$52 |
| 180% |
190% |
$61 |
| 190% |
200% |
$71 |
| 200% |
$80 |
new text begin
(e) Beginning January 1, 2021, the commissioner shall adjust the premium scale
established under paragraph (d) to ensure that premiums do not exceed the amount that an
individual would have been required to pay if the individual was enrolled in an applicable
benchmark plan in accordance with the Code of Federal Regulations, title 42, section
600.505(a)(1).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from January 1, 2021 and
applies to premiums due on or after that date.
new text end
Sec. 48.
Minnesota Statutes 2020, section 256L.15, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Tobacco use premium surcharge. new text end
new text begin
(a) An enrollee who uses tobacco products
as defined in paragraph (e) and is not actively participating in a tobacco cessation program
must pay a tobacco premium surcharge in an amount that is equal to ten percent of the
enrollee's monthly premium. The tobacco use premium surcharge must be calculated on a
monthly basis and paid in accordance with section 256L.06, rounded up to the nearest dollar
amount. Nonpayment of the surcharge may result in disenrollment.
new text end
new text begin
(b) Enrollees who initially apply or renew enrollment in the MinnesotaCare program on
or after July 1, 2021, must attest as part of the application or renewal process whether the
enrollee is using tobacco products and if so, whether the enrollee is actively participating
in a tobacco cessation program. Upon request of the commissioner, the enrollee must provide
documentation verifying that the enrollee is actively participating in tobacco cessation.
new text end
new text begin
(c) If an enrollee indicates on the initial application or at renewal that the enrollee does
not use tobacco or is using tobacco products but is actively participating in a tobacco
cessation program, and it is determined that the enrollee was using tobacco products and
was not actively participating in a tobacco cessation program during the period of enrollment,
the enrollee must pay the total amount of the tobacco use premium surcharge that the enrollee
would have been required to pay as a tobacco user during that enrollment period. If the
enrollee fails to pay the surcharge amount due, the enrollee may be disenrolled and the
unpaid amount may be subject to recovery by the commissioner.
new text end
new text begin
(d) Nonpayment of the surcharge amount owed by the enrollee under paragraph (a) or
(c) shall result in disenrollment effective for the calendar month following the month for
which the surcharge was due. Disenrollment for nonpayment of the surcharge must meet
the requirements in section 256L.06, subdivision 3, paragraphs (d) and (e).
new text end
new text begin
(e) For purposes of this subdivision, the use of tobacco products means the use of a
tobacco product four or more times per week within the past six months. Tobacco products
include the use of cigarettes, cigars, pipe tobacco, chewing tobacco, or snuff. Tobacco
products do not include the use of tobacco by an American Indian who meets the
requirements in Code of Federal Regulations, title 42, sections 447.51 and 447.56, as part
of a traditional Native American spiritual or cultural ceremony.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 49.
Minnesota Statutes 2020, section 295.53, subdivision 1, is amended to read:
Subdivision 1.
Exclusions and exemptions.
(a) The following payments are excluded
from the gross revenues subject to the hospital, surgical center, or health care provider taxes
under sections 295.50 to 295.59:
(1) payments received by a health care provider or the wholly owned subsidiary of a
health care provider for care provided outside Minnesota;
(2) government payments received by the commissioner of human services for
state-operated services;
(3) payments received by a health care provider for hearing aids and related equipment
or prescription eyewear delivered outside of Minnesota; and
(4) payments received by an educational institution from student tuition, student activity
fees, health care service fees, government appropriations, donations, or grants, and for
services identified in and provided under an individualized education program as defined
in section 256B.0625 or Code of Federal Regulations, chapter 34, section 300.340(a). Fee
for service payments and payments for extended coverage are taxable.
(b) The following payments are exempted from the gross revenues subject to hospital,
surgical center, or health care provider taxes under sections 295.50 to 295.59:
(1) payments received for services provided under the Medicare program, including
payments received from the government and organizations governed by sections 1833,
1853, and 1876 of title XVIII of the federal Social Security Act, United States Code, title
42, section 1395; and enrollee deductibles, co-insurance, and co-payments, whether paid
by the Medicare enrollee, by Medicare supplemental coverage as described in section
62A.011, subdivision 3, clause (10), or by Medicaid payments under title XIX of the federal
Social Security Act. Payments for services not covered by Medicare are taxable;
(2) payments received for home health care services;
(3) payments received from hospitals or surgical centers for goods and services on which
liability for tax is imposed under section 295.52 or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(4) payments received from the health care providers for goods and services on which
liability for tax is imposed under this chapter or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(5) amounts paid for legend drugs to a wholesale drug distributor who is subject to tax
under section 295.52, subdivision 3, reduced by reimbursement received for legend drugs
otherwise exempt under this chapter;
(6) payments received from the chemical dependency fund under chapter 254B;
(7) payments received in the nature of charitable donations that are not designated for
providing patient services to a specific individual or group;
(8) payments received for providing patient services incurred through a formal program
of health care research conducted in conformity with federal regulations governing research
on human subjects. Payments received from patients or from other persons paying on behalf
of the patients are subject to tax;
(9) payments received from any governmental agency for services benefiting the public,
not including payments made by the government in its capacity as an employer or insurer
or payments made by the government for services provided under the MinnesotaCare
program or the medical assistance program governed by title XIX of the federal Social
Security Act, United States Code, title 42, sections 1396 to 1396v;
(10) payments received under the federal Employees Health Benefits Act, United States
Code, title 5, section 8909(f), as amended by the Omnibus Reconciliation Act of 1990.
Enrollee deductibles, co-insurance, and co-payments are subject to tax;
(11) payments received under the federal Tricare program, Code of Federal Regulations,
title 32, section 199.17(a)(7). Enrollee deductibles, co-insurance, and co-payments are
subject to tax; and
(12) supplemental deleted text begin ordeleted text end new text begin ,new text end enhancednew text begin , or directednew text end payments authorized under section 256B.196
deleted text begin ordeleted text end new text begin ,new text end 256B.197new text begin , or 256B.1973new text end .
(c) Payments received by wholesale drug distributors for legend drugs sold directly to
veterinarians or veterinary bulk purchasing organizations are excluded from the gross
revenues subject to the wholesale drug distributor tax under sections 295.50 to 295.59.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for taxable years beginning after December
31, 2020.
new text end
Sec. 50. new text begin CAPITATION PAYMENT DELAY.
new text end
new text begin
(a) The commissioner of human services shall delay $93,742,000 of the medical assistance
capitation payment to managed care plans and county-based purchasing plans due in May
2023 until July 1, 2023. The payment shall be made no earlier than July 1, 2023, and no
later than July 31, 2023.
new text end
new text begin
(b) The commissioner of human services shall delay $114,103,000 of the medical
assistance capitation payment to managed care plans and county-based purchasing plans
due in May 2025 until July 1, 2025. The payment shall be made no earlier than July 1, 2025,
and no later than July 31, 2025
new text end
Sec. 51. new text begin DENTAL HOME DEMONSTRATION PROJECT PLAN.
new text end
new text begin
(a) The commissioner of human services shall develop a plan to implement a dental
home demonstration project. The demonstration project must create dental homes to provide
incentives to dental providers for the provision of patient-centered, high quality,
comprehensive, and coordinated dental care to medical assistance and MinnesotaCare
enrollees. The demonstration project must be designed to establish and evaluate alternative
models of delivery systems and payment methods that:
new text end
new text begin
(1) emphasize, enhance, and encourage access to primary dental care by using dental
teams that include dentists, dental hygienists, dental therapists, advanced dental therapists,
and dental assistants;
new text end
new text begin
(2) ensure enrollees with a consistent and ongoing contact with a dental provider or
dental team and coordination with the enrollee's medical care;
new text end
new text begin
(3) decrease administrative burdens and create greater transparency and accountability;
new text end
new text begin
(4) incorporate outcome measures on access, quality, cost of care and patient experience;
and
new text end
new text begin
(5) establish value-based incentives to:
new text end
new text begin
(i) provide flexibility in enrollment criteria in order to increase the number of dental
providers currently serving medical assistance and MinnesotaCare enrollees;
new text end
new text begin
(ii) reduce disparities in access to dental services for high risk and medically and socially
complex patients; and
new text end
new text begin
(iii) increase overall access to quality dental services.
new text end
new text begin
(b) The commissioner shall develop outcome measures for the demonstration projects
that include measurements for access to preventive care, follow-up care after an oral health
evaluation, patient satisfaction, and administrative costs for delivering dental services.
new text end
new text begin
(c) In developing the dental home demonstration project, the commissioner shall consult
with interested stakeholders including but not limited to representatives of:
new text end
new text begin
(1) private practice dental clinics for which medical assistance and MinnesotaCare
enrollees comprise more than 25 percent of the clinic's patient load;
new text end
new text begin
(2) nonprofit dental clinics with a primary focus on serving Indigenous communities
and other communities of color;
new text end
new text begin
(3) nonprofit dental clinics with a primary focus on providing eldercare;
new text end
new text begin
(4) nonprofit dental clinics with a primary focus on serving children;
new text end
new text begin
(5) nonprofit dental clinics providing services in the seven-county metropolitan area;
new text end
new text begin
(6) nonprofit dental clinics providing services outside of the seven-county metropolitan
area;
new text end
new text begin
(7) multispecialty hospital-based dental clinics; and
new text end
new text begin
(8) educational institutions operating dental programs.
new text end
new text begin
(d) The commissioner of human services shall submit recommendations for the
establishment of a dental home demonstration project to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by February 1, 2022.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 52. new text begin FEDERAL APPROVAL; EXTENSION OF POSTPARTUM COVERAGE.
new text end
new text begin
The commissioner of human services shall seek all necessary federal waivers and
approvals necessary to extend medical assistance postpartum coverage, as provided in
Minnesota Statutes, section 256B.055, subdivision 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 53. new text begin OVERPAYMENTS FOR DURABLE MEDICAL EQUIPMENT,
PROSTHETICS, ORTHOTICS, OR SUPPLIES.
new text end
new text begin
(a) Notwithstanding any other law to the contrary, providers who received payment for
durable medical equipment, prosthetics, orthotics, or supplies between January 1, 2018, and
June 30, 2019, that were subject to the upper payment limits under United States Code, title
42, section 1396b(i)(27), shall not be required to repay any amount received in excess of
the allowable amount to either the state or the Centers for Medicare and Medicaid Services.
new text end
new text begin
(b) The state shall repay with state funds any amount owed to the Centers for Medicare
and Medicaid Services for the federal financial participation amount received by the state
for payments identified in paragraph (a) in excess of the amount allowed effective January
1, 2018, and the state shall hold harmless the providers who received these payments from
recovery of both the state and federal share of the amount determined to have exceeded the
Medicare upper payment limit.
new text end
new text begin
(c) Nothing in this section shall be construed to prohibit the commissioner from recouping
past overpayments due to false claims or for reasons other than exceeding the Medicare
upper payment limits or from recouping future overpayments including the recoupment of
payments that exceed the upper Medicare payment limits.
new text end
Sec. 54. new text begin PROPOSED FORMULARY COMMITTEE.
new text end
new text begin
By March 1, 2022, the commissioner of human services, in consultation with relevant
professional associations and consumer groups, shall submit to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services a proposed reorganization of the Formulary Committee under Minnesota Statutes,
section 256B.0625, subdivision 13c, that includes:
new text end
new text begin
(1) the proposed membership of the committee, including adequate representation of
consumers and health care professionals with expertise in clinical prescribing; and
new text end
new text begin
(2) proposed policies and procedures for the operation of the committee that ensures
public input, including providing public notice and gathering public comments on the
committee's recommendations and proposed actions.
new text end
Sec. 55. new text begin OPIATE EPIDEMIC RESPONSE ADVISORY COUNCIL; INITIAL
MEMBERSHIP TERMS.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 256.042, subdivision 2, paragraph (c), the
initial term for members of the Opiate Epidemic Response Advisory Council established
under Minnesota Statutes, section 256.042, identified in Minnesota Statutes, section 256.042,
subdivision 2, paragraph (a), clauses (1), (3), (5), (7), (9), (11), (13), (15), and (17), ends
September 30, 2022. The initial term for members identified under Minnesota Statutes,
section 256.042, subdivision 2, paragraph (a), clauses (2), (4), (6), (8), (10), (12), (14), and
(16), ends September 30, 2023.
new text end
Sec. 56. new text begin DIRECTION TO COMMISSIONER; DIRECTED PAYMENT
APPLICATION.
new text end
new text begin
The commissioner of human services, in consultation with Hennepin Healthcare System,
shall submit Section 438.6(c) Preprint to the Centers for Medicare and Medicaid Services
no later than July 31, 2021. The commissioner shall request from the Centers for Medicare
and Medicaid Services an effective date of January 1, 2022.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 57. new text begin DIRECTIONS TO COMMISSIONER; SCREENING TOOL; SUBSTANCE
USE DISORDER REFORM EVALUATION; SUBSTANCE USE DISORDER
REFORM EDUCATION.
new text end
new text begin
(a) By July 1, 2022, the commissioner of human services shall develop or authorize a
tool for screening individuals for pretreatment coordination services and a template to
document an individual's screening result.
new text end
new text begin
(b) By July 1, 2022, the commissioner of human services shall, in consultation with
counties and substance use disorder treatment providers, develop a tool to evaluate the
effects of substance use disorder treatment reform proposals enacted during the 2019 and
2021 legislative sessions, including access to services, appropriateness of services, and
accuracy of billing service units.
new text end
new text begin
(c) By July 1, 2022, the commissioner of human services shall, in consultation with
counties and substance use disorder treatment providers, develop educational materials for
county staff, providers, and the general public regarding the content and timing of changes
for implementation pursuant to substance use disorder treatment reform proposals enacted
during the 2019 and 2021 legislative sessions.
new text end
Sec. 58. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FUNDING FOR RECUPERATIVE CARE.
new text end
new text begin
The commissioner of human services shall develop a medical assistance reimbursable
recuperative care service, not limited to a health home model, designed to serve individuals
with chronic conditions, as defined in United States Code, title 42, section 1396w-4(h), who
also lack a permanent place of residence at the time of discharge from an emergency
department or hospital in order to prevent a return to the emergency department, readmittance
to the hospital, or hospitalization. This section is contingent on the receipt of nonstate
funding to the commissioner of human services for this purpose as permitted by Minnesota
Statutes, section 256.01, subdivision 25.
new text end
Sec. 59. new text begin FUNDING RECOMMENDATIONS FOR PRETREATMENT
COORDINATION SERVICES.
new text end
new text begin
If federal approval is not obtained for pretreatment coordination services under Minnesota
Statutes, section 256B.0625, subdivision 67, the commissioner of human services, in
consultation with the counties, shall submit recommendations on a funding mechanism for
pretreatment coordination services to the chairs and ranking minority members of the
legislative committees with jurisdiction over health hand human services policy and finance
by March 15, 2022.
new text end
Sec. 60. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes must change the term "Health Services Policy Committee" to
"Health Services Advisory Council" wherever the term appears in Minnesota Statutes and
may make any necessary changes to grammar or sentence structure to preserve the meaning
of the text.
new text end
Sec. 61. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 16A.724, subdivision 2,
new text end
new text begin
is repealed effective July 1,
2024.
new text end
ARTICLE 2
HEALTH DEPARTMENT
Section 1.
Minnesota Statutes 2020, section 62J.495, subdivision 1, is amended to read:
Subdivision 1.
Implementation.
The commissioner of health, in consultation with the
e-Health Advisory Committee, shall develop uniform standards to be used for the
interoperable electronic health records system for sharing and synchronizing patient data
across systems. The standards must be compatible with federal efforts. The uniform standards
must be developed by January 1, 2009, and updated on an ongoing basis. deleted text begin The commissioner
shall include an update on standards development as part of an annual report to the legislature.deleted text end
Individual health care providers in private practice with no other providers and health care
providers that do not accept reimbursement from a group purchaser, as defined in section
62J.03, subdivision 6, are excluded from the requirements of this section.
Sec. 2.
Minnesota Statutes 2020, section 62J.495, subdivision 2, is amended to read:
Subd. 2.
E-Health Advisory Committee.
(a) The commissioner shall establish an
e-Health Advisory Committee governed by section 15.059 to advise the commissioner on
the following matters:
(1) assessment of the adoption and effective use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;
(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for clinical data exchange, clinical support programs, patient privacy requirements, and
maintenance of the security and confidentiality of individual patient data;
(3) recommendations for encouraging use of innovative health care applications using
information technology and systems to improve patient care and reduce the cost of care,
including applications relating to disease management and personal health management
that enable remote monitoring of patients' conditions, especially those with chronic
conditions; and
(4) other related issues as requested by the commissioner.
(b) The members of the e-Health Advisory Committee shall include the commissioners,
or commissioners' designees, of health, human services, administration, and commerce and
additional members to be appointed by the commissioner to include persons representing
Minnesota's local public health agencies, licensed hospitals and other licensed facilities and
providers, private purchasers, the medical and nursing professions, health insurers and health
plans, the state quality improvement organization, academic and research institutions,
consumer advisory organizations with an interest and expertise in health information
technology, and other stakeholders as identified by the commissioner to fulfill the
requirements of section 3013, paragraph (g), of the HITECH Act.
(c) deleted text begin The commissioner shall prepare and issue an annual report not later than January 30
of each year outlining progress to date in implementing a statewide health information
infrastructure and recommending action on policy and necessary resources to continue the
promotion of adoption and effective use of health information technology.
deleted text end
deleted text begin (d)deleted text end This subdivision expires June 30, 2021.
Sec. 3.
Minnesota Statutes 2020, section 62J.495, subdivision 3, is amended to read:
Subd. 3.
Interoperable electronic health record requirements.
(a) Hospitals and health
care providers must meet the following criteria when implementing an interoperable
electronic health records system within their hospital system or clinical practice setting.
(b) The electronic health record must be a qualified electronic health record.
(c) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and health
care providers if a certified electronic health record product for the provider's particular
practice setting is available. This criterion shall be considered met if a hospital or health
care provider is using an electronic health records system that has been certified within the
last three years, even if a more current version of the system has been certified within the
three-year period.
(d) The electronic health record must meet the standards established according to section
3004 of the HITECH Act as applicable.
(e) The electronic health record must have the ability to generate information on clinical
quality measures and other measures reported under sections 4101, 4102, and 4201 of the
HITECH Act.
(f) The electronic health record system must be connected to a state-certified health
information organization either directly or through a connection facilitated by a deleted text begin state-certifieddeleted text end
health data intermediary as defined in section 62J.498.
(g) A health care provider who is a prescriber or dispenser of legend drugs must have
an electronic health record system that meets the requirements of section 62J.497.
Sec. 4.
Minnesota Statutes 2020, section 62J.495, subdivision 4, is amended to read:
Subd. 4.
Coordination with national HIT activities.
(a) The commissioner, in
consultation with the e-Health Advisory Committee, shall update the statewide
implementation plan required under subdivision 2 and released June 2008, to be consistent
with the updated federal deleted text begin HIT Strategic Plan released by the Office of the National Coordinator
in accordance with section 3001 of the HITECH Act. The statewide plan shall meet the
requirements for a plan required under section 3013 of the HITECH Actdeleted text end new text begin plansnew text end .
(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
work to ensure coordination between state, regional, and national efforts to support and
accelerate efforts to effectively use health information technology to improve the quality
and coordination of health care and the continuity of patient care among health care providers,
to reduce medical errors, to improve population health, to reduce health disparities, and to
reduce chronic disease. The commissioner's coordination efforts shall include but not be
limited to:
deleted text begin
(1) assisting in the development and support of health information technology regional
extension centers established under section 3012(c) of the HITECH Act to provide technical
assistance and disseminate best practices;
deleted text end
deleted text begin
(2) providing supplemental information to the best practices gathered by regional centers
to ensure that the information is relayed in a meaningful way to the Minnesota health care
community;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end providing financial and technical support to Minnesota health care providers to
encourage implementation of admission, discharge and transfer alerts, and care summary
document exchange transactions and to evaluate the impact of health information technology
on cost and quality of care. Communications about available financial and technical support
shall include clear information about the interoperable health record requirements in
subdivision 1, including a separate statement in bold-face type clarifying the exceptions to
those requirements;
deleted text begin (4)deleted text end new text begin (2)new text end providing educational resources and technical assistance to health care providers
and patients related to state and national privacy, security, and consent laws governing
clinical health information, including the requirements in sections 144.291 to 144.298. In
carrying out these activities, the commissioner's technical assistance does not constitute
legal advice;
deleted text begin (5)deleted text end new text begin (3)new text end assessing Minnesota's legal, financial, and regulatory framework for health
information exchange, including the requirements in sections 144.291 to 144.298, and
making recommendations for modifications that would strengthen the ability of Minnesota
health care providers to securely exchange data in compliance with patient preferences and
in a way that is efficient and financially sustainable; and
deleted text begin (6)deleted text end new text begin (4)new text end seeking public input on both patient impact and costs associated with requirements
related to patient consent for release of health records for the purposes of treatment, payment,
and health care operations, as required in section 144.293, subdivision 2. The commissioner
shall provide a report to the legislature on the findings of this public input process no later
than February 1, 2017.
(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
monitor national activity related to health information technology and shall coordinate
statewide input on policy development. The commissioner shall coordinate statewide
responses to proposed federal health information technology regulations in order to ensure
that the needs of the Minnesota health care community are adequately and efficiently
addressed in the proposed regulations. The commissioner's responses may include, but are
not limited to:
(1) reviewing and evaluating any standard, implementation specification, or certification
criteria proposed by the national HIT standards deleted text begin committeedeleted text end new text begin committeesnew text end ;
(2) reviewing and evaluating policy proposed by deleted text begin thedeleted text end national HIT policy deleted text begin committeedeleted text end new text begin
committeesnew text end relating to the implementation of a nationwide health information technology
infrastructure;new text begin and
new text end
(3) deleted text begin monitoring and responding to activity related to the development of quality measures
and other measures as required by section 4101 of the HITECH Act. Any response related
to quality measures shall consider and address the quality efforts required under chapter
62U; and
deleted text end
deleted text begin (4)deleted text end monitoring and responding to national activity related to privacy, security, and data
stewardship of electronic health information and individually identifiable health information.
(d) To the extent that the state is either required or allowed to apply, or designate an
entity to apply for or carry out activities and programs deleted text begin under section 3013 of the HITECH
Actdeleted text end , the commissioner of health, in consultation with the e-Health Advisory Committee
and the commissioner of human services, shall be the lead applicant or sole designating
authority. The commissioner shall make such designations consistent with the goals and
objectives of sections 62J.495 to 62J.497 and 62J.50 to 62J.61.
(e) The commissioner of human services shall apply for funding necessary to administer
the incentive payments to providers authorized under title IV of the American Recovery
and Reinvestment Act.
deleted text begin
(f) The commissioner shall include in the report to the legislature information on the
activities of this subdivision and provide recommendations on any relevant policy changes
that should be considered in Minnesota.
deleted text end
Sec. 5.
Minnesota Statutes 2020, section 62J.498, is amended to read:
62J.498 HEALTH INFORMATION EXCHANGE.
Subdivision 1.
Definitions.
(a) The following definitions apply to sections 62J.498 to
62J.4982:
(b) "Clinical data repository" means a real time database that consolidates data from a
variety of clinical sources to present a unified view of a single patient and is used by a
deleted text begin state-certifieddeleted text end health information exchange service provider to enable health information
exchange among health care providers that are not related health care entities as defined in
section 144.291, subdivision 2, paragraph (k). This does not include clinical data that are
submitted to the commissioner for public health purposes required or permitted by law,
including any rules adopted by the commissioner.
(c) "Clinical transaction" means any meaningful use transaction or other health
information exchange transaction that is not covered by section 62J.536.
(d) "Commissioner" means the commissioner of health.
(e) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.
(f) "Health data intermediary" means an entity that provides the technical capabilities
or related products and services to enable health information exchange among health care
providers that are not related health care entities as defined in section 144.291, subdivision
2, paragraph (k). This includes but is not limited to health information service providers
(HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries
as defined in section 62J.495.
(g) "Health information exchange" means the electronic transmission of health-related
information between organizations according to nationally recognized standards.
(h) "Health information exchange service provider" means a health data intermediary
or health information organization.
(i) "Health information organization" means an organization that oversees, governs, and
facilitates health information exchange among health care providers that are not related
health care entities as defined in section 144.291, subdivision 2, paragraph (k), to improve
coordination of patient care and the efficiency of health care delivery.
deleted text begin
(j) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act as defined in section 62J.495.
deleted text end
deleted text begin (k)deleted text end new text begin (j)new text end "Major participating entity" means:
(1) a participating entity that receives compensation for services that is greater than 30
percent of the health information organization's gross annual revenues from the health
information exchange service provider;
(2) a participating entity providing administrative, financial, or management services to
the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and
(3) a participating entity that nominates or appoints 30 percent or more of the board of
directors or equivalent governing body of the health information organization.
deleted text begin (l)deleted text end new text begin (k)new text end "Master patient index" means an electronic database that holds unique identifiers
of patients registered at a care facility and is used by a deleted text begin state-certifieddeleted text end health information
exchange service provider to enable health information exchange among health care providers
that are not related health care entities as defined in section 144.291, subdivision 2, paragraph
(k). This does not include data that are submitted to the commissioner for public health
purposes required or permitted by law, including any rules adopted by the commissioner.
deleted text begin
(m) "Meaningful use" means use of certified electronic health record technology to
improve quality, safety, and efficiency and reduce health disparities; engage patients and
families; improve care coordination and population and public health; and maintain privacy
and security of patient health information as established by the Centers for Medicare and
Medicaid Services and the Minnesota Department of Human Services pursuant to sections
4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin
(n) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin (o)deleted text end new text begin (l)new text end "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization deleted text begin or health
data intermediarydeleted text end has contracts or other agreements for the provision of health information
exchange services:
(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;
(2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;
(3) a group, professional corporation, or other organization that provides the services of
individuals or entities identified in clause (2), including but not limited to a medical clinic,
a medical group, a home health care agency, an urgent care center, and an emergent care
center;
(4) a health plan as defined in section 62A.011, subdivision 3; and
(5) a state agency as defined in section 13.02, subdivision 17.
deleted text begin (p)deleted text end new text begin (m)new text end "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of clinical transactions.
deleted text begin
(q) "State-certified health data intermediary" means a health data intermediary that has
been issued a certificate of authority to operate in Minnesota.
deleted text end
deleted text begin (r)deleted text end new text begin (n)new text end "State-certified health information organization" means a health information
organization that has been issued a certificate of authority to operate in Minnesota.
Subd. 2.
Health information exchange oversight.
(a) The commissioner shall protect
the public interest on matters pertaining to health information exchange. The commissioner
shall:
(1) review and act on applications from deleted text begin health data intermediaries anddeleted text end health information
organizations for certificates of authority to operate in Minnesota;
new text begin
(2) require information to be provided as needed from health information exchange
service providers in order to meet requirements established under sections 62J.498 to
62J.4982;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;
deleted text begin (3)deleted text end new text begin (4)new text end respond to public complaints related to health information exchange services;
deleted text begin (4)deleted text end new text begin (5)new text end take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;
deleted text begin (5)deleted text end new text begin (6)new text end provide a biennial report on the status of health information exchange services
that includes but is not limited to:
(i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;
(ii) recommendations on enforcement actions to ensure that health information exchange
service providers act in the public interest without causing disruption in health information
exchange services;
(iii) recommendations on updates to criteria for obtaining certificates of authority under
this section; and
(iv) recommendations on standard operating procedures for health information exchange,
including but not limited to the management of consumer preferences; and
deleted text begin (6)deleted text end new text begin (7)new text end other duties necessary to protect the public interest.
(b) As part of the application review process for certification under paragraph (a), prior
to issuing a certificate of authority, the commissioner shall:
(1) make all portions of the application classified as public data available to the public
for at least ten days while an application is under consideration. At the request of the
commissioner, the applicant shall participate in a public hearing by presenting an overview
of their application and responding to questions from interested parties; and
(2) consult with hospitals, physicians, and other providers prior to issuing a certificate
of authority.
(c) When the commissioner is actively considering a suspension or revocation of a
certificate of authority as described in section 62J.4982, subdivision 3, all investigatory data
that are collected, created, or maintained related to the suspension or revocation are classified
as confidential data on individuals and as protected nonpublic data in the case of data not
on individuals.
(d) The commissioner may disclose data classified as protected nonpublic or confidential
under paragraph (c) if disclosing the data will protect the health or safety of patients.
(e) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified as
public data.
Sec. 6.
Minnesota Statutes 2020, section 62J.4981, is amended to read:
62J.4981 CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.
Subdivision 1.
Authority to require organizations to apply.
The commissioner shall
require deleted text begin a health data intermediary ordeleted text end a health information organization to apply for a
certificate of authority under this section. An applicant may continue to operate until the
commissioner acts on the application. If the application is denied, the applicant is considered
a health information exchange service provider whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).
deleted text begin Subd. 2. deleted text end
deleted text begin Certificate of authority for health data intermediaries. deleted text end
deleted text begin
(a) A health data
intermediary must be certified by the state and comply with requirements established in this
section.
deleted text end
deleted text begin
(b) Notwithstanding any law to the contrary, any corporation organized to do so may
apply to the commissioner for a certificate of authority to establish and operate as a health
data intermediary in compliance with this section. No person shall establish or operate a
health data intermediary in this state, nor sell or offer to sell, or solicit offers to purchase
or receive advance or periodic consideration in conjunction with a health data intermediary
contract unless the organization has a certificate of authority or has an application under
active consideration under this section.
deleted text end
deleted text begin
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
deleted text end
deleted text begin
(1) hold reciprocal agreements with at least one state-certified health information
organization to access patient data, and for the transmission and receipt of clinical
transactions. Reciprocal agreements must meet the requirements established in subdivision
5; and
deleted text end
deleted text begin
(2) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability between state-certified health information
organizations and state-certified health data intermediaries.
deleted text end
Subd. 3.
Certificate of authority for health information organizations.
(a) A health
information organization must obtain a certificate of authority from the commissioner and
demonstrate compliance with the criteria in paragraph (c).
(b) Notwithstanding any law to the contrary, an organization may apply for a certificate
of authority to establish and operate a health information organization under this section.
No person shall establish or operate a health information organization in this state, nor sell
or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in
conjunction with a health information organization or health information contract unless
the organization has a certificate of authority under this section.
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
(1) the entity is a legally established organization;
(2) appropriate insurance, including liability insurance, for the operation of the health
information organization is in place and sufficient to protect the interest of the public and
participating entities;
(3) strategic and operational plans address governance, technical infrastructure, legal
and policy issues, finance, and business operations in regard to how the organization will
expand to support providers in achieving health information exchange goals over time;
(4) the entity addresses the parameters to be used with participating entities and other
health information exchange service providers for clinical transactions, compliance with
Minnesota law, and interstate health information exchange trust agreements;
(5) the entity's board of directors or equivalent governing body is composed of members
that broadly represent the health information organization's participating entities and
consumers;
(6) the entity maintains a professional staff responsible to the board of directors or
equivalent governing body with the capacity to ensure accountability to the organization's
mission;
(7) the organization is compliant with national certification and accreditation programs
designated by the commissioner;
(8) the entity maintains the capability to query for patient information based on national
standards. The query capability may utilize a master patient index, clinical data repository,
or record locator service as defined in section 144.291, subdivision 2, paragraph (j). The
entity must be compliant with the requirements of section 144.293, subdivision 8, when
conducting clinical transactions;
(9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;
(10) the organization demonstrates compliance with all privacy and security requirements
required by state and federal law; and
(11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's financials
on an annual basis.
(d) Health information organizations that have obtained a certificate of authority must:
(1) meet the requirements established for connecting to the National eHealth Exchange;
(2) annually submit strategic and operational plans for review by the commissioner that
address:
(i) progress in achieving objectives included in previously submitted strategic and
operational plans across the following domains: business and technical operations, technical
infrastructure, legal and policy issues, finance, and organizational governance;
(ii) plans for ensuring the necessary capacity to support clinical transactions;
(iii) approach for attaining financial sustainability, including public and private financing
strategies, and rate structures;
(iv) rates of adoption, utilization, and transaction volume, and mechanisms to support
health information exchange; and
(v) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;
(3) enter into reciprocal agreements with all other state-certified health information
organizations deleted text begin and state-certified health data intermediariesdeleted text end to enable access to patient data,
and for the transmission and receipt of clinical transactions. Reciprocal agreements must
meet the requirements in subdivision 5;
(4) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability deleted text begin between state-certified health information
organizations and state-certified health data intermediariesdeleted text end ; and
(5) comply with additional requirements for the certification or recertification of health
information organizations that may be established by the commissioner.
Subd. 4.
Application for certificate of authority for health information deleted text begin exchange
service providersdeleted text end new text begin organizationsnew text end .
(a) Each application for a certificate of authority shall
be in a form prescribed by the commissioner and verified by an officer or authorized
representative of the applicant. Each application shall include the following in addition to
information described in the criteria in deleted text begin subdivisions 2 anddeleted text end new text begin subdivisionnew text end 3:
(1) deleted text begin for health information organizations only,deleted text end a copy of the basic organizational document,
if any, of the applicant and of each major participating entity, such as the articles of
incorporation, or other applicable documents, and all amendments to it;
(2) deleted text begin for health information organizations only,deleted text end a list of the names, addresses, and official
positions of the following:
(i) all members of the board of directors or equivalent governing body, and the principal
officers and, if applicable, shareholders of the applicant organization; and
(ii) all members of the board of directors or equivalent governing body, and the principal
officers of each major participating entity and, if applicable, each shareholder beneficially
owning more than ten percent of any voting stock of the major participating entity;
(3) deleted text begin for health information organizations only,deleted text end the name and address of each participating
entity and the agreed-upon duration of each contract or agreement if applicable;
(4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end . Contractual
provisions shall be consistent with the purposes of this section, in regard to the services to
be performed under the standard agreement or contract, the manner in which payment for
services is determined, the nature and extent of responsibilities to be retained by the health
information organization, and contractual termination provisions;
(5) a statement generally describing the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end , its health information exchange contracts, facilities, and personnel, including
a statement describing the manner in which the applicant proposes to provide participants
with comprehensive health information exchange services;
(6) a statement reasonably describing the geographic area or areas to be served and the
type or types of participants to be served;
(7) a description of the complaint procedures to be used as required under this section;
(8) a description of the mechanism by which participating entities will have an opportunity
to participate in matters of policy and operation;
(9) a copy of any pertinent agreements between the health information organization and
insurers, including liability insurers, demonstrating coverage is in place;
(10) a copy of the conflict of interest policy that applies to all members of the board of
directors or equivalent governing body and the principal officers of the health information
organization; and
(11) other information as the commissioner may reasonably require to be provided.
(b) Within 45 days after the receipt of the application for a certificate of authority, the
commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.
(c) Within 90 days after the receipt of a complete application for a certificate of authority,
the commissioner shall issue a certificate of authority to the applicant if the commissioner
determines that the applicant meets the minimum criteria requirements of subdivision 2 deleted text begin for
health data intermediaries or subdivision 3 for health information organizationsdeleted text end . If the
commissioner determines that the applicant is not qualified, the commissioner shall notify
the applicant and specify the reasons for disqualification.
(d) Upon being granted a certificate of authority to operate as a state-certified health
information organization deleted text begin or state-certified health data intermediarydeleted text end , the organization must
operate in compliance with the provisions of this section. Noncompliance may result in the
imposition of a fine or the suspension or revocation of the certificate of authority according
to section 62J.4982.
Subd. 5.
Reciprocal agreements between health information deleted text begin exchange entitiesdeleted text end new text begin
organizationsnew text end .
(a) Reciprocal agreements between two health information organizations
deleted text begin or between a health information organization and a health data intermediarydeleted text end must include
a fair and equitable model for charges between the entities that:
(1) does not impede the secure transmission of clinical transactions;
(2) does not charge a fee for the exchange of deleted text begin meaningful usedeleted text end transactions transmitted
according to nationally recognized standards where no additional value-added service is
rendered to the sending or receiving health information organization deleted text begin or health data
intermediarydeleted text end either directly or on behalf of the client;
(3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and
(4) prevents health care stakeholders from being charged multiple times for the same
service.
(b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.
(c) Reciprocal agreements are subject to review and approval by the commissioner.
(d) Nothing in this section precludes a state-certified health information organization deleted text begin or
state-certified health data intermediarydeleted text end from entering into contractual agreements for the
provision of value-added services deleted text begin beyond meaningful use transactionsdeleted text end .
Sec. 7.
Minnesota Statutes 2020, section 62J.4982, is amended to read:
62J.4982 ENFORCEMENT AUTHORITY; COMPLIANCE.
Subdivision 1.
Penalties and enforcement.
(a) The commissioner may, for any violation
of statute or rule applicable to a health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end ,
levy an administrative penalty in an amount up to $25,000 for each violation. In determining
the level of an administrative penalty, the commissioner shall consider the following factors:
(1) the number of participating entities affected by the violation;
(2) the effect of the violation on participating entities' access to health information
exchange services;
(3) if only one participating entity is affected, the effect of the violation on the patients
of that entity;
(4) whether the violation is an isolated incident or part of a pattern of violations;
(5) the economic benefits derived by the health information organization deleted text begin or a health data
intermediarydeleted text end by virtue of the violation;
(6) whether the violation hindered or facilitated an individual's ability to obtain health
care;
(7) whether the violation was intentional;
(8) whether the violation was beyond the direct control of the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end ;
(9) any history of prior compliance with the provisions of this section, including
violations;
(10) whether and to what extent the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end attempted to correct previous violations;
(11) how the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end responded to
technical assistance from the commissioner provided in the context of a compliance effort;
and
(12) the financial condition of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end whether the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end had financial difficulties that affected its ability to comply or whether
the imposition of an administrative monetary penalty would jeopardize the ability of the
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end to continue to deliver health
information exchange services.
The commissioner shall give reasonable notice in writing to the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end of the intent to levy the penalty and the reasons for
it. A health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may have 15 days within
which to contest whether the facts found constitute a violation of sections 62J.4981 and
62J.4982, according to the contested case and judicial review provisions of sections 14.57
to 14.69.
(b) If the commissioner has reason to believe that a violation of section 62J.4981 or
62J.4982 has occurred or is likely, the commissioner may confer with the persons involved
before commencing action under subdivision 2. The commissioner may notify the health
information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end and the representatives, or other persons
who appear to be involved in the suspected violation, to arrange a voluntary conference
with the alleged violators or their authorized representatives. The purpose of the conference
is to attempt to learn the facts about the suspected violation and, if it appears that a violation
has occurred or is threatened, to find a way to correct or prevent it. The conference is not
governed by any formal procedural requirements, and may be conducted as the commissioner
considers appropriate.
(c) The commissioner may issue an order directing a health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end or a representative of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to cease and desist from engaging in any act or practice in violation of sections
62J.4981 and 62J.4982.
(d) Within 20 days after service of the order to cease and desist, a health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may contest whether the facts found constitute a
violation of sections 62J.4981 and 62J.4982 according to the contested case and judicial
review provisions of sections 14.57 to 14.69.
(e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or other
appropriate relief in Ramsey County District Court.
Subd. 2.
Suspension or revocation of certificates of authority.
(a) The commissioner
may suspend or revoke a certificate of authority issued to a deleted text begin health data intermediary ordeleted text end
health information organization under section 62J.4981 if the commissioner finds that:
(1) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is operating
significantly in contravention of its basic organizational document, or in a manner contrary
to that described in and reasonably inferred from any other information submitted under
section 62J.4981, unless amendments to the submissions have been filed with and approved
by the commissioner;
(2) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;
(3) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is no longer financially
solvent or may not reasonably be expected to meet its obligations to participating entities;
(4) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has failed to implement
the complaint system in a manner designed to reasonably resolve valid complaints;
(5) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end , or any person acting
with its sanction, has advertised or merchandised its services in an untrue, misleading,
deceptive, or unfair manner;
(6) the continued operation of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end would be hazardous to its participating entities or the patients served by the
participating entities; or
(7) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has otherwise failed
to substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.
(b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.
(c) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is suspended, the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end
shall not, during the period of suspension, enroll any additional participating entities, and
shall not engage in any advertising or solicitation.
(d) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is revoked, the organization shall proceed, immediately following the effective
date of the order of revocation, to wind up its affairs, and shall conduct no further business
except as necessary to the orderly conclusion of the affairs of the organization. The
organization shall engage in no further advertising or solicitation. The commissioner may,
by written order, permit further operation of the organization as the commissioner finds to
be in the best interest of participating entities, to the end that participating entities will be
given the greatest practical opportunity to access continuing health information exchange
services.
Subd. 3.
Denial, suspension, and revocation; administrative procedures.
(a) When
the commissioner has cause to believe that grounds for the denial, suspension, or revocation
of a certificate of authority exist, the commissioner shall notify the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end in writing stating the grounds for denial, suspension,
or revocation and setting a time within 20 days for a hearing on the matter.
(b) After a hearing before the commissioner at which the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to appear at the hearing, the commissioner shall take action as deemed necessary
and shall issue written findings and mail them to the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end .
(c) If suspension, revocation, or administrative penalty is proposed according to this
section, the commissioner must deliver, or send by certified mail with return receipt
requested, to the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end written notice
of the commissioner's intent to impose a penalty. This notice of proposed determination
must include:
(1) a reference to the statutory basis for the penalty;
(2) a description of the findings of fact regarding the violations with respect to which
the penalty is proposed;
(3) the nature and amount of the proposed penalty;
(4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;
(5) instructions for responding to the notice, including a statement of the health
information deleted text begin exchange service provider'sdeleted text end new text begin organization'snew text end right to a contested case proceeding
and a statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and
(6) the address to which the contested case proceeding request must be sent.
Subd. 4.
Coordination.
The commissioner shall, to the extent possible, seek the advice
of the Minnesota e-Health Advisory Committee, in the review and update of criteria for the
certification and recertification of health information deleted text begin exchange service providersdeleted text end new text begin
organizationsnew text end when implementing sections 62J.498 to 62J.4982.
Subd. 5.
Fees and monetary penalties.
(a) The commissioner shall assess fees on every
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end subject to sections 62J.4981 and
62J.4982 as follows:
(1) filing an application for certificate of authority to operate as a health information
organization, $7,000;new text begin and
new text end
(2) deleted text begin filing an application for certificate of authority to operate as a health data intermediary,
$7,000;
deleted text end
deleted text begin (3)deleted text end annual health information organization certificate fee, $7,000deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) annual health data intermediary certificate fee, $7,000.
deleted text end
(b) Fees collected under this section shall be deposited in the state treasury and credited
to the state government special revenue fund.
(c) Administrative monetary penalties imposed under this subdivision shall be credited
to an account in the special revenue fund and are appropriated to the commissioner for the
purposes of sections 62J.498 to 62J.4982.
Sec. 8.
Minnesota Statutes 2020, section 62J.84, subdivision 6, is amended to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, and 5.
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
new text begin
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
new text end
Sec. 9.
Minnesota Statutes 2020, section 144.05, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Expiration of report mandates. new text end
new text begin
(a) If the submission of a report by the
commissioner of health to the legislature is mandated by statute and the enabling legislation
does not include a date for the submission of a final report, the mandate to submit the report
shall expire in accordance with this section.
new text end
new text begin
(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1,2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end
new text begin
(c) Any reporting mandate enacted on or after January 1, 2021 shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report, unless the enacting legislation provides for a difference
expiration date.
new text end
new text begin
(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over health by February 15 of each year, beginning
February 15, 2022, of all reports set to expire during the following calendar year in
accordance with this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
new text begin
[144.064] THE VIVIAN ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
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This section shall be known and may be cited as the "Vivian
Act."
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
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For purposes of this section, the following terms have the meanings
given them:
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(1) "commissioner" means the commissioner of health;
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(2) "health care practitioner" means a medical professional that provides prenatal or
postnatal care;
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(3) "CMV" means the human herpesvirus cytomegalovirus, also called HCMV, human
herpesvirus 5, and HHV-5; and
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(4) "congenital CMV" means the transmission of a CMV infection from a pregnant
mother to her fetus.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner duties. new text end
new text begin
(a) The commissioner shall make available to health
care practitioners, women who may become pregnant, expectant parents, and parents of
infants up-to-date and evidence-based information about congenital CMV that has been
reviewed by experts with knowledge of the disease. The information shall include the
following:
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(1) the recommendation to consider testing for congenital CMV if the parent or legal
guardian of the infant elected not to have newborn screening performed under section
144.125, and the infant failed a newborn hearing screening or pregnancy history suggests
increased risk for congenital CMV infection;
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(2) the incidence of CMV;
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(3) the transmission of CMV to pregnant women and women who may become pregnant;
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(4) birth defects caused by congenital CMV;
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(5) available preventative measures to avoid the infection of women who are pregnant
or may become pregnant; and
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(6) resources available for families of children born with congenital CMV.
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(b) The commissioner shall follow existing department practice, inclusive of community
engagement, to ensure that the information in paragraph (a) is culturally and linguistically
appropriate for all recipients.
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(c) The department shall establish an outreach program to:
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(1) educate women who may become pregnant, expectant parents, and parents of infants
about CMV; and
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(2) raise awareness for CMV among health care providers who provide care to expectant
mothers or infants.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144.1205, subdivision 2, is amended to read:
Subd. 2.
new text begin Initial and new text end annual fee.
new text begin
(a) A licensee must pay an initial fee that is equivalent
to the annual fee upon issuance of the initial license.
new text end
new text begin (b) new text end A licensee must pay an annual fee at least 60 days before the anniversary date of the
issuance of the license. The annual fee is as follows:
| TYPE |
deleted text begin ANNUALdeleted text end new text begin LICENSEnew text end FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$19,920
deleted text end
new text begin
$25,896 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
19,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
19,920 deleted text end |
||
|
new text begin
Academic broad scope - type A, B, or C (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Academic broad scope - type A, B, or C (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| Medical broad scope - type A |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Medical broad scope- type A (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Medical broad scope- type A (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$4,784 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (4-8 locations) new text end |
new text begin
$5,740 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (9 or more locations) new text end |
new text begin
$6,697 new text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
3,680 deleted text end |
||
| Teletherapy |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Gamma knife |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Veterinary medicine |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| In vitro testing lab |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Nuclear pharmacy |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Nuclear pharmacy (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Radiopharmaceutical processing and distribution (10 CFR 32.72) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Medical sealed sources - processing and distribution (10 CFR 32.74) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Well logging - sealed sources |
deleted text begin
3,760
deleted text end
new text begin
$4,888 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
2,000 deleted text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (4-8 locations) new text end |
new text begin
$3,120 new text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (9 or more locations) new text end |
new text begin
$3,640 new text end |
||
| X-ray fluorescent analyzer |
deleted text begin
1,520
deleted text end
new text begin
$1,976 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
2,000 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
2,000 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin broad scope new text end |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Bnew text begin or C broad scope new text end |
deleted text begin
17,600
deleted text end
new text begin
$22,880 new text end |
||
|
deleted text begin
Broad scope Manufacturing and distribution - type C deleted text end |
deleted text begin
17,600 deleted text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (4-8 locations) new text end |
new text begin
$27,456 new text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (9 or more locations) new text end |
new text begin
$32,032 new text end |
||
| Manufacturing and distribution - other |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
|
new text begin
Manufacturing and distribution - other (4-8 locations) new text end |
new text begin
$8,236 new text end |
||
|
new text begin
Manufacturing and distribution - other (9 or more locations) new text end |
new text begin
$9,609 new text end |
||
| Nuclear laundry |
deleted text begin
18,640
deleted text end
new text begin
$24,232 new text end |
||
| Decontamination services |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Leak test services only |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
2,000 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
6,000
deleted text end
new text begin
$7,800 new text end |
||
| Waste disposal |
deleted text begin
8,320
deleted text end
new text begin
$10,816 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
1,760
deleted text end
new text begin
$2,288 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
1,120
deleted text end
new text begin
$1,456 new text end |
||
| Industrial radiography - fixednew text begin or temporarynew text end location |
deleted text begin
9,840
deleted text end
new text begin
$12,792 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
9,840 deleted text end |
||
|
new text begin
Industrial radiography - fixed or temporary location (5 or more locations) new text end |
new text begin
$16,629 new text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
2,880
deleted text end
new text begin
$3,744 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
5,360
deleted text end
new text begin
$6,968 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
2,880 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
9,520
deleted text end
new text begin
$12,376 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (4-8 locations) new text end |
new text begin
$14,851 new text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (9 or more locations) new text end |
new text begin
$17,326 new text end |
||
| Research and development - other |
deleted text begin
4,480
deleted text end
new text begin
$5,824 new text end |
||
| Storage - no operations |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Source material - shielding |
deleted text begin
584
deleted text end
new text begin
$759 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$500 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 12.
Minnesota Statutes 2020, section 144.1205, subdivision 4, is amended to read:
Subd. 4.
new text begin Initial and renewal new text end application fee.
A licensee must pay an new text begin initial and a
renewal new text end application fee deleted text begin as follows:deleted text end new text begin according to this subdivision.
new text end
| TYPE |
APPLICATION FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$ 5,920
deleted text end
new text begin
$6,808 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Medical broad scope - type A |
deleted text begin
3,920
deleted text end
new text begin
$4,508 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$1,748 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
1,520 deleted text end |
||
| Teletherapy |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Gamma knife |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Veterinary medicine |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| In vitro testing lab |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Nuclear pharmacy |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Well logging - sealed sources |
deleted text begin
1,600
deleted text end
new text begin
$1,840 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
960 deleted text end |
||
| X-ray fluorescent analyzer |
deleted text begin
584
deleted text end
new text begin
$671 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
960 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
960 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin , B, and C broad scope new text end |
deleted text begin
5,920
deleted text end
new text begin
$6,854 new text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Manufacturing and distribution - other |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Nuclear laundry |
deleted text begin
10,080
deleted text end
new text begin
$11,592 new text end |
||
| Decontamination services |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Leak test services only |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
960 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
2,240
deleted text end
new text begin
$2,576 new text end |
||
| Waste disposal |
deleted text begin
1,520
deleted text end
new text begin
$1,748 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
880
deleted text end
new text begin
$1,012 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
520
deleted text end
new text begin
$598 new text end |
||
| Industrial radiography - fixed new text begin or temporary new text end location |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
2,640 deleted text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
1,440
deleted text end
new text begin
$1,656 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
2,960
deleted text end
new text begin
$3,404 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
1,440 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
4,960
deleted text end
new text begin
$5,704 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
| Research and development - other |
deleted text begin
2,400
deleted text end
new text begin
$2,760 new text end |
||
| Storage - no operations |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Source material - shielding |
deleted text begin
136
deleted text end
new text begin
$156 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
4,100
deleted text end
new text begin
$4,715 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$345 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
0 deleted text end |
||
|
deleted text begin
Industrial radiographer certification deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 13.
Minnesota Statutes 2020, section 144.1205, subdivision 8, is amended to read:
Subd. 8.
Reciprocity fee.
A licensee submitting an application for reciprocal recognition
of a materials license issued by another agreement state or the United States Nuclear
Regulatory Commission for a period of 180 days or less during a calendar year must pay
deleted text begin $1,200deleted text end new text begin $2,400new text end . For a period of 181 days or more, the licensee must obtain a license under
subdivision 4.
Sec. 14.
Minnesota Statutes 2020, section 144.1205, subdivision 9, is amended to read:
Subd. 9.
Fees for license amendments.
A licensee must pay a fee of deleted text begin $300deleted text end new text begin $600new text end to
amend a license as follows:
(1) to amend a license requiring review including, but not limited to, addition of isotopes,
procedure changes, new authorized users, or a new radiation safety officer; and
(2) to amend a license requiring review and a site visit including, but not limited to,
facility move or addition of processes.
Sec. 15.
Minnesota Statutes 2020, section 144.1205, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Fees for general license registrations. new text end
new text begin
A person required to register generally
licensed devices according to Minnesota Rules, part 4731.3215, must pay an annual
registration fee of $450.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.125, subdivision 1, is amended to read:
Subdivision 1.
Duty to perform testing.
(a) It is the duty of (1) the administrative officer
or other person in charge of each institution caring for infants 28 days or less of age, (2) the
person required in pursuance of the provisions of section 144.215, to register the birth of a
child, or (3) the nurse midwife or midwife in attendance at the birth, to arrange to have
administered to every infant or child in its care tests for heritable and congenital disorders
according to subdivision 2 and rules prescribed by the state commissioner of health.
(b) Testing, recording of test results, reporting of test results, and follow-up of infants
with heritable congenital disorders, including hearing loss detected through the early hearing
detection and intervention program in section 144.966, shall be performed at the times and
in the manner prescribed by the commissioner of health.
(c) The fee to support the newborn screening program, including tests administered
under this section and section 144.966, shall be deleted text begin $135deleted text end new text begin $177new text end per specimen. This fee amount
shall be deposited in the state treasury and credited to the state government special revenue
fund.
(d) The fee to offset the cost of the support services provided under section 144.966,
subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
and credited to the general fund.
Sec. 17.
Minnesota Statutes 2020, section 144.125, subdivision 2, is amended to read:
Subd. 2.
Determination of tests to be administered.
new text begin (a) new text end The commissioner shall
periodically revise the list of tests to be administered for determining the presence of a
heritable or congenital disorder. Revisions to the list shall reflect advances in medical
science, new and improved testing methods, or other factors that will improve the public
health. In determining whether a test must be administered, the commissioner shall take
into consideration the adequacy of analytical methods to detect the heritable or congenital
disorder, the ability to treat or prevent medical conditions caused by the heritable or
congenital disorder, and the severity of the medical conditions caused by the heritable or
congenital disorder. The list of tests to be performed may be revised if the changes are
recommended by the advisory committee established under section 144.1255, approved by
the commissioner, and published in the State Register. The revision is exempt from the
rulemaking requirements in chapter 14, and sections 14.385 and 14.386 do not apply.
new text begin
(b) Notwithstanding paragraph (a), a test to detect congenital human herpesvirus
cytomegalovirus shall be added to the list of tests to be administered under this section.
new text end
Sec. 18.
new text begin
[144.1461] PREGNANCY AND CHILDBIRTH; MIDWIFE AND DOULA
CARE.
new text end
new text begin
In order to improve maternal and infant health as well as improving birth outcomes in
groups with the most significant disparities that include Black, Indigenous, and other
communities of color; rural communities; and people with low incomes, the commissioner
of health in partnership with patient groups and culturally based community organizations
shall, within existing appropriations:
new text end
new text begin
(1) develop procedures and services designed for making midwife and doula services
available to groups with the most maternal and infant mortality and morbidity disparities;
new text end
new text begin
(2) promote racial, ethnic, and language diversity in the midwife and doula workforce
that better aligns with the childbearing population in groups with the most significant
maternal and infant mortality and morbidity disparities; and
new text end
new text begin
(3) ensure that midwife and doula training and education is tailored to the specific needs
of groups with the most significant maternal and infant mortality and morbidity disparities,
including trauma-informed care, maternal mood disorders, intimate partner violence, and
systemic racism.
new text end
Sec. 19.
Minnesota Statutes 2020, section 144.1481, subdivision 1, is amended to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 15-memberdeleted text end new text begin 16-membernew text end Rural Health Advisory Committee. The committee shall consist
of the following members, all of whom must reside outside the seven-county metropolitan
area, as defined in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) new text begin a dentist licensed under chapter 150A;
new text end
new text begin (8) new text end a midlevel practitioner;
deleted text begin (8)deleted text end new text begin (9)new text end a registered nurse or licensed practical nurse;
deleted text begin (9)deleted text end new text begin (10)new text end a licensed health care professional from an occupation not otherwise represented
on the committee;
deleted text begin (10)deleted text end new text begin (11)new text end a representative of an institution of higher education located outside the
seven-county metropolitan area that provides training for rural health care providers; and
deleted text begin (11)deleted text end new text begin (12)new text end three consumers, at least one of whom must be an advocate for persons who
are mentally ill or developmentally disabled.
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 20.
Minnesota Statutes 2020, section 144.216, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Reporting safe place newborn births. new text end
new text begin
A hospital that receives a safe place
newborn under section 145.902 shall report the birth of the newborn to the Office of Vital
Records within five days after receiving the newborn. The state registrar must register
information about the safe place newborn according to Minnesota Rules, part 4601.0600,
subpart 4, item C.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 144.216, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Status of safe place birth registrations. new text end
new text begin
(a) Information about the safe place
newborn registered under subdivision 3 shall constitute the record of birth for the child. The
birth record for the child is confidential data on individuals as defined in section 13.02,
subdivision 3. Information about the child's birth record or a child's birth certificate issued
from the child's birth record shall be disclosed only to the responsible social services agency
as defined in section 260C.007, subdivision 27a, or pursuant to court order.
new text end
new text begin
(b) Pursuant to section 144.218, subdivision 6, if the safe place newborn was born in a
hospital and it is known that the child's record of birth was registered, the Office of Vital
Records shall replace the original birth record registered under section 144.215.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 144.218, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Safe place newborns. new text end
new text begin
If a hospital receives a safe place newborn under section
145.902 and it is known that the child's record of birth was registered, the hospital shall
report the newborn to the Office of Vital Records and identify the child's birth record. The
state registrar shall issue a replacement birth record for the child that is free of information
that identifies a parent. The prior vital record is confidential data on individuals as defined
in section 13.02, subdivision 3, and shall not be disclosed except pursuant to court order.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 144.223, is amended to read:
144.223 REPORT OF MARRIAGE.
Data relating to certificates of marriage registered shall be reported to the state registrar
by the local registrar or designee of the county board in each of the 87 registration districts
pursuant to the rules of the commissioner. The information in clause (1) necessary to compile
the report shall be furnished by the applicant prior to the issuance of the marriage license.
The report shall contain the following:
(1) personal information on bride and groom:
(i) name;
(ii) residence;
(iii) date and place of birth;
deleted text begin
(iv) race;
deleted text end
deleted text begin (v)deleted text end new text begin (iv)new text end if previously married, how terminated; and
deleted text begin (vi)deleted text end new text begin (v)new text end signature of applicant, date signed, and Social Security number; and
(2) information concerning the marriage:
(i) date of marriage;
(ii) place of marriage; and
(iii) civil or religious ceremony.
Sec. 24.
Minnesota Statutes 2020, section 144.225, subdivision 7, is amended to read:
Subd. 7.
Certified birth or death record.
(a) The state registrar or local issuance office
shall issue a certified birth or death record or a statement of no vital record found to an
individual upon the individual's proper completion of an attestation provided by the
commissioner and payment of the required fee:
(1) to a person who deleted text begin has a tangible interest in the requested vital record. A person who
has a tangible interestdeleted text end is:
(i) the subject of the vital record;
(ii) a child of the subject;
(iii) the spouse of the subject;
(iv) a parent of the subject;
(v) the grandparent or grandchild of the subject;
(vi) if the requested record is a death record, a sibling of the subject;
deleted text begin
(vii) the party responsible for filing the vital record;
deleted text end
deleted text begin (viii)deleted text end new text begin (vii)new text end the legal custodian, guardian or conservator, or health care agent of the subject;
deleted text begin (ix)deleted text end new text begin (viii)new text end a personal representative, by sworn affidavit of the fact that the certified copy
is required for administration of the estate;
deleted text begin (x)deleted text end new text begin (ix)new text end a successor of the subject, as defined in section 524.1-201, if the subject is
deceased, by sworn affidavit of the fact that the certified copy is required for administration
of the estate;
deleted text begin (xi)deleted text end new text begin (x)new text end if the requested record is a death record, a trustee of a trust by sworn affidavit
of the fact that the certified copy is needed for the proper administration of the trust;
deleted text begin (xii)deleted text end new text begin (xi)new text end a person or entity who demonstrates that a certified vital record is necessary
for the determination or protection of a personal or property right, pursuant to rules adopted
by the commissioner; or
deleted text begin (xiii)deleted text end new text begin (xii)new text end an adoption agency in order to complete confidential postadoption searches
as required by section 259.83;
(2) to any local, state, tribal, or federal governmental agency upon request if the certified
vital record is necessary for the governmental agency to perform its authorized duties;
(3) to an attorney new text begin representing the subject of the vital record or another person listed in
clause (1), new text end upon evidence of the attorney's license;
(4) pursuant to a court order issued by a court of competent jurisdiction. For purposes
of this section, a subpoena does not constitute a court order; or
(5) to a representative authorized by a person under clauses (1) to (4).
(b) The state registrar or local issuance office shall also issue a certified death record to
an individual described in paragraph (a), clause (1), items (ii) to deleted text begin (viii)deleted text end new text begin (xi)new text end , if, on behalf of
the individual, a licensed mortician furnishes the registrar with a properly completed
attestation in the form provided by the commissioner within 180 days of the time of death
of the subject of the death record. This paragraph is not subject to the requirements specified
in Minnesota Rules, part 4601.2600, subpart 5, item B.
Sec. 25.
Minnesota Statutes 2020, section 144.226, subdivision 1, is amended to read:
Subdivision 1.
Which services are for fee.
(a) The fees for the following services shall
be the following or an amount prescribed by rule of the commissioner:
(b) The fee for the administrative review and processing of a request for a certified vital
record or a certification that the vital record cannot be found is $9. The fee is payable at the
time of application and is nonrefundable.
(c) The fee for processing a request for the replacement of a birth record for all events,
except new text begin for safe place newborns pursuant to section 144.218, subdivision 6, and new text end when filing
a recognition of parentage pursuant to section 257.73, subdivision 1, is $40. The fee is
payable at the time of application and is nonrefundable.
(d) The fee for administrative review and processing of a request for the filing of a
delayed registration of birth, stillbirth, or death is $40. The fee is payable at the time of
application and is nonrefundable.
(e) The fee for administrative review and processing of a request for the amendment of
any vital record is $40. The fee is payable at the time of application and is nonrefundable.
(f) The fee for administrative review and processing of a request for the verification of
information from vital records is $9 when the applicant furnishes the specific information
to locate the vital record. When the applicant does not furnish specific information, the fee
is $20 per hour for staff time expended. Specific information includes the correct date of
the event and the correct name of the subject of the record. Fees charged shall approximate
the costs incurred in searching and copying the vital records. The fee is payable at the time
of application and is nonrefundable.
(g) The fee for administrative review and processing of a request for the issuance of a
copy of any document on file pertaining to a vital record or statement that a related document
cannot be found is $9. The fee is payable at the time of application and is nonrefundable.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 144.551, subdivision 1, is amended to read:
Subdivision 1.
Restricted construction or modification.
(a) The following construction
or modification may not be commenced:
(1) any erection, building, alteration, reconstruction, modernization, improvement,
extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
to another, or otherwise results in an increase or redistribution of hospital beds within the
state; and
(2) the establishment of a new hospital.
(b) This section does not apply to:
(1) construction or relocation within a county by a hospital, clinic, or other health care
facility that is a national referral center engaged in substantial programs of patient care,
medical research, and medical education meeting state and national needs that receives more
than 40 percent of its patients from outside the state of Minnesota;
(2) a project for construction or modification for which a health care facility held an
approved certificate of need on May 1, 1984, regardless of the date of expiration of the
certificate;
(3) a project for which a certificate of need was denied before July 1, 1990, if a timely
appeal results in an order reversing the denial;
(4) a project exempted from certificate of need requirements by Laws 1981, chapter 200,
section 2;
(5) a project involving consolidation of pediatric specialty hospital services within the
Minneapolis-St. Paul metropolitan area that would not result in a net increase in the number
of pediatric specialty hospital beds among the hospitals being consolidated;
(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds to
an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
the number of hospital beds. Upon completion of the reconstruction, the licenses of both
hospitals must be reinstated at the capacity that existed on each site before the relocation;
(7) the relocation or redistribution of hospital beds within a hospital building or
identifiable complex of buildings provided the relocation or redistribution does not result
in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds from
one physical site or complex to another; or (iii) redistribution of hospital beds within the
state or a region of the state;
(8) relocation or redistribution of hospital beds within a hospital corporate system that
involves the transfer of beds from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the capacity of the closed facility is
transferred; (ii) the capacity of the site or complex to which the beds are transferred does
not increase by more than 50 percent; (iii) the beds are not transferred outside of a federal
health systems agency boundary in place on July 1, 1983; and (iv) the relocation or
redistribution does not involve the construction of a new hospital building;
(9) a construction project involving up to 35 new beds in a psychiatric hospital in Rice
County that primarily serves adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;
(10) a project to replace a hospital or hospitals with a combined licensed capacity of
130 beds or less if: (i) the new hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement hospital, either at the time of
construction of the initial building or as the result of future expansion, will not exceed 70
licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;
(11) the relocation of licensed hospital beds from an existing state facility operated by
the commissioner of human services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one regional treatment center site
to another; or from one building or site to a new or existing building or site on the same
campus;
(12) the construction or relocation of hospital beds operated by a hospital having a
statutory obligation to provide hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;
(13) a construction project involving the addition of up to 31 new beds in an existing
nonfederal hospital in Beltrami County;
(14) a construction project involving the addition of up to eight new beds in an existing
nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
(15) a construction project involving the addition of 20 new hospital beds in an existing
hospital in Carver County serving the southwest suburban metropolitan area;
(16) a project for the construction or relocation of up to 20 hospital beds for the operation
of up to two psychiatric facilities or units for children provided that the operation of the
facilities or units have received the approval of the commissioner of human services;
(17) a project involving the addition of 14 new hospital beds to be used for rehabilitation
services in an existing hospital in Itasca County;
(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin County
that closed 20 rehabilitation beds in 2002, provided that the beds are used only for
rehabilitation in the hospital's current rehabilitation building. If the beds are used for another
purpose or moved to another location, the hospital's licensed capacity is reduced by 20 beds;
(19) a critical access hospital established under section 144.1483, clause (9), and section
1820 of the federal Social Security Act, United States Code, title 42, section 1395i-4, that
delicensed beds since enactment of the Balanced Budget Act of 1997, Public Law 105-33,
to the extent that the critical access hospital does not seek to exceed the maximum number
of beds permitted such hospital under federal law;
(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
(i) the project, including each hospital or health system that will own or control the entity
that will hold the new hospital license, is approved by a resolution of the Maple Grove City
Council as of March 1, 2006;
(ii) the entity that will hold the new hospital license will be owned or controlled by one
or more not-for-profit hospitals or health systems that have previously submitted a plan or
plans for a project in Maple Grove as required under section 144.552, and the plan or plans
have been found to be in the public interest by the commissioner of health as of April 1,
2005;
(iii) the new hospital's initial inpatient services must include, but are not limited to,
medical and surgical services, obstetrical and gynecological services, intensive care services,
orthopedic services, pediatric services, noninvasive cardiac diagnostics, behavioral health
services, and emergency room services;
(iv) the new hospital:
(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold the
new hospital license;
(B) will provide uncompensated care;
(C) will provide mental health services, including inpatient beds;
(D) will be a site for workforce development for a broad spectrum of health-care-related
occupations and have a commitment to providing clinical training programs for physicians
and other health care providers;
(E) will demonstrate a commitment to quality care and patient safety;
(F) will have an electronic medical records system, including physician order entry;
(G) will provide a broad range of senior services;
(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to enhance
the continuity of care for emergency medical patients; and
(I) will be completed by December 31, 2009, unless delayed by circumstances beyond
the control of the entity holding the new hospital license; and
(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;
(21) a project approved under section 144.553;
(22) a project for the construction of a hospital with up to 25 beds in Cass County within
a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's license holder
is approved by the Cass County Board;
(23) a project for an acute care hospital in Fergus Falls that will increase the bed capacity
from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 and closing
a separately licensed 13-bed skilled nursing facility;
(24) notwithstanding section 144.552, a project for the construction and expansion of a
specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for patients
who are under 21 years of age on the date of admission. The commissioner conducted a
public interest review of the mental health needs of Minnesota and the Twin Cities
metropolitan area in 2008. No further public interest review shall be conducted for the
construction or expansion project under this clause;
(25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if the
commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete;
(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;
(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and
(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review;
(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission; deleted text begin or
deleted text end
(28) a project to add 55 licensed beds in an existing safety net, level I trauma center
hospital in Ramsey County as designated under section 383A.91, subdivision 5, of which
15 beds are to be used for inpatient mental health and 40 are to be used for other services.
In addition, five unlicensed observation mental health beds shall be addeddeleted text begin .deleted text end new text begin ;
new text end
new text begin
(29) notwithstanding section 144.552, a project to add 45 licensed beds in an existing
safety net, level I trauma center hospital in Ramsey County as designated under section
383A.91, subdivision 5. The commissioner conducted a public interest review of the
construction and expansion of this hospital in 2018. No further public interest review shall
be conducted for the project under this clause; or
new text end
new text begin
(30) the addition of licensed beds in a hospital or hospital corporate system to provide
primarily mental health services or substance use disorder services. Beds added under this
clause must be available to serve medical assistance and MinnesotaCare enrollees.
Notwithstanding section 144.552, a public interest review shall not be required for the
addition of beds under this clause.
new text end
Sec. 27.
Minnesota Statutes 2020, section 145.32, subdivision 1, is amended to read:
Subdivision 1.
Hospital records.
The superintendent or other chief administrative officer
of any public or private hospital, by and with the consent and approval of the board of
directors or other governing body of the hospital, may divest the files and records of that
hospital of any individual case records and, with that consent and approval, may destroy
the records. The records shall first have been transferred and recorded as authorized in
section 145.30.
Portions of individual hospital medical records that comprise an individual permanent
medical record, as defined by the commissioner of health, shall be retained as authorized
in section 145.30. Other portions of the individual medical record, including any
miscellaneous documents, papers, and correspondence in connection with them, may be
divested and destroyed after seven years without transfer to photographic film, electronic
image, or other state-of-the-art electronic preservation technology.
All portions of individual hospital medical records of minors shall be maintained for
seven years deleted text begin following the age of majoritydeleted text end new text begin or until the patient reaches the age of majority,
whichever occurs last, at which time the patient may request that the patient's hospital
records be deletednew text end .
Nothing in this section shall be construed to prohibit the retention of hospital medical
records beyond the periods described in this section. Nor shall anything in this section be
construed to prohibit patient access to hospital medical records as provided in sections
144.291 to 144.298.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
new text begin
[145.4161] LICENSURE OF ABORTION FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions
apply.
new text end
new text begin
(b) "Abortion facility" means a clinic, health center, or other facility in which the
pregnancies of ten or more women known to be pregnant are willfully terminated or aborted
each month. A facility licensed as a hospital or as an outpatient surgical center pursuant to
sections 144.50 to 144.56 shall not be considered an abortion facility.
new text end
new text begin
(c) "Accrediting or membership organization" means a national organization that
establishes evidence-based clinical standards for abortion care and accredits abortion facilities
or accepts as members abortion facilities following an application and inspection process.
new text end
new text begin
(d) "Commissioner" means the commissioner of health.
new text end
new text begin Subd. 2. new text end
new text begin License required. new text end
new text begin
(a) Beginning July 1, 2022, no abortion facility shall be
established, operated, or maintained in the state without first obtaining a license from the
commissioner according to this section.
new text end
new text begin
(b) A license issued under this section is not transferable or assignable and is subject to
suspension or revocation at any time for failure to comply with this section.
new text end
new text begin
(c) If a single entity maintains abortion facilities on different premises, each facility
must obtain a separate license.
new text end
new text begin
(d) To be eligible for licensure under this section, an abortion facility must be accredited
or a member of an accrediting or membership organization or must obtain accreditation or
membership within six months of the date of the application for licensure. If the abortion
facility loses its accreditation or membership, the abortion facility must immediately notify
the commissioner.
new text end
new text begin
(e) The commissioner, the attorney general, an appropriate county attorney, or a woman
upon whom an abortion has been performed or attempted to be performed at an unlicensed
facility may seek an injunction in district court against the continued operation of the facility.
Proceedings for securing an injunction may be brought by the attorney general or by the
appropriate county attorney.
new text end
new text begin
(f) Sanctions provided in this subdivision do not restrict other available sanctions.
new text end
new text begin Subd. 3. new text end
new text begin Temporary license. new text end
new text begin
For new abortion facilities planning to begin operations
on or after July 1, 2022, the commissioner may issue a temporary license to the abortion
facility that is valid for a period of six months from the date of issuance. The abortion facility
must submit to the commissioner an application and applicable fee for licensure as required
by subdivisions 4 and 7. The application must include the information required under
subdivision 4, clauses (1), (2), and (4), and provide documentation that the abortion facility
has submitted the application for accreditation or membership from an accrediting or
membership organization. Upon receipt of accreditation or membership verification, the
abortion facility must submit to the commissioner the information required in subdivision
4, clause (3), and the applicable fee under subdivision 7. The commissioner shall then issue
a new license.
new text end
new text begin Subd. 4. new text end
new text begin Application. new text end
new text begin
An application for a license to operate an abortion facility and
the applicable fee under subdivision 7 must be submitted to the commissioner on a form
provided by the commissioner and must contain:
new text end
new text begin
(1) the name of the applicant;
new text end
new text begin
(2) the site location of the abortion facility;
new text end
new text begin
(3) documentation that the abortion facility is accredited or an approved member of an
accrediting or membership organization, including the effective date and the expiration date
of the accreditation or membership, and the date of the last site visit by the accrediting or
membership organization; and
new text end
new text begin
(4) any other information that the commissioner deems necessary.
new text end
new text begin Subd. 5. new text end
new text begin Inspections. new text end
new text begin
Prior to initial licensure and at least once every two years thereafter,
the commissioner shall perform a routine and comprehensive inspection of each abortion
facility. Facilities shall be open at all reasonable times to an inspection authorized in writing
by the commissioner. No notice need be given to any person prior to an inspection authorized
by the commissioner.
new text end
new text begin Subd. 6. new text end
new text begin Suspension, revocation, and refusal to renew. new text end
new text begin
The commissioner may refuse
to grant or renew, or may suspend or revoke, a license on any of the grounds described in
section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or upon the loss of
accreditation or membership described in subdivision 4, clause (3). The applicant or licensee
is entitled to notice and a hearing as described under section 144.55, subdivision 7, and a
new license may be issued after the proper inspection of an abortion facility has been
conducted.
new text end
new text begin Subd. 7. new text end
new text begin Fees. new text end
new text begin
(a) The biennial license fee for abortion facilities is $365.
new text end
new text begin
(b) The temporary license fee is $365.
new text end
new text begin
(c) Fees shall be collected and deposited according to section 144.122.
new text end
new text begin Subd. 8. new text end
new text begin Renewal. new text end
new text begin
(a) A license issued under this section expires two years from the
date of issuance.
new text end
new text begin
(b) A temporary license issued under this section expires six months from the date of
issuance and may be renewed for one additional six-month period.
new text end
new text begin Subd. 9. new text end
new text begin Records. new text end
new text begin
All health records maintained on each client by an abortion facility
are subject to sections 144.292 to 144.298.
new text end
new text begin Subd. 10. new text end
new text begin Severability. new text end
new text begin
If any one or more provision, section, subdivision, sentence,
clause, phrase, or word of this section or the application of it to any person or circumstance
is found to be unconstitutional, it is declared to be severable and the balance of this section
shall remain effective notwithstanding such unconstitutionality. The legislature intends that
it would have passed this section, and each provision, section, subdivision, sentence, clause,
phrase, or word, regardless of the fact that any one provision, section, subdivision, sentence,
clause, phrase, or word is declared unconstitutional.
new text end
Sec. 29.
new text begin
[145.87] HOME VISITING FOR PREGNANT WOMEN AND FAMILIES
WITH YOUNG CHILDREN.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section
and have the meanings given them.
new text end
new text begin
(b) "Evidence-based home visiting program" means a program that:
new text end
new text begin
(1) is based on a clear, consistent program or model that is research-based and grounded
in relevant, empirically based knowledge;
new text end
new text begin
(2) is linked to program-determined outcomes and is associated with a national
organization, institution of higher education, or national or state public health institute;
new text end
new text begin
(3) has comprehensive home visitation standards that ensure high-quality service delivery
and continuous quality improvement;
new text end
new text begin
(4) has demonstrated significant, sustained positive outcomes; and
new text end
new text begin
(5) either:
new text end
new text begin
(i) has been evaluated using rigorous randomized controlled research designs and the
evaluation results have been published in a peer-reviewed journal; or
new text end
new text begin
(ii) is based on quasi-experimental research using two or more separate, comparable
client samples.
new text end
new text begin
(c) "Evidence-informed home visiting program" means a program that:
new text end
new text begin
(1) has data or evidence demonstrating effectiveness at achieving positive outcomes for
pregnant women and young children; and
new text end
new text begin
(2) either:
new text end
new text begin
(i) has an active evaluation of the program; or
new text end
new text begin
(ii) has a plan and timeline for an active evaluation of the program to be conducted.
new text end
new text begin
(d) "Health equity" means every individual has a fair opportunity to attain the individual's
full health potential and no individual is disadvantaged from achieving this potential.
new text end
new text begin
(e) "Promising practice home visiting program" means a program that has shown
improvement toward achieving positive outcomes for pregnant women or young children.
new text end
new text begin Subd. 2. new text end
new text begin Grants for home visiting programs. new text end
new text begin
(a) The commissioner of health shall
award grants to community health boards, nonprofit organizations, and Tribal nations to
start up or expand voluntary home visiting programs serving pregnant women and families
with young children. Home visiting programs supported under this section shall provide
voluntary home visits by early childhood professionals or health professionals, including
but not limited to nurses, social workers, early childhood educators, and trained
paraprofessionals. Grant money shall be used to:
new text end
new text begin
(1) establish or expand evidence-based, evidence-informed, or promising practice home
visiting programs that address health equity and utilize community-driven health strategies;
new text end
new text begin
(2) serve families with young children or pregnant women who have high needs or are
high-risk, including but not limited to a family with low income, a parent or pregnant woman
with a mental illness or a substance use disorder, or a parent or pregnant woman experiencing
housing instability or domestic abuse; and
new text end
new text begin
(3) improve program outcomes in two or more of the following areas:
new text end
new text begin
(i) maternal and newborn health;
new text end
new text begin
(ii) school readiness and achievement;
new text end
new text begin
(iii) family economic self-sufficiency;
new text end
new text begin
(iv) coordination and referral for other community resources and supports;
new text end
new text begin
(v) reduction in child injuries, abuse, or neglect; or
new text end
new text begin
(vi) reduction in crime or domestic violence.
new text end
new text begin
(b) Grants awarded to evidence-informed and promising practice home visiting programs
must include money to evaluate program outcomes for up to four of the areas listed in
paragraph (a), clause (3).
new text end
new text begin Subd. 3. new text end
new text begin Grant prioritization. new text end
new text begin
(a) In awarding grants, the commissioner shall give
priority to community health boards, nonprofit organizations, and Tribal nations seeking to
expand home visiting services with community or regional partnerships.
new text end
new text begin
(b) The commissioner shall allocate at least 75 percent of the grant money awarded each
grant cycle to evidence-based home visiting programs that address health equity and up to
25 percent of the grant money awarded each grant cycle to evidence-informed or promising
practice home visiting programs that address health equity and utilize community-driven
health strategies.
new text end
new text begin Subd. 4. new text end
new text begin Administrative costs. new text end
new text begin
The commissioner may use up to seven percent of the
annual appropriation under this section to provide training and technical assistance and to
administer and evaluate the program. The commissioner may contract for training,
capacity-building support for grantees or potential grantees, technical assistance, and
evaluation support.
new text end
new text begin Subd. 5. new text end
new text begin Use of state general fund appropriations. new text end
new text begin
Appropriations dedicated to
establishing or expanding evidence-based home visiting programs shall, for grants awarded
on or after July 1, 2021, be awarded according to this section. This section shall not govern
grant awards of federal funds for home visiting programs and shall not govern grant awards
using state general fund appropriations dedicated to establishing or expanding nurse-family
partnership home visiting programs.
new text end
Sec. 30.
Minnesota Statutes 2020, section 145.902, is amended to read:
145.902 GIVE LIFE A CHANCE; SAFE PLACE FOR NEWBORNS DUTIES;
IMMUNITY.
Subdivision 1.
General.
(a) For purposes of this section, a "safe place" means a hospital
licensed under sections 144.50 to 144.56,new text begin including the hospital where the newborn was
born,new text end a health care provider who provides urgent care medical services, or an ambulance
service licensed under chapter 144E dispatched in response to a 911 call from a mother or
a person with the mother's permission to relinquish a newborn infant.
(b) A safe place shall receive a newborn left with an employee on the premises of the
safe place during its hours of operation, provided that:
(1) the newborn was born within seven days of being left at the safe place, as determined
within a reasonable degree of medical certainty; and
(2) the newborn is left in an unharmed condition.
(c) The safe place must not inquire as to the identity of the mother or the person leaving
the newborn or call the police, provided the newborn is unharmed when presented to the
hospital. The safe place may ask the mother or the person leaving the newborn about the
medical history of the mother or newborn new text begin and if the newborn may have lineage to an Indian
Tribe and, if known, the name of the Tribe new text end but the mother or the person leaving the newborn
is not required to provide any information. The safe place may provide the mother or the
person leaving the newborn with information about how to contact relevant social service
agencies.
(d) A safe place that is a health care provider who provides urgent care medical services
shall dial 911, advise the dispatcher that the call is being made from a safe place for
newborns, and ask the dispatcher to send an ambulance or take other appropriate action to
transport the newborn to a hospital. An ambulance with whom a newborn is left shall
transport the newborn to a hospital for care. Hospitals must receive a newborn left with a
safe place and make the report as required in subdivision 2.
Subd. 2.
Reporting.
new text begin (a) new text end Within 24 hours of receiving a newborn under this section, the
hospital must inform the responsible social service agency that a newborn has been left at
the hospital, but must not do so in the presence of the mother or the person leaving the
newborn. The hospital must provide necessary care to the newborn pending assumption of
legal responsibility by the responsible social service agency pursuant to section 260C.139,
subdivision 5.
new text begin
(b) Within five days of receiving a newborn under this section, a hospital shall report
the newborn to the Office of Vital Records pursuant to section 144.216, subdivision 3. If a
hospital receives a safe place newborn under section 145.902 and it is known that the child's
record of birth was registered because the newborn was born at that hospital, the hospital
shall report the newborn to the Office of Vital Records and identify the child's birth record.
The state registrar shall issue a replacement birth record for the child pursuant to section
144.218, subdivision 6.
new text end
Subd. 3.
Immunity.
(a) A safe place with responsibility for performing duties under
this section, and any employee, doctor, ambulance personnel, or other medical professional
working at the safe place, are immune from any criminal liability that otherwise might result
from their actions, if they are acting in good faith in receiving a newborn, and are immune
from any civil liability that otherwise might result from merely receiving a newborn.
(b) A safe place performing duties under this section, or an employee, doctor, ambulance
personnel, or other medical professional working at the safe place who is a mandated reporter
under chapter 260E, is immune from any criminal or civil liability that otherwise might
result from the failure to make a report under that section if the person is acting in good
faith in complying with this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 31.
new text begin
[145A.145] NURSE-FAMILY PARTNERSHIP PROGRAMS.
new text end
new text begin
(a) The commissioner of health shall award expansion grants to community health boards
and tribal nations to expand existing nurse-family partnership programs. Grant funds must
be used to start up, expand, or sustain nurse-family partnership programs in the county,
reservation, or region to serve families in accordance with the Nurse-Family Partnership
Service Office nurse-family partnership model. The commissioner shall award grants to
community health boards, nonprofit organizations, or tribal nations in metropolitan and
rural areas of the state.
new text end
new text begin
(b) Priority for all grants shall be given to nurse-family partnership programs that provide
services through a Minnesota health care program-enrolled provider that accepts medical
assistance. Priority for grants to rural areas shall be given to community health boards,
nonprofit organizations, and tribal nations that start up, expand, or sustain services within
regional partnerships that provide the nurse-family partnership program.
new text end
new text begin
(c) Funding available under this section may only be used to supplement, not to replace,
funds being used for nurse-family partnership home visiting services as of June 30, 2015.
new text end
Sec. 32.
Minnesota Statutes 2020, section 157.22, is amended to read:
157.22 EXEMPTIONS.
This chapter does not apply to:
(1) interstate carriers under the supervision of the United States Department of Health
and Human Services;
(2) weddings, fellowship meals, or funerals conducted by a faith-based organization
using any building constructed and primarily used for religious worship or education;
(3) any building owned, operated, and used by a college or university in accordance
with health regulations promulgated by the college or university under chapter 14;
(4) any person, firm, or corporation whose principal mode of business is licensed under
sections 28A.04 and 28A.05, is exempt at that premises from licensure as a food or beverage
establishment; provided that the holding of any license pursuant to sections 28A.04 and
28A.05 shall not exempt any person, firm, or corporation from the applicable provisions of
this chapter or the rules of the state commissioner of health relating to food and beverage
service establishments;
(5) family day care homes and group family day care homes governed by sections
245A.01 to 245A.16;
(6) nonprofit senior citizen centers for the sale of home-baked goods;
(7) fraternal, sportsman, or patriotic organizations that are tax exempt under section
501(c)(3), 501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue
Code of 1986, or organizations related to, affiliated with, or supported by such fraternal,
sportsman, or patriotic organizations for events held in the building or on the grounds of
the organization and at which home-prepared food is donated by organization members for
sale at the events, provided:
(i) the event is not a circus, carnival, or fair;
(ii) the organization controls the admission of persons to the event, the event agenda, or
both; and
(iii) the organization's licensed kitchen is not used in any manner for the event;
(8) food not prepared at an establishment and brought in by individuals attending a
potluck event for consumption at the potluck event. An organization sponsoring a potluck
event under this clause may advertise the potluck event to the public through any means.
Individuals who are not members of an organization sponsoring a potluck event under this
clause may attend the potluck event and consume the food at the event. Licensed food
establishments other than schools cannot be sponsors of potluck events. A school may
sponsor and hold potluck events in areas of the school other than the school's kitchen,
provided that the school's kitchen is not used in any manner for the potluck event. For
purposes of this clause, "school" means a public school as defined in section 120A.05,
subdivisions 9, 11, 13, and 17, or a nonpublic school, church, or religious organization at
which a child is provided with instruction in compliance with sections 120A.22 and 120A.24.
Potluck event food shall not be brought into a licensed food establishment kitchen;
(9) a home school in which a child is provided instruction at home;
(10) school concession stands serving commercially prepared, nonpotentially hazardous
foods, as defined in Minnesota Rules, chapter 4626;
(11) group residential facilities of ten or fewer beds licensed by the commissioner of
human services under Minnesota Rules, chapter 2960, provided the facility employs or
contracts with a certified food manager under Minnesota Rules, part 4626.2015;
(12) food served at fund-raisers or community eventsnew text begin , including fellowship meals,new text end
conducted in the building or on the grounds of a faith-based organization, new text begin or made available
for curbside pickup or for delivery to members of the faith-based organization or the
community in which the faith-based organization serves, new text end provided that a certified food
manager, or a volunteer trained in a food safety course, trains the food preparation workers
in safe food handling practices. This exemption does not apply to faith-based organizations
at the state agricultural society or county fairs or to faith-based organizations that choose
to apply for a license;
(13) food service events conducted following a disaster for purposes of feeding disaster
relief staff and volunteers serving commercially prepared, nonpotentially hazardous foods,
as defined in Minnesota Rules, chapter 4626;
(14) chili or soup served at a chili or soup cook-off fund-raiser conducted by a
community-based nonprofit organization, provided:
(i) the municipality where the event is located approves the event;
(ii) the sponsoring organization must develop food safety rules and ensure that participants
follow these rules; and
(iii) if the food is not prepared in a kitchen that is licensed or inspected, a visible sign
or placard must be posted that states: "These products are homemade and not subject to
state inspection."
Foods exempt under this clause must be labeled to accurately reflect the name and
address of the person preparing the foods; and
(15) a special event food stand or a seasonal temporary food stand provided:
(i) the stand is located on private property with the permission of the property owner;
(ii) the stand has gross receipts or contributions of $1,000 or less in a calendar year; and
(iii) the operator of the stand posts a sign or placard at the site that states "The products
sold at this stand are not subject to state inspection or regulation." if the stand offers for sale
potentially hazardous food as defined in Minnesota Rules, part 4626.0020, subpart 62.
Sec. 33.
Minnesota Statutes 2020, section 326.71, subdivision 4, is amended to read:
Subd. 4.
Asbestos-related work.
"Asbestos-related work" means the enclosure, removal,
or encapsulation of asbestos-containing material in a quantity that meets or exceeds 260
linear feet of friable asbestos-containing material on pipes, 160 square feet of friable
asbestos-containing material on other facility components, or, if linear feet or square feet
cannot be measured, a total of 35 cubic feet of friable asbestos-containing material on or
off all facility components in one facility. In the case of single or multifamily residences,
"asbestos-related work" also means the enclosure, removal, or encapsulation of greater than
ten but less than 260 linear feet of friable asbestos-containing material on pipes, greater
than six but less than 160 square feet of friable asbestos-containing material on other facility
components, or, if linear feet or square feet cannot be measured, greater than one cubic foot
but less than 35 cubic feet of friable asbestos-containing material on or off all facility
components in one facility. deleted text begin This provision excludes asbestos-containing floor tiles and
sheeting, roofing materials, siding, and all ceilings with asbestos-containing material in
single family residences and buildings with no more than four dwelling units.deleted text end
Asbestos-related work includes asbestos abatement area preparation; enclosure, removal,
or encapsulation operations; and an air quality monitoring specified in rule to assure that
the abatement and adjacent areas are not contaminated with asbestos fibers during the project
and after completion.
For purposes of this subdivision, the quantity of deleted text begin asbestos containingdeleted text end material applies
separately for every project.
Sec. 34.
Minnesota Statutes 2020, section 326.75, subdivision 1, is amended to read:
Subdivision 1.
Licensing fee.
A person required to be licensed under section 326.72
shall, before receipt of the license and before causing asbestos-related work to be performed,
pay the commissioner an annual license fee of deleted text begin $100deleted text end new text begin $105new text end .
Sec. 35.
Minnesota Statutes 2020, section 326.75, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
An individual required to be certified new text begin as an asbestos worker
or asbestos site supervisor new text end under section 326.73, subdivision 1, shall pay the commissioner
a certification fee of deleted text begin $50deleted text end new text begin $52.50new text end before the issuance of the certificate. deleted text begin The commissioner
may establish by rule fees required before the issuance ofdeleted text end new text begin An individual required to be
certified as annew text end asbestos inspector, asbestos management planner, deleted text begin anddeleted text end new text begin ornew text end asbestos project
designer deleted text begin certificates requireddeleted text end under section 326.73, subdivisions 2, 3, and 4new text begin , shall pay the
commissioner a certification fee of $105 before the issuance of the certificatenew text end .
Sec. 36.
Minnesota Statutes 2020, section 326.75, subdivision 3, is amended to read:
Subd. 3.
Permit fee.
Five calendar days before beginning asbestos-related work, a person
shall pay a project permit fee to the commissioner equal to deleted text begin onedeleted text end new text begin twonew text end percent of the total costs
of the asbestos-related work. For asbestos-related work performed in single or multifamily
residences, of greater than ten but less than 260 linear feet of asbestos-containing material
on pipes, or greater than six but less than 160 square feet of asbestos-containing material
on other facility components, a person shall pay a project permit fee of $35 to the
commissioner.
Sec. 37. new text begin DIRECTION TO MODIFY MARRIAGE LICENSE APPLICATIONS.
new text end
new text begin
A local registrar or a designee of the county board shall delete from the county's marriage
license application any space or other manner in which the applicant is required to specify
the applicant's race.
new text end
ARTICLE 3
HEALTH OCCUPATION AND HEALTH RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2020, section 144E.001, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Education program primary instructor or primary instructor. new text end
new text begin
"Education
program primary instructor" or "primary instructor" means an individual, as approved by
the board, who serves as the lead instructor of an emergency medical care initial certification
course and who is responsible for planning or conducting the course according to the most
current version of the National EMS Education Standards by the NHTSA, United States
Department of Transportation.
new text end
Sec. 2.
Minnesota Statutes 2020, section 144E.27, is amended to read:
144E.27 deleted text begin EDUCATION PROGRAMS; BOARD APPROVALdeleted text end new text begin REGISTRATION
OF EMRnew text end .
Subdivision 1.
Education program instructor.
An education program instructor must
be an emergency medical responder, EMT, AEMT, paramedic, physician, physician assistant,
or registered nurse.
Subd. 1a.
Approval required.
(a) All education programs for an emergency medical
responder must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type and length of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program
education coordinator, and instructors;
(iii) admission criteria for students; and
(iv) materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department
of Transportation EMS Education Standards, or its equivalent as determined by the board
applicable to Emergency Medical Responder registration education;
(3) have a program medical director and a program coordinator;
(4) have at least one instructor for every ten students at the practical skill stations;
(5) retain documentation of program approval by the board, course outline, and student
information; and
(6) submit the appropriate fee as required under section 144E.29.
(c) The National EMS Education Standards by the NHTSA, United States Department
of Transportation contains the minimal entry level of knowledge and skills for emergency
medical responders. Medical directors of emergency medical responder groups may expand
the knowledge and skill set.
Subd. 2.
Registrationnew text begin requirementsnew text end .
To be eligible for registration with the board as
an emergency medical responder, an individual shalldeleted text begin complete a board-approved application
deleted text end deleted text begin form anddeleted text end :
(1) successfully completedeleted text begin a board-approved initial emergency medical responder
deleted text end deleted text begin education program. Registration under this clause is valid for two years and expires on
deleted text end deleted text begin October 31deleted text end new text begin the United States Department of Transportation course or its equivalent as
approved by the board, specific to the emergency medical responder classificationnew text end ; deleted text begin or
deleted text end
(2) be credentialed as an emergency medical responder by the National Registry of
Emergency Medical Techniciansdeleted text begin . Registration under this clause expires the same day as
deleted text end deleted text begin the National Registry credential.deleted text end new text begin ; and
new text end
new text begin
(3) complete a board-approved application form.
new text end
Subd. 2a.
Registration new text begin expiration new text end dates.
new text begin Emergency medical responder new text end registration
expiration dates are as follows:
(1) for initial registration granted between January 1 and June 30 of an even-numbered
year, the expiration date is October 31 of the next even-numbered year;
(2) for initial registration granted between July 1 and December 31 of an even-numbered
year, the expiration date is October 31 of the second odd-numbered year;
(3) for initial registration granted between January 1 and June 30 of an odd-numbered
year, the expiration date is October 31 of the next odd-numbered year; and
(4) for initial registration granted between July 1 and December 31 of an odd-numbered
year, the expiration date is October 31 of the second even-numbered year.
Subd. 3.
Renewal.
(a) The board may renew the registration of an emergency medical
responder who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
(2) new text begin successfully completes a course in cardiopulmonary resuscitation approved by the
board or the licensee's medical director; and
new text end
new text begin (3) new text end submits a completed renewal application to the board before the registration expiration
date.
(b) The board may renew the lapsed registration of an emergency medical responder
who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
(2)new text begin successfully completes a course in cardiopulmonary resuscitation approved by the
board or the licensee's medical director; and
new text end
new text begin (3)new text end submits a completed renewal application to the board within 12 months after the
registration expiration date.
Subd. 5.
Denial, suspension, revocation.
(a) The board may deny, suspend, revoke,
place conditions on, or refuse to renew the registration new text begin as an emergency medical responder
new text end of an individual who the board determines:
(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, an
agreement for corrective action, or an order that the board issued or is otherwise empowered
to enforce;
(2) misrepresents or falsifies information on an application form for registration;
(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
alcohol;
(4) is actually or potentially unable to provide emergency medical services with
reasonable skill and safety to patients by reason of illness, use of alcohol, drugs, chemicals,
or any other material, or as a result of any mental or physical condition;
(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
defraud, or harm the public, or demonstrating a willful or careless disregard for the health,
welfare, or safety of the public;
(6) maltreats or abandons a patient;
(7) violates any state or federal controlled substance law;
(8) engages in unprofessional conduct or any other conduct which has the potential for
causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;
(9) provides emergency medical services under lapsed or nonrenewed credentials;
(10) is subject to a denial, corrective, disciplinary, or other similar action in another
jurisdiction or by another regulatory authority;
(11) engages in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient; or
(12) makes a false statement or knowingly provides false information to the board, or
fails to cooperate with an investigation of the board as required by section 144E.30.
(b) Before taking action under paragraph (a), the board shall give notice to an individual
of the right to a contested case hearing under chapter 14. If an individual requests a contested
case hearing within 30 days after receiving notice, the board shall initiate a contested case
hearing according to chapter 14.
(c) The administrative law judge shall issue a report and recommendation within 30
days after closing the contested case hearing record. The board shall issue a final order
within 30 days after receipt of the administrative law judge's report.
(d) After six months from the board's decision to deny, revoke, place conditions on, or
refuse renewal of an individual's registration for disciplinary action, the individual shall
have the opportunity to apply to the board for reinstatement.
Subd. 6.
Temporary suspension.
(a) In addition to any other remedy provided by law,
the board may temporarily suspend the registration of an individual new text begin as an emergency
responder new text end after conducting a preliminary inquiry to determine whether the board believes
that the individual has violated a statute or rule that the board is empowered to enforce and
determining that the continued provision of service by the individual would create an
imminent risk to public health or harm to others.
(b) A temporary suspension order prohibiting an individual from providing emergency
medical care shall give notice of the right to a preliminary hearing according to paragraph
(d) and shall state the reasons for the entry of the temporary suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
individual personally or by certified mail, which is complete upon receipt, refusal, or return
for nondelivery to the most recent address provided to the board for the individual.
(d) At the time the board issues a temporary suspension order, the board shall schedule
a hearing, to be held before a group of its members designated by the board, that shall begin
within 60 days after issuance of the temporary suspension order or within 15 working days
of the date of the board's receipt of a request for a hearing from the individual, whichever
is sooner. The hearing shall be on the sole issue of whether there is a reasonable basis to
continue, modify, or lift the temporary suspension. A hearing under this paragraph is not
subject to chapter 14.
(e) Evidence presented by the board or the individual may be in the form of an affidavit.
The individual or the individual's designee may appear for oral argument.
(f) Within five working days of the hearing, the board shall issue its order and, if the
suspension is continued, notify the individual of the right to a contested case hearing under
chapter 14.
(g) If an individual requests a contested case hearing within 30 days after receiving
notice under paragraph (f), the board shall initiate a contested case hearing according to
chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The board shall issue a final
order within 30 days after receipt of the administrative law judge's report.
Sec. 3.
Minnesota Statutes 2020, section 144E.28, subdivision 1, is amended to read:
Subdivision 1.
Requirements.
To be eligible for certification by the board as an EMT,
AEMT, or paramedic, an individual shall:
(1) successfully complete the United States Department of Transportation course, or its
equivalent as approved by the board, specific to the EMT, AEMT, or paramedic classification;
(2) deleted text begin pass the written and practical examinations approved by the board and administered
by the board or its designee,deleted text end new text begin obtain National Registry of Emergency Medical Technicians
certificationnew text end specific to the EMT, AEMT, or paramedic classification; and
(3) complete a board-approved application form.
Sec. 4.
Minnesota Statutes 2020, section 144E.28, subdivision 3, is amended to read:
Subd. 3.
Reciprocity.
The board may certify an individual who possesses a current
National Registry of Emergency Medical Technicians deleted text begin registrationdeleted text end new text begin certificationnew text end from another
jurisdiction if the individual submits a board-approved application form. The board
certification classification shall be the same as the National Registry's classification.
Certification shall be for the duration of the applicant's deleted text begin registrationdeleted text end new text begin certificationnew text end period in
another jurisdiction, not to exceed two years.
Sec. 5.
Minnesota Statutes 2020, section 144E.28, subdivision 7, is amended to read:
Subd. 7.
Renewal.
(a) Before the expiration date of certification, an applicant for renewal
of certification as an EMT shall:
(1) successfully complete a course in cardiopulmonary resuscitation that is approved by
the board or the licensee's medical director;
(2) deleted text begin take the United States Department of Transportation EMT refresher course and
successfully pass the practical skills test portion of the course, or successfully complete 48
hours of continuing education in EMT programs that are consistent with the United States
Department of Transportation National EMS Education Standards or its equivalent as
approved by the board or as approved by the licensee's medical director and pass a practical
skills test approved by the board and administered by an education program approved by
the board. The cardiopulmonary resuscitation course and practical skills test may be included
as part of the refresher course or continuing education renewal requirements; anddeleted text end new text begin satisfy
one of the following requirements:
new text end
new text begin
(i) maintain National Registry of Emergency Medical Technicians certification following
the requirements of the National Continued Competency Program, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course required under clause (1)
shall count toward the continuing education requirements for renewal; or
new text end
new text begin
(ii) for an individual who only holds Minnesota EMT certification and held the
certification prior to April 1, 2021, maintain Minnesota certification by completing the
required hours of continuing education as determined in the National Continued Competency
Program of the National Registry of Emergency Medical Technicians, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course required under clause (1)
shall count toward the continuing education requirements for renewal. This item expires
April 1, 2036; and
new text end
(3) complete a board-approved application form.
(b) Before the expiration date of certification, an applicant for renewal of certification
as an AEMT or paramedic shall:
(1) for an AEMT, successfully complete a course in cardiopulmonary resuscitation that
is approved by the board or the licensee's medical directornew text begin ,new text end and for a paramedic, successfully
complete a course in advanced cardiac life support that is approved by the board or the
licensee's medical director;
(2) deleted text begin successfully complete 48 hours of continuing education in emergency medical training
programs, appropriate to the level of the applicant's AEMT or paramedic certification, that
are consistent with the United States Department of Transportation National EMS Education
Standards or its equivalent as approved by the board or as approved by the licensee's medical
director. An applicant may take the United States Department of Transportation Emergency
Medical Technician refresher course or its equivalent without the written or practical test
as approved by the board, and as appropriate to the applicant's level of certification, as part
of the 48 hours of continuing education. Each hour of the refresher course, the
cardiopulmonary resuscitation course, and the advanced cardiac life-support course counts
toward the 48-hour continuing education requirement; anddeleted text end new text begin satisfy one of the following
requirements:
new text end
new text begin
(i) maintain National Registry of Emergency Medical Technicians certification following
the requirements of the National Continued Competency Program, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course or advanced cardiac life
support course required under clause (1) shall count toward the continuing education
requirements for renewal; or
new text end
new text begin
(ii) for an individual who only holds Minnesota AEMT or paramedic certification and
held the certification prior to April 1, 2021, maintain Minnesota certification by completing
the required hours of continuing education as determined in the National Continued
Competency Program of the National Registry of Emergency Medical Technicians, or its
equivalent as approved by the board. The cardiopulmonary resuscitation course or advanced
cardiac life support course required under clause (1) shall count toward the continuing
education requirements for renewal. This item expires April 1, 2036; and
new text end
(3) complete a board-approved application form.
(c) Certification shall be renewed every two years.
(d) If the applicant does not meet the renewal requirements under this subdivision, the
applicant's certification expires.
Sec. 6.
Minnesota Statutes 2020, section 144E.28, subdivision 8, is amended to read:
Subd. 8.
Reinstatement.
(a) Within deleted text begin fourdeleted text end new text begin twonew text end years of a certification expiration date, a
person whose certification has expired under subdivision 7, paragraph (d), may have the
certification reinstated upon submission of:
(1) evidence to the board of training equivalent to the continuing education requirements
of subdivision 7; and
(2) a board-approved application form.
(b) If more than deleted text begin fourdeleted text end new text begin twonew text end years have passed since a certificate expiration date, an applicant
must complete the initial certification process required under subdivision 1.
Sec. 7.
Minnesota Statutes 2020, section 144E.283, is amended to read:
144E.283 new text begin PRIMARY new text end INSTRUCTOR QUALIFICATIONS.
deleted text begin (a)deleted text end An deleted text begin emergency medical techniciandeleted text end new text begin education program primarynew text end instructor must:
(1) possess deleted text begin validdeleted text end new text begin current Minnesotanew text end certification, registration, or licensure asnew text begin one of the
following, at a level that is equivalent to or higher than the level of certification or registration
being taught:
new text end
new text begin (i)new text end an new text begin EMR, new text end EMT, AEMT, new text begin or new text end paramedicdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (ii) anew text end physiciandeleted text begin ,deleted text end new text begin with certification in adult or pediatric emergency medicine from the
American Board of Emergency Medicine or the American Board of Osteopathic Emergency
Medicine, with certification in an emergency medical services subspecialty, or serving as
a medical director of a licensed ambulance service;
new text end
new text begin (iii) anew text end physician assistantdeleted text begin ,deleted text end new text begin with experience in emergency medicine;new text end or
new text begin (iv) anew text end registered nursenew text begin with certification in adult or pediatric prehospital nursing from
(A) the Board of Certification for Emergency Nursing, including certified flight registered
nurse or certified transport registered nurse, or (B) the National Certification Corporation,
including certified in neonatal pediatric transportnew text end ;
(2) deleted text begin have two years of active emergency medical practical experiencedeleted text end new text begin if required under
this chapter for Minnesota certification or registration, possess National Registry of
Emergency Medical Technicians certification or registration as an EMR, EMT, AEMT, or
paramedic, at a level that is equivalent to or higher than the level of certification or
registration being taughtnew text end ;
new text begin
(3) satisfy one of the following requirements:
new text end
new text begin
(i) hold at least an associate's degree and have been certified for at least three years at a
level that is equivalent to or higher than the level of certification or registration being taught;
or
new text end
new text begin
(ii) have been certified for at least five years at a level that is equivalent to or higher
than the level of certification or registration being taught;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end be recommended by a medical director of a licensed hospital, ambulance service,
or education program approved by the board;
deleted text begin (4)deleted text end new text begin (5) satisfy one of the following requirements:
new text end
new text begin (i) new text end successfully complete the United States Department of Transportation Emergency
Medical Services Instructor deleted text begin Education Program or its equivalent as approved by the boarddeleted text end new text begin
coursenew text end ; deleted text begin and
deleted text end
new text begin
(ii) successfully complete the National Association of EMS Educators Instructor level
1 course;
new text end
new text begin
(iii) successfully complete the Fire Instructor I course;
new text end
new text begin
(iv) hold at least a bachelor's degree in education;
new text end
new text begin
(v) hold at least a master's degree in a related field of study;
new text end
new text begin
(vi) have been vetted through the Minnesota State faculty credentialing process; or
new text end
new text begin
(vii) successfully complete an equivalent course or hold an equivalent degree as approved
by the board;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end complete eight hours of continuing education in educational topics every two
years, with documentation filed with the education program coordinatordeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) complete a board-approved application form; and
new text end
new text begin
(8) receive board approval as a primary instructor.
new text end
deleted text begin
(b) An emergency medical responder instructor must possess valid registration,
certification, or licensure as an EMR, EMT, AEMT, paramedic, physician, physician
assistant, or registered nurse.
deleted text end
Sec. 8.
Minnesota Statutes 2020, section 144E.285, subdivision 1, is amended to read:
Subdivision 1.
Approval required.
(a) All education programs for annew text begin EMR,new text end EMT,
AEMT, or paramedic must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type deleted text begin and lengthdeleted text end of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program
education coordinator, and instructors;
deleted text begin
(iii) names and addresses of clinical sites, including a contact person and telephone
number;
deleted text end
deleted text begin (iv)deleted text end new text begin (iii)new text end admission criteria for students; and
deleted text begin (v)deleted text end new text begin (iv)new text end materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department
of Transportation EMS Education Standards, or its equivalent as determined by the board
applicable to new text begin EMR, new text end EMT, AEMT, or paramedic education;
(3) have a program medical director and a program coordinator;
(4) utilize new text begin primary new text end instructors who meet the requirements of section 144E.283 for teaching
at least 50 percent of the course content. The remaining 50 percent of the course may be
taught by guest lecturers approved by the education program coordinator or medical director;
deleted text begin
(5) have at least one instructor for every ten students at the practical skill stations;
deleted text end
deleted text begin
(6) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site;
deleted text end
deleted text begin (7)deleted text end new text begin (5)new text end retain documentation of program approval by the board, course outline, and
student information;
deleted text begin (8)deleted text end new text begin (6)new text end notify the board of the starting date of a course prior to the beginning of a course;new text begin
and
new text end
deleted text begin (9)deleted text end new text begin (7)new text end submit the appropriate fee as required under section 144E.29deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(10) maintain a minimum average yearly pass rate as set by the board on an annual basis.
The pass rate will be determined by the percent of candidates who pass the exam on the
first attempt. An education program not meeting this yearly standard shall be placed on
probation and shall be on a performance improvement plan approved by the board until
meeting the pass rate standard. While on probation, the education program may continue
providing classes if meeting the terms of the performance improvement plan as determined
by the board. If an education program having probation status fails to meet the pass rate
standard after two years in which an EMT initial course has been taught, the board may
take disciplinary action under subdivision 5.
deleted text end
Sec. 9.
Minnesota Statutes 2020, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin EMR requirements. new text end
new text begin
The National EMS Education Standards established by
the NHTSA, United States Department of Transportation, specifies the minimum
requirements for knowledge and skills for emergency medical responders. A medical director
of an emergency medical responder education group may establish additional knowledge
and skill requirements for EMRs.
new text end
Sec. 10.
Minnesota Statutes 2020, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin EMT requirements. new text end
new text begin
In addition to the requirements under subdivision 1,
paragraph (b), an education program applying for approval to teach EMTs must:
new text end
new text begin
(1) in the application prescribed by the board, include names and addresses of clinical
sites, including a contact person and telephone number;
new text end
new text begin
(2) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site; and
new text end
new text begin
(3) maintain a minimum average yearly pass rate as set by the board. An education
program not meeting the standard in this subdivision shall be placed on probation and must
comply with a performance improvement plan approved by the board until the program
meets the pass-rate standard. While on probation, the education program may continue to
provide classes if the program meets the terms of the performance improvement plan, as
determined by the board. If an education program that is on probation status fails to meet
the pass-rate standard after two years in which an EMT initial course has been taught, the
board may take disciplinary action under subdivision 5.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144E.285, subdivision 2, is amended to read:
Subd. 2.
AEMT and paramedic requirements.
(a) In addition to the requirements
under subdivision 1, paragraph (b), an education program applying for approval to teach
AEMTs and paramedics mustnew text begin :
new text end
new text begin (1)new text end be administered by an educational institution accredited by the Commission of
Accreditation of Allied Health Education Programs (CAAHEP)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) in the application prescribed by the board, include names and addresses of clinical
sites, including a contact person and telephone number; and
new text end
new text begin
(3) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site.
new text end
(b) An AEMT and paramedic education program that is administered by an educational
institution not accredited by CAAHEP, but that is in the process of completing the
accreditation process, may be granted provisional approval by the board upon verification
of submission of its self-study report and the appropriate review fee to CAAHEP.
(c) An educational institution that discontinues its participation in the accreditation
process must notify the board immediately and provisional approval shall be withdrawn.
deleted text begin
(d) This subdivision does not apply to a paramedic education program when the program
is operated by an advanced life-support ambulance service licensed by the Emergency
Medical Services Regulatory Board under this chapter, and the ambulance service meets
the following criteria:
deleted text end
deleted text begin
(1) covers a rural primary service area that does not contain a hospital within the primary
service area or contains a hospital within the primary service area that has been designated
as a critical access hospital under section 144.1483, clause (9);
deleted text end
deleted text begin
(2) has tax-exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
deleted text end
deleted text begin
(3) received approval before 1991 from the commissioner of health to operate a paramedic
education program;
deleted text end
deleted text begin
(4) operates an AEMT and paramedic education program exclusively to train paramedics
for the local ambulance service; and
deleted text end
deleted text begin
(5) limits enrollment in the AEMT and paramedic program to five candidates per
biennium.
deleted text end
Sec. 12.
Minnesota Statutes 2020, section 144E.285, subdivision 4, is amended to read:
Subd. 4.
Reapproval.
An education program shall apply to the board for reapproval at
least three months prior to the expiration date of its approval and must:
(1) submit an application prescribed by the board specifying any changes from the
information provided for prior approval and any other information requested by the board
to clarify incomplete or ambiguous information presented in the application; deleted text begin and
deleted text end
(2) comply with the requirements under subdivision 1, paragraph (b), clauses (2) to deleted text begin (10).deleted text end new text begin
(7);
new text end
new text begin
(3) be subject to a site visit;
new text end
new text begin
(4) for education programs that teach EMTs, comply with the requirements in subdivision
1b; and
new text end
new text begin
(5) for education programs that teach AEMTs and paramedics, comply with the
requirements in subdivision 2 and maintain accreditation with the CAAHEP.
new text end
Sec. 13.
Minnesota Statutes 2020, section 148.995, subdivision 2, is amended to read:
Subd. 2.
Certified doula.
"Certified doula" means an individual who has received a
certification to perform doula services from the International Childbirth Education
Association, the Doulas of North America (DONA), the Association of Labor Assistants
and Childbirth Educators (ALACE), Birthworks, the Childbirth and Postpartum Professional
Association (CAPPA), Childbirth International, the International Center for Traditional
Childbearing, deleted text begin ordeleted text end Commonsense Childbirth, Incnew text begin ., Modern Doula Education (MDE), or an
organization designated by the commissioner under section 148.9965new text end .
Sec. 14.
Minnesota Statutes 2020, section 148.996, subdivision 2, is amended to read:
Subd. 2.
Qualifications.
The commissioner shall include on the registry any individual
who:
(1) submits an application on a form provided by the commissioner. The form must
include the applicant's name, address, and contact information;
(2) deleted text begin maintainsdeleted text end new text begin submits evidence of maintainingnew text end a current certification from one of the
organizations listed in section 148.995, subdivision 2new text begin , or from an organization designated
by the commissioner under section 148.9965new text end ; and
(3) pays the fees required under section 148.997.
Sec. 15.
Minnesota Statutes 2020, section 148.996, subdivision 4, is amended to read:
Subd. 4.
Renewal.
Inclusion on the registry maintained by the commissioner is valid
for three yearsnew text begin , provided the doula meets the requirement in subdivision 2, clause (2), during
the entire periodnew text end . At the end of the three-year period, the certified doula may submit a new
application to remain on the doula registry by meeting the requirements described in
subdivision 2.
Sec. 16.
Minnesota Statutes 2020, section 148.996, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Removal from registry. new text end
new text begin
(a) If the commissioner determines that a doula
included on the registry does not meet the requirement in subdivision 2, clause (2), the
commissioner shall notify the affected doula that the doula no longer meets the requirement
in subdivision 2, clause (2), specify steps the doula must take to maintain inclusion on the
registry, and specify the effect of failing to take such steps. The commissioner must provide
this notice by first class mail to the address on file with the commissioner for the affected
doula.
new text end
new text begin
(b) Following the provision of notice under paragraph (a), the commissioner shall remove
from the registry any doula who no longer meets the requirement in subdivision 2, clause
(2), and who does not take the steps specified by the commissioner to maintain inclusion
on the registry.
new text end
Sec. 17.
new text begin
[148.9965] DESIGNATION OF DOULA CERTIFICATION
ORGANIZATIONS BY COMMISSIONER.
new text end
new text begin Subdivision 1. new text end
new text begin Review and designation by commissioner. new text end
new text begin
The commissioner shall
periodically review the doula certification organizations listed in section 148.995, subdivision
2, or designated by the commissioner under this section. The commissioner may: (1)
designate additional organizations from which individuals, if maintaining current doula
certification from such an organization, are eligible for inclusion on the registry of certified
doulas; and (2) remove the designation of a doula certification organization previously
designated by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Designation. new text end
new text begin
A doula certification organization seeking designation under this
section shall provide the commissioner with evidence that the organization satisfies
designation criteria established by the commissioner. If the commissioner designates a doula
certification organization under this section, the commissioner shall provide notice of the
designation by publication in the State Register and on the Department of Health website
for the registry of certified doulas and shall specify the date after which a certification by
the organization authorizes a doula certified by the organization to be included on the
registry.
new text end
new text begin Subd. 3. new text end
new text begin Removal of designation. new text end
new text begin
(a) The commissioner may remove the designation
of a doula certification organization previously designated by the commissioner under this
section upon a determination by the commissioner that the organization does not meet the
commissioner's criteria for designation. If the commissioner removes a designation, the
commissioner shall provide notice of the removal by publication in the State Register and
shall specify the date after which a certification by the organization no longer authorizes a
doula certified by the organization to be included on the registry.
new text end
new text begin
(b) Following removal of a designation, the Department of Health website for the registry
of certified doulas shall be modified to reflect the removal.
new text end
Sec. 18.
Minnesota Statutes 2020, section 151.01, subdivision 29, is amended to read:
Subd. 29.
deleted text begin Legenddeleted text end Medical gas.
"deleted text begin Legenddeleted text end Medical gas" means deleted text begin a liquid or gaseous
substance used for medical purposes and that is required by federal law to be dispensed
only pursuant to the prescription of a licensed practitionerdeleted text end new text begin any gas or liquid manufactured
or stored in a liquefied, nonliquefied, or cryogenic state that:
new text end
new text begin
(1) has a chemical or physical action in or on the human body or animals or is used in
conjunction with medical gas equipment; and
new text end
new text begin (2) is intended to be used for the diagnosis, cure, mitigation, treatment, or prevention of
diseasenew text end .
Sec. 19.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29a. new text end
new text begin Medical gas manufacturer. new text end
new text begin
"Medical gas manufacturer" means any person:
new text end
new text begin
(1) originally manufacturing a medical gas by chemical reaction, physical separation,
compression of atmospheric air, purification, or other means;
new text end
new text begin
(2) filling a medical gas into a dispensing container via gas to gas, liquid to gas, or liquid
to liquid processes;
new text end
new text begin
(3) combining two or more medical gases into a container to form a medically appropriate
mixture; or
new text end
new text begin
(4) filling a medical gas via liquid to liquid into a final use container at the point of use.
new text end
Sec. 20.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29b. new text end
new text begin Medical gas wholesaler. new text end
new text begin
"Medical gas wholesaler" means any person who
sells a medical gas to another business or entity for the purpose of reselling or providing
that medical gas to the ultimate consumer or patient.
new text end
Sec. 21.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29c. new text end
new text begin Medical gas dispenser. new text end
new text begin
"Medical gas dispenser" means any person, other
than a licensed practitioner or pharmacy, who sells or provides a medical gas directly to the
ultimate consumer or patient via a valid prescription.
new text end
Sec. 22.
new text begin
[151.191] LICENSING MEDICAL GAS FACILITIES; FEES;
PROHIBITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Medical gas manufacturers; requirements. new text end
new text begin
(a) No person shall act as
a medical gas manufacturer without first obtaining a license from the board and paying any
applicable fee specified in section 151.065.
new text end
new text begin
(b) Application for a medical gas manufacturer license under this section must be made
in a manner specified by the board.
new text end
new text begin
(c) A license must not be issued or renewed for a medical gas manufacturer unless the
applicant agrees to operate in a manner prescribed by federal and state law and according
to Minnesota Rules.
new text end
new text begin
(d) A license must not be issued or renewed for a medical gas manufacturer that is
required to be licensed or registered by the state in which it is physically located unless the
applicant supplies the board with proof of licensure or registration. The board may establish
standards for the licensure of a medical gas manufacturer that is not required to be licensed
or registered by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate license for each facility located within the state at
which medical gas manufacturing occurs and for each facility located outside of the state
at which medical gases that are shipped into the state are manufactured.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed license for a medical gas manufacturing
facility, the board may require the facility to pass an inspection conducted by an authorized
representative of the board. In the case of a medical gas manufacturing facility located
outside of the state, the board may require the applicant to pay the cost of the inspection,
in addition to the license fee in section 151.065, unless the applicant furnishes the board
with a report, issued by the appropriate regulatory agency of the state in which the facility
is located, of an inspection that has occurred within the 24 months immediately preceding
receipt of the license application by the board. The board may deny licensure unless the
applicant submits documentation satisfactory to the board that any deficiencies noted in an
inspection report have been corrected.
new text end
new text begin
(g) A duly licensed medical gas manufacturing facility may also wholesale or dispense
any medical gas that is manufactured by the licensed facility, or manufactured or wholesaled
by another properly licensed medical gas facility, without also obtaining a medical gas
wholesaler license or medical gas dispenser registration.
new text end
new text begin
(h) The filling of a medical gas into a final use container, at the point of use and by liquid
to liquid transfer, is permitted as long as the facility used as the base of operations is duly
licensed as a medical gas manufacturer.
new text end
new text begin Subd. 2. new text end
new text begin Medical gas wholesalers; requirements. new text end
new text begin
(a) No person shall act as a medical
gas wholesaler without first obtaining a license from the board and paying any applicable
fee specified in section 151.065.
new text end
new text begin
(b) Application for a medical gas wholesaler license under this section must be made in
a manner specified by the board.
new text end
new text begin
(c) A license must not be issued or renewed for a medical gas wholesaler unless the
applicant agrees to operate in a manner prescribed by federal and state law and according
to Minnesota Rules.
new text end
new text begin
(d) A license must not be issued or renewed for a medical gas wholesaler that is required
to be licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of licensure or registration. The board may establish standards
for the licensure of a medical gas wholesaler that is not required to be licensed or registered
by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate license for each facility located within the state at
which medical gas wholesaling occurs and for each facility located outside of the state from
which medical gases that are shipped into the state are wholesaled.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed license for a medical gas wholesaling
facility, the board may require the facility to pass an inspection conducted by an authorized
representative of the board. In the case of a medical gas wholesaling facility located outside
of the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.
new text end
new text begin
(g) A duly licensed medical gas wholesaling facility may also dispense any medical gas
that is manufactured or wholesaled by another properly licensed medical gas facility.
new text end
new text begin Subd. 3. new text end
new text begin Medical gas dispensers; requirements. new text end
new text begin
(a) A person or establishment not
licensed as a pharmacy, practitioner, medical gas manufacturer, or medical gas dispenser
must not engage in the dispensing of medical gases without first obtaining a registration
from the board and paying the applicable fee specified in section 151.065. The registration
must be displayed in a conspicuous place in the business for which it is issued and expires
on the date set by the board.
new text end
new text begin
(b) Application for a medical gas dispenser registration under this section must be made
in a manner specified by the board.
new text end
new text begin
(c) A registration must not be issued or renewed for a medical gas dispenser located
within the state unless the applicant agrees to operate in a manner prescribed by federal and
state law and according to the rules adopted by the board. A license must not be issued for
a medical gas dispenser located outside of the state unless the applicant agrees to operate
in a manner prescribed by federal law and, when dispensing medical gases for residents of
this state, the laws of this state and Minnesota Rules.
new text end
new text begin
(d) A registration must not be issued or renewed for a medical gas dispenser that is
required to be licensed or registered by the state in which it is physically located unless the
applicant supplies the board with proof of the licensure or registration. The board may
establish standards for the registration of a medical gas dispenser that is not required to be
licensed or registered by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate registration for each medical gas dispenser located
within the state and for each facility located outside of the state from which medical gases
are dispensed to residents of this state.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed registration for a medical gas dispenser,
the board may require the medical gas dispenser to pass an inspection conducted by an
authorized representative of the board. In the case of a medical gas dispenser located outside
of the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.
new text end
new text begin
(g) A facility holding a medical gas dispenser registration must not engage in the
manufacturing or wholesaling of medical gases, except that a medical gas dispenser may
transfer medical gases from one of its duly registered facilities to other duly registered
medical gas manufacturing, wholesaling, or dispensing facilities owned or operated by that
same company, without requiring a medical gas wholesaler license.
new text end
Sec. 23. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes, the revisor of statutes shall recode as Minnesota Statutes, section
144E.28, subdivision 8a, the community emergency medical technician certification
requirements that are currently coded as Minnesota Statutes, section 144E.275, subdivision
7, and shall revise any necessary cross-references consistent with that recoding.
new text end
Sec. 24. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 144E.27, subdivisions 1 and 1a; and 151.19,
subdivision 3,
new text end
new text begin
are repealed.
new text end
ARTICLE 4
PRESCRIPTION DRUGS AND OPIATES
Section 1.
Minnesota Statutes 2020, section 16A.151, subdivision 2, is amended to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, against
one or more opioid manufacturers or opioid wholesale drug distributors new text begin or consulting firms
working for an opioid manufacturer or opioid wholesale drug distributor new text end related to alleged
violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids, must
be deposited in a separate account in the state treasury and the commissioner shall notify
the chairs and ranking minority members of the Finance Committee in the senate and the
Ways and Means Committee in the house of representatives that an account has been created.
new text begin Notwithstanding section 11A.20, all investment income and all investment losses attributable
to the investment of this account shall be credited to the account. new text end This paragraph does not
apply to attorney fees and costs awarded to the state or the Attorney General's Office, to
contract attorneys hired by the state or Attorney General's Office, or to other state agency
attorneys. If the licensing fees under section 151.065, subdivision 1, clause (16), and
subdivision 3, clause (14), are reduced and the registration fee under section 151.066,
subdivision 3, is repealed in accordance with section 256.043, subdivision 4, then the
commissioner shall transfer from the separate account created in this paragraph to the opiate
epidemic response fund under section 256.043 an amount that ensures that $20,940,000
each fiscal year is available for distribution in accordance with section 256.043, deleted text begin subdivisions
2 anddeleted text end new text begin subdivisionnew text end 3.
new text begin
(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or
an assurance of discontinuance entered into by the attorney general of the state or a court
order in litigation brought by the attorney general of the state on behalf of the state or a state
agency against a consulting firm working for an opioid manufacturer or opioid wholesale
drug distributor and deposited into the separate account created under paragraph (f), the
commissioner shall annually transfer from the separate account to the opiate epidemic
response fund under section 256.043 an amount equal to the estimated amount submitted
to the commissioner by the Board of Pharmacy in accordance with section 151.066,
subdivision 3, paragraph (b). The amount transferred shall be included in the amount available
for distribution in accordance with section 256.043, subdivision 3. This transfer shall occur
each year until the registration fee under section 151.066, subdivision 3, is repealed in
accordance with section 256.043, subdivision 4, or the money deposited in the account in
accordance with this paragraph has been transferred, whichever occurs first.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
new text begin
[62J.85] PRESCRIPTION DRUG MANUFACTURER IMPORTATION
PATHWAY PLAN.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Drug product" or "drug" means a prescription drug or biological product that is
intended for human use and regulated as a drug except where specific reference is made to
a drug approved under section 505 of the federal Food, Drug, and Cosmetic Act, United
States Code, title 21, section 355, or biological product approved under section 351 of the
federal Public Health Act, United States Code, title 42, section 262. Drug product or drug
does not include biological products that are intended for transfusions, including blood or
blood products; or allogeneic-, cellular-, or tissue-based products.
new text end
new text begin
(c) "FD&C Act" means the federal Food, Drug, and Cosmetic Act, United States Code,
title 21, section 301, et seq.
new text end
new text begin
(d) "Importation guidance" means the draft guidance released by the federal Food and
Drug Administration (FDA) titled "Importation of Certain FDA-Approved Human
Prescription Drugs, Including Biological Products, Under Section 801(d)(1)(B) of the Federal
Food, Drug, and Cosmetic Act; Draft Guidance for the Industry," which if finalized allows
for the importation of MMA products.
new text end
new text begin
(e) "Manufacturer" means the entity that is the holder of the New Drug Application or
Biologics License Application for the drug product.
new text end
new text begin
(f) "Multimarket-approved product" or "MMA product" means a FDA-approved drug
product that:
new text end
new text begin
(1) was manufactured outside the United States and authorized for marketing by another
country's regulatory authority;
new text end
new text begin
(2) is subject to a new drug application or biologics license application;
new text end
new text begin
(3) is imported into the United States and is authorized by the manufacturer to be
marketed in the United States; and
new text end
new text begin
(4) continues to meet the quality standards for marketing in its originally intended foreign
market.
new text end
new text begin Subd. 2. new text end
new text begin Application. new text end
new text begin
This section applies to any MMA product in which the
manufacturer of the product has obtained a new National Drug Code (NDC) for the MMA
product and has imported the MMA product in compliance with the FD&C Act and any
importation guidance finalized by the FDA.
new text end
new text begin Subd. 3. new text end
new text begin Incentives. new text end
new text begin
(a) In order to facilitate importation of drugs pursuant to importation
guidance finalized by the FDA, any MMA product offered for sale in Minnesota at a cost
that is at least 23 percent lower than the wholesale acquisition cost for the FDA-approved
product manufactured in the United States shall be:
new text end
new text begin
(1) included on the uniform preferred drug list and covered under the medical assistance
and MinnesotaCare programs; and
new text end
new text begin
(2) a covered drug under the state employee group insurance program pursuant to chapter
43A.
new text end
new text begin
(b) A health plan company must provide coverage for each MMA product that meets
the requirements in paragraph (a) if the manufacturer's FDA-approved drug product
manufactured in the United States is covered by the health plan company and the health
plan company must not impose any enrollee cost-sharing requirements for the covered
MMA product.
new text end
new text begin
(c) This subdivision shall not become effective for MMA products that are offered for
sale in Minnesota in accordance with paragraph (a) unless affirmative action is taken by
the legislature.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62W.11, is amended to read:
62W.11 GAG CLAUSE PROHIBITION.
(a) No contract between a pharmacy benefit manager or health carrier and a pharmacy
or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing
to an enrollee any health care information that the pharmacy or pharmacist deems appropriate
regarding the nature of treatment; the risks or alternatives; the availability of alternative
therapies, consultations, or tests; the decision of utilization reviewers or similar persons to
authorize or deny services; the process that is used to authorize or deny health care services
or benefits; or information on financial incentives and structures used by the health carrier
or pharmacy benefit manager.
(b) A pharmacy or pharmacist must provide to an enrollee information regarding the
enrollee's total cost for each prescription drug dispensed where part or all of the cost of the
prescription is being paid or reimbursed by the employer-sponsored plan or by a health
carrier or pharmacy benefit manager, in accordance with section 151.214, subdivision 1.
(c) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing information regarding the total cost for pharmacy services for a
prescription drug, including the patient's co-payment amount deleted text begin anddeleted text end new text begin ,new text end the pharmacy's own usual
and customary price deleted text begin ofdeleted text end new text begin fornew text end the prescriptionnew text begin drug, the pharmacy's acquisition cost for the
prescription drug, and the amount the pharmacy is being reimbursed by the pharmacy benefit
manager or health carrier for the prescription drugnew text end .
new text begin
(d) A pharmacy benefit manager must not prohibit a pharmacist or pharmacy from
discussing with a health carrier the amount the pharmacy is being paid or reimbursed for a
prescription drug by the pharmacy benefit manager or the pharmacy's acquisition cost for
a prescription drug.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing the availability of any therapeutically equivalent alternative
prescription drugs or alternative methods for purchasing the prescription drug, including
but not limited to paying out-of-pocket the pharmacy's usual and customary price when that
amount is less expensive to the enrollee than the amount the enrollee is required to pay for
the prescription drug under the enrollee's health plan.
Sec. 4.
Minnesota Statutes 2020, section 151.065, subdivision 1, is amended to read:
Subdivision 1.
Application fees.
Application fees for licensure and registration are as
follows:
(1) pharmacist licensed by examination, $175;
(2) pharmacist licensed by reciprocity, $275;
(3) pharmacy intern, $50;
(4) pharmacy technician, $50;
(5) pharmacy, $260;
(6) drug wholesaler, legend drugs only, $5,260;
(7) drug wholesaler, legend and nonlegend drugs, $5,260;
(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(9) drug wholesaler, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(10) third-party logistics provider, $260;
(11) drug manufacturer, nonopiate legend drugs only, $5,260;
(12) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(13) drug manufacturer, nonlegend or veterinary legend drugs, $5,260;
(14) drug manufacturer, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(16) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, $55,260;
(17) medical gas dispenser, $260;
(18) controlled substance researcher, $75; and
(19) pharmacy professional corporation, $150.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 151.065, subdivision 3, is amended to read:
Subd. 3.
Annual renewal fees.
Annual licensure and registration renewal fees are as
follows:
(1) pharmacist, $175;
(2) pharmacy technician, $50;
(3) pharmacy, $260;
(4) drug wholesaler, legend drugs only, $5,260;
(5) drug wholesaler, legend and nonlegend drugs, $5,260;
(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(7) drug wholesaler, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(8) third-party logistics provider, $260;
(9) drug manufacturer, nonopiate legend drugs only, $5,260;
(10) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $5,260;
(12) drug manufacturer, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(14) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, $55,260;
(15) medical gas dispenser, $260;
(16) controlled substance researcher, $75; and
(17) pharmacy professional corporation, $100.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2020, section 151.065, subdivision 7, is amended to read:
Subd. 7.
Deposit of fees.
(a) The license fees collected under this section, with the
exception of the fees identified in paragraphs (b) and (c), shall be deposited in the state
government special revenue fund.
(b) $5,000 of each fee collected under subdivision 1, clauses (6) to deleted text begin (9)deleted text end new text begin (8)new text end , deleted text begin anddeleted text end (11) to
new text begin (13), and new text end (15), and subdivision 3, clauses (4) to deleted text begin (7)deleted text end new text begin (6)new text end , deleted text begin anddeleted text end (9) to new text begin (11), and new text end (13), and $55,000
of each fee collected under subdivision 1, clause (16), and subdivision 3, clause (14), shall
be deposited in the opiate epidemic response fund established in section 256.043.
(c) If the fees collected under subdivision 1, clause (16), or subdivision 3, clause (14),
are reduced under section 256.043, $5,000 of the reduced fee shall be deposited in the opiate
epidemic response fund in section 256.043.
Sec. 7.
Minnesota Statutes 2020, section 151.066, subdivision 3, is amended to read:
Subd. 3.
Determination of an opiate product registration fee.
(a) The board shall
annually assess an opiate product registration fee on any manufacturer of an opiate that
annually sells, delivers, or distributes an opiate within or into the state 2,000,000 or more
units as reported to the board under subdivision 2.
(b) new text begin For purposes of assessing the annual registration fee under this section and
determining the number of opiate units a manufacturer sold, delivered, or distributed within
or into the state, the board shall not consider any opiate that is used for medication-assisted
therapy for substance use disorders. If there is money deposited into the separate account
as described in section 16A.151, subdivision 2, paragraph (g), the board shall submit to the
commissioner of management and budget an estimate of the difference in the annual fee
revenue collected under this section due to this exception.
new text end
new text begin (c) new text end The annual registration fee for each manufacturer meeting the requirement under
paragraph (a) is $250,000.
deleted text begin (c)deleted text end new text begin (d)new text end In conjunction with the data reported under this section, and notwithstanding
section 152.126, subdivision 6, the board may use the data reported under section 152.126,
subdivision 4, to determine which manufacturers meet the requirement under paragraph (a)
and are required to pay the registration fees under this subdivision.
deleted text begin (d)deleted text end new text begin (e)new text end By April 1 of each year, beginning April 1, 2020, the board shall notify a
manufacturer that the manufacturer meets the requirement in paragraph (a) and is required
to pay the annual registration fee in accordance with section 151.252, subdivision 1,
paragraph (b).
deleted text begin (e)deleted text end new text begin (f)new text end A manufacturer may dispute the board's determination that the manufacturer must
pay the registration fee no later than 30 days after the date of notification. However, the
manufacturer must still remit the fee as required by section 151.252, subdivision 1, paragraph
(b). The dispute must be filed with the board in the manner and using the forms specified
by the board. A manufacturer must submit, with the required forms, data satisfactory to the
board that demonstrates that the assessment of the registration fee was incorrect. The board
must make a decision concerning a dispute no later than 60 days after receiving the required
dispute forms. If the board determines that the manufacturer has satisfactorily demonstrated
that the fee was incorrectly assessed, the board must refund the amount paid in error.
deleted text begin (f)deleted text end new text begin (g)new text end For purposes of this subdivision, a unit means the individual dosage form of the
particular drug product that is prescribed to the patient. One unit equals one tablet, capsule,
patch, syringe, milliliter, or gram.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 151.555, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility registered under chapter 144D where there is centralized
storage of drugs and 24-hour on-site licensed nursing coverage provided seven days a week;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donationnew text begin ; or any over-the-counter
medication that meets the criteria established under this section for donationnew text end . This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription and nonprescription medical
supplies needed to administer a prescription drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2020, section 151.555, subdivision 7, is amended to read:
Subd. 7.
Standards and procedures for inspecting and storing donated prescription
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
prescription drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory. deleted text begin If
donated drugs or supplies are not inspected immediately upon receipt, a repository must
quarantine the donated drugs or supplies separately from all dispensing stock until the
donated drugs or supplies have been inspected and (1) approved for dispensing under the
program; (2) disposed of pursuant to paragraph (c); or (3) returned to the donor pursuant to
paragraph (d).
deleted text end
(c) The central repository and local repositories shall dispose of all prescription drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or prescription drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least deleted text begin fivedeleted text end new text begin twonew text end years. For each drug or supply
destroyed, the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 151.555, subdivision 11, is amended to read:
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) drug repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) drug repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated prescription
drugs and medical supplies, must be maintained by a repository for a minimum of deleted text begin fivedeleted text end new text begin twonew text end
years. Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the drug repository program from all local repositories shall be
submitted quarterly or upon request to the central repository. Data collected may consist of
the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 151.555, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Cooperation. new text end
new text begin
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256.043, subdivision 3, is amended to read:
Subd. 3.
Appropriations from fund.
(a) After the appropriations in Laws 2019, chapter
63, article 3, section 1, paragraphs (e)deleted text begin ,deleted text end new text begin andnew text end (f), deleted text begin (g), and (h)deleted text end are made, $249,000 is appropriated
to the commissioner of human services for the provision of administrative services to the
Opiate Epidemic Response Advisory Council and for the administration of the grants awarded
under paragraph (e).
(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.
(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
(d) After the appropriations in paragraphs (a) to (c) are made, 50 percent of the remaining
amount is appropriated to the commissioner of human services for distribution to county
social service and tribal social service agencies to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to counties and tribal social service agencies based on out-of-home
placement episodes where parental drug abuse is the primary reason for the out-of-home
placement using data from the previous calendar year. County and tribal social service
agencies receiving funds from the opiate epidemic response fund must annually report to
the commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and tribal social service agencies must not use funds received under this paragraph to supplant
current state or local funding received for child protection services for children and families
who are affected by addiction.
(e) After making the appropriations in paragraphs (a) to (d), the remaining amount in
the fund is appropriated to the commissioner to award grants as specified by the Opiate
Epidemic Response Advisory Council in accordance with section 256.042, unless otherwise
appropriated by the legislature.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 13. new text begin OPIATE REGISTRATION FEE REDUCTION.
new text end
new text begin
(a) For purposes of assessing the opiate registration fee under Minnesota Statutes, section
151.066, subdivision 3, that is required to be paid on June 1, 2021, in accordance with
Minnesota Statutes, section 151.252, subdivision 1, paragraph (b), the Board of Pharmacy
shall not consider any injectable opiate product distributed to a hospital or hospital pharmacy.
If there is money deposited into the separate account as described in Minnesota Statutes,
section 16A.151, subdivision 2, paragraph (g), the board shall submit to the commissioner
of management and budget an estimate of the difference in the annual opiate registration
fee revenue collected under Minnesota Statutes, section 151.066, due to the exception
described in this paragraph.
new text end
new text begin
(b) Any estimated loss to the opiate registration fee revenue attributable to paragraph
(a) must be included in any transfer that occurs under Minnesota Statutes, section 16A.151,
subdivision 2, paragraph (g), in calendar year 2021.
new text end
new text begin
(c) If a manufacturer has already paid the opiate registration fee due on June 1, 2021,
the Board of Pharmacy shall return the amount of the fee to the manufacturer if the
manufacturer would not have been required to pay the fee after the calculations described
in paragraph (a) were made.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 5
HEALTH COVERAGE AND TRANSPARENCY
Section 1.
Minnesota Statutes 2020, section 62J.81, subdivision 1, is amended to read:
Subdivision 1.
Required disclosure by provider.
(a) A health care provider, as defined
in section 62J.03, subdivision 8, or the provider's designee as agreed to by that designee,
shall, at the request of a consumer, and at no cost to the consumer or the consumer's
employer, provide that consumer with a good faith estimate of the allowable payment the
provider has agreed to accept from the consumer's health plan company for the services
specified by the consumer, specifying the amount of the allowable payment due from the
health plan company. If a consumer has no applicable public or private coverage, the health
care provider must give the consumer, and at no cost to the consumer, a good faith estimate
of the average allowable reimbursement the provider accepts as payment from private
third-party payers for the services specified by the consumer and the estimated amount the
noncovered consumer will be required to pay.
(b) In addition to the information required to be disclosed under paragraph (a), a provider
must also provide the consumer with information regarding other types of fees or charges
that the consumer may be required to pay in conjunction with a visit to the provider, including
but not limited to any applicable facility fees.
(c) new text begin For a consumer with health plan coverage, new text end the information required under this
subdivision must be provided to deleted text begin adeleted text end new text begin thenew text end consumer within deleted text begin tendeleted text end new text begin fivenew text end business days from the day
new text begin that new text end a complete request was received by the health care provider. deleted text begin For purposes of this section,
"complete request" includes all the patient and service information the health care provider
requires to provide a good faith estimate, including a completed good faith estimate form
if required by the health care provider.deleted text end new text begin For a consumer with no applicable public or private
coverage, the information required by this subdivision must be provided to the consumer
within three business days from the day that a complete request was received by the health
care provider.
new text end
(d) Payment information provided by a provider, or by the provider's designee as agreed
to by that designee, to a patient pursuant to this subdivision does not constitute a legally
binding estimate of the allowable charge for or cost to the consumer of services.
(e) No contract between a health plan company and a provider shall prohibit a provider
from disclosing the pricing information required under this subdivision.
new text begin
(f) For purposes of this subdivision, "complete request" includes all of the patient and
service information that the health care provider requires to provide a good faith estimate,
including a completed good faith estimate form, if required by the health care provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62J.81, subdivision 1a, is amended to read:
Subd. 1a.
Required disclosure by health plan company.
(a) A health plan company,
as defined in section 62J.03, subdivision 10, shall, at the request of an enrollee intending
to receive specific health care services or the enrollee's designee, provide that enrollee with
a good faith estimate of the allowable amount the health plan company has contracted for
with a specified provider within the network as total payment for a health care service
specified by the enrollee and the portion of the allowable amount due from the enrollee and
the enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph
is not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.
(b) The information required under this subdivision must be provided by the health plan
company to an enrollee within deleted text begin tendeleted text end new text begin fivenew text end business days from the day a complete request was
received by the health plan company.
new text begin (c) new text end For purposes of this deleted text begin sectiondeleted text end new text begin subdivisionnew text end , "complete request" includes all the patient
and service information the health plan company requires to provide a good faith estimate,
including a completed good faith estimate form if required by the health plan company.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 3.
new text begin
[62Q.097] REQUIREMENTS FOR TIMELY PROVIDER CREDENTIALING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "Clean application for provider credentialing" or "clean application" means an
application for provider credentialing submitted by a health care provider to a health plan
company that is complete, is in the format required by the health plan company, and includes
all information and substantiation required by the health plan company and does not require
evaluation of any identified potential quality or safety concern.
new text end
new text begin
(c) "Provider credentialing" means the process undertaken by a health plan company to
evaluate and approve a health care provider's education, training, residency, licenses,
certifications, and history of significant quality or safety concerns in order to approve the
health care provider to provide health care services to patients at a clinic or facility.
new text end
new text begin Subd. 2. new text end
new text begin Time limit for credentialing determination. new text end
new text begin
A health plan company that
receives an application for provider credentialing must:
new text end
new text begin
(1) if the application is determined to be a clean application for provider credentialing
and if the health care provider submitting the application or the clinic or facility at which
the health care provider provides services requests the information, affirm that the health
care provider's application is a clean application and notify the health care provider or clinic
or facility of the date by which the health plan company will make a determination on the
health care provider's application;
new text end
new text begin
(2) if the application is determined not to be a clean application, inform the health care
provider of the application's deficiencies or missing information or substantiation within
three business days after the health plan company determines the application is not a clean
application; and
new text end
new text begin
(3) make a determination on the health care provider's clean application within 45 days
after receiving the clean application unless the health plan company identifies a substantive
quality or safety concern in the course of provider credentialing that requires further
investigation. Upon notice to the health care provider, clinic, or facility, the health plan
company is allowed 30 additional days to investigate any quality or safety concerns.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section applies to applications for provider credentialing
submitted to a health plan company on or after January 1, 2022.
new text end
Sec. 4.
new text begin
[62Q.524] DISCLOSURE OF APPLICATION OF FUNDS FROM A PATIENT
ASSISTANCE PROGRAM TO A DEDUCTIBLE.
new text end
new text begin
A health plan company must include in the summary of benefits and coverage a statement
indicating whether funds from a patient assistance program, as defined in section 62J.84,
subdivision 2, paragraph (h), are applied by the health plan company to an enrollee's
deductible.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
ARTICLE 6
DHS LICENSING AND BACKGROUND STUDIES
Section 1.
Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Background study required. new text end
new text begin
(a) The board must initiate background studies
under section 245C.03 of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The board may initiate the background studies required by paragraph (a) using the
online NETStudy 2.0 system operated by the commissioner of human services.
new text end
new text begin
(c) The board shall not permit any individual to provide any service or function listed
in paragraph (a) until the board has received notification from the commissioner of human
services indicating that the individual:
new text end
new text begin
(1) is not disqualified under chapter 245C; or
new text end
new text begin
(2) is disqualified, but has received a set aside from the board of that disqualification
according to sections 245C.22 and 245C.23.
new text end
new text begin
(d) The board or its delegate shall review a reconsideration request of an individual in
paragraph (a), including granting a set aside, according to the procedures and criteria in
chapter 245C. The board shall notify the individual and the Department of Human Services
of the board's decision.
new text end
Sec. 2.
new text begin
[119B.27] OMBUDSPERSON FOR CHILD CARE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Appointment. new text end
new text begin
The commissioner of human services shall appoint two
ombudspersons in the classified service to assist child care providers, including family child
care providers and legal nonlicensed child care providers, with licensing, compliance, and
other issues facing child care providers. Each ombudsperson must be selected without regard
to the person's political affiliation, and at least one ombudsperson must have been a licensed
family child care provider for at least three years. Each ombudsperson shall serve a term of
four years and may be removed prior to the end of the term for just cause.
new text end
new text begin Subd. 2. new text end
new text begin Duties. new text end
new text begin
(a) Each ombudsperson's duties shall include:
new text end
new text begin
(1) advocating on behalf of a child care provider to address all areas of concern related
to the provision of child care services, including licensing actions, correction orders, penalty
assessments, complaint investigations, and other interactions with state and county staff;
new text end
new text begin
(2) providing recommendations to the commissioner or providers for child care program
improvement or child care provider education;
new text end
new text begin
(3) operating a telephone line to answer questions, receive complaints, and discuss
agency actions when a child care provider believes that the provider's rights or program
may have been adversely affected; and
new text end
new text begin
(4) assisting child care license applicants with the license application process.
new text end
new text begin
(b) The ombudspersons must report annually by December 31 to the commissioner and
the chairs and ranking minority members of the legislative committees with jurisdiction
over child care on the services provided by each ombudsperson to child care providers,
including the number, types, and locations of child care providers served, and the activities
of each ombudsperson to carry out the duties under this section. The commissioner shall
determine the form of the report.
new text end
new text begin Subd. 3. new text end
new text begin Staff. new text end
new text begin
The ombudspersons may appoint and compensate from available funds
a deputy, confidential secretary, and other employees in the unclassified service as authorized
by law. Each ombudsperson and the full-time staff are members of the Minnesota State
Retirement Association. The ombudspersons may delegate to members of the staff any
authority or duties of the office except the duty to provide reports to the governor,
commissioner, or legislature.
new text end
new text begin Subd. 4. new text end
new text begin Access to records. new text end
new text begin
(a) Each ombudsperson or designee, excluding volunteers,
must have access to data of a state agency necessary for the discharge of the ombudsperson's
duties, including records classified as confidential data on individuals or private data on
individuals under chapter 13, or any other law. An ombudsperson's data request must relate
to a specific case. If the data concerns an individual, the ombudsperson or designee shall
first obtain the individual's consent. If the individual cannot consent and has no parent or
legal guardian, then the ombudsperson's access to the data is authorized by this section.
new text end
new text begin
(b) Each ombudsperson and all designees must adhere to the Minnesota Government
Data Practices Act and may not disseminate any private or confidential data on individuals
unless specifically authorized by state, local, or federal law or pursuant to a court order.
new text end
new text begin
(c) The commissioner of human services and county agencies must provide
ombudspersons with copies of all correction orders, fix-it tickets, and licensing actions
issued to child care providers.
new text end
new text begin Subd. 5. new text end
new text begin Independence of action. new text end
new text begin
When carrying out duties under this section,
ombudspersons must act independently of the department to provide testimony to the
legislature, make periodic reports to the legislature, and address areas of concern to child
care providers.
new text end
new text begin Subd. 6. new text end
new text begin Civil actions. new text end
new text begin
Each ombudsperson and designee is not civilly liable for any
action taken under this section if the action was taken in good faith, was within the scope
of the ombudsperson's authority, and did not constitute willful or reckless misconduct.
new text end
new text begin Subd. 7. new text end
new text begin Qualifications. new text end
new text begin
Each ombudsperson must be a person who has knowledge and
experience concerning the provision of child care. Each ombudsperson must be experienced
in dealing with governmental entities, interpretation of laws and regulations, investigations,
record keeping, report writing, public speaking, and management. A person is not eligible
to serve as an ombudsperson while running for or holding public office, or while holding
an active child care license.
new text end
new text begin Subd. 8. new text end
new text begin Office support. new text end
new text begin
The commissioner shall provide ombudspersons with the
necessary office space, supplies, equipment, and clerical support to effectively perform
duties under this section.
new text end
new text begin Subd. 9. new text end
new text begin Posting. new text end
new text begin
(a) The commissioner shall post on the department's website the
mailing address, e-mail address, and telephone number for the office of the ombudsperson.
The commissioner shall provide all licensed child care providers and legal nonlicensed child
care providers with the mailing address, e-mail address, and telephone number of the office
on the department's child care licensing website or upon request from a child care license
applicant or provider. Counties must provide child care license applicants and providers
with the name, mailing address, e-mail address, and telephone number of the office.
new text end
new text begin
(b) Ombudspersons must approve of all posting and notice required by the department
and counties under this subdivision.
new text end
Sec. 3.
Minnesota Statutes 2020, section 122A.18, subdivision 8, is amended to read:
Subd. 8.
Background deleted text begin checksdeleted text end new text begin studiesnew text end .
(a) The Professional Educator Licensing and
Standards Board and the Board of School Administrators must deleted text begin obtain adeleted text end new text begin initiatenew text end criminal
history background deleted text begin check ondeleted text end new text begin studies ofnew text end all first-time deleted text begin teachingdeleted text end applicants for new text begin educator new text end licenses
under their jurisdiction. Applicants must include with their licensure applications:
(1) an executed criminal history consent form, including fingerprints; and
(2) payment to conduct the background deleted text begin checkdeleted text end new text begin studynew text end . The Professional Educator Licensing
and Standards Board must deposit payments received under this subdivision in an account
in the special revenue fund. Amounts in the account are annually appropriated to the
Professional Educator Licensing and Standards Board to pay for the costs of background
deleted text begin checksdeleted text end new text begin studiesnew text end on applicants for licensure.
(b) The background deleted text begin checkdeleted text end new text begin studynew text end for all first-time teaching applicants for licenses must
include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository. The superintendent of the Bureau of Criminal
Apprehension is authorized to exchange fingerprints with the Federal Bureau of Investigation
for purposes of the criminal history check. deleted text begin The superintendent shall recover the cost to the
bureau of a deleted text end deleted text begin background check through the fee charged to the applicant under paragraph (a).
deleted text end
(c) The Professional Educator Licensing and Standards Board deleted text begin must contract withdeleted text end new text begin may
initiate criminal history background studies throughnew text end the commissioner of human services
new text begin according to section 245C.03 new text end to deleted text begin conduct background checks anddeleted text end obtain background deleted text begin checkdeleted text end
new text begin studynew text end data required under this chapter.
Sec. 4.
Minnesota Statutes 2020, section 144.057, subdivision 1, is amended to read:
Subdivision 1.
Background studies required.
new text begin (a) Except as specified in paragraph (b),
new text end the commissioner of health shall contract with the commissioner of human services to
conduct background studies of:
(1) individuals providing services that have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; assisted living facilities and assisted living
facilities with dementia care licensed under chapter 144G; and board and lodging
establishments that are registered to provide supportive or health supervision services under
section 157.17;
(2) individuals specified in section 245C.03, subdivision 1, who perform direct contact
services in a nursing home or a home care agency licensed under chapter 144A; an assisted
living facility or assisted living facility with dementia care licensed under chapter 144G;
or a boarding care home licensed under sections 144.50 to 144.58. If the individual under
study resides outside Minnesota, the study must include a check for substantiated findings
of maltreatment of adults and children in the individual's state of residence when the
information is made available by that state, and must include a check of the National Crime
Information Center database;
(3) all other employees in assisted living facilities or assisted living facilities with
dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A,
and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual from positions allowing direct
contact or access to patients or residents receiving services. "Access" means physical access
to a client or the client's personal property without continuous, direct supervision as defined
in section 245C.02, subdivision 8, when the employee's employment responsibilities do not
include providing direct contact services;
(4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities; and
(5) controlling persons of a supplemental nursing services agency, as defined under
section 144A.70.
new text begin
(b) The commissioner of human services is not required to conduct a background study
on any individual identified in paragraph (a) if the individual has a valid license issued by
a health-related licensing board as defined in section 214.01, subdivision 2, and has completed
the criminal background check as required in section 214.075.
new text end
new text begin (c) new text end If a facility or program is licensed by the Department of Human Services and subject
to the background study provisions of chapter 245C and is also licensed by the Department
of Health, the Department of Human Services is solely responsible for the background
studies of individuals in the jointly licensed programs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Family or group family child care program. new text end
new text begin
"Family or group family child
care program" means a licensed child care program operated in the residence in which the
license holder lives. The license holder is the primary provider of care and may only hold
one family child care license.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 24. new text end
new text begin Special family child care program. new text end
new text begin
"Special family child care program"
means a licensed child care program operated in a residence in which the license holder
does not live. The license holder is the primary provider of care.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 25. new text end
new text begin Nonresidential family child care program. new text end
new text begin
"Nonresidential family child
care program" means a licensed child care program operated in a location other than the
license holder's own residence, excluding licensed child care centers. The license holder is
one of the individuals or entities listed in section 245A.141, subdivision 1, paragraph (a).
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.03, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin
Group family day care licensed capacity; child-to-adult capacity ratios;
age distribution restrictions.
new text end
new text begin
(a) Notwithstanding Minnesota Rules, parts 9502.0365,
subpart 1, and 9502.0367, item C, the commissioner shall issue licenses for group family
day care according to the capacity limits, child-to-adult ratios, and age distribution restrictions
in this subdivision.
new text end
new text begin
(b) For purposes of this subdivision, "group family day care" means day care for no
more than 16 children at any one time. The licensed capacity of a group family day care
must include all children of any caregiver when the children are present in the residence,
except notwithstanding Minnesota Rules, part 9502.0365, subpart 1, item A, the licensed
capacity does not include the license holder's biological or adopted children who are nine
years old or older.
new text end
new text begin
(c) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (1), for a group
family day care program with a licensed capacity of ten children, one adult caregiver shall
serve no more than ten children younger than 11 years of age. Of those ten, no more than
seven may be younger than four years of age. Of those seven, no more than three may be
younger than 18 months of age. Of those three, no more than two may be infants.
new text end
new text begin
(d) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (2), for a group
family day care program with a licensed capacity of 12 children, one adult caregiver shall
serve no more than 12 children younger than 11 years of age. Of those 12, no more than
nine may be younger than four years of age. Of those nine, no more than two may be younger
than 18 months of age.
new text end
new text begin
(e) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (3), for a group
family day care program with a licensed capacity of 16 children, two adult caregivers shall
serve no more than 16 children younger than 11 years of age. Of those 16, no more than 11
may be younger than four years of age. Of those 11, no more than four may be younger
than 18 months of age. Of those four, no more than three may be infants. A helper may be
used in place of a second adult caregiver when there is no more than one child younger than
18 months of age present.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.043, subdivision 3, is amended to read:
Subd. 3.
Change of ownership process.
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. deleted text begin A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
deleted text end
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
Sec. 10.
Minnesota Statutes 2020, section 245A.05, is amended to read:
245A.05 DENIAL OF APPLICATION.
(a) The commissioner may deny a license if an applicant or controlling individual:
(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;
(2) fails to comply with applicable laws or rules;
(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;
(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;
(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;
(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted;
(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g);
(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
(9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C; deleted text begin or
deleted text end
(10) is prohibited from holding a license according to section 245.095deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(11) for a family foster setting, has nondisqualifying background study information, as
described in section 245C.05, subdivision 4, that reflects on the individual's ability to safely
provide care to foster children.
new text end
(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail or personal service. The notice must state the reasons the
application was denied and must inform the applicant of the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The applicant may
appeal the denial by notifying the commissioner in writing by certified mail or personal
service. If mailed, the appeal must be postmarked and sent to the commissioner within 20
calendar days after the applicant received the notice of denial. If an appeal request is made
by personal service, it must be received by the commissioner within 20 calendar days after
the applicant received the notice of denial. Section 245A.08 applies to hearings held to
appeal the commissioner's denial of an application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 11.
Minnesota Statutes 2020, section 245A.07, subdivision 1, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rulenew text begin , or who has nondisqualifying background
study information, as described in section 245C.05, subdivision 4, that reflects on the license
holder's ability to safely provide care to foster childrennew text end . When applying sanctions authorized
under this section, the commissioner shall consider the nature, chronicity, or severity of the
violation of law or rule and the effect of the violation on the health, safety, or rights of
persons served by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. If a license holder fails to comply with
applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license issued under this chapter is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.
(d) Failure to reapply or closure of a license issued under this chapter by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this section or section 245A.06 at the conclusion
of the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 12.
Minnesota Statutes 2020, section 245A.08, subdivision 4, is amended to read:
Subd. 4.
Recommendation new text begin or decision new text end of administrative law judge.
new text begin (a) Except as
provided in paragraph (b), new text end the administrative law judge shall recommend whether or not
the commissioner's order should be affirmed. The recommendations must be consistent with
this chapter and the rules of the commissioner. The recommendations must be in writing
and accompanied by findings of fact and conclusions and must be mailed to the parties by
certified mail to their last known addresses as shown on the license or application.
new text begin
(b) Following a hearing relating to the license of a family child care provider or group
family child care provider, the administrative law judge shall decide whether the
commissioner's order should be affirmed. The decision of the administrative law judge is
binding on both parties to the proceeding and is the final decision of the commissioner. The
decision of the administrative law judge must be:
new text end
new text begin
(1) consistent with this chapter and the applicable licensing rules;
new text end
new text begin
(2) in writing and accompanied by findings of fact and conclusions of law;
new text end
new text begin
(3) mailed to the family child care provider or group family child care provider by
certified mail to the last known address shown on the license or application, or, if service
by certified mail is waived by the provider, served in accordance with Minnesota Rules,
part 1400.8610; and
new text end
new text begin
(4) served in accordance with Minnesota Rules, part 1400.8610, on the Department of
Human Services and any other party.
new text end
new text begin
Any person aggrieved by a final decision under this paragraph is entitled to seek judicial
review of the decision under the provisions of sections 14.63 to 14.68.
new text end
Sec. 13.
Minnesota Statutes 2020, section 245A.08, subdivision 5, is amended to read:
Subd. 5.
Notice of commissioner's final order.
After considering the findings of fact,
conclusions, and recommendations of the administrative law judge, the commissioner shall
issue a final order. The commissioner shall consider, but shall not be bound by, the
recommendations of the administrative law judge. The appellant must be notified of the
commissioner's final order as required by chapter 14 and Minnesota Rules, parts 1400.8505
to 1400.8612. The notice must also contain information about the appellant's rights under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The institution of
proceedings for judicial review of the commissioner's final order shall not stay the
enforcement of the final order except as provided in section 14.65.new text begin This subdivision does
not apply to hearings relating to the license of a family child care provider or group family
child care provider.
new text end
Sec. 14.
Minnesota Statutes 2020, section 245A.14, subdivision 1, is amended to read:
Subdivision 1.
Permitted single-family residential use.
A licensed nonresidential
program with a licensed capacity of 12 or fewer persons and a group family day care facility
licensed under Minnesota Rules, parts 9502.0315 to 9502.0445, to serve deleted text begin 14deleted text end new text begin 16new text end or fewer
children shall be considered a permitted single-family residential use of property for the
purposes of zoning and other land use regulations.
Sec. 15.
Minnesota Statutes 2020, section 245A.14, subdivision 4, is amended to read:
Subd. 4.
Special family deleted text begin daydeleted text end new text begin childnew text end care homes.
new text begin (a) new text end deleted text begin Nonresidential childdeleted text end new text begin Childnew text end care
programs serving deleted text begin 14deleted text end new text begin 16new text end or fewer children that are conducted at a location other than the
license holder's own residence shall be licensed under this section and the rules governing
family day care or group family day care ifdeleted text begin :
deleted text end
deleted text begin (a)deleted text end the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwellingnew text begin other than the license holder's own residencenew text end that is
located on a residential lotdeleted text begin ;deleted text end new text begin .
new text end
deleted text begin
(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
deleted text end
deleted text begin
(c) the license holder is a church or religious organization;
deleted text end
deleted text begin
(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
deleted text end
deleted text begin
(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
deleted text end
deleted text begin
(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;
deleted text end
deleted text begin
(2) the program meets a one to seven staff-to-child ratio during the variance period;
deleted text end
deleted text begin
(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;
deleted text end
deleted text begin
(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
deleted text end
deleted text begin
(5) the program is in compliance with local zoning regulations;
deleted text end
deleted text begin
(6) the program is in compliance with the applicable fire code as follows:
deleted text end
deleted text begin
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
deleted text end
deleted text begin
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code 2015,
Section 202, unless the rooms in which the children are cared for are located on a level of
exit discharge and each of these child care rooms has an exit door directly to the exterior,
then the applicable fire code is Group E occupancies, as provided in the Minnesota State
Fire Code 2015, Section 202; and
deleted text end
deleted text begin
(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
deleted text end
deleted text begin
(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
deleted text end
deleted text begin
(1) the program is in compliance with local zoning regulations;
deleted text end
deleted text begin
(2) the program is in compliance with the applicable fire code as follows:
deleted text end
deleted text begin
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
deleted text end
deleted text begin
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code 2015,
Section 202;
deleted text end
deleted text begin
(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
deleted text end
deleted text begin
(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."
deleted text end
deleted text begin
(g) The commissioner may approve two or more licenses under paragraphs (a) to (f) to
be issued at the same location or under one contiguous roof, if each license holder is able
to demonstrate compliance with all applicable rules and laws. Each license holder must
operate the license holder's respective licensed program as a distinct program and within
the capacity, age, and ratio distributions of each license.
deleted text end
deleted text begin (h)deleted text end new text begin (b)new text end The commissioner may grant variances to this section to allow a primary provider
of caredeleted text begin , a not-for-profit organization, a church or religious organization, an employer, or a
community collaborativedeleted text end to be licensed to provide child care under deleted text begin paragraphs (e) and (f)deleted text end
new text begin section 245A.141, subdivision 1, paragraph (a), clauses (4) and (5), new text end if the license holder
meets the other requirements of the statute.
Sec. 16.
new text begin
[245A.141] NONRESIDENTIAL FAMILY CHILD CARE PROGRAM
LICENSING.
new text end
new text begin Subdivision 1. new text end
new text begin Nonresidential family child care programs. new text end
new text begin
(a) The following child
care programs serving 16 or fewer children that are conducted at a location other than the
license holder's own residence shall be licensed under this section:
new text end
new text begin
(1) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
new text end
new text begin
(2) the license holder is a church or religious organization;
new text end
new text begin
(3) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
new text end
new text begin
(4) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 16 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
new text end
new text begin
(i) the program does not exceed a capacity of 16 children more than a cumulative total
of four hours per day;
new text end
new text begin
(ii) the program meets a one-to-eight staff-to-child ratio during the variance period;
new text end
new text begin
(iii) all employees receive at least an extra four hours of training per year than are required
in the rules governing family child care each year;
new text end
new text begin
(iv) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
new text end
new text begin
(v) the program is in compliance with local zoning regulations;
new text end
new text begin
(vi) the program is in compliance with the applicable fire code as follows:
new text end
new text begin
(A) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or younger, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
new text end
new text begin
(B) if the program serves more than five children 2-1/2 years of age or younger, the
applicable fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code
2015, Section 202, unless the rooms in which the children are cared for are located on a
level of exit discharge and each of these child care rooms has an exit door directly to the
exterior, then the applicable fire code is Group E Occupancies, as provided in the Minnesota
State Fire Code 2015, Section 202; and
new text end
new text begin
(vii) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
new text end
new text begin
(5) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
new text end
new text begin
(i) the program is in compliance with local zoning regulations;
new text end
new text begin
(ii) the program is in compliance with the applicable fire code as follows:
new text end
new text begin
(A) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or younger, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
new text end
new text begin
(B) if the program serves more than five children 2-1/2 years of age or younger, the
applicable fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire
Code 2015, Section 202;
new text end
new text begin
(iii) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
new text end
new text begin
(iv) the license holder prominently displays the license issued by the commissioner that
contains the statement "This special family child care provider is not licensed as a child
care center."
new text end
new text begin
(b) Programs licensed under this section shall be subject to the rules governing family
day care or group family day care.
new text end
new text begin
(c) Programs licensed under this section shall be monitored by county licensing agencies
under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Multiple license approval. new text end
new text begin
The commissioner may approve up to four licenses
under subdivision 1, paragraph (a), clause (1) or (2), to be issued at the same location or
under one contiguous roof, if each license holder is able to demonstrate compliance with
all applicable rules and laws. Each license holder must operate the license holder's respective
licensed program as a distinct program and within the capacity, age, and ratio distributions
of each license.
new text end
new text begin Subd. 3. new text end
new text begin Variances. new text end
new text begin
The commissioner may grant variances to this section to allow a
primary provider of care, a not-for-profit organization, a church or religious organization,
an employer, or a community collaborative to be licensed to provide child care under
subdivision 1, paragraph (a), clauses (4) and (5), if the license holder meets the other
requirements of the statute.
new text end
Sec. 17.
Minnesota Statutes 2020, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours;
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder; and
(8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in care.
Except as provided in section deleted text begin 245A.14, subdivision 4, paragraph (e)deleted text end new text begin 245A.141, subdivision
1, paragraph (a), clause (4)new text end , a county agency must not grant a license holder a variance to
exceed the maximum allowable family child care license capacity of deleted text begin 14deleted text end new text begin 16new text end children.
(b) A county agency that has been designated by the commissioner to issue family child
care variances must:
(1) publish the county agency's policies and criteria for issuing variances on the county's
public website and update the policies as necessary; and
(2) annually distribute the county agency's policies and criteria for issuing variances to
all family child care license holders in the county.
(c) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
(d) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.
(e) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(f) A license issued under this section may be issued for up to two years.
(g) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(h) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
(i) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued;
(2) any death, serious injury, or determination of substantiated maltreatment; and
(3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the state fire marshal within two
business days of receiving notice from a licensed family child care provider.
new text begin
(j) A county agency must forward all communications from the Department of Human
Services about family child care to family child care providers in the county. Additional
comments by the county agency may be included if labeled as county agency comments.
new text end
Sec. 18.
Minnesota Statutes 2020, section 245A.16, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Licensed family foster settings. new text end
new text begin
(a) Before recommending to grant a license,
deny a license under section 245A.05, or revoke a license under section 245A.07 for
nondisqualifying background study information received under section 245C.05, subdivision
4, paragraph (a), clause (3), for a licensed family foster setting, a county agency or private
agency that has been designated or licensed by the commissioner must review the following:
new text end
new text begin
(1) the type of offenses;
new text end
new text begin
(2) the number of offenses;
new text end
new text begin
(3) the nature of the offenses;
new text end
new text begin
(4) the age of the individual at the time of the offenses;
new text end
new text begin
(5) the length of time that has elapsed since the last offense;
new text end
new text begin
(6) the relationship of the offenses and the capacity to care for a child;
new text end
new text begin
(7) evidence of rehabilitation;
new text end
new text begin
(8) information or knowledge from community members regarding the individual's
capacity to provide foster care;
new text end
new text begin
(9) any available information regarding child maltreatment reports or child in need of
protection or services petitions, or related cases, in which the individual has been involved
or implicated, and documentation that the individual has remedied issues or conditions
identified in child protection or court records that are relevant to safely caring for a child;
new text end
new text begin
(10) a statement from the study subject;
new text end
new text begin
(11) a statement from the license holder; and
new text end
new text begin
(12) other aggravating and mitigating factors.
new text end
new text begin
(b) For purposes of this section, "evidence of rehabilitation" includes but is not limited
to the following:
new text end
new text begin
(1) maintaining a safe and stable residence;
new text end
new text begin
(2) continuous, regular, or stable employment;
new text end
new text begin
(3) successful participation in an education or job training program;
new text end
new text begin
(4) positive involvement with the community or extended family;
new text end
new text begin
(5) compliance with the terms and conditions of probation or parole following the
individual's most recent conviction;
new text end
new text begin
(6) if the individual has had a substance use disorder, successful completion of a substance
use disorder assessment, substance use disorder treatment, and recommended continuing
care, if applicable, demonstrated abstinence from controlled substances, as defined in section
152.01, subdivision 4, or the establishment of a sober network;
new text end
new text begin
(7) if the individual has had a mental illness or documented mental health issues,
demonstrated completion of a mental health evaluation, participation in therapy or other
recommended mental health treatment, or appropriate medication management, if applicable;
new text end
new text begin
(8) if the individual's offense or conduct involved domestic violence, demonstrated
completion of a domestic violence or anger management program, and the absence of any
orders for protection or harassment restraining orders against the individual since the previous
offense or conduct;
new text end
new text begin
(9) written letters of support from individuals of good repute, including but not limited
to employers, members of the clergy, probation or parole officers, volunteer supervisors,
or social services workers;
new text end
new text begin
(10) demonstrated remorse for convictions or conduct, or demonstrated positive behavior
changes; and
new text end
new text begin
(11) absence of convictions or arrests since the previous offense or conduct, including
any convictions that were expunged or pardoned.
new text end
new text begin
(c) An applicant for a family foster setting license must sign all releases of information
requested by the county or private licensing agency.
new text end
new text begin
(d) When licensing a relative for a family foster setting, the commissioner shall also
consider the importance of maintaining the child's relationship with relatives as an additional
significant factor in determining whether an application will be denied.
new text end
new text begin
(e) When recommending that the commissioner deny or revoke a license, the county or
private licensing agency must send a summary of the review completed according to
paragraph (a), on a form developed by the commissioner, to the commissioner and include
any recommendation for licensing action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 245A.50, subdivision 1a, is amended to read:
Subd. 1a.
Definitions and general provisions.
For the purposes of this section, the
following terms have the meanings given:
(1) "second adult caregiver" means an adult who cares for children in the licensed
program along with the license holder for a cumulative total of more than 500 hours annually;
(2) "helper" means a minor, ages 13 to 17, who assists in caring for children; deleted text begin and
deleted text end
(3) "substitute" means an adult who assumes responsibility for a license holder for a
cumulative total of not more than 500 hours annuallynew text begin ; and
new text end
new text begin (4) "adult assistant" means an adult who assists in caring for children exclusively under
the direct supervision of the license holder. An adult assistant may not serve as a second
adult caregiver and has the same training requirements as helpersnew text end .
An adultnew text begin , except for an adult assistant,new text end who cares for children in the licensed program along
with the license holder for a cumulative total of not more than 500 hours annually has the
same training requirements as a substitute.
Sec. 20.
Minnesota Statutes 2020, section 245A.50, subdivision 7, is amended to read:
Subd. 7.
Training requirements for family and group family child care.
new text begin (a) new text end For
purposes of family and group family child care, the license holder and each second adult
caregiver must complete 16 hours of ongoing training each year. Repeat of topical training
requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
requirement. Additional ongoing training subjects to meet the annual 16-hour training
requirement must be selected from the following areas:
(1) child development and learning training in understanding how a child develops
physically, cognitively, emotionally, and socially, and how a child learns as part of the
child's family, culture, and community;
(2) developmentally appropriate learning experiences, including training in creating
positive learning experiences, promoting cognitive development, promoting social and
emotional development, promoting physical development, promoting creative development;
and behavior guidance;
(3) relationships with families, including training in building a positive, respectful
relationship with the child's family;
(4) assessment, evaluation, and individualization, including training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality;
(5) historical and contemporary development of early childhood education, including
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs;
(6) professionalism, including training in knowledge, skills, and abilities that promote
ongoing professional development; and
(7) health, safety, and nutrition, including training in establishing healthy practices;
ensuring safety; and providing healthy nutrition.
new text begin
(b) A provider who is approved as a trainer through the Develop data system may count
up to two hours of training instruction toward the annual 16-hour training requirement in
paragraph (a). The provider may only count training instruction hours for the first instance
in which they deliver a particular content-specific training during each licensing year. Hours
counted as training instruction must be approved through the Develop data system with
attendance verified on the trainer's individual learning record.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245C.02, subdivision 4a, is amended to read:
Subd. 4a.
Authorized fingerprint collection vendor.
"Authorized fingerprint collection
vendor" means deleted text begin adeleted text end new text begin one of up to three new text end qualified deleted text begin organizationdeleted text end new text begin organizationsnew text end under deleted text begin adeleted text end written
contract with the commissioner to provide services in accordance with section 245C.05,
subdivision 5, paragraph (b).
Sec. 22.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin
First-time applicants for educator licenses with the Professional Educator
Licensing and Standards Board.
new text end
new text begin
The Professional Educator Licensing and Standards
Board shall make all eligibility determinations for background studies conducted under this
section for the Professional Educator Licensing and Standards Board. The commissioner
may conduct a background study of all first-time applicants for educator licenses pursuant
to section 122A.18, subdivision 8. The background study of all first-time applicants for
educator licenses must include a review of information from the Bureau of Criminal
Apprehension, including criminal history data as defined in section 13.87, and must also
include a review of the national criminal records repository.
new text end
Sec. 23.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin
First-time applicants for administrator licenses with the Board of School
Administrators.
new text end
new text begin
The Board of School Administrators shall make all eligibility determinations
for background studies conducted under this section for the Board of School Administrators.
The commissioner may conduct a background study of all first-time applicants for
administrator licenses pursuant to section 122A.18, subdivision 8. The background study
of all first-time applicants for administrator licenses must include a review of information
from the Bureau of Criminal Apprehension, including criminal history data as defined in
section 13.87, and must also include a review of the national criminal records repository.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
(a) The commissioner shall conduct a
background study of any individual required under section 62V.05 to have a background
study completed under this chapter. The commissioner shall conduct a background study
only based on Minnesota criminal records of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The MNsure board of directors may initiate background studies required by paragraph
(a) using the online NETStudy 2.0 system operated by the commissioner.
new text end
new text begin
(c) The commissioner shall review information that the commissioner receives to
determine if the study subject has potentially disqualifying offenses. The commissioner
shall send a letter to the subject indicating any of the subject's potential disqualifications as
well as any relevant records. The commissioner shall send a copy of the letter indicating
any of the subject's potential disqualifications to the MNsure board.
new text end
new text begin
(d) The MNsure board or the board's delegate shall review a reconsideration request of
an individual in paragraph (a), including granting a set-aside, according to the procedures
and criteria in chapter 245C. The board shall notify the individual and the Department of
Human Services of the board's decision.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall conduct background studies according to this chapter when initiated by
an early intensive developmental and behavioral intervention provider under section
256B.0949.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2020, section 245C.05, subdivision 2c, is amended to read:
Subd. 2c.
Privacy notice to background study subject.
(a) Prior to initiating each
background study, the entity initiating the study must provide the commissioner's privacy
notice to the background study subject required under section 13.04, subdivision 2. The
notice must be available through the commissioner's electronic NETStudy and NETStudy
2.0 systems and shall include the information in paragraphs (b) and (c).
(b) The background study subject shall be informed that any previous background studies
that received a set-aside will be reviewed, and without further contact with the background
study subject, the commissioner may notify the agency that initiated the subsequent
background study:
(1) that the individual has a disqualification that has been set aside for the program or
agency that initiated the study;
(2) the reason for the disqualification; and
(3) that information about the decision to set aside the disqualification will be available
to the license holder upon request without the consent of the background study subject.
(c) The background study subject must also be informed that:
(1) the subject's fingerprints collected for purposes of completing the background study
under this chapter must not be retained by the Department of Public Safety, Bureau of
Criminal Apprehension, or by the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text end new text begin not retain background study
subjects' fingerprintsnew text end ;
(2) effective upon implementation of NETStudy 2.0, the subject's photographic image
will be retained by the commissioner, and if the subject has provided the subject's Social
Security number for purposes of the background study, the photographic image will be
available to prospective employers and agencies initiating background studies under this
chapter to verify the identity of the subject of the background study;
(3) deleted text begin the commissioner'sdeleted text end new text begin annew text end authorized fingerprint collection vendor shall, for purposes
of verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. deleted text begin Thedeleted text end new text begin Annew text end authorized fingerprint collection vendor shall retain no more than the subject's
name and the date and time the subject's fingerprints were recorded and sent, only as
necessary for auditing and billing activities;
(4) the commissioner shall provide the subject notice, as required in section 245C.17,
subdivision 1, paragraph (a), when an entity initiates a background study on the individual;
(5) the subject may request in writing a report listing the entities that initiated a
background study on the individual as provided in section 245C.17, subdivision 1, paragraph
(b);
(6) the subject may request in writing that information used to complete the individual's
background study in NETStudy 2.0 be destroyed if the requirements of section 245C.051,
paragraph (a), are met; and
(7) notwithstanding clause (6), the commissioner shall destroy:
(i) the subject's photograph after a period of two years when the requirements of section
245C.051, paragraph (c), are met; and
(ii) any data collected on a subject under this chapter after a period of two years following
the individual's death as provided in section 245C.051, paragraph (d).
Sec. 27.
Minnesota Statutes 2020, section 245C.05, subdivision 2d, is amended to read:
Subd. 2d.
Fingerprint data notification.
The commissioner of human services shall
notify all background study subjects under this chapter that the Department of Human
Services, Department of Public Safety, and the Bureau of Criminal Apprehension do not
retain fingerprint data after a background study is completed, and that the Federal Bureau
of Investigation deleted text begin only retains the fingerprints of subjects who have a criminal historydeleted text end new text begin does
not retain background study subjects' fingerprintsnew text end .
Sec. 28.
Minnesota Statutes 2020, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study results to counties for background studies conducted by the
commissioner for child foster carenew text begin , including a summary of nondisqualifying results, except
as prohibited by lawnew text end ; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 29.
Minnesota Statutes 2020, section 245C.05, subdivision 5, is amended to read:
Subd. 5.
Fingerprints and photograph.
(a) Notwithstanding paragraph (b), for
background studies conducted by the commissioner for child foster care, children's residential
facilities, adoptions, or a transfer of permanent legal and physical custody of a child, the
subject of the background study, who is 18 years of age or older, shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency for
a national criminal history record check.
(b) For background studies initiated on or after the implementation of NETStudy 2.0,
except as provided under subdivision 5a, every subject of a background study must provide
the commissioner with a set of the background study subject's classifiable fingerprints and
photograph. The photograph and fingerprints must be recorded at the same time by deleted text begin the
commissioner'sdeleted text end new text begin annew text end authorized fingerprint collection vendor and sent to the commissioner
through the commissioner's secure data system described in section 245C.32, subdivision
1a, paragraph (b).
(c) The fingerprints shall be submitted by the commissioner to the Bureau of Criminal
Apprehension and, when specifically required by law, submitted to the Federal Bureau of
Investigation for a national criminal history record check.
(d) The fingerprints must not be retained by the Department of Public Safety, Bureau
of Criminal Apprehension, or the commissioner. The Federal Bureau of Investigation will
not retain background study subjects' fingerprints.
(e) deleted text begin The commissioner'sdeleted text end new text begin Annew text end authorized fingerprint collection vendor shall, for purposes
of verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. deleted text begin Thedeleted text end new text begin Annew text end authorized fingerprint collection vendor shall retain no more than the name
and date and time the subject's fingerprints were recorded and sent, only as necessary for
auditing and billing activities.
(f) For any background study conducted under this chapter, the subject shall provide the
commissioner with a set of classifiable fingerprints when the commissioner has reasonable
cause to require a national criminal history record check as defined in section 245C.02,
subdivision 15a.
Sec. 30.
Minnesota Statutes 2020, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, new text begin paragraph (a), new text end clause (2);
(6) for a background study related to a child foster family setting application for licensure,
foster residence settings, children's residential facilities, a transfer of permanent legal and
physical custody of a child under sections 260C.503 to 260C.515, or adoptions, and for a
background study required for family child care, certified license-exempt child care, child
care centers, and legal nonlicensed child care authorized under chapter 119B, the
commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years;
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
(iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry; and
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
Sec. 31.
Minnesota Statutes 2020, section 245C.08, subdivision 3, is amended to read:
Subd. 3.
Arrest and investigative information.
(a) For any background study completed
under this section, if the commissioner has reasonable cause to believe the information is
pertinent to the disqualification of an individual, the commissioner also may review arrest
and investigative information from:
(1) the Bureau of Criminal Apprehension;
(2) the commissioners of health and human services;
(3) a county attorney;
(4) a county sheriff;
(5) a county agency;
(6) a local chief of police;
(7) other states;
(8) the courts;
(9) the Federal Bureau of Investigation;
(10) the National Criminal Records Repository; and
(11) criminal records from other states.
(b) Except when specifically required by law, the commissioner is not required to conduct
more than one review of a subject's records from the Federal Bureau of Investigation if a
review of the subject's criminal history with the Federal Bureau of Investigation has already
been completed by the commissioner and there has been no break in the subject's affiliation
with the entity that initiated the background study.
(c) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the data obtained is private data and cannot be shared with
deleted text begin county agencies,deleted text end private agenciesdeleted text begin ,deleted text end or prospective employers of the background study subject.
(d) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the license holder or entity that submitted the study is not
required to obtain a copy of the background study subject's disqualification letter under
section 245C.17, subdivision 3.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 15, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $20 per study charged to the enrolled
agency. The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
The commissioner shall set fees to
recover the cost of background studies and criminal background checks initiated by MNsure
under sections 62V.05 and 245C.03. The fee amount shall be established through interagency
agreement between the commissioner and the board of MNsure or its designee. The fees
collected under this subdivision shall be deposited in the special revenue fund and are
appropriated to the commissioner for the purpose of conducting background studies and
criminal background checks.
new text end
Sec. 34.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 19. new text end
new text begin Professional Educators Licensing Standards Board. new text end
new text begin
The commissioner
shall recover the cost of background studies initiated by the Professional Educators Licensing
Standards Board through a fee of no more than $51 per study. Fees collected under this
subdivision are appropriated to the commissioner for purposes of conducting background
studies.
new text end
Sec. 35.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin Board of School Administrators. new text end
new text begin
The commissioner shall recover the cost
of background studies initiated by the Board of School Administrators through a fee of no
more than $51 per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
new text end
Sec. 36.
Minnesota Statutes 2020, section 245C.14, subdivision 1, is amended to read:
Subdivision 1.
Disqualification from direct contact.
(a) The commissioner shall
disqualify an individual who is the subject of a background study from any position allowing
direct contact with persons receiving services from the license holder or entity identified in
section 245C.03, upon receipt of information showing, or when a background study
completed under this chapter shows any of the following:
(1) a conviction of, admission to, or Alford plea to one or more crimes listed in section
245C.15, regardless of whether the conviction or admission is a felony, gross misdemeanor,
or misdemeanor level crime;
(2) a preponderance of the evidence indicates the individual has committed an act or
acts that meet the definition of any of the crimes listed in section 245C.15, regardless of
whether the preponderance of the evidence is for a felony, gross misdemeanor, or
misdemeanor level crime; or
(3) an investigation results in an administrative determination listed under section
245C.15, subdivision 4, paragraph (b).
(b) No individual who is disqualified following a background study under section
245C.03, subdivisions 1 and 2, may be retained in a position involving direct contact with
persons served by a program or entity identified in section 245C.03, unless the commissioner
has provided written notice under section 245C.17 stating that:
(1) the individual may remain in direct contact during the period in which the individual
may request reconsideration as provided in section 245C.21, subdivision 2;
(2) the commissioner has set aside the individual's disqualification for that program or
entity identified in section 245C.03, as provided in section 245C.22, subdivision 4; or
(3) the license holder has been granted a variance for the disqualified individual under
section 245C.30.
new text begin
(c) Notwithstanding paragraph (a), for the purposes of a background study affiliated
with a licensed family foster setting, the commissioner shall disqualify an individual who
is the subject of a background study from any position allowing direct contact with persons
receiving services from the license holder or entity identified in section 245C.03, upon
receipt of information showing or when a background study completed under this chapter
shows reason for disqualification under section 245C.15, subdivision 4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 37.
Minnesota Statutes 2020, section 245C.15, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Licensed family foster setting disqualifications. new text end
new text begin
(a) Notwithstanding
subdivisions 1 to 4, for a background study affiliated with a licensed family foster setting,
regardless of how much time has passed, an individual is disqualified under section 245C.14
if the individual committed an act that resulted in a felony-level conviction for sections:
609.185 (murder in the first degree); 609.19 (murder in the second degree); 609.195 (murder
in the third degree); 609.20 (manslaughter in the first degree); 609.205 (manslaughter in
the second degree); 609.2112 (criminal vehicular homicide); 609.221 (assault in the first
degree); 609.223, subdivision 2 (assault in the third degree, past pattern of child abuse);
609.223, subdivision 3 (assault in the third degree, victim under four); a felony offense
under sections 609.2242 and 609.2243 (domestic assault, spousal abuse, child abuse or
neglect, or a crime against children); 609.2247 (domestic assault by strangulation); 609.2325
(criminal abuse of a vulnerable adult resulting in the death of a vulnerable adult); 609.245
(aggravated robbery); 609.25 (kidnapping); 609.255 (false imprisonment); 609.2661 (murder
of an unborn child in the first degree); 609.2662 (murder of an unborn child in the second
degree); 609.2663 (murder of an unborn child in the third degree); 609.2664 (manslaughter
of an unborn child in the first degree); 609.2665 (manslaughter of an unborn child in the
second degree); 609.267 (assault of an unborn child in the first degree); 609.2671 (assault
of an unborn child in the second degree); 609.268 (injury or death of an unborn child in the
commission of a crime); 609.322, subdivision 1 (solicitation, inducement, and promotion
of prostitution; sex trafficking in the first degree); 609.324, subdivision 1 (other prohibited
acts; engaging in, hiring, or agreeing to hire minor to engage in prostitution); 609.342
(criminal sexual conduct in the first degree); 609.343 (criminal sexual conduct in the second
degree); 609.344 (criminal sexual conduct in the third degree); 609.345 (criminal sexual
conduct in the fourth degree); 609.3451 (criminal sexual conduct in the fifth degree);
609.3453 (criminal sexual predatory conduct); 609.352 (solicitation of children to engage
in sexual conduct); 609.377 (malicious punishment of a child); 609.378 (neglect or
endangerment of a child); 609.561 (arson in the first degree); 609.582, subdivision 1 (burglary
in the first degree); 609.746 (interference with privacy); 617.23 (indecent exposure); 617.246
(use of minors in sexual performance prohibited); or 617.247 (possession of pictorial
representations of minors).
new text end
new text begin
(b) Notwithstanding subdivisions 1 to 4, for the purposes of a background study affiliated
with a licensed family foster setting, an individual is disqualified under section 245C.14,
regardless of how much time has passed, if the individual:
new text end
new text begin
(1) committed an action under paragraph (d) that resulted in death or involved sexual
abuse, as defined in section 260E.03, subdivision 20;
new text end
new text begin
(2) committed an act that resulted in a gross misdemeanor-level conviction for section
609.3451 (criminal sexual conduct in the fifth degree);
new text end
new text begin
(3) committed an act against or involving a minor that resulted in a felony-level conviction
for: section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the
third degree); 609.2231 (assault in the fourth degree); or 609.224 (assault in the fifth degree);
or
new text end
new text begin
(4) committed an act that resulted in a misdemeanor or gross misdemeanor-level
conviction for section 617.293 (dissemination and display of harmful materials to minors).
new text end
new text begin
(c) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than 20
years have passed since the termination of the individual's parental rights under section
260C.301, subdivision 1, paragraph (b), or if the individual consented to a termination of
parental rights under section 260C.301, subdivision 1, paragraph (a), to settle a petition to
involuntarily terminate parental rights. An individual is disqualified under section 245C.14
if less than 20 years have passed since the termination of the individual's parental rights in
any other state or country, where the conditions for the individual's termination of parental
rights are substantially similar to the conditions in section 260C.301, subdivision 1, paragraph
(b).
new text end
new text begin
(d) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than five
years have passed since a felony-level violation for sections: 152.021 (controlled substance
crime in the first degree); 152.022 (controlled substance crime in the second degree); 152.023
(controlled substance crime in the third degree); 152.024 (controlled substance crime in the
fourth degree); 152.025 (controlled substance crime in the fifth degree); 152.0261 (importing
controlled substances across state borders); 152.0262, subdivision 1, paragraph (b)
(possession of substance with intent to manufacture methamphetamine); 152.027, subdivision
6, paragraph (c) (sale or possession of synthetic cannabinoids); 152.096 (conspiracies
prohibited); 152.097 (simulated controlled substances); 152.136 (anhydrous ammonia;
prohibited conduct; criminal penalties; civil liabilities); 152.137 (methamphetamine-related
crimes involving children or vulnerable adults); 169A.24 (felony first-degree driving while
impaired); 243.166 (violation of predatory offender registration requirements); 609.2113
(criminal vehicular operation; bodily harm); 609.2114 (criminal vehicular operation; unborn
child); 609.228 (great bodily harm caused by distribution of drugs); 609.2325 (criminal
abuse of a vulnerable adult not resulting in the death of a vulnerable adult); 609.233 (criminal
neglect); 609.235 (use of drugs to injure or facilitate a crime); 609.24 (simple robbery);
609.322, subdivision 1a (solicitation, inducement, and promotion of prostitution; sex
trafficking in the second degree); 609.498, subdivision 1 (tampering with a witness in the
first degree); 609.498, subdivision 1b (aggravated first-degree witness tampering); 609.562
(arson in the second degree); 609.563 (arson in the third degree); 609.582, subdivision 2
(burglary in the second degree); 609.66 (felony dangerous weapons); 609.687 (adulteration);
609.713 (terroristic threats); 609.749, subdivision 3, 4, or 5 (felony-level harassment or
stalking); 609.855, subdivision 5 (shooting at or in a public transit vehicle or facility); or
624.713 (certain people not to possess firearms).
new text end
new text begin
(e) Notwithstanding subdivisions 1 to 4, except as provided in paragraph (a), for a
background study affiliated with a licensed family child foster care license, an individual
is disqualified under section 245C.14 if less than five years have passed since:
new text end
new text begin
(1) a felony-level violation for an act not against or involving a minor that constitutes:
section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the third
degree); 609.2231 (assault in the fourth degree); or 609.224, subdivision 4 (assault in the
fifth degree);
new text end
new text begin
(2) a violation of an order for protection under section 518B.01, subdivision 14;
new text end
new text begin
(3) a determination or disposition of the individual's failure to make required reports
under section 260E.06 or 626.557, subdivision 3, for incidents in which the final disposition
under chapter 260E or section 626.557 was substantiated maltreatment and the maltreatment
was recurring or serious;
new text end
new text begin
(4) a determination or disposition of the individual's substantiated serious or recurring
maltreatment of a minor under chapter 260E, a vulnerable adult under section 626.557, or
serious or recurring maltreatment in any other state, the elements of which are substantially
similar to the elements of maltreatment under chapter 260E or section 626.557 and meet
the definition of serious maltreatment or recurring maltreatment;
new text end
new text begin
(5) a gross misdemeanor-level violation for sections: 609.224, subdivision 2 (assault in
the fifth degree); 609.2242 and 609.2243 (domestic assault); 609.233 (criminal neglect);
609.377 (malicious punishment of a child); 609.378 (neglect or endangerment of a child);
609.746 (interference with privacy); 609.749 (stalking); or 617.23 (indecent exposure); or
new text end
new text begin
(6) committing an act against or involving a minor that resulted in a misdemeanor-level
violation of section 609.224, subdivision 1 (assault in the fifth degree).
new text end
new text begin
(f) For purposes of this subdivision, the disqualification begins from:
new text end
new text begin
(1) the date of the alleged violation, if the individual was not convicted;
new text end
new text begin
(2) the date of conviction, if the individual was convicted of the violation but not
committed to the custody of the commissioner of corrections; or
new text end
new text begin
(3) the date of release from prison, if the individual was convicted of the violation and
committed to the custody of the commissioner of corrections.
new text end
new text begin
Notwithstanding clause (3), if the individual is subsequently reincarcerated for a violation
of the individual's supervised release, the disqualification begins from the date of release
from the subsequent incarceration.
new text end
new text begin
(g) An individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraphs (a) and (b), as each of these offenses is defined in Minnesota
Statutes, permanently disqualifies the individual under section 245C.14. An individual is
disqualified under section 245C.14 if less than five years have passed since the individual's
aiding and abetting, attempt, or conspiracy to commit any of the offenses listed in paragraphs
(d) and (e).
new text end
new text begin
(h) An individual's offense in any other state or country, where the elements of the
offense are substantially similar to any of the offenses listed in paragraphs (a) and (b),
permanently disqualifies the individual under section 245C.14. An individual is disqualified
under section 245C.14 if less than five years have passed since an offense in any other state
or country, the elements of which are substantially similar to the elements of any offense
listed in paragraphs (d) and (e).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 38.
Minnesota Statutes 2020, section 245C.24, subdivision 2, is amended to read:
Subd. 2.
Permanent bar to set aside a disqualification.
(a) Except as provided in
paragraphs (b) to deleted text begin (e)deleted text end new text begin (f)new text end , the commissioner may not set aside the disqualification of any
individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
1.
(b) For an individual in the chemical dependency or corrections field who was disqualified
for a crime or conduct listed under section 245C.15, subdivision 1, and whose disqualification
was set aside prior to July 1, 2005, the commissioner must consider granting a variance
pursuant to section 245C.30 for the license holder for a program dealing primarily with
adults. A request for reconsideration evaluated under this paragraph must include a letter
of recommendation from the license holder that was subject to the prior set-aside decision
addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that service.
(c) If an individual who requires a background study for nonemergency medical
transportation services under section 245C.03, subdivision 12, was disqualified for a crime
or conduct listed under section 245C.15, subdivision 1, and if more than 40 years have
passed since the discharge of the sentence imposed, the commissioner may consider granting
a set-aside pursuant to section 245C.22. A request for reconsideration evaluated under this
paragraph must include a letter of recommendation from the employer. This paragraph does
not apply to a person disqualified based on a violation of sections 243.166; 609.185 to
609.205; 609.25; 609.342 to 609.3453; 609.352; 617.23, subdivision 2, clause (1), or 3,
clause (1); 617.246; or 617.247.
(d) When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.
new text begin
(e) For an individual 18 years of age or older affiliated with a licensed family foster
setting, the commissioner must not set aside or grant a variance for the disqualification of
any individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
4a, paragraphs (a) and (b).
new text end
new text begin
(f) In connection with a family foster setting license, the commissioner may grant a
variance to the disqualification for an individual who is under 18 years of age at the time
the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 39.
Minnesota Statutes 2020, section 245C.24, subdivision 3, is amended to read:
Subd. 3.
Ten-year bar to set aside disqualification.
(a) The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if: (1) less than ten years has passed since
the discharge of the sentence imposed, if any, for the offense; or (2) when disqualified based
on a preponderance of evidence determination under section 245C.14, subdivision 1,
paragraph (a), clause (2), or an admission under section 245C.14, subdivision 1, paragraph
(a), clause (1), and less than ten years has passed since the individual committed the act or
admitted to committing the act, whichever is later; and (3) the individual has committed a
violation of any of the following offenses: sections 609.165 (felon ineligible to possess
firearm); criminal vehicular homicide or criminal vehicular operation causing death under
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.215 (aiding
suicide or aiding attempted suicide); felony violations under 609.223 or 609.2231 (assault
in the third or fourth degree); 609.229 (crimes committed for benefit of a gang); 609.713
(terroristic threats); 609.235 (use of drugs to injure or to facilitate crime); 609.24 (simple
robbery); 609.255 (false imprisonment); 609.562 (arson in the second degree); 609.71 (riot);
609.498, subdivision 1 or 1b (aggravated first-degree or first-degree tampering with a
witness); burglary in the first or second degree under 609.582 (burglary); 609.66 (dangerous
weapon); 609.665 (spring guns); 609.67 (machine guns and short-barreled shotguns);
609.749, subdivision 2 (gross misdemeanor harassment); 152.021 or 152.022 (controlled
substance crime in the first or second degree); 152.023, subdivision 1, clause (3) or (4) or
subdivision 2, clause (4) (controlled substance crime in the third degree); 152.024,
subdivision 1, clause (2), (3), or (4) (controlled substance crime in the fourth degree);
609.224, subdivision 2, paragraph (c) (fifth-degree assault by a caregiver against a vulnerable
adult); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of residents or
patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal neglect of a
vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult); 609.234 (failure
to report); 609.265 (abduction); 609.2664 to 609.2665 (manslaughter of an unborn child in
the first or second degree); 609.267 to 609.2672 (assault of an unborn child in the first,
second, or third degree); 609.268 (injury or death of an unborn child in the commission of
a crime); repeat offenses under 617.23 (indecent exposure); 617.293 (disseminating or
displaying harmful material to minors); a felony-level conviction involving alcohol or drug
use, a gross misdemeanor offense under 609.324, subdivision 1 (other prohibited acts); a
gross misdemeanor offense under 609.378 (neglect or endangerment of a child); a gross
misdemeanor offense under 609.377 (malicious punishment of a child); 609.72, subdivision
3 (disorderly conduct against a vulnerable adult); or 624.713 (certain persons not to possess
firearms); or Minnesota Statutes 2012, section 609.21.
(b) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the individual's aiding and abetting, attempt, or conspiracy to
commit any of the offenses listed in paragraph (a) as each of these offenses is defined in
Minnesota Statutes.
(c) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the discharge of the sentence imposed for an offense in any
other state or country, the elements of which are substantially similar to the elements of any
of the offenses listed in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 40.
Minnesota Statutes 2020, section 245C.24, subdivision 4, is amended to read:
Subd. 4.
Seven-year bar to set aside disqualification.
The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if within seven years preceding the study:
(1) the individual committed an act that constitutes maltreatment of a child under sections
260E.24, subdivisions 1, 2, and 3, and 260E.30, subdivisions 1, 2, and 4, and the maltreatment
resulted in substantial bodily harm as defined in section 609.02, subdivision 7a, or substantial
mental or emotional harm as supported by competent psychological or psychiatric evidence;
or
(2) the individual was determined under section 626.557 to be the perpetrator of a
substantiated incident of maltreatment of a vulnerable adult that resulted in substantial
bodily harm as defined in section 609.02, subdivision 7a, or substantial mental or emotional
harm as supported by competent psychological or psychiatric evidence.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 41.
Minnesota Statutes 2020, section 245C.24, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Five-year bar to set aside disqualification; family foster setting. new text end
new text begin
(a) The
commissioner shall not set aside or grant a variance for the disqualification of an individual
18 years of age or older in connection with a foster family setting license if within five years
preceding the study the individual is convicted of a felony in section 245C.15, subdivision
4a, paragraph (d).
new text end
new text begin
(b) In connection with a foster family setting license, the commissioner may set aside
or grant a variance to the disqualification for an individual who is under 18 years of age at
the time the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 42.
Minnesota Statutes 2020, section 245C.32, subdivision 1a, is amended to read:
Subd. 1a.
NETStudy 2.0 system.
(a) The commissioner shall design, develop, and test
the NETStudy 2.0 system and implement it no later than September 1, 2015.
(b) The NETStudy 2.0 system developed and implemented by the commissioner shall
incorporate and meet all applicable data security standards and policies required by the
Federal Bureau of Investigation (FBI), Department of Public Safety, Bureau of Criminal
Apprehension, and the Office of MN.IT Services. The system shall meet all required
standards for encryption of data at the database level as well as encryption of data that
travels electronically among agencies initiating background studies, deleted text begin the commissioner'sdeleted text end
authorized fingerprint collection deleted text begin vendordeleted text end new text begin vendorsnew text end , the commissioner, the Bureau of Criminal
Apprehension, and in cases involving national criminal record checks, the FBI.
(c) The data system developed and implemented by the commissioner shall incorporate
a system of data security that allows the commissioner to control access to the data field
level by the commissioner's employees. The commissioner shall establish that employees
have access to the minimum amount of private data on any individual as is necessary to
perform their duties under this chapter.
(d) The commissioner shall oversee regular quality and compliance audits of deleted text begin thedeleted text end
authorized fingerprint collection deleted text begin vendordeleted text end new text begin vendorsnew text end .
Sec. 43.
Minnesota Statutes 2020, section 245F.04, subdivision 2, is amended to read:
Subd. 2.
Contents of application.
Prior to the issuance of a license, an applicant must
submit, on forms provided by the commissioner, documentation demonstrating the following:
(1) compliance with this section;
(2) compliance with applicable building, fire, and safety codes; health rules; zoning
ordinances; and other applicable rules and regulations or documentation that a waiver has
been granted. The granting of a waiver does not constitute modification of any requirement
of this section;new text begin and
new text end
(3) deleted text begin completion of an assessment of need for a new or expanded program as required by
Minnesota Rules, part 9530.6800; and
deleted text end
deleted text begin (4)deleted text end insurance coverage, including bonding, sufficient to cover all patient funds, property,
and interests.
Sec. 44.
Minnesota Statutes 2020, section 245G.03, subdivision 2, is amended to read:
Subd. 2.
Application.
new text begin (a) new text end Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires.
new text begin
(b) At least 60 days prior to submitting an application for licensure under this chapter,
the applicant must notify the county human services director in writing of the applicant's
intent to open a new treatment program. The written notification must include, at a minimum:
new text end
new text begin
(1) a description of the proposed treatment program;
new text end
new text begin
(2) a description of the target population served by the treatment program; and
new text end
new text begin
(3) a copy of the program's abuse prevention plan, required by section 245A.65,
subdivision 2.
new text end
new text begin
(c) The county human services director may submit a written statement to the
commissioner regarding the county's support of or opposition to opening the new treatment
program. The written statement must include documentation of the rationale for the county's
determination. The commissioner shall consider the county's written statement when
determining whether to issue a license for the treatment program. If the county does not
submit a written statement, the commissioner shall confirm with the county that the county
received the notification required by paragraph (b).
new text end
Sec. 45.
new text begin
[245G.031] ALTERNATIVE LICENSING INSPECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Eligibility for an alternative licensing inspection. new text end
new text begin
(a) A license holder
providing services licensed under this chapter, with a qualifying accreditation and meeting
the eligibility criteria in paragraphs (b) and (c), may request approval for an alternative
licensing inspection when all services provided under the license holder's license are
accredited. A license holder with a qualifying accreditation and meeting the eligibility
criteria in paragraphs (b) and (c) may request approval for an alternative licensing inspection
for individual community residential settings or day services facilities licensed under this
chapter.
new text end
new text begin
(b) In order to be eligible for an alternative licensing inspection, the program must have
had at least one inspection by the commissioner following issuance of the initial license.
new text end
new text begin
(c) In order to be eligible for an alternative licensing inspection, the program must have
been in substantial and consistent compliance at the time of the last licensing inspection
and during the current licensing period. For purposes of this section, "substantial and
consistent compliance" means:
new text end
new text begin
(1) the license holder's license was not made conditional, suspended, or revoked;
new text end
new text begin
(2) there have been no substantiated allegations of maltreatment against the license
holder within the past ten years; and
new text end
new text begin
(3) the license holder maintained substantial compliance with the other requirements of
chapters 245A and 245C and other applicable laws and rules.
new text end
new text begin
(d) For the purposes of this section, the license holder's license includes services licensed
under this chapter that were previously licensed under chapter 245A or Minnesota Rules,
chapter 9530, until January 1, 2018.
new text end
new text begin Subd. 2. new text end
new text begin Qualifying accreditation. new text end
new text begin
The commissioner must accept an accreditation
from the joint commission as a qualifying accreditation.
new text end
new text begin Subd. 3. new text end
new text begin Request for approval of an alternative inspection status. new text end
new text begin
(a) A request for
an alternative inspection must be made on the forms and in the manner prescribed by the
commissioner. When submitting the request, the license holder must submit all documentation
issued by the accrediting body verifying that the license holder has obtained and maintained
the qualifying accreditation and has complied with recommendations or requirements from
the accrediting body during the period of accreditation. Based on the request and the
additional required materials, the commissioner may approve an alternative inspection
status.
new text end
new text begin
(b) The commissioner must notify the license holder in writing that the request for an
alternative inspection status has been approved. Approval must be granted until the end of
the qualifying accreditation period.
new text end
new text begin
(c) The license holder must submit a written request for approval of an alternative
inspection status to be renewed one month before the end of the current approval period
according to the requirements in paragraph (a). If the license holder does not submit a request
to renew approval of an alternative inspection status as required, the commissioner must
conduct a licensing inspection.
new text end
new text begin Subd. 4. new text end
new text begin
Programs approved for alternative licensing inspection; deemed compliance
licensing requirements.
new text end
new text begin
(a) A license holder approved for alternative licensing inspection
under this section is required to maintain compliance with all licensing standards according
to this chapter.
new text end
new text begin
(b) A license holder approved for alternative licensing inspection under this section is
deemed to be in compliance with all the requirements of this chapter, and the commissioner
must not perform routine licensing inspections.
new text end
new text begin
(c) Upon receipt of a complaint regarding the services of a license holder approved for
alternative licensing inspection under this section, the commissioner must investigate the
complaint and may take any action as provided under section 245A.06 or 245A.07.
new text end
new text begin Subd. 5. new text end
new text begin Investigations of alleged or suspected maltreatment. new text end
new text begin
Nothing in this section
changes the commissioner's responsibilities to investigate alleged or suspected maltreatment
of a minor under chapter 260E or a vulnerable adult under section 626.557.
new text end
new text begin Subd. 6. new text end
new text begin Termination or denial of subsequent approval. new text end
new text begin
Following approval of an
alternative licensing inspection, the commissioner may terminate or deny subsequent approval
of an alternative licensing inspection if the commissioner determines that:
new text end
new text begin
(1) the license holder has not maintained the qualifying accreditation;
new text end
new text begin
(2) the commissioner has substantiated maltreatment for which the license holder or
facility is determined to be responsible during the qualifying accreditation period; or
new text end
new text begin
(3) during the qualifying accreditation period, the license holder has been issued an order
for conditional license, fine, suspension, or license revocation that has not been reversed
upon appeal.
new text end
new text begin Subd. 7. new text end
new text begin Appeals. new text end
new text begin
The commissioner's decision that the conditions for approval for an
alternative licensing inspection have not been met is subject to appeal under the provisions
of chapter 14.
new text end
new text begin Subd. 8. new text end
new text begin Commissioner's programs. new text end
new text begin
Substance use disorder treatment services licensed
under this chapter for which the commissioner is the license holder with a qualifying
accreditation are excluded from being approved for an alternative licensing inspection.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2021.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256B.0949, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Background studies. new text end
new text begin
An early intensive developmental and behavioral
intervention services agency must fulfill any background studies requirements under this
section by initiating a background study through the commissioner's NETStudy system as
provided under sections 245C.03, subdivision 15, and 245C.10, subdivision 17.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 47.
Minnesota Statutes 2020, section 260C.215, subdivision 4, is amended to read:
Subd. 4.
Duties of commissioner.
The commissioner of human services shall:
(1) provide practice guidance to responsible social services agencies and licensed
child-placing agencies that reflect federal and state laws and policy direction on placement
of children;
(2) develop criteria for determining whether a prospective adoptive or foster family has
the ability to understand and validate the child's cultural background;
(3) provide a standardized training curriculum for adoption and foster care workers and
administrators who work with children. Training must address the following objectives:
(i) developing and maintaining sensitivity to all cultures;
(ii) assessing values and their cultural implications;
(iii) making individualized placement decisions that advance the best interests of a
particular child under section 260C.212, subdivision 2; and
(iv) issues related to cross-cultural placement;
(4) provide a training curriculum for all prospective adoptive and foster families that
prepares them to care for the needs of adoptive and foster children taking into consideration
the needs of children outlined in section 260C.212, subdivision 2, paragraph (b), and, as
necessary, preparation is continued after placement of the child and includes the knowledge
and skills related to reasonable and prudent parenting standards for the participation of the
child in age or developmentally appropriate activities, according to section 260C.212,
subdivision 14;
(5) develop and provide to responsible social services agencies and licensed child-placing
agencies a home study format to assess the capacities and needs of prospective adoptive
and foster families. The format must address problem-solving skills; parenting skills; evaluate
the degree to which the prospective family has the ability to understand and validate the
child's cultural background, and other issues needed to provide sufficient information for
agencies to make an individualized placement decision consistent with section 260C.212,
subdivision 2. For a study of a prospective foster parent, the format must also address the
capacity of the prospective foster parent to provide a safe, healthy, smoke-free home
environment. If a prospective adoptive parent has also been a foster parent, any update
necessary to a home study for the purpose of adoption may be completed by the licensing
authority responsible for the foster parent's license. If a prospective adoptive parent with
an approved adoptive home study also applies for a foster care license, the license application
may be made with the same agency which provided the adoptive home study; deleted text begin and
deleted text end
(6) consult with representatives reflecting diverse populations from the councils
established under sections 3.922 and 15.0145, and other state, local, and community
organizationsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) establish family foster setting licensing guidelines for county agencies and private
agencies designated or licensed by the commissioner to perform licensing functions and
activities under section 245A.04. Guidelines that the commissioner establishes under this
paragraph shall be considered directives of the commissioner under section 245A.16.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 48.
Minnesota Statutes 2020, section 466.03, subdivision 6d, is amended to read:
Subd. 6d.
Licensing of providers.
new text begin (a) new text end A claim against a municipality based on the failure
of a provider to meet the standards needed for a license to operate a day care facility under
chapter 245A for children, unless the municipality had actual knowledge of a failure to meet
licensing standards that resulted in a dangerous condition that foreseeably threatened the
plaintiff. A municipality shall be immune from liability for a claim arising out of a provider's
use of a swimming pool located at a family day care or group family day care home under
section 245A.14, subdivision deleted text begin 10deleted text end new text begin 11new text end , unless the municipality had actual knowledge of a
provider's failure to meet the licensing standards under section 245A.14, subdivision deleted text begin 10deleted text end new text begin 11new text end ,
paragraph (a), clauses (1) to (3), that resulted in a dangerous condition that foreseeably
threatened the plaintiff.
new text begin
(b) For purposes of paragraph (a), the fact that a licensing variance had been granted for
a day care facility for children under chapter 245A shall not constitute actual knowledge
by the municipality that granted the variance of a failure to meet licensing standards that
resulted in a dangerous condition that foreseeably threatened the plaintiff.
new text end
Sec. 49.
Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
new text begin Subd. 5. new text end
new text begin Waiver extension; 180-day transition period. new text end
new text begin
When the peacetime emergency
declared by the governor in response to the COVID-19 outbreak expires, is terminated, or
is rescinded by the proper authority, the modification in CV23: modifying certain background
study requirements, issued by the commissioner of human services pursuant to Executive
Orders 20-11 and 20-12, and including any amendments to the modification issued before
the peacetime emergency expires, shall remain in effect for no more than 180 days.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 50.
Laws 2020, First Special Session chapter 7, section 1, subdivision 3, is amended
to read:
Subd. 3.
Waivers and modifications; 60-day transition period.
When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, all waivers or modifications issued by
the commissioner of human services in response to the COVID-19 outbreak that have not
been extended as provided in subdivisions 1, 2, deleted text begin anddeleted text end 4new text begin , and 5new text end of this section may remain in
effect for no more than 60 days, only for purposes of transitioning affected programs back
to operating without the waivers or modifications in place.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51. new text begin FAMILY CHILD CARE TRAINING ADVISORY COMMITTEE.
new text end
new text begin Subdivision 1. new text end
new text begin Formation; duties. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee shall advise the commissioner of human services on the training requirements
for licensed family and group family child care providers. Beginning January 1, 2022, the
advisory committee shall meet at least twice per year. The advisory committee shall annually
elect a chair from among its members who shall establish the agenda for each meeting. The
commissioner or commissioner's designee shall attend all advisory committee meetings.
new text end
new text begin
(b) The Family Child Care Training Advisory Committee shall advise and make
recommendations to the commissioner of human services on:
new text end
new text begin
(1) updates to the rules and statutes governing family child care training, including
technical updates to facilitate providers' understanding of training requirements;
new text end
new text begin
(2) modernization of family child care training requirements, including substantive
changes to the training subject areas;
new text end
new text begin
(3) difficulties facing family child care providers in completing training requirements,
including proposed solutions to provider difficulties; and
new text end
new text begin
(4) any other aspect of family child care training, as requested by:
new text end
new text begin
(i) a committee member, who may request an item to be placed on the agenda for a future
meeting. The request may be considered by the committee and voted upon. If the motion
carries, the meeting agenda item may be developed for presentation to the committee;
new text end
new text begin
(ii) a member of the public, who may approach the committee by letter or e-mail
requesting that an item be placed on a future meeting agenda. The request may be considered
by the committee and voted upon. If the motion carries, the agenda item may be developed
for presentation to the committee; or
new text end
new text begin
(iii) the commissioner of human services or the commissioner's designee.
new text end
new text begin
(c) The Family Child Care Training Advisory Committee shall expire December 1, 2025.
new text end
new text begin Subd. 2. new text end
new text begin Advisory committee members. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee consists of:
new text end
new text begin
(1) four members who are family child care providers from greater Minnesota, including
one member appointed by the speaker of the house, one member appointed by the senate
majority leader, one member appointed by the Minnesota Association of Child Care
Professionals, and one member appointed by the Minnesota Child Care Provider Network;
new text end
new text begin
(2) four members who are family child care providers from the metropolitan area as
defined in Minnesota Statutes, section 473.121, subdivision 2, including one member
appointed by the speaker of the house, one member appointed by the senate majority leader,
one member appointed by the Minnesota Association of Child Care Professionals, and one
member appointed by the Minnesota Child Care Provider Network; and
new text end
new text begin
(3) up to seven members who have expertise in child development, instructional design,
or training delivery, including up to two members appointed by the speaker of the house,
up to two members appointed by the senate majority leader, one member appointed by the
Minnesota Association of Child Care Professionals, one member appointed by the Minnesota
Child Care Provider Network, and one member appointed by the Greater Minnesota
Partnership.
new text end
new text begin
(b) Advisory committee members shall not be employed by the Department of Human
Services. Advisory committee members shall receive no compensation, except that public
members of the advisory committee may be compensated as provided by Minnesota Statutes,
section 15.059, subdivision 3.
new text end
new text begin
(c) Advisory committee members must include representatives of diverse cultural
communities.
new text end
new text begin
(d) Advisory committee members shall serve two-year terms. Initial appointments to
the advisory committee must be made by December 1, 2021. Subsequent appointments to
the advisory committee must be made by December 1 of the year in which the member's
term expires.
new text end
new text begin
(e) The commissioner of human services must convene the first meeting of the advisory
committee by March 1, 2022.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner report. new text end
new text begin
The commissioner of human services shall report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over child care on any recommendations from the Family Child Care Training Advisory
Committee, including any draft legislation necessary to implement the recommendations.
new text end
Sec. 52. new text begin LEGISLATIVE TASK FORCE; HUMAN SERVICES BACKGROUND
STUDY ELIGIBILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Creation; duties. new text end
new text begin
A legislative task force is created to review the statutes
relating to human services background study eligibility and disqualifications, including but
not limited to Minnesota Statutes, sections 245C.14 and 245C.15, in order to:
new text end
new text begin
(1) evaluate the existing statutes' effectiveness in achieving their intended purposes,
including by gathering and reviewing available background study disqualification data;
new text end
new text begin
(2) identify the existing statutes' weaknesses, inefficiencies, unintended consequences,
or other areas for improvement or modernization; and
new text end
new text begin
(3) develop legislative proposals that improve or modernize the human services
background study eligibility statutes, or otherwise address the issues identified in clauses
(1) and (2).
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The task force shall consist of 26 members, appointed as
follows:
new text end
new text begin
(1) two members representing licensing boards whose licensed providers are subject to
the provisions in Minnesota Statutes, section 245C.03, one appointed by the speaker of the
house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(2) the commissioner of human services or a designee;
new text end
new text begin
(3) the commissioner of health or a designee;
new text end
new text begin
(4) two members representing county attorneys and law enforcement, one appointed by
the speaker of the house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(5) two members representing licensed service providers who are subject to the provisions
in Minnesota Statutes, section 245C.15, one appointed by the speaker of the house of
representatives, and one appointed by the senate majority leader;
new text end
new text begin
(6) four members of the public, including two who have been subject to disqualification
based on the provisions of Minnesota Statutes, section 245C.15, and two who have been
subject to a set-aside based on the provisions of Minnesota Statutes, section 245C.15, with
one from each category appointed by the speaker of the house of representatives, and one
from each category appointed by the senate majority leader;
new text end
new text begin
(7) one member appointed by the governor's Workforce Development Board;
new text end
new text begin
(8) one member appointed by the One Minnesota Council on Diversity, Inclusion, and
Equity;
new text end
new text begin
(9) two members representing the Minnesota courts, one appointed by the speaker of
the house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(10) one member appointed jointly by Mid-Minnesota Legal Aid, Southern Minnesota
Legal Services, and the Legal Rights Center;
new text end
new text begin
(11) one member representing Tribal organizations, appointed by the Minnesota Indian
Affairs Council;
new text end
new text begin
(12) two members from the house of representatives, including one appointed by the
speaker of the house of representatives and one appointed by the minority leader in the
house of representatives;
new text end
new text begin
(13) two members from the senate, including one appointed by the senate majority leader
and one appointed by the senate minority leader;
new text end
new text begin
(14) two members representing county human services agencies appointed by the
Minnesota Association of County Social Service Administrators, including one appointed
to represent the metropolitan area as defined in Minnesota Statutes, section 473.121,
subdivision 2, and one appointed to represent the area outside of the metropolitan area; and
new text end
new text begin
(15) two attorneys who have represented individuals that appealed a background study
disqualification determination based on Minnesota Statutes, sections 245C.14 and 245C.15,
one appointed by the speaker of the house of representatives, and one appointed by the
senate majority leader.
new text end
new text begin
(b) Appointments to the task force must be made by August 18, 2021.
new text end
new text begin Subd. 3. new text end
new text begin Compensation. new text end
new text begin
Public members of the task force may be compensated as
provided by Minnesota Statutes, section 15.059, subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The first meeting of the task force shall be cochaired
by the task force member from the majority party of the house of representatives and the
task force member from the majority party of the senate. The task force shall elect a chair
and vice chair at the first meeting who shall preside at the remainder of the task force
meetings. The task force may elect other officers as necessary.
new text end
new text begin
(b) The task force shall meet at least monthly. The Legislative Coordinating Commission
shall convene the first meeting by September 1, 2021.
new text end
new text begin
(c) Meetings of the task force are subject to the Minnesota Open Meeting Law under
Minnesota Statutes, chapter 13D.
new text end
new text begin Subd. 5. new text end
new text begin Reports required. new text end
new text begin
The task force shall submit an interim written report by
March 11, 2022, and a final report by December 16, 2022, to the chairs and ranking minority
members of the committees in the house of representatives and the senate with jurisdiction
over human services licensing. The reports shall explain the task force's findings and
recommendations relating to each of the duties under subdivision 1, and include any draft
legislation necessary to implement the recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Expiration. new text end
new text begin
The task force expires upon submission of the final report in
subdivision 5 or December 20, 2022, whichever is later.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
expires December 31, 2022.
new text end
Sec. 53. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; CHILD
FOSTER CARE LICENSING GUIDELINES.
new text end
new text begin
By July 1, 2023, the commissioner of human services shall, in consultation with
stakeholders with expertise in child protection and children's behavioral health, develop
family foster setting licensing guidelines for county agencies and private agencies that
perform licensing functions. Stakeholders include but are not limited to child advocates,
representatives from community organizations, representatives of the state ethnic councils,
the ombudsperson for families, family foster setting providers, youth who have experienced
family foster setting placements, county child protection staff, and representatives of county
and private licensing agencies.
new text end
Sec. 54. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; DHS
FAMILY CHILD CARE FREQUENTLY ASKED QUESTIONS WEBSITE
MODIFICATIONS.
new text end
new text begin
By January 1, 2022, the commissioner of human services shall expand the "frequently
asked questions" website for family child care providers to include more answers to submitted
questions and a function to search for answers to specific question topics.
new text end
Sec. 55. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE TASK FORCE RECOMMENDATIONS IMPLEMENTATION PLAN.
new text end
new text begin
The commissioner of human services shall include individuals representing family child
care providers in any group that develops a plan for implementing the recommendations of
the Family Child Care Task Force.
new text end
Sec. 56. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FAMILY CHILD CARE REGULATION MODERNIZATION.
new text end
new text begin
(a) The commissioner of human services shall contract with an experienced and
independent organization or individual consultant to conduct the work outlined in this
section. If practicable, the commissioner must contract with the National Association for
Regulatory Administration.
new text end
new text begin
(b) The consultant shall develop a proposal for a risk-based model for monitoring
compliance with family child care licensing standards, grounded in national regulatory best
practices. Violations in the new model must be weighted to reflect the potential risk they
pose to children's health and safety, and licensing sanctions must be tied to the potential
risk. The proposed new model must protect the health and safety of children in family child
care programs and be child-centered, family-friendly, and fair to providers. The proposal
shall also include updates to family child care licensing standards.
new text end
new text begin
(c) The consultant shall develop and implement a stakeholder engagement process that
solicits input from parents, licensed family child care providers, county licensors, staff of
the Department of Human Services, and experts in child development about licensing
standards, tiers for violations of the standards based on the potential risk of harm that each
violation poses, and licensing sanctions for each tier.
new text end
new text begin
(d) The consultant shall solicit input from parents, licensed family child care providers,
county licensors, and staff of the Department of Human Services about which family child
care providers should be eligible for abbreviated inspections that predict compliance with
other licensing standards for licensed family child care providers using key indicators
previously identified by an empirically based statistical methodology developed by the
National Association for Regulatory Administration and the Research Institute for Key
Indicators.
new text end
new text begin
(e) No later than February 1, 2024, the commissioner shall submit a report and proposed
legislation required to implement the new licensing model and updated licensing standards
to the chairs and ranking minority members of the legislative committees with jurisdiction
over child care regulation.
new text end
Sec. 57. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE ONE-STOP ASSISTANCE NETWORK.
new text end
new text begin
By January 1, 2022, the commissioner of human services shall, in consultation with
county agencies, providers, and other relevant stakeholders, develop a proposal to create,
advertise, and implement a one-stop regional assistance network comprised of individuals
who have experience starting a licensed family or group family day care or technical expertise
regarding the applicable licensing statutes and procedures, in order to assist individuals with
matters relating to starting or sustaining a licensed family or group family day care program.
The proposal shall include an estimated timeline for implementation of the assistance
network, an estimated budget of the cost of the assistance network, and any necessary
legislative proposals to implement the assistance network. The proposal shall also include
a plan to raise awareness and distribute contact information for the assistance network to
all licensed family or group family day care providers.
new text end
Sec. 58. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FAMILY CHILD CARE LICENSE APPLICANT ORIENTATION TRAINING.
new text end
new text begin
By July 1, 2022, working with licensed family child care providers and county agencies,
the commissioner of human services shall develop and implement orientation training for
family child care license applicants to ensure that all family child care license applicants
have the same critical baseline information about Minnesota Statutes, chapters 245A and
245C, and Minnesota Rules, chapter 9502.
new text end
Sec. 59. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; ON-SITE
BACKGROUND STUDY FINGERPRINTING.
new text end
new text begin
(a) The commissioner of human services shall contract with a qualified contractor to
conduct on-site fingerprinting beginning August 1, 2021, at locations of employers with 50
or more staff with outstanding background studies, including studies that have been delayed
pursuant to the commissioner's modifications to background study requirements issued in
response to the COVID-19 outbreak. The commissioner shall develop a list of employers
with 50 or more staff who need fingerprints taken in order to complete a background study.
The commissioner and the contractor shall coordinate to develop a plan to identify which
employer locations the contractor shall serve and inform those employers and staff of the
timing and nature of the contractor's services.
new text end
new text begin
(b) The commissioner may contract with the qualified contractor to provide services
under paragraph (a) up to the date of the expiration of the modification in CV23: modifying
certain background study requirements, issued by the commissioner of human services
pursuant to Executive Orders 20-11 and 20-12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 60. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE REGULATION MODERNIZATION PROJECT.
new text end
new text begin
The commissioner of human services shall allocate $1,170,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2201, for the child care and development block grant for the family child care
regulation modernization project. This is a onetime allocation and remains available until
June 30, 2024.
new text end
Sec. 61. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE ONE-STOP ASSISTANCE NETWORK.
new text end
new text begin
The commissioner of human services shall allocate $4,000,000 in fiscal year 2023 and
$4,000,000 in fiscal year 2024 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the family child care one-stop
assistance network. This is a onetime allocation.
new text end
Sec. 62. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE LICENSE APPLICANT ORIENTATION TRAINING.
new text end
new text begin
The commissioner of human services shall allocate $1,000,000 in fiscal year 2023 and
$1,000,000 in fiscal year 2024 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for family child care license applicant
orientation training. This is a onetime allocation.
new text end
Sec. 63. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
DHS FAMILY CHILD CARE FREQUENTLY ASKED QUESTIONS WEBSITE
MODIFICATIONS.
new text end
new text begin
The commissioner of human services shall allocate $50,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2201, for the modifications to the family child care provider "frequently asked
questions" website. This is a onetime allocation.
new text end
Sec. 64. new text begin REPEALER.
new text end
new text begin
Minnesota Rules, parts 9530.6800; and 9530.6810,
new text end
new text begin
are repealed.
new text end
ARTICLE 7
MINNESOTA HEALTH AND EDUCATION FACILITIES AUTHORITY
Section 1.
Minnesota Statutes 2020, section 3.732, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
As used in this section and section 3.736 the terms defined
in this section have the meanings given them.
(1) "State" includes each of the departments, boards, agencies, commissions, courts, and
officers in the executive, legislative, and judicial branches of the state of Minnesota and
includes but is not limited to the Housing Finance Agency, the Minnesota Office of Higher
Education, the deleted text begin Higherdeleted text end new text begin Health andnew text end Education Facilities Authority, the Health Technology
Advisory Committee, the Armory Building Commission, the Zoological Board, the
Department of Iron Range Resources and Rehabilitation, the Minnesota Historical Society,
the State Agricultural Society, the University of Minnesota, the Minnesota State Colleges
and Universities, state hospitals, and state penal institutions. It does not include a city, town,
county, school district, or other local governmental body corporate and politic.
(2) "Employee of the state" means all present or former officers, members, directors, or
employees of the state, members of the Minnesota National Guard, members of a bomb
disposal unit approved by the commissioner of public safety and employed by a municipality
defined in section 466.01 when engaged in the disposal or neutralization of bombs or other
similar hazardous explosives, as defined in section 299C.063, outside the jurisdiction of the
municipality but within the state, or persons acting on behalf of the state in an official
capacity, temporarily or permanently, with or without compensation. It does not include
either an independent contractor except, for purposes of this section and section 3.736 only,
a guardian ad litem acting under court appointment, or members of the Minnesota National
Guard while engaged in training or duty under United States Code, title 10, or title 32,
section 316, 502, 503, 504, or 505, as amended through December 31, 1983. Notwithstanding
sections 43A.02 and 611.263, for purposes of this section and section 3.736 only, "employee
of the state" includes a district public defender or assistant district public defender in the
Second or Fourth Judicial District, a member of the Health Technology Advisory Committee,
and any officer, agent, or employee of the state of Wisconsin performing work for the state
of Minnesota pursuant to a joint state initiative.
(3) "Scope of office or employment" means that the employee was acting on behalf of
the state in the performance of duties or tasks lawfully assigned by competent authority.
(4) "Judicial branch" has the meaning given in section 43A.02, subdivision 25.
Sec. 2.
Minnesota Statutes 2020, section 10A.01, subdivision 35, is amended to read:
Subd. 35.
Public official.
"Public official" means any:
(1) member of the legislature;
(2) individual employed by the legislature as secretary of the senate, legislative auditor,
director of the Legislative Budget Office, chief clerk of the house of representatives, revisor
of statutes, or researcher, legislative analyst, fiscal analyst, or attorney in the Office of
Senate Counsel, Research and Fiscal Analysis, House Research, or the House Fiscal Analysis
Department;
(3) constitutional officer in the executive branch and the officer's chief administrative
deputy;
(4) solicitor general or deputy, assistant, or special assistant attorney general;
(5) commissioner, deputy commissioner, or assistant commissioner of any state
department or agency as listed in section 15.01 or 15.06, or the state chief information
officer;
(6) member, chief administrative officer, or deputy chief administrative officer of a state
board or commission that has either the power to adopt, amend, or repeal rules under chapter
14, or the power to adjudicate contested cases or appeals under chapter 14;
(7) individual employed in the executive branch who is authorized to adopt, amend, or
repeal rules under chapter 14 or adjudicate contested cases under chapter 14;
(8) executive director of the State Board of Investment;
(9) deputy of any official listed in clauses (7) and (8);
(10) judge of the Workers' Compensation Court of Appeals;
(11) administrative law judge or compensation judge in the State Office of Administrative
Hearings or unemployment law judge in the Department of Employment and Economic
Development;
(12) member, regional administrator, division director, general counsel, or operations
manager of the Metropolitan Council;
(13) member or chief administrator of a metropolitan agency;
(14) director of the Division of Alcohol and Gambling Enforcement in the Department
of Public Safety;
(15) member or executive director of the deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority;
(16) member of the board of directors or president of Enterprise Minnesota, Inc.;
(17) member of the board of directors or executive director of the Minnesota State High
School League;
(18) member of the Minnesota Ballpark Authority established in section 473.755;
(19) citizen member of the Legislative-Citizen Commission on Minnesota Resources;
(20) manager of a watershed district, or member of a watershed management organization
as defined under section 103B.205, subdivision 13;
(21) supervisor of a soil and water conservation district;
(22) director of Explore Minnesota Tourism;
(23) citizen member of the Lessard-Sams Outdoor Heritage Council established in section
97A.056;
(24) citizen member of the Clean Water Council established in section 114D.30;
(25) member or chief executive of the Minnesota Sports Facilities Authority established
in section 473J.07;
(26) district court judge, appeals court judge, or supreme court justice;
(27) county commissioner;
(28) member of the Greater Minnesota Regional Parks and Trails Commission; or
(29) member of the Destination Medical Center Corporation established in section
469.41.
Sec. 3.
Minnesota Statutes 2020, section 136A.25, is amended to read:
136A.25 CREATION.
A state agency known as the Minnesota deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities Authority
is hereby created.
Sec. 4.
Minnesota Statutes 2020, section 136A.26, is amended to read:
136A.26 MEMBERSHIPS; OFFICERS; COMPENSATION; REMOVAL.
Subdivision 1.
Membership.
The Minnesota deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority shall consist of deleted text begin eightdeleted text end new text begin ninenew text end members appointed by the governor with the advice
and consent of the senate, and a representative of the deleted text begin officedeleted text end new text begin Office of Higher Educationnew text end .
All members to be appointed by the governor shall be residents of the state. At least two
members must reside outside the metropolitan area as defined in section 473.121, subdivision
2. At least one of the members shall be a person having a favorable reputation for skill,
knowledge, and experience in the field of state and municipal finance; deleted text begin anddeleted text end at least one shall
be a person having a favorable reputation for skill, knowledge, and experience in the building
construction field; deleted text begin anddeleted text end at least one of the members shall be a trustee, director, officer, or
employee of an institution of higher educationnew text begin ; and at least one of the members shall be a
trustee, director, officer, or employee of a health care organizationnew text end .
Subd. 1a.
Private College Council member.
The president of the Minnesota Private
College Council, or the president's designee, shall serve without compensation as an advisory,
nonvoting member of the authority.
new text begin Subd. 1b. new text end
new text begin Nonprofit health care association member. new text end
new text begin
The chief executive officer of
a Minnesota nonprofit membership association whose members are primarily nonprofit
health care organizations, or the chief executive officer's designee, shall serve without
compensation as an advisory, nonvoting member of the authority. The identity of the
Minnesota nonprofit membership association shall be determined and may be changed from
time to time by the members of the authority in accordance with and as shall be provided
in the bylaws of the authority.
new text end
Subd. 2.
Term; compensation; removal.
The membership terms, compensation, removal
of members, and filling of vacancies for authority members other than the representative
of the office, deleted text begin anddeleted text end the president of the Private College Council,new text begin or the chief executive officer
of the Minnesota nonprofit membership association described in subdivision 1bnew text end shall be as
provided in section 15.0575.
Sec. 5.
Minnesota Statutes 2020, section 136A.27, is amended to read:
136A.27 POLICY.
It is hereby declared that for the benefit of the people of the state, the increase of their
commerce, welfare and prosperity and the improvement of their health and living conditions
it is essential that new text begin health care organizations within the state be provided with appropriate
additional means to establish, acquire, construct, improve, and expand health care facilities
in furtherance of their purposes; that new text end this and future generations of youth be given the fullest
opportunity to learn and to develop their intellectual and mental capacities; deleted text begin that it is essentialdeleted text end
that institutions of higher education within the state be provided with appropriate additional
means to assist such youth in achieving the required levels of learning and development of
their intellectual and mental capacitiesnew text begin ;new text end andnew text begin that health care organizations and institutions
of higher educationnew text end be enabled to refinance outstanding indebtedness incurred to provide
existing facilities used for such purposes in order to preserve and enhance the utilization of
facilities for purposes of new text begin health care and new text end higher education, to extend or adjust maturities in
relation to the resources available for their payment, and to save interest costs and thereby
reduce new text begin health care costs or higher education new text end tuition, feesnew text begin ,new text end and chargesdeleted text begin ; anddeleted text end new text begin . It is hereby
further declarednew text end that it is the purpose of sections 136A.25 to 136A.42 to provide a measure
of assistance and an alternative method to enable new text begin health care organizations and new text end institutions
of higher education in the state to provide the facilities and structures which are sorely
needed to accomplish the purposes of sections 136A.25 to 136A.42, all to the public benefit
and good, to the extent and manner provided herein.
Sec. 6.
Minnesota Statutes 2020, section 136A.28, is amended to read:
136A.28 DEFINITIONS.
Subdivision 1.
Scope.
In sections 136A.25 to 136A.42, the following words and terms
shall, unless the context otherwise requires, have the meanings ascribed to them.
new text begin Subd. 1a. new text end
new text begin Affiliate. new text end
new text begin
"Affiliate" means an entity that directly or indirectly controls, is
controlled by, or is under common control with, another entity. For the purposes of this
subdivision, "control" means either the power to elect a majority of the members of the
governing body of an entity or the power, whether by contract or otherwise, to direct the
management and policies of the entity. Affiliate also means an entity whose business or
substantially all of whose property is operated under a lease, management agreement, or
operating agreement by another entity, or an entity who operates the business or substantially
all of the property of another entity under a lease, management agreement, or operating
agreement.
new text end
Subd. 2.
Authority.
"Authority" means the deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority created by sections 136A.25 to 136A.42.
Subd. 3.
Project.
"Project" means deleted text begin a structure or structures available for use as a dormitory
or other student housing facility, a dining hall, student union, administration building,
academic building, library, laboratory, research facility, classroom, athletic facility, health
care facility, child care facility, and maintenance, storage, or utility facility and other
structures or facilities related thereto or required or useful for the instruction of students or
the conducting of research or the operation of an institution of higher education, whether
proposed, under construction, or completed, including parking and other facilities or
structures essential or convenient for the orderly conduct of such institution for higher
education, and shall also include landscaping, site preparation, furniture, equipment and
machinery, and other similar items necessary or convenient for the operation of a particular
facility or structure in the manner for which its use is intended but shall not include such
items as books, fuel, supplies, or other items the costs of which are customarily deemed to
result in a current operating charge, and shalldeleted text end new text begin a health care facility or an education facility
whether proposed, under construction, or completed, and includes land or interests in land,
appurtenances, site preparation, landscaping, buildings and structures, systems, fixtures,
furniture, machinery, equipment, and parking. Project also includes other structures, facilities,
improvements, machinery, equipment, and means of transport of a capital nature that are
necessary or convenient for the operation of the facility. Project does new text end not includenew text begin : (1)new text end any
facility used or to be used for sectarian instruction or as a place of religious worship deleted text begin nordeleted text end new text begin ;
(2)new text end any facility which is used or to be used primarily in connection with any part of the
program of a school or department of divinity for any religious denominationnew text begin ; nor (3) any
books, supplies, medicine, medical supplies, fuel, or other items, the cost of which are
customarily deemed to result in a current operating chargenew text end .
Subd. 4.
Cost.
"Cost," as applied to a project or any portion thereof financed under the
provisions of sections 136A.25 to 136A.42, means all or any part of the cost of construction,
acquisition, alteration, enlargement, reconstruction and remodeling of a project including
all lands, structures, real or personal property, rights, rights-of-way, franchises, easements
and interests acquired or used for or in connection with a project, the cost of demolishing
or removing any buildings or structures on land so acquired, including the cost of acquiring
any lands to which deleted text begin suchdeleted text end buildings or structures may be moved, the cost of all machinery
and equipment, financing charges, interest prior to, during and for a period after completion
of such construction and acquisition, provisions for reserves for principal and interest and
for extensions, enlargements, additions and improvements, the cost of architectural,
engineering, financial and legal services, plans, specifications, studies, surveys, estimates
of cost and of revenues, administrative expenses, expenses necessary or incident to
determining the feasibility or practicability of constructing the project and such other
expenses as may be necessary or incident to the construction and acquisition of the project,
the financing of such construction and acquisition and the placing of the project in operation.
Subd. 5.
Bonds.
"Bonds," or "revenue bonds" means revenue bonds of the authority
issued under the provisions of sections 136A.25 to 136A.42, including revenue refunding
bonds, notwithstanding that the same may be secured by mortgage or the full faith and credit
of a participating institution deleted text begin for higher educationdeleted text end or any other lawfully pledged security of
a participating institution deleted text begin for higher educationdeleted text end .
Subd. 6.
Institution of higher education.
"Institution of higher education" means a
nonprofit educational institution within the state authorized to provide a program of education
beyond the high school level.
new text begin Subd. 6a. new text end
new text begin Health care organization. new text end
new text begin
(a) "Health care organization" means a nonprofit
organization located within the state and authorized by law to operate a nonprofit health
care facility in the state. Health care organization also means a nonprofit affiliate of a health
care organization as defined under this paragraph, provided the affiliate is located within
the state or within a state that is geographically contiguous to Minnesota.
new text end
new text begin
(b) Health care organization also means a nonprofit organization located within another
state that is geographically contiguous to Minnesota and authorized by law to operate a
nonprofit health care facility in that state, provided that the nonprofit organization located
within the contiguous state is an affiliate of a health care organization located within the
state.
new text end
new text begin Subd. 6b. new text end
new text begin Education facility. new text end
new text begin
"Education facility" means a structure or structures
available for use as a dormitory or other student housing facility, dining hall, student union,
administration building, academic building, library, laboratory, research facility, classroom,
athletic facility, student health care facility, or child care facility, and includes other facilities
or structures related thereto essential or convenient for the orderly conduct of an institution
of higher education.
new text end
new text begin Subd. 6c. new text end
new text begin Health care facility. new text end
new text begin
(a) "Health care facility" means a structure or structures
available for use within this state as a hospital, clinic, psychiatric residential treatment
facility, birth center, outpatient surgical center, comprehensive outpatient rehabilitation
facility, outpatient physical therapy or speech pathology facility, end-stage renal dialysis
facility, medical laboratory, pharmacy, radiation therapy facility, diagnostic imaging facility,
medical office building, residence for nurses or interns, nursing home, boarding care home,
assisted living facility, residential hospice, intermediate care facility for persons with
developmental disabilities, supervised living facility, housing with services establishment,
board and lodging establishment with special services, adult day care center, day services
facility, prescribed pediatric extended care facility, community residential setting, adult
foster home, or other facility related to medical or health care research, or the delivery or
administration of health care services, and includes other structures or facilities related
thereto essential or convenient for the orderly conduct of a health care organization.
new text end
new text begin
(b) Health care facility also means a facility in a state that is geographically contiguous
to Minnesota operated by a health care organization that corresponds by purpose, function,
or use with a facility listed in paragraph (a).
new text end
Subd. 7.
Participating institution deleted text begin of higher educationdeleted text end .
"Participating institution deleted text begin of
higher educationdeleted text end " meansnew text begin a health care organization ornew text end an institution of higher education
that, under the provisions of sections 136A.25 to 136A.42, undertakes the financing and
construction or acquisition of a project or undertakes the refunding or refinancing of
obligations or of a mortgage or of advances as provided in sections 136A.25 to 136A.42.
Community colleges and technical colleges may be considered participating institutions deleted text begin of
higher educationdeleted text end for the purpose of financing and constructing child care facilities and
parking facilities.
Sec. 7.
Minnesota Statutes 2020, section 136A.29, subdivision 1, is amended to read:
Subdivision 1.
Purpose.
The purpose of the authority shall be to assist new text begin health care
organizations and new text end institutions of higher education in the construction, financing, and
refinancing of projects. The exercise by the authority of the powers conferred by sections
136A.25 to 136A.42, shall be deemed and held to be the performance of an essential public
function. For the purpose of sections 136A.25 to 136A.42, the authority shall have the
powers and duties set forth in subdivisions 2 to 23.
Sec. 8.
Minnesota Statutes 2020, section 136A.29, subdivision 3, is amended to read:
Subd. 3.
Employees.
The authority is authorized and empowered to appoint and employ
employees as it may deem necessary to carry out its duties, determine the title of the
employees so employed, and fix the salary of deleted text begin saiddeleted text end new text begin itsnew text end employees. Employees of the authority
shall participate in retirement and other benefits in the same manner that employees in the
deleted text begin unclassified service of the officedeleted text end new text begin managerial plan under section 43A.18, subdivision 3,new text end
participate.
Sec. 9.
Minnesota Statutes 2020, section 136A.29, subdivision 6, is amended to read:
Subd. 6.
Projects; generally.
new text begin (a) new text end The authority is authorized and empowered to determine
the location and character of any project to be financed under the provisions of sections
136A.25 to 136A.42, and to construct, reconstruct, remodel, maintain, manage, enlarge,
alter, add to, repair, operate, lease, as lessee or lessor, and regulate the same, to enter into
contracts for any or all of such purposes, to enter into contracts for the management and
operation of a project, and to designate a participating institution deleted text begin of higher educationdeleted text end as its
agent to determine the location and character of a project undertaken by such participating
institution deleted text begin of higher educationdeleted text end under the provisions of sections 136A.25 to 136A.42 and as
the agent of the authority, to construct, reconstruct, remodel, maintain, manage, enlarge,
alter, add to, repair, operate, lease, as lessee or lessor, and regulate the same, and as the
agent of the authority, to enter into contracts for any or all of such purposes, including
contracts for the management and operation of such project.
new text begin
(b) Notwithstanding paragraph (a), a project involving a health care facility within the
state financed under sections 136A.25 to 136A.42, must comply with all applicable
requirements in state law related to authorizing construction of or modifications to a health
care facility, including the requirements of sections 144.5509, 144.551, 144A.071, and
252.291.
new text end
new text begin (c) new text end Contracts of the authority or of a participating institution deleted text begin of higher educationdeleted text end to
acquire or to construct, reconstruct, remodel, maintain, enlarge, alter, add to, or repair
projects shall not be subject to the provisions of chapter 16C or section 574.26, or any other
public contract or competitive bid law.
Sec. 10.
Minnesota Statutes 2020, section 136A.29, subdivision 9, is amended to read:
Subd. 9.
Revenue bonds; limit.
The authority is authorized and empowered to issue
revenue bonds whose aggregate principal amount at any time shall not exceed deleted text begin $1,300,000,000deleted text end new text begin
$4,000,000,000new text end and to issue notes, bond anticipation notes, and revenue refunding bonds
of the authority under the provisions of sections 136A.25 to 136A.42, to provide funds for
acquiring, constructing, reconstructing, enlarging, remodeling, renovating, improving,
furnishing, or equipping one or more projects or parts thereof.
Sec. 11.
Minnesota Statutes 2020, section 136A.29, subdivision 10, is amended to read:
Subd. 10.
Revenue bonds; issuance, purpose, conditions.
The authority is authorized
and empowered to issue revenue bonds to acquire projects from or to make loans to
participating institutions deleted text begin of higher educationdeleted text end and thereby refinance outstanding indebtedness
incurred by participating institutions deleted text begin of higher educationdeleted text end to provide funds for the acquisition,
construction or improvement of a facility before or after the enactment of sections 136A.25
to 136A.42, but otherwise eligible to be and being a project thereunder, whenever the
authority finds that such refinancing will enhance or preserve such participating institutions
and such facilities or utilization thereof for new text begin health care or new text end educational purposes or extend
or adjust maturities to correspond to the resources available for their payment, or reduce
new text begin charges or fees imposed on patients or occupants, or new text end the tuition, chargesnew text begin ,new text end or fees imposed
on students for the use new text begin or occupancy new text end of the facilities of such participating institutions deleted text begin of
higher educationdeleted text end or costs met by federal or state public funds, or enhance or preserve new text begin health
care or new text end educational programs and research or the acquisition or improvement of other
facilities eligible to be a project or part thereof by the participating institution deleted text begin of higher
educationdeleted text end . The amount of revenue bonds to be issued to refinance outstanding indebtedness
of a participating institution deleted text begin of higher educationdeleted text end shall not exceed the lesser of (a) the fair
value of the project to be acquired by the authority from the institution or mortgaged to the
authority by the institution or (b) the amount of the outstanding indebtedness including any
premium thereon and any interest accrued or to accrue to the date of redemption and any
legal, fiscal and related costs in connection with such refinancing and reasonable reserves,
as determined by the authority. The provisions of this subdivision do not prohibit the authority
from issuing revenue bonds within and charged against the limitations provided in subdivision
9 to provide funds for improvements, alteration, renovation, or extension of the project
refinanced.
Sec. 12.
Minnesota Statutes 2020, section 136A.29, subdivision 14, is amended to read:
Subd. 14.
Rules for use of projects.
The authority is authorized and empowered to
establish rules for the use of a project or any portion thereof and to designate a participating
institution deleted text begin of higher educationdeleted text end as its agent to establish rules for the use of a project undertaken
for such participating institution deleted text begin of higher educationdeleted text end .
Sec. 13.
Minnesota Statutes 2020, section 136A.29, subdivision 19, is amended to read:
Subd. 19.
Surety.
Before the issuance of any revenue bonds under the provisions of
sections 136A.25 to 136A.42, any member or officer of the authority authorized by resolution
of the authority to handle funds or sign checks of the authority shall be covered under a
surety or fidelity bond in an amount to be determined by the authority. Each such bond shall
be conditioned upon the faithful performance of the duties of the office of the member or
officer, new text begin and new text end shall be executed by a surety company authorized to transact business in the
state of Minnesota as surety. The cost of each such bond shall be paid by the authority.
Sec. 14.
Minnesota Statutes 2020, section 136A.29, subdivision 20, is amended to read:
Subd. 20.
Sale, lease, and disposal of property.
The authority is authorized and
empowered to sell, lease, releasenew text begin ,new text end or otherwise dispose of real and personal property or
interests therein, or a combination thereof, acquired by the authority under authority of
sections 136A.25 to 136A.42 and no longer needed for the purposes of deleted text begin suchdeleted text end new text begin thisnew text end chapter or
of the authority, and grant such easements and other rights in, over, under, or across a project
as will not interfere with its use of deleted text begin suchdeleted text end new text begin thenew text end property. deleted text begin Suchdeleted text end new text begin Thenew text end sale, lease, release,
disposition, or grant may be made without competitive bidding and in deleted text begin suchdeleted text end new text begin thenew text end mannernew text begin andnew text end
for such consideration as the authority in its judgment deems appropriate.
Sec. 15.
Minnesota Statutes 2020, section 136A.29, subdivision 21, is amended to read:
Subd. 21.
Loans.
The authority is authorized and empowered to make loans to any
participating institution deleted text begin of higher educationdeleted text end for the cost of a project in accordance with an
agreement between the authority and the participating institution deleted text begin of higher educationdeleted text end ;
provided that no deleted text begin suchdeleted text end loan shall exceed the total cost of the project as determined by the
participating institution deleted text begin of higher educationdeleted text end and approved by the authority.
Sec. 16.
Minnesota Statutes 2020, section 136A.29, subdivision 22, is amended to read:
Subd. 22.
Costs, expenses, and other charges.
The authority is authorized and
empowered to charge to and apportion among participating institutions deleted text begin of higher educationdeleted text end
its administrative costs and expenses incurred in the exercise of the powers and duties
conferred by sections 136A.25 to 136A.42new text begin in the manner as the authority in its judgment
deems appropriatenew text end .
Sec. 17.
Minnesota Statutes 2020, section 136A.29, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Determination of affiliate status. new text end
new text begin
The authority is authorized and empowered
to determine whether an entity is an affiliate as defined in section 136A.28, subdivision 1a.
A determination by the authority of affiliate status shall be deemed conclusive for the
purposes of sections 136A.25 to 136A.42.
new text end
Sec. 18.
Minnesota Statutes 2020, section 136A.32, subdivision 4, is amended to read:
Subd. 4.
Provisions of resolution authorizing bonds.
Any resolution or resolutions
authorizing any revenue bonds or any issue of revenue bonds may contain provisions, which
shall be a part of the contract with the holders of the revenue bonds to be authorized, as to:
(1) pledging all or any part of the revenues of a project or projects, any revenue producing
contract or contracts made by the authority with deleted text begin any individual partnership, corporation or
association or other bodydeleted text end new text begin one or more partnerships, corporations or associations, or other
bodiesnew text end , public or private, to secure the payment of the revenue bonds or of any particular
issue of revenue bonds, subject to such agreements with bondholders as may then exist;
(2) the rentals, fees and other charges to be charged, and the amounts to be raised in
each year thereby, and the use and disposition of the revenues;
(3) the setting aside of reserves or sinking funds, and the regulation and disposition
thereof;
(4) limitations on the right of the authority or its agent to restrict and regulate the use of
the project;
(5) limitations on the purpose to which the proceeds of sale of any issue of revenue
bonds then or thereafter to be issued may be applied and pledging such proceeds to secure
the payment of the revenue bonds or any issue of the revenue bonds;
(6) limitations on the issuance of additional bonds, the terms upon which additional
bonds may be issued and secured and the refunding of outstanding bonds;
(7) the procedure, if any, by which the terms of any contract with bondholders may be
amended or abrogated, the amount of bonds the holders of which must consent thereto, and
the manner in which such consent may be given;
(8) limitations on the amount of moneys derived from the project to be expended for
operating, administrative or other expenses of the authority;
(9) defining the acts or omissions to act which shall constitute a default in the duties of
the authority to holders of its obligations and providing the rights and remedies of such
holders in the event of a default;new text begin or
new text end
(10) the mortgaging of a project and the site thereof for the purpose of securing the
bondholders.
Sec. 19.
Minnesota Statutes 2020, section 136A.33, is amended to read:
136A.33 TRUST AGREEMENT.
In the discretion of the authority any revenue bonds issued under the provisions of
sections 136A.25 to 136A.42, may be secured by a trust agreement by and between the
authority and a corporate trustee or trustees, which may be any trust company or bank having
the powers of a trust company within the state. deleted text begin Suchdeleted text end new text begin Thenew text end trust agreement or the resolution
providing for the issuance of deleted text begin suchdeleted text end revenue bonds may pledge or assign the revenues to be
received or proceeds of any contract or contracts pledged and may convey or mortgage the
project or any portion thereof. deleted text begin Suchdeleted text end new text begin Thenew text end trust agreement or resolution providing for the
issuance of deleted text begin suchdeleted text end revenue bonds may contain such provisions for protecting and enforcing
the rights and remedies of the bondholders as may be reasonable and proper and not in
violation of laws, including particularly such provisions as have hereinabove been specifically
authorized to be included in any resolution or resolutions of the authority authorizing revenue
bonds thereof. Any bank or trust company incorporated under the laws of the state deleted text begin whichdeleted text end new text begin
thatnew text end may act as depository of the proceeds of bonds or of revenues or other moneys may
furnish deleted text begin suchdeleted text end indemnifying bonds or deleted text begin pledges suchdeleted text end new text begin pledge new text end securities as may be required by
the authority. Any deleted text begin suchdeleted text end trust agreement may set forth the rights and remedies of the
bondholders and of the trustee or trustees and may restrict the individual right of action by
bondholders. In addition to the foregoing, any deleted text begin suchdeleted text end trust agreement or resolution may contain
deleted text begin suchdeleted text end other provisions as the authority may deem reasonable and proper for the security of
the bondholders. All expenses incurred in carrying out the provisions of deleted text begin suchdeleted text end new text begin thenew text end trust
agreement or resolution may be treated as a part of the cost of the operation of a project.
Sec. 20.
Minnesota Statutes 2020, section 136A.34, subdivision 3, is amended to read:
Subd. 3.
Investment.
Any deleted text begin suchdeleted text end escrowed proceeds, pending such use, may be invested
and reinvested in direct obligations of the United States of America, or in certificates of
deposit or time deposits secured by direct obligations of the United States of America, new text begin or
in shares or units in any money market mutual fund whose investment portfolio consists
solely of direct obligations of the United States of America, new text end maturing at such time or times
as shall be appropriate to assure the prompt payment, as to principal, interest and redemption
premium, if any, of the outstanding revenue bonds to be so refunded. The interest, income
and profits, if any, earned or realized on any such investment may also be applied to the
payment of the outstanding revenue bonds to be so refunded. After the terms of the escrow
have been fully satisfied and carried out, any balance of such proceeds and interest, income
and profits, if any, earned or realized on the investments thereof may be returned to the
authority for use by it in any lawful manner.
Sec. 21.
Minnesota Statutes 2020, section 136A.34, subdivision 4, is amended to read:
Subd. 4.
Additional purpose; improvements.
The portion of the proceeds of any deleted text begin suchdeleted text end
revenue bonds issued for the additional purpose of paying all or any part of the cost of
constructing and acquiring additions, improvements, extensions or enlargements of a project
may be invested or deposited deleted text begin in time depositsdeleted text end as provided in section 136A.32, subdivision
7.
Sec. 22.
Minnesota Statutes 2020, section 136A.36, is amended to read:
136A.36 REVENUES.
The authority may fix, revise, charge and collect rates, rents, fees and charges for the
use of and for the services furnished or to be furnished by each project and deleted text begin todeleted text end new text begin maynew text end contract
with any person, partnership, association or corporation, or other body, public or private,
in respect thereof. deleted text begin Suchdeleted text end new text begin Thenew text end rates, rents, feesnew text begin ,new text end and charges new text begin may vary between projects
involving an education facility and projects involving a health care facility and new text end shall be
fixed and adjusted in respect of the aggregate of rates, rents, feesnew text begin ,new text end and charges from deleted text begin suchdeleted text end new text begin
thenew text end project so as to provide funds sufficient with other revenues, if any:
(1) to pay the cost of maintaining, repairing and operating the project and each and every
portion thereof, to the extent that the payment of such cost has not otherwise been adequately
provided for;
(2) to pay the principal of and the interest on outstanding revenue bonds of the authority
issued in respect of such project as the same shall become due and payable; and
(3) to create and maintain reserves required or provided for in any resolution authorizing,
or trust agreement securing, deleted text begin suchdeleted text end revenue bonds of the authority. deleted text begin Suchdeleted text end new text begin Thenew text end rates, rents, fees
and charges shall not be subject to supervision or regulation by any department, commission,
board, body, bureau or agency of this state other than the authority. A sufficient amount of
the revenues derived in respect of a project, except deleted text begin suchdeleted text end part of deleted text begin suchdeleted text end new text begin thenew text end revenues as may
be necessary to pay the cost of maintenance, repair and operation and to provide reserves
and for renewals, replacements, extensions, enlargements and improvements as may be
provided for in the resolution authorizing the issuance of any revenue bonds of the authority
or in the trust agreement securing the same, shall be set aside at such regular intervals as
may be provided in deleted text begin suchdeleted text end new text begin thenew text end resolution or trust agreement in a sinking or other similar fund
deleted text begin whichdeleted text end new text begin thatnew text end is hereby pledged to, and charged with, the payment of the principal of and the
interest on deleted text begin suchdeleted text end revenue bonds as the same shall become due, and the redemption price or
the purchase price of bonds retired by call or purchase as therein provided. deleted text begin Suchdeleted text end new text begin Thenew text end pledge
shall be valid and binding from the time when the pledge is made; the rates, rents, fees and
charges and other revenues or other moneys so pledged and thereafter received by the
authority shall immediately be subject to the lien of deleted text begin suchdeleted text end new text begin thenew text end pledge without physical delivery
thereof or further act, and the lien of any such pledge shall be valid and binding as against
all parties having claims of any kind against the authority, irrespective of whether such
parties have notice thereof. Neither the resolution nor any trust agreement by which a pledge
is created need be filed or recorded except in the records of the authority. The use and
disposition of moneys to the credit of such sinking or other similar fund shall be subject to
the provisions of the resolution authorizing the issuance of such bonds or of such trust
agreement. Except as may otherwise be provided in deleted text begin suchdeleted text end new text begin thenew text end resolution or deleted text begin suchdeleted text end trust
agreement, deleted text begin suchdeleted text end new text begin thenew text end sinking or other similar fund shall be a fund for all deleted text begin suchdeleted text end revenue bonds
issued to finance a project or projects at one or more participating institutions deleted text begin of higher
educationdeleted text end without distinction or priority of one over another; provided the authority in any
such resolution or trust agreement may provide that such sinking or other similar fund shall
be the fund for a particular project at deleted text begin andeleted text end new text begin a participatingnew text end institution deleted text begin of higher educationdeleted text end and
for the revenue bonds issued to finance a particular project and may, additionally, permit
and provide for the issuance of revenue bonds having a subordinate lien in respect of the
security herein authorized to other revenue bonds of the authority and, in such case, the
authority may create separate or other similar funds in respect of deleted text begin suchdeleted text end new text begin thenew text end subordinate lien
bonds.
Sec. 23.
Minnesota Statutes 2020, section 136A.38, is amended to read:
136A.38 BONDS ELIGIBLE FOR INVESTMENT.
Bonds issued bynew text begin thenew text end authority under the provisions of sections 136A.25 to 136A.42, are
hereby made securities in which all public officers and public bodies of the state and its
political subdivisions, all insurance companies, trust companies, banking associations,
investment companies, executors, administrators, trustees and other fiduciaries may properly
and legally invest funds, including capital in their control or belonging to them; it being the
purpose of this section to authorize the investment in such bonds of all sinking, insurance,
retirement, compensation, pension and trust funds, whether owned or controlled by private
or public persons or officers; provided, however, that nothing contained in this section may
be construed as relieving any person, firm, or corporation from any duty of exercising due
care in selecting securities for purchase or investment; and provide further, that in no event
shall assets of pension funds of public employees of the state of Minnesota or any of its
agencies, boards or subdivisions, whether publicly or privately administered, be invested
in bonds issued under the provisions of sections 136A.25 to 136A.42. Such bonds are hereby
constituted "authorized securities" within the meaning and for the purposes of Minnesota
Statutes 1969, section 50.14. deleted text begin Suchdeleted text end new text begin Thenew text end bonds are hereby made securities deleted text begin whichdeleted text end new text begin thatnew text end may
properly and legally be deposited with and received by any state or municipal officer or any
agency or political subdivision of the state for any purpose for which the deposit of bonds
or obligations of the state now or may hereafter be authorized by law.
Sec. 24.
Minnesota Statutes 2020, section 136A.41, is amended to read:
136A.41 CONFLICT OF INTEREST.
Notwithstanding any other law to the contrary it shall not be or constitute a conflict of
interest for a trustee, director, officer or employee of any participating institution deleted text begin of higher
educationdeleted text end , financial institution, investment banking firm, brokerage firm, commercial bank
or trust company, architecture firm, insurance company, construction company, or any other
firm, person or corporation to serve as a member of the authority, provided such trustee,
director, officer or employee shall abstain from deliberation, action and vote by the authority
in each instance where the business affiliation of any such trustee, director, officer or
employee is involved.
Sec. 25.
Minnesota Statutes 2020, section 136A.42, is amended to read:
136A.42 ANNUAL REPORT.
The authority shall keep an accurate account of all of its activities and all of its receipts
and expenditures deleted text begin and shall annually report to the officedeleted text end .new text begin Each year, the authority shall submit
to the Minnesota Historical Society and the Legislative Reference Library a report of the
authority's activities in the previous year, including all financial activities.
new text end
Sec. 26.
Minnesota Statutes 2020, section 136F.67, subdivision 1, is amended to read:
Subdivision 1.
Authorization.
A technical college or a community college must not
seek financing for child care facilities or parking facilities through the deleted text begin Higherdeleted text end new text begin Health andnew text end
Education Facilities Authority, as provided in section 136A.28, subdivision 7, without the
explicit authorization of the board.
Sec. 27.
Minnesota Statutes 2020, section 354B.20, subdivision 7, is amended to read:
Subd. 7.
Employing unit.
"Employing unit," if the agency employs any persons covered
by the individual retirement account plan under section 354B.211, means:
(1) the board;
(2) the Minnesota Office of Higher Education; and
(3) the deleted text begin Higherdeleted text end new text begin Health andnew text end Education Facilities Authority.
Sec. 28. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber the law establishing and governing the Minnesota
Higher Education Facilities Authority, renamed the Minnesota Health and Education
Facilities Authority in this act, as Minnesota Statutes, chapter 16F, coded in Minnesota
Statutes 2020, sections 136A.25 to 136A.42, as amended or repealed in this act. The revisor
of statutes shall also duplicate any required definitions from Minnesota Statutes, chapter
136A, revise any statutory cross-references consistent with the recoding, and report the
history in Minnesota Statutes, chapter 16F.
new text end
Sec. 29. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 136A.29, subdivision 4,
new text end
new text begin
is repealed.
new text end
ARTICLE 8
TELEHEALTH
Section 1.
new text begin
[62A.673] COVERAGE OF SERVICES PROVIDED THROUGH
TELEHEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This section may be cited as the "Minnesota Telehealth Act."
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
new text end
new text begin
(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.
new text end
new text begin
(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional as
defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; a mental health
practitioner as defined under section 245.462, subdivision 17, or 245.4871, subdivision 26;
a treatment coordinator under section 245G.11, subdivision 7; an alcohol and drug counselor
under section 245G.11, subdivision 5; and a recovery peer under section 245G.11, subdivision
8.
new text end
new text begin
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
new text end
new text begin
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.
new text end
new text begin
(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
technology, the originating site also means the location at which a health care provider
transfers or transmits information to the distant site.
new text end
new text begin
(g) "Store-and-forward technology" means the asynchronous electronic transfer or
transmission of a patient's medical information or data from an originating site to a distant
site for the purposes of diagnostic and therapeutic assistance in the care of a patient.
new text end
new text begin
(h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual or audio-only communications to
provide or support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes
the application of secure video conferencing, store-and-forward technology, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. Telehealth includes audio-only communication between a health care
provider and a patient if the communication is a scheduled appointment and the standard
of care for the service can be met through the use of audio-only communication. Telehealth
does not include communication between health care providers or between a health care
provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth
does not include communication between health care providers that consists solely of a
telephone conversation. Telehealth does not include telemonitoring services as defined in
paragraph (i).
new text end
new text begin
(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.
new text end
new text begin Subd. 3. new text end
new text begin Coverage of telehealth. new text end
new text begin
(a) A health plan sold, issued, or renewed by a health
carrier in Minnesota must (1) cover benefits delivered through telehealth in the same manner
as any other benefits covered under the health plan, and (2) comply with this section.
new text end
new text begin
(b) Coverage for services delivered through telehealth must not be limited on the basis
of geography, location, or distance for travel subject to the health care provider network
available to the enrollee through the enrollee's health plan.
new text end
new text begin
(c) A health carrier must not create a separate provider network to deliver services
through telehealth that does not include network providers who provide in-person care to
patients for the same service or require an enrollee to use a specific provider within the
network to receive services through telehealth.
new text end
new text begin
(d) A health carrier may require a deductible, co-payment, or coinsurance payment for
a health care service provided through telehealth, provided that the deductible, co-payment,
or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment,
or coinsurance applicable for the same service provided through in-person contact.
new text end
new text begin
(e) Nothing in this section:
new text end
new text begin
(1) requires a health carrier to provide coverage for services that are not medically
necessary or are not covered under the enrollee's health plan; or
new text end
new text begin
(2) prohibits a health carrier from:
new text end
new text begin
(i) establishing criteria that a health care provider must meet to demonstrate the safety
or efficacy of delivering a particular service through telehealth for which the health carrier
does not already reimburse other health care providers for delivering the service through
telehealth; or
new text end
new text begin
(ii) establishing reasonable medical management techniques, provided the criteria or
techniques are not unduly burdensome or unreasonable for the particular service; or
new text end
new text begin
(iii) requiring documentation or billing practices designed to protect the health carrier
or patient from fraudulent claims, provided the practices are not unduly burdensome or
unreasonable for the particular service.
new text end
new text begin
(f) Nothing in this section requires the use of telehealth when a health care provider
determines that the delivery of a health care service through telehealth is not appropriate or
when an enrollee chooses not to receive a health care service through telehealth.
new text end
new text begin Subd. 4. new text end
new text begin Parity between telehealth and in-person services. new text end
new text begin
(a) A health carrier must
not restrict or deny coverage of a health care service that is covered under a health plan
solely:
new text end
new text begin
(1) because the health care service provided by the health care provider through telehealth
is not provided through in-person contact; or
new text end
new text begin
(2) based on the communication technology or application used to deliver the health
care service through telehealth, provided the technology or application complies with this
section and is appropriate for the particular service.
new text end
new text begin
(b) Prior authorization may be required for health care services delivered through
telehealth only if prior authorization is required before the delivery of the same service
through in-person contact.
new text end
new text begin
(c) A health carrier may require a utilization review for services delivered through
telehealth, provided the utilization review is conducted in the same manner and uses the
same clinical review criteria as a utilization review for the same services delivered through
in-person contact.
new text end
new text begin
(d) A health carrier or health care provider shall not require an enrollee to pay a fee to
download a specific communication technology or application.
new text end
new text begin Subd. 5. new text end
new text begin Reimbursement for services delivered through telehealth. new text end
new text begin
(a) A health carrier
must reimburse the health care provider for services delivered through telehealth on the
same basis and at the same rate as the health carrier would apply to those services if the
services had been delivered by the health care provider through in-person contact.
new text end
new text begin
(b) A health carrier must not deny or limit reimbursement based solely on a health care
provider delivering the service or consultation through telehealth instead of through in-person
contact.
new text end
new text begin
(c) A health carrier must not deny or limit reimbursement based solely on the technology
and equipment used by the health care provider to deliver the health care service or
consultation through telehealth, provided the technology and equipment used by the provider
meets the requirements of this section and is appropriate for the particular service.
new text end
new text begin Subd. 6. new text end
new text begin Telehealth equipment. new text end
new text begin
(a) A health carrier must not require a health care
provider to use specific telecommunications technology and equipment as a condition of
coverage under this section, provided the health care provider uses telecommunications
technology and equipment that complies with current industry interoperable standards and
complies with standards required under the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that
Act, unless authorized under this section.
new text end
new text begin
(b) A health carrier must provide coverage for health care services delivered through
telehealth by means of the use of audio-only communication if the communication is a
scheduled appointment and the standard of care for that particular service can be met through
the use of audio-only communication.
new text end
new text begin
(c) Notwithstanding paragraph (b), substance use disorder treatment services and mental
health services delivered through telehealth by means of audio-only communication may
be covered without a scheduled appointment if the communication was initiated by the
enrollee while in an emergency or crisis situation and a scheduled appointment was not
possible due to the need of an immediate response.
new text end
new text begin Subd. 7. new text end
new text begin Telemonitoring services. new text end
new text begin
A health carrier must provide coverage for
telemonitoring services if:
new text end
new text begin
(1) the telemonitoring service is medically appropriate based on the enrollee's medical
condition or status;
new text end
new text begin
(2) the enrollee is cognitively and physically capable of operating the monitoring device
or equipment, or the enrollee has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end
new text begin
(3) the enrollee resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end
new text begin Subd. 8. new text end
new text begin Exception. new text end
new text begin
This section does not apply to coverage provided to state public
health care program enrollees under chapter 256B or 256L.
new text end
Sec. 2.
Minnesota Statutes 2020, section 147.033, is amended to read:
147.033 PRACTICE OF deleted text begin TELEMEDICINEdeleted text end new text begin TELEHEALTHnew text end .
Subdivision 1.
Definition.
For the purposes of this section, deleted text begin "telemedicine" means the
delivery of health care services or consultations while the patient is at an originating site
and the licensed health care provider is at a distant site. A communication between licensed
health care providers that consists solely of a telephone conversation, e-mail, or facsimile
transmission does not constitute telemedicine consultations or services. A communication
between a licensed health care provider and a patient that consists solely of an e-mail or
facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way interactive audio, and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, that facilitate the assessment, diagnosis,
consultation, treatment, education, and care management of a patient's health care.deleted text end new text begin
"telehealth" has the meaning given in section 62A.673, subdivision 2, paragraph (h).
new text end
Subd. 2.
Physician-patient relationship.
A physician-patient relationship may be
established through deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Subd. 3.
Standards of practice and conduct.
A physician providing health care services
by deleted text begin telemedicinedeleted text end new text begin telehealthnew text end in this state shall be held to the same standards of practice and
conduct as provided in this chapter for in-person health care services.
Sec. 3.
Minnesota Statutes 2020, section 151.37, subdivision 2, is amended to read:
Subd. 2.
Prescribing and filing.
(a) A licensed practitioner in the course of professional
practice only, may prescribe, administer, and dispense a legend drug, and may cause the
same to be administered by a nurse, a physician assistant, or medical student or resident
under the practitioner's direction and supervision, and may cause a person who is an
appropriately certified, registered, or licensed health care professional to prescribe, dispense,
and administer the same within the expressed legal scope of the person's practice as defined
in Minnesota Statutes. A licensed practitioner may prescribe a legend drug, without reference
to a specific patient, by directing a licensed dietitian or licensed nutritionist, pursuant to
section 148.634; a nurse, pursuant to section 148.235, subdivisions 8 and 9; physician
assistant; medical student or resident; or pharmacist according to section 151.01, subdivision
27, to adhere to a particular practice guideline or protocol when treating patients whose
condition falls within such guideline or protocol, and when such guideline or protocol
specifies the circumstances under which the legend drug is to be prescribed and administered.
An individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
This paragraph applies to a physician assistant only if the physician assistant meets the
requirements of deleted text begin section 147A.18deleted text end new text begin sections 147A.02 and 147A.09new text end .
(b) The commissioner of health, if a licensed practitioner, or a person designated by the
commissioner who is a licensed practitioner, may prescribe a legend drug to an individual
or by protocol for mass dispensing purposes where the commissioner finds that the conditions
triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. The
commissioner, if a licensed practitioner, or a designated licensed practitioner, may prescribe,
dispense, or administer a legend drug or other substance listed in subdivision 10 to control
tuberculosis and other communicable diseases. The commissioner may modify state drug
labeling requirements, and medical screening criteria and documentation, where time is
critical and limited labeling and screening are most likely to ensure legend drugs reach the
maximum number of persons in a timely fashion so as to reduce morbidity and mortality.
(c) A licensed practitioner that dispenses for profit a legend drug that is to be administered
orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must file with the
practitioner's licensing board a statement indicating that the practitioner dispenses legend
drugs for profit, the general circumstances under which the practitioner dispenses for profit,
and the types of legend drugs generally dispensed. It is unlawful to dispense legend drugs
for profit after July 31, 1990, unless the statement has been filed with the appropriate
licensing board. For purposes of this paragraph, "profit" means (1) any amount received by
the practitioner in excess of the acquisition cost of a legend drug for legend drugs that are
purchased in prepackaged form, or (2) any amount received by the practitioner in excess
of the acquisition cost of a legend drug plus the cost of making the drug available if the
legend drug requires compounding, packaging, or other treatment. The statement filed under
this paragraph is public data under section 13.03. This paragraph does not apply to a licensed
doctor of veterinary medicine or a registered pharmacist. Any person other than a licensed
practitioner with the authority to prescribe, dispense, and administer a legend drug under
paragraph (a) shall not dispense for profit. To dispense for profit does not include dispensing
by a community health clinic when the profit from dispensing is used to meet operating
expenses.
(d) A prescription drug order for the following drugs is not valid, unless it can be
established that the prescription drug order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying conditions
and contraindications to treatment:
(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;
(3) muscle relaxants;
(4) centrally acting analgesics with opioid activity;
(5) drugs containing butalbital; or
(6) phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.
deleted text begin
For purposes of prescribing drugs listed in clause (6), the requirement for a documented
patient evaluation, including an examination, may be met through the use of telemedicine,
as defined in section 147.033, subdivision 1.
deleted text end
(e) For the purposes of paragraph (d), the requirement for an examination shall be met
ifnew text begin :
new text end
new text begin (1)new text end an in-person examination has been completed in any of the following circumstances:
deleted text begin (1)deleted text end new text begin (i)new text end the prescribing practitioner examines the patient at the time the prescription or
drug order is issued;
deleted text begin (2)deleted text end new text begin (ii)new text end the prescribing practitioner has performed a prior examination of the patient;
deleted text begin (3)deleted text end new text begin (iii)new text end another prescribing practitioner practicing within the same group or clinic as
the prescribing practitioner has examined the patient;
deleted text begin (4)deleted text end new text begin (iv)new text end a consulting practitioner to whom the prescribing practitioner has referred the
patient has examined the patient; or
deleted text begin (5)deleted text end new text begin (v)new text end the referring practitioner has performed an examination in the case of a consultant
practitioner issuing a prescription or drug order when providing services by means of
telemedicinedeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) the prescription order is for a drug listed in paragraph (d), clause (6), or for medication
assisted therapy for a substance use disorder, and the prescribing practitioner has completed
an examination of the patient via telehealth as defined in section 62A.673, subdivision 2,
paragraph (h).
new text end
(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a
drug through the use of a guideline or protocol pursuant to paragraph (a).
(g) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription
or dispensing a legend drug in accordance with the Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases guidance document issued by the United
States Centers for Disease Control.
(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing of
legend drugs through a public health clinic or other distribution mechanism approved by
the commissioner of health or a community health board in order to prevent, mitigate, or
treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of
a biological, chemical, or radiological agent.
(i) No pharmacist employed by, under contract to, or working for a pharmacy located
within the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug based on a prescription that the pharmacist knows, or would reasonably be expected
to know, is not valid under paragraph (d).
(j) No pharmacist employed by, under contract to, or working for a pharmacy located
outside the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug to a resident of this state based on a prescription that the pharmacist knows, or would
reasonably be expected to know, is not valid under paragraph (d).
(k) Nothing in this chapter prohibits the commissioner of health, if a licensed practitioner,
or, if not a licensed practitioner, a designee of the commissioner who is a licensed
practitioner, from prescribing legend drugs for field-delivered therapy in the treatment of
a communicable disease according to the Centers For Disease Control and Prevention Partner
Services Guidelines.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245G.01, subdivision 13, is amended to read:
Subd. 13.
Face-to-face.
"Face-to-face" means two-way, real-time, interactive deleted text begin and visualdeleted text end
communication between a client and a treatment service provider and includes services
delivered in person or via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Sec. 5.
Minnesota Statutes 2020, section 245G.01, subdivision 26, is amended to read:
Subd. 26.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end .
deleted text begin "Telemedicine"deleted text end new text begin "Telehealth"new text end means the delivery
of a substance use disorder treatment service while the client is at an originating site and
the deleted text begin licenseddeleted text end health care provider is at a distant sitenew text begin via telehealth as defined in section
256B.0625, subdivision 3b, andnew text end as specified in section 254B.05, subdivision 5, paragraph
(f).
Sec. 6.
Minnesota Statutes 2020, section 245G.06, subdivision 1, is amended to read:
Subdivision 1.
General.
Each client must have a person-centered individual treatment
plan developed by an alcohol and drug counselor within ten days from the day of service
initiation for a residential program and within five calendar days on which a treatment
session has been provided from the day of service initiation for a client in a nonresidential
program. Opioid treatment programs must complete the individual treatment plan within
21 days from the day of service initiation. The individual treatment plan must be signed by
the client and the alcohol and drug counselor and document the client's involvement in the
development of the plan. The individual treatment plan is developed upon the qualified staff
member's dated signature. Treatment planning must include ongoing assessment of client
needs. An individual treatment plan must be updated based on new information gathered
about the client's condition, the client's level of participation, and on whether methods
identified have the intended effect. A change to the plan must be signed by the client and
the alcohol and drug counselor. If the client chooses to have family or others involved in
treatment services, the client's individual treatment plan must include how the family or
others will be involved in the client's treatment.new text begin If a client is receiving treatment services
or an assessment via telehealth and the alcohol and drug counselor documents the reason
the client's signature cannot be obtained, the alcohol and drug counselor may document the
client's verbal approval of the treatment plan or change to the treatment plan in lieu of the
client's signature.
new text end
Sec. 7.
Minnesota Statutes 2020, section 254A.19, subdivision 5, is amended to read:
Subd. 5.
Assessment via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Notwithstanding Minnesota Rules,
part 9530.6615, subpart 3, item A, a chemical use assessment may be conducted via
deleted text begin telemedicinedeleted text end new text begin telehealth as defined in section 256B.0625, subdivision 3bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in section 256B.0625, subdivision 3bnew text end . The use of deleted text begin two-way interactive videodeleted text end new text begin telehealth
to deliver servicesnew text end must be medically appropriate to the condition and needs of the person
being served. Reimbursement shall be at the same rates and under the same conditions that
would otherwise apply to direct face-to-face services. deleted text begin The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
Sec. 9.
Minnesota Statutes 2020, section 256B.0621, subdivision 10, is amended to read:
Subd. 10.
Payment rates.
The commissioner shall set payment rates for targeted case
management under this subdivision. Case managers may bill according to the following
criteria:
(1) for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face contact, telephone contact, and interactive
video contact deleted text begin according to section 256B.0924, subdivision 4a,deleted text end in the lesser of:
(i) 180 days preceding an eligible recipient's discharge from an institution; or
(ii) the limits and conditions which apply to federal Medicaid funding for this service;
(2) for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and
(3) billings for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
Sec. 10.
Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a licensed mental health professional who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A. Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing clinical
oversight of services in conjunction with the psychiatrist or psychiatric care provider, and
supervising team members to ensure delivery of best and ethical practices; and
(iv) must be available to provide overall clinical oversight to the ACT team after regular
business hours and on weekends and holidays. The team leader may delegate this duty to
another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item A. The psychiatric care
provider must have demonstrated clinical experience working with individuals with serious
and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide clinical
supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may deleted text begin notdeleted text end provide deleted text begin specific roles and responsibilities by telemedicine unless approved
by the commissionerdeleted text end new text begin services through telehealth as defined under section 256B.0625,
subdivision 3b, when necessary to ensure the continuation of psychiatric and medication
services availability for clients and to maintain statutory requirements for psychiatric care
provider staffing levelsnew text end ; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) should not refer individuals to receive any type of vocational services or linkage by
providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent mental health certified peer specialist as defined in
section 256B.0615. No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include licensed
mental health professionals as defined in Minnesota Rules, part 9505.0371, subpart 5, item
A; mental health practitioners as defined in section 245.462, subdivision 17; a mental health
practitioner working as a clinical trainee according to Minnesota Rules, part 9505.0371,
subpart 5, item C; or mental health rehabilitation workers as defined in section 256B.0623,
subdivision 5, paragraph (a), clause (4). These individuals shall have the knowledge, skills,
and abilities required by the population served to carry out rehabilitation and support
functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 11.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end services.
(a) Medical assistance covers medically
necessary services and consultations delivered by a deleted text begin licenseddeleted text end health care provider deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end in the same manner as if the service or consultation was
delivered deleted text begin in persondeleted text end new text begin through in-person contactnew text end . deleted text begin Coverage is limited to three telemedicine
services per enrollee per calendar week, except as provided in paragraph (f). Telemedicinedeleted text end
Services new text begin or consultations delivered through telehealth new text end shall be paid at the full allowable
rate.
(b) The commissioner deleted text begin shalldeleted text end new text begin maynew text end establish criteria that a health care provider must attest
to in order to demonstrate the safety or efficacy of delivering a particular service deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end . The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
deleted text begin via telemedicinedeleted text end new text begin through telehealthnew text end ;
(2) has written policies and procedures specific to deleted text begin telemedicinedeleted text end servicesnew text begin delivered through
telehealthnew text end that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the deleted text begin telemedicinedeleted text end service is deleted text begin rendereddeleted text end new text begin delivered through telehealthnew text end ;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to deleted text begin telemedicinedeleted text end new text begin deliveringnew text end servicesnew text begin
through telehealthnew text end .
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end to a
medical assistance enrollee. Health care service records for services deleted text begin provided by telemedicinedeleted text end new text begin
delivered through telehealthnew text end must meet the requirements set forth in Minnesota Rules, part
9505.2175, subparts 1 and 2, and must document:
(1) the type of service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end ;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the deleted text begin licenseddeleted text end health care provider's basis for determining that deleted text begin telemedicinedeleted text end new text begin telehealthnew text end
is an appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission deleted text begin ofdeleted text end new text begin used to delivernew text end the deleted text begin telemedicinedeleted text end service new text begin through telehealth
new text end and records evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's deleted text begin telemedicinedeleted text end consultation with
another physiciannew text begin through telehealthnew text end , the written opinion from the consulting physician
providing the deleted text begin telemedicinedeleted text end new text begin telehealthnew text end consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
new text begin
(d) Telehealth visits, as described in this subdivision provided through audio and visual
communication, may be used to satisfy the face-to-face requirement for reimbursement
under the payment methods that apply to a federally qualified health center, rural health
clinic, Indian health service, 638 tribal clinic, and certified community behavioral health
clinic, if the service would have otherwise qualified for payment if performed in person.
new text end
new text begin
(e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval of
the treatment plan or change in the treatment plan in lieu of the client's signature in
accordance with Minnesota Rules, part 9505.0371.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end For purposes of this subdivision, unless otherwise covered under this chapterdeleted text begin ,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.deleted text end new text begin :
new text end
new text begin
(1) "telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual communication to provide or support
health care delivery and facilitate the assessment, diagnosis, consultation, treatment,
education, and care management of a patient's health care. Telehealth includes the application
of secure video conferencing, store-and-forward technology, and synchronous interactions
between a patient located at an originating site and a health care provider located at a distant
site.Telehealth does not include communication between health care providers or between
a health care provider and a patient that consists solely of a audio-only communication , an
e-mail, or facsimile transmission unless authorized by the commissioner or specified by
law;
new text end
deleted text begin (e) For purposes of this section, "licenseddeleted text end new text begin (2) "new text end health care provider" means a deleted text begin licenseddeleted text end
health care provider deleted text begin under section 62A.671, subdivision 6deleted text end new text begin as defined under section 62A.673new text end ,
a community paramedic as defined under section 144E.001, subdivision 5f, deleted text begin or a mental
health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision
26, working under the general supervision of a mental health professional, anddeleted text end a community
health worker who meets the criteria under subdivision 49, paragraph (a)deleted text begin ; "health care
provider" is defined under section 62A.671, subdivision 3;deleted text end new text begin , a mental health certified peer
specialist under section 256B.0615, subdivision 5, a mental health certified family peer
specialist under section 256B.0616, subdivision 5, a mental health rehabilitation worker
under section 256B.0623, subdivision 5, paragraph (a), clause (4), and paragraph (b), a
mental health behavioral aide under section 256B.0943, subdivision 7, paragraph (b), clause
(3), a treatment coordinator under section 245G.11, subdivision 7, an alcohol and drug
counselor under section 245G.11, subdivision 5, a recovery peer under section 245G.11,
subdivision 8;new text end and
new text begin (3) new text end "originating site" deleted text begin is defined under section 62A.671, subdivision 7deleted text end new text begin , "distant site," and
"store-and-forward technology" have the meanings given in section 62A.673, subdivision
2new text end .
deleted text begin
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
deleted text end
deleted text begin
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
deleted text end
deleted text begin
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
deleted text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 3h. new text end
new text begin Telemonitoring services. new text end
new text begin
(a) Medical assistance covers telemonitoring services
if:
new text end
new text begin
(1) the telemonitoring service is medically appropriate based on the recipient's medical
condition or status;
new text end
new text begin
(2) the recipient's health care provider has identified that telemonitoring services would
likely prevent the recipient's admission or readmission to a hospital, emergency room, or
nursing facility;
new text end
new text begin
(3) the recipient is cognitively and physically capable of operating the monitoring device
or equipment, or the recipient has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end
new text begin
(4) the recipient resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end
new text begin
(b) For purposes of this subdivision, "telemonitoring services" means the remote
monitoring of data related to a recipient's vital signs or biometric data by a monitoring
device or equipment that transmits the data electronically to a provider for analysis. The
assessment and monitoring of the health data transmitted by telemonitoring must be
performed by one of the following licensed health care professionals: physician, podiatrist,
registered nurse, advanced practice registered nurse, physician assistant, respiratory therapist,
or licensed professional working under the supervision of a medical director.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0625, subdivision 13h, is amended to
read:
Subd. 13h.
Medication therapy management services.
(a) Medical assistance covers
medication therapy management services for a recipient taking prescriptions to treat or
prevent one or more chronic medical conditions. For purposes of this subdivision,
"medication therapy management" means the provision of the following pharmaceutical
care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's
medications:
(1) performing or obtaining necessary assessments of the patient's health status;
(2) formulating a medication treatment plan, which may include prescribing medications
or products in accordance with section 151.37, subdivision 14, 15, or 16;
(3) monitoring and evaluating the patient's response to therapy, including safety and
effectiveness;
(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
(5) documenting the care delivered and communicating essential information to the
patient's other primary care providers;
(6) providing verbal education and training designed to enhance patient understanding
and appropriate use of the patient's medications;
(7) providing information, support services, and resources designed to enhance patient
adherence with the patient's therapeutic regimens; and
(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.
Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.
(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:
(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;
(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;new text begin and
new text end
deleted text begin
(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the setting,
or in home settings, including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end make use of an electronic patient record system that meets state standards.
(c) For purposes of reimbursement for medication therapy management services, the
commissioner may enroll individual pharmacists as medical assistance providers. The
commissioner may also establish deleted text begin contact requirements between the pharmacist and recipient,
including limitingdeleted text end new text begin limits on new text end the number of reimbursable consultations per recipient.
(d) deleted text begin If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide Thedeleted text end new text begin Medication therapy managementnew text end services new text begin may be provided
new text end via deleted text begin two-way interactive videodeleted text end new text begin telehealth as defined in subdivision 3b and may be delivered
into a patient's residencenew text end . Reimbursement shall be at the same rates and under the same
conditions that would otherwise apply to the services provided. To qualify for reimbursement
under this paragraph, the pharmacist providing the services must meet the requirements of
paragraph (b)deleted text begin , and must be located within an ambulatory care setting that meets the
requirements of paragraph (b), clause (3). The patient must also be located within an
ambulatory care setting that meets the requirements of paragraph (b), clause (3). Services
provided under this paragraph may not be transmitted into the patient's residencedeleted text end .
deleted text begin
(e) Medication therapy management services may be delivered into a patient's residence
via secure interactive video if the medication therapy management services are performed
electronically during a covered home care visit by an enrolled provider. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to the
services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b) and must be located
within an ambulatory care setting that meets the requirements of paragraph (b), clause (3).
deleted text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact new text begin either in person or by interactive
video that meets the requirements of subdivision 20bnew text end with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the adult's legal representative deleted text begin ordeleted text end deleted text begin adeleted text end
deleted text begin contact bydeleted text end deleted text begin interactive videodeleted text end new text begin either in person or by interactive videonew text end that meets the
requirements of subdivision 20b; or
(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact deleted text begin or a contact bydeleted text end deleted text begin interactive videodeleted text end new text begin either in person or by
interactive videonew text end that meets the requirements of subdivision 20b with the adult or the adult's
legal representative within the preceding two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribe may negotiate a team rate with a vendor who is a member of the team. The team
shall determine how to distribute the rate among its members. No reimbursement received
by contracted vendors shall be returned to the county or tribe, except to reimburse the county
or tribe for advance funding provided by the county or tribe to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
Sec. 15.
Minnesota Statutes 2020, section 256B.0625, subdivision 20b, is amended to
read:
Subd. 20b.
deleted text begin Mental healthdeleted text end Targeted case management deleted text begin throughdeleted text end new text begin by new text end interactive
video.
(a) deleted text begin Subject to federal approval, contact made for targeted case management by
interactive video shall be eligible for payment if:deleted text end new text begin Minimum required face-to-face contacts
for targeted case management may be provided by interactive video if interactive video is
in the best interests of the person and is deemed appropriate by the person receiving targeted
case management or the person's legal guardian and the case management provider.
new text end
deleted text begin
(1) the person receiving targeted case management services is residing in:
deleted text end
deleted text begin
(i) a hospital;
deleted text end
deleted text begin
(ii) a nursing facility; or
deleted text end
deleted text begin
(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;
deleted text end
deleted text begin
(2) interactive video is in the best interests of the person and is deemed appropriate by
the person receiving targeted case management or the person's legal guardian, the case
management provider, and the provider operating the setting where the person is residing;
deleted text end
deleted text begin
(3) the use of interactive video is approved as part of the person's written personal service
or case plan, taking into consideration the person's vulnerability and active personal
relationships; and
deleted text end
deleted text begin
(4) interactive video is used for up to, but not more than, 50 percent of the minimum
required face-to-face contact.
deleted text end
(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of interactive video under this subdivision and
has the right to refuse the use of interactive video at any time.
(c) The commissionerdeleted text begin shalldeleted text end new text begin may new text end establish criteria that a targeted case management
provider must attest to in order to demonstrate the safety or efficacy ofdeleted text begin delivering the service
via interactive video. The attestation may include that the case management provider has:deleted text end new text begin
meeting the minimum face-to-face contact requirements for targeted case management by
interactive video.
new text end
deleted text begin
(1) written policies and procedures specific to interactive video services that are regularly
reviewed and updated;
deleted text end
deleted text begin
(2) policies and procedures that adequately address client safety before, during, and after
the interactive video services are rendered;
deleted text end
deleted text begin
(3) established protocols addressing how and when to discontinue interactive video
services; and
deleted text end
deleted text begin
(4) established a quality assurance process related to interactive video services.
deleted text end
(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by interactive
videonew text begin for the purposes of face-to-face contactnew text end :
(1) the time thedeleted text begin servicedeleted text end new text begin contact new text end began and the time the service ended, including an a.m.
and p.m. designationdeleted text begin ;
deleted text end
(2) the basis for determining that interactive video is an appropriate and effective means
fordeleted text begin delivering the service todeleted text end new text begin contactingnew text end the person receiving new text begin targeted new text end case management
services;
(3) the mode of transmission of thedeleted text begin interactive videodeleted text end servicesnew text begin delivered by interactive
videonew text end and recordsdeleted text begin evidencingdeleted text end new text begin stating new text end that a particular mode of transmission was utilized;new text begin
and
new text end
(4) the location of the originating site and the distant sitedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).
deleted text end
new text begin
(e) Interactive video must not be used to meet minimum face-to-face contact requirements
for children receiving case management services for child protection reasons or who are in
out-of-home placement.
new text end
new text begin
(f) For purposes of this section, "interactive video" means the delivery of targeted case
management services in real time through the use of two-way interactive audio and visual
communication.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.0625, subdivision 46, is amended to read:
Subd. 46.
Mental health deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
deleted text begin Effective January 1, 2006, anddeleted text end Subject
to federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in subdivision 3bnew text end . Use of deleted text begin two-way interactive videodeleted text end new text begin telehealth to deliver servicesnew text end
must be medically appropriate to the condition and needs of the person being served.
Reimbursement is at the same rates and under the same conditions that would otherwise
apply to the service. deleted text begin The interactive video equipment and connection must comply with
Medicare standards in effect at the time the service is provided.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:
Subd. 6.
Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
new text begin either in person or by interactive video that meets the requirements in section 256B.0625,
subdivision 20bnew text end with the adult or the adult's legal representative, family, primary caregiver,
or other relevant persons identified as necessary to the development or implementation of
the goals of the personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to other payers. If the service is
provided by a team of contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county, except to reimburse the county for advance funding provided by the county
to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.
(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.
(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
Sec. 18.
Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:
Subd. 6.
Medical assistance reimbursement of case management services.
(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the deleted text begin minimum standardsdeleted text end new text begin requirementsnew text end in clauses (1)
deleted text begin and (2)deleted text end new text begin to (3)new text end :
(1) there must be a face-to-face contact at least once a month except as provided in deleted text begin clausedeleted text end
new text begin clausesnew text end (2) new text begin and (3)new text end ; deleted text begin and
deleted text end
(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face deleted text begin contact.deleted text end new text begin in-person contact; and
new text end
new text begin
(3) for a child receiving case management services for child protection reasons or who
is in out-of-home placement, face-to-face contact must be through in-person contact.
new text end
(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).
(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.
(d) Payment for case management provided by county or tribal social services contracted
vendors shall be based on a monthly rate negotiated by the host county or tribal social
services. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribal social services may negotiate a team rate with a vendor who is a member of the
team. The team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county or tribal social
services, except to reimburse the county or tribal social services for advance funding provided
by the county or tribal social services to the vendor.
(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.
Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.
Sec. 19.
Minnesota Statutes 2020, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
(c) "Clinical trainee" means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item C.
(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.
(e) "Culturally competent provider" means a provider who understands and can utilize
to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
(f) "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a multidisciplinary team, under the clinical supervision of a
mental health professional.
(g) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0372,
subpart 1.
(h) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered deleted text begin telemedicinedeleted text end servicesnew text begin through tehehealth as
defined under section 256B.0625, subdivision 3bnew text end . Direct service time includes time in which
the provider obtains a client's history, develops a client's treatment plan, records individual
treatment outcomes, or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling or maintaining clinical records.
(i) "Direction of mental health behavioral aide" means the activities of a mental health
professional or mental health practitioner in guiding the mental health behavioral aide in
providing services to a client. The direction of a mental health behavioral aide must be based
on the client's individualized treatment plan and meet the requirements in subdivision 6,
paragraph (b), clause (5).
(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 15.
(k) "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional or mental health practitioner, under the
clinical supervision of a mental health professional, to guide the work of the mental health
behavioral aide. The individual behavioral plan may be incorporated into the child's individual
treatment plan so long as the behavioral plan is separately communicable to the mental
health behavioral aide.
(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 7.
(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3), to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professional or mental health practitioner and as described in the
child's individual treatment plan and individual behavior plan. Activities involve working
directly with the child or child's family as provided in subdivision 9, paragraph (b), clause
(4).
(n) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experience.
(o) "Mental health professional" means an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18.
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, as
provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and
(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plan.
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means a series or
multidisciplinary combination of psychiatric and psychosocial interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
psychotherapy to address internal psychological, emotional, and intellectual processing
deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
Sec. 20.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e) An individual treatment plan must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
new text begin
(i) The services and responsibilities of the psychiatric provider may be provided through
telehealth as defined under section 256B.0625, subdivision 3b, when necessary to prevent
disruption in client services or to maintain the required psychiatric staffing level.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0949, subdivision 13, is amended to read:
Subd. 13.
Covered services.
(a) The services described in paragraphs (b) to (l) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, including nonverbal or social
communication, social or interpersonal interaction, restrictive or repetitive behaviors,
hyperreactivity or hyporeactivity to sensory input, behavioral challenges and self-regulation,
cognition, learning and play, self-care, and safety.
(b) EIDBI treatment must be delivered consistent with the standards of an approved
modality, as published by the commissioner. EIDBI modalities include:
(1) applied behavior analysis (ABA);
(2) developmental individual-difference relationship-based model (DIR/Floortime);
(3) early start Denver model (ESDM);
(4) PLAY project;
(5) relationship development intervention (RDI); or
(6) additional modalities not listed in clauses (1) to (5) upon approval by the
commissioner.
(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model.
(d) Each qualified EIDBI provider must identify and provide assurance of qualifications
for professional licensure certification, or training in evidence-based treatment methods,
and must document the required qualifications outlined in subdivision 15 in a manner
determined by the commissioner.
(e) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.
(f) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the current
treatment protocol to support the outcomes outlined in the ITP.
(g) Intervention is medically necessary direct treatment provided to a person with ASD
or a related condition as outlined in their ITP. All intervention services must be provided
under the direction of a QSP. Intervention may take place across multiple settings. The
frequency and intensity of intervention services are provided based on the number of
treatment goals, person and family or caregiver preferences, and other factors. Intervention
services may be provided individually or in a group. Intervention with a higher provider
ratio may occur when deemed medically necessary through the person's ITP.
(1) Individual intervention is treatment by protocol administered by a single qualified
EIDBI provider delivered deleted text begin face-to-facedeleted text end to one person.
(2) Group intervention is treatment by protocol provided by one or more qualified EIDBI
providers, delivered to at least two people who receive EIDBI services.
(h) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring documents
provide oversight and ongoing evaluation of a person's treatment and progress on targeted
goals and objectives and integrate and coordinate the person's and the person's legal
representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I provider
or a level II provider.
(i) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
provider, or level II provider.
(j) A coordinated care conference is a voluntary deleted text begin face-to-facedeleted text end meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I provider or a level II provider.
(k) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide deleted text begin face-to-facedeleted text end new text begin in-personnew text end EIDBI intervention, observation and
direction, or family caregiver training and counseling. The person's ITP must specify the
reasons the provider must travel to the person.
(l) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end , as defined under
section 256B.0625, subdivision 3b, in the same manner as if the service or consultation was
delivered in person.
Sec. 22. new text begin COMMISSIONER OF HUMAN SERVICES; EXTENSION OF COVID-19
HUMAN SERVICES PROGRAM MODIFICATIONS.
new text end
new text begin
Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2,
as amended by Laws 2020, Third Special Session chapter 1, section 3, when the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following modifications issued by
the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and
including any amendments to the modification issued before the peacetime emergency
expires, shall remain in effect until June 30, 2023:
new text end
new text begin
(1) CV16: expanding access to telemedicine services for Children's Health Insurance
Program, Medical Assistance, and MinnesotaCare enrollees;
new text end
new text begin
(2) CV21: allowing telemedicine alternative for school-linked mental health services
and intermediate school district mental health services;
new text end
new text begin
(3) CV24: allowing phone or video use for targeted case management visits;
new text end
new text begin
(4) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings; and
new text end
new text begin
(5) CV45: permitting comprehensive assessments to be completed by telephone or video
communication and permitting a counselor, recovery peer, or treatment coordinator to
provide treatment services from their home by telephone or video communication to a client
in their home.
new text end
Sec. 23. new text begin EXPANDING TELEHEALTH DELIVERY OPTIONS STUDY.
new text end
new text begin
The commissioner of human services, in consultation with enrollees, providers, and
other interested stakeholders, shall study the viability of the use of audio-only communication
as a permitted option for delivering services through telehealth within the public health care
programs. The study shall examine the use of audio-only communication in supporting
equitable access to health care services, including behavioral health services for the elderly,
rural communities, and communities of color, and eliminating barriers for vulnerable and
underserved populations. The commissioner shall submit recommendations to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finances, by December 15, 2022.
new text end
Sec. 24. new text begin STUDY OF TELEHEALTH.
new text end
new text begin
(a) The commissioner of health, in consultation with the commissioner of human services,
shall study the impact of telehealth payment methodologies and expansion under this act
on the coverage and provision of telehealth services under public health care programs and
private health insurance. The study shall review:
new text end
new text begin
(1) the impacts of telehealth payment methodologies and expansion on access to health
care services, quality of care, and value-based payments and innovation in care delivery;
new text end
new text begin
(2) the short-term and long-term impacts of telehealth payment methodologies and
expansion in reducing health care disparities and providing equitable access for underserved
communities;
new text end
new text begin
(3) the short-term and long-term impacts, especially in rural areas, on access to and the
availability of in-person care and specialty care due to an expansion in the use of and
investment in telehealth to deliver health care services;
new text end
new text begin
(4) the criteria used for determining whether delivering a service by telehealth is medically
appropriate to the condition and to the needs of the person receiving the services;
new text end
new text begin
(5) the methods used to ensure that the rights of the patient to choose between receiving
a service through telehealth or in person are respected; and
new text end
new text begin
(6) and make recommendations on interstate licensing options for health care
professionals by reviewing advances in the delivery of health care through interstate telehealth
while ensuring the safety and health of patients.
new text end
new text begin
(b) In conducting the study, the commissioner shall consult with stakeholders and
communities impacted by telehealth payment and expansion. The commissioner,
notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, may use data available
under that section to conduct the study. The commissioner shall report findings to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finance and commerce, by February 15, 2024.
new text end
Sec. 25. new text begin TASK FORCE ON A PUBLIC-PRIVATE TELEPRESENCE STRATEGY.
new text end
new text begin Subdivision 1. new text end
new text begin Membership. new text end
new text begin
(a) The task force on person-centered telepresence platform
strategy consists of the following 20 members:
new text end
new text begin
(1) two senators, one appointed by the majority leader of the senate and one appointed
by the minority leader of the senate;
new text end
new text begin
(2) two members of the house of representatives, one appointed by the speaker of the
house of representatives and one appointed by the minority leader of the house of
representatives;
new text end
new text begin
(3) two members appointed by the Association of Minnesota Counties representing
county services in the areas of human services, public health, and corrections or law
enforcement. One of these members must represent counties outside the metropolitan area
defined in Minnesota Statutes, section 473.121, and one of these members must represent
the metropolitan area defined in Minnesota Statutes, section 473.121;
new text end
new text begin
(4) one member appointed by the Minnesota American Indian Mental Health Advisory
Council;
new text end
new text begin
(5) one member appointed by the Minnesota Medical Association who is a primary care
provider practicing in Minnesota;
new text end
new text begin
(6) one member appointed by the NAMI of Minnesota;
new text end
new text begin
(7) one member appointed by the Minnesota School Boards Association;
new text end
new text begin
(8) one member appointed by the Minnesota Hospital Association to represent hospital
emergency departments;
new text end
new text begin
(9) one member appointed by the Minnesota Association of Community Mental Health
Programs to represent rural community mental health centers;
new text end
new text begin
(10) one member appointed by the Council of Health Plans;
new text end
new text begin
(11) one member from a rural nonprofit foundation with expertise in delivering health
and human services via broadband, appointed by the Blandin Foundation;
new text end
new text begin
(12) one member representing child advocacy centers, appointed by the Minnesota Social
Service Association;
new text end
new text begin
(13) one member appointed by the Minnesota Social Service Association;
new text end
new text begin
(14) one member appointed by the Medical Alley Association;
new text end
new text begin
(15) one member appointed by the Minnesota Nurses Association;
new text end
new text begin
(16) one member appointed by the chief justice of the supreme court; and
new text end
new text begin
(17) the state public defender or a designee.
new text end
new text begin
(b) In addition to the members identified in paragraph (a), the task force shall include
the following members as ex officio, nonvoting members:
new text end
new text begin
(1) the commissioner of corrections or a designee;
new text end
new text begin
(2) the commissioner of human services or a designee;
new text end
new text begin
(3) the commissioner of health or a designee; and
new text end
new text begin
(4) the commissioner of education or a designee.
new text end
new text begin Subd. 2. new text end
new text begin Appointment deadline; first meeting; chair. new text end
new text begin
Appointing authorities must
complete appointments by June 15, 2021. The task force shall select a chair from among
their members at their first meeting. The member appointed by the senate majority leader
shall convene the first meeting of the task force by July 15, 2021.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The task force shall:
new text end
new text begin
(1) explore opportunities for improving behavioral health and other health care service
delivery through the use of a common interoperable person-centered telepresence platform
that provides HIPAA compliant connectivity and technical support to potential users;
new text end
new text begin
(2) review and coordinate state and local innovation initiatives and investments designed
to leverage telepresence connectivity and collaboration for Minnesotans;
new text end
new text begin
(3) determine standards for a single interoperable telepresence platform;
new text end
new text begin
(4) determine statewide capabilities for a single interoperable telepresence platform;
new text end
new text begin
(5) identify barriers to providing a telepresence technology, including limited availability
of bandwidth, limitations in providing certain services via telepresence, and broadband
infrastructure needs;
new text end
new text begin
(6) identify and make recommendations for governance that will assure person-centered
responsiveness;
new text end
new text begin
(7) identify how the business model can be innovated to provide an incentive for ongoing
innovation in Minnesota's health care, human services, education, corrections, and related
ecosystems;
new text end
new text begin
(8) identify criteria for suggested deliverables including:
new text end
new text begin
(i) equitable statewide access;
new text end
new text begin
(ii) evaluating bandwidth availability; and
new text end
new text begin
(iii) competitive pricing;
new text end
new text begin
(9) identify sustainable financial support for a single telepresence platform, including
infrastructure costs and startup costs for potential users;
new text end
new text begin
(10) identify the benefits to partners in the private sector, state, political subdivisions,
tribal governments, and the constituents they serve in using a common person-centered
telepresence platform for delivering behavioral health services; and
new text end
new text begin
(11) consult with members of communities who are likely to use a common
person-centered telepresence platform, including communities of color, the disability
community, and other underserved communities.
new text end
new text begin Subd. 4. new text end
new text begin Administrative support. new text end
new text begin
The Legislative Coordinating Commission shall
provide administrative support to the task force. The Legislative Coordinating Commission
may provide meeting space or may use space provided by the Minnesota Social Service
Association for meetings.
new text end
new text begin Subd. 5. new text end
new text begin Per diem; expenses. new text end
new text begin
Public members of the task force may be compensated
and have their expenses reimbursed as provided in Minnesota Statutes, section 15.059,
subdivision 3.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
The task force shall report to the chairs and ranking minority members
of the committees in the senate and the house of representatives with primary jurisdiction
over health and state information technology by January 15, 2022, with recommendations
related to expanding the state's telepresence platform and any legislation required to
implement the recommendations.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
The task force expires July 31, 2022, or the day after the task force
submits the report required in this section, whichever is earlier.
new text end
Sec. 26. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall substitute the
term "telemedicine" with "telehealth" whenever the term appears and substitute Minnesota
Statutes, section 62A.673, whenever references to Minnesota Statutes, sections 62A.67,
62A.671, and 62A.672 appear.
new text end
Sec. 27. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020; 256.0596; and section 256B.0924, subdivision 4a, sections
62A.67; 62A.671; 62A.672,
new text end
new text begin
are repealed.
new text end
ARTICLE 9
ECONOMIC SUPPORTS
Section 1.
Minnesota Statutes 2020, section 119B.09, subdivision 4, is amended to read:
Subd. 4.
Eligibility; annual income; calculation.
(a) Annual income of the applicant
family is the current monthly income of the family multiplied by 12 or the income for the
12-month period immediately preceding the date of application, or income calculated by
the method which provides the most accurate assessment of income available to the family.
(b) Self-employment income must be calculated based on deleted text begin gross receipts less operating
expensesdeleted text end new text begin section 256P.05, subdivision 2new text end .
(c) Income changes are processed under section 119B.025, subdivision 4. Included lump
sums counted as income under section 256P.06, subdivision 3, must be annualized over 12
months. Income must be verified with documentary evidence. If the applicant does not have
sufficient evidence of income, verification must be obtained from the source of the income.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 2.
Minnesota Statutes 2020, section 252.27, subdivision 2a, is amended to read:
Subd. 2a.
Contribution amount.
(a) The natural or adoptive parents of a minor child,
new text begin not new text end including a child determined eligible for medical assistance without consideration of
parental incomenew text begin under the TEFRA option or for the purposes of accessing home and
community-based waiver servicesnew text end , must contribute to the cost of services used by making
monthly payments on a sliding scale based on income, unless the child is married or has
been married, parental rights have been terminated, or the child's adoption is subsidized
according to chapter 259A or through title IV-E of the Social Security Act. The parental
contribution is a partial or full payment for medical services provided for diagnostic,
therapeutic, curing, treating, mitigating, rehabilitation, maintenance, and personal care
services as defined in United States Code, title 26, section 213, needed by the child with a
chronic illness or disability.
(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:
(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 1.65 percent of adjusted gross income at 275 percent of
federal poverty guidelines and increases to 4.5 percent of adjusted gross income for those
with adjusted gross income up to 545 percent of federal poverty guidelines;
(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
4.5 percent of adjusted gross income;
(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at 4.5 percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to 5.99 percent of adjusted gross income for those with
adjusted gross income up to 975 percent of federal poverty guidelines; and
(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be 7.49 percent of adjusted gross income.
If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.
(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.
(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.
(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.
(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.
(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).
(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.
Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.
(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:
(1) the parent applied for insurance for the child;
(2) the insurer denied insurance;
(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and
(4) as a result of the dispute, the insurer reversed its decision and granted insurance.
For purposes of this section, "insurance" has the meaning given in paragraph (h).
A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end the insurer's denial of insurance, the written letter or complaint
of the parents, court documents, and the written response of the insurer approving insurance.
The determinations of the commissioner or county agency under this paragraph are not rules
subject to chapter 14.
Sec. 3.
Minnesota Statutes 2020, section 256B.14, subdivision 2, is amended to read:
Subd. 2.
Actions to obtain payment.
The state agency shall promulgate rules to
determine the ability of responsible relatives to contribute partial or complete payment or
repayment of medical assistance furnished to recipients for whom they are responsible. All
medical assistance exclusions shall be allowed, and a resource limit of $10,000 for
nonexcluded resources shall be implemented. Above these limits, a contribution of one-third
of the excess resources shall be required. These rules shall not require payment or repayment
when payment would cause undue hardship to the responsible relative or that relative's
immediate family. These rules shall deleted text begin be consistent with the requirements of section 252.27
fordeleted text end new text begin not apply tonew text end parents of children whose eligibility for medical assistance was determined
without deeming of the parents' resources and incomenew text begin under the TEFRA option or for the
purposes of accessing home and community-based waiver servicesnew text end . The county agency
shall give the responsible relative notice of the amount of the payment or repayment. If the
state agency or county agency finds that notice of the payment obligation was given to the
responsible relative, but that the relative failed or refused to pay, a cause of action exists
against the responsible relative for that portion of medical assistance granted after notice
was given to the responsible relative, which the relative was determined to be able to pay.
The action may be brought by the state agency or the county agency in the county where
assistance was granted, for the assistance, together with the costs of disbursements incurred
due to the action.
In addition to granting the county or state agency a money judgment, the court may,
upon a motion or order to show cause, order continuing contributions by a responsible
relative found able to repay the county or state agency. The order shall be effective only
for the period of time during which the recipient receives medical assistance from the county
or state agency.
Sec. 4.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin SNAP employment and training. new text end
new text begin
The commissioner shall implement a
Supplemental Nutrition Assistance Program (SNAP) employment and training program
that meets the SNAP employment and training participation requirements of the United
States Department of Agriculture governed by Code of Federal Regulations, title 7, section
273.7. The commissioner shall operate a SNAP employment and training program in which
SNAP recipients elect to participate. In order to receive SNAP assistance beyond the time
limit, unless residing in an area covered by a time-limit waiver governed by Code of Federal
Regulations, title 7, section 273.24, nonexempt SNAP recipients who do not meet federal
SNAP work requirements must participate in an employment and training program. In
addition to county and Tribal agencies that administer SNAP, the commissioner may contract
with third-party providers for SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin County and Tribal agency duties. new text end
new text begin
County or Tribal agencies that administer
SNAP shall inform adult SNAP recipients about employment and training services and
providers in the recipient's area. County or Tribal agencies that administer SNAP may elect
to subcontract with a public or private entity approved by the commissioner to provide
SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Duties of commissioner. new text end
new text begin
In addition to any other duties imposed by law, the
commissioner shall:
new text end
new text begin
(1) supervise the administration of SNAP employment and training services to county,
Tribal, and contracted agencies under this section and Code of Federal Regulations, title 7,
section 273.7;
new text end
new text begin
(2) disburse money allocated and reimbursed for SNAP employment and training services
to county, Tribal, and contracted agencies;
new text end
new text begin
(3) accept and supervise the disbursement of any funds that may be provided by the
federal government or other sources for SNAP employment and training services;
new text end
new text begin
(4) cooperate with other agencies, including any federal agency or agency of another
state, in all matters concerning the powers and duties of the commissioner under this section;
new text end
new text begin
(5) coordinate with the commissioner of employment and economic development to
deliver employment and training services statewide;
new text end
new text begin
(6) work in partnership with counties, tribes, and other agencies to enhance the reach
and services of a statewide SNAP employment and training program; and
new text end
new text begin
(7) identify eligible nonfederal funds to earn federal reimbursement for SNAP
employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 23. new text end
new text begin Participant duties. new text end
new text begin
Unless residing in an area covered by a time-limit waiver,
nonexempt SNAP recipients must meet federal SNAP work requirements to receive SNAP
assistance beyond the time limit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Program funding. new text end
new text begin
(a) The United States Department of Agriculture annually
allocates SNAP employment and training funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(b) The United States Department of Agriculture authorizes the disbursement of SNAP
employment and training reimbursement funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(c) Except for funds allocated for state program development and administrative purposes
or designated by the United States Department of Agriculture for a specific project, the
commissioner of human services shall disburse money allocated for federal SNAP
employment and training to counties and tribes that administer SNAP based on a formula
determined by the commissioner that includes but is not limited to the county's or tribe's
proportion of adult SNAP recipients as compared to the statewide total.
new text end
new text begin
(d) The commissioner of human services shall disburse federal funds that the
commissioner receives as reimbursement for SNAP employment and training costs to the
state agency, county, tribe, or contracted agency that incurred the costs being reimbursed.
new text end
new text begin
(e) The commissioner of human services may reallocate unexpended money disbursed
under this section to county, Tribal, or contracted agencies that demonstrate a need for
additional funds.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256E.30, subdivision 2, is amended to read:
Subd. 2.
Allocation of money.
(a) State money appropriated and community service
block grant money allotted to the state and all money transferred to the community service
block grant from other block grants shall be allocated annually to community action agencies
and Indian reservation governments under paragraphs (b) and (c), and to migrant and seasonal
farmworker organizations under paragraph (d).
(b) The available annual money will provide base funding to all community action
agencies and the Indian reservations. Base funding amounts per agency are as follows: for
agencies with low income populations up to deleted text begin 1,999, $25,000; 2,000 todeleted text end 23,999, $50,000; and
24,000 or more, $100,000.
(c) All remaining money of the annual money available after the base funding has been
determined must be allocated to each agency and reservation in proportion to the size of
the poverty level population in the agency's service area compared to the size of the poverty
level population in the state.
(d) Allocation of money to migrant and seasonal farmworker organizations must not
exceed three percent of the total annual money available. Base funding allocations must be
made for all community action agencies and Indian reservations that received money under
this subdivision, in fiscal year 1984, and for community action agencies designated under
this section with a service area population of 35,000 or greater.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256E.34, subdivision 1, is amended to read:
Subdivision 1.
Distribution of appropriation.
The commissioner must distribute funds
appropriated to the commissioner by law for that purpose to Hunger Solutions, a statewide
association of food shelves organized as a nonprofit corporation as defined under section
501(c)(3) of the Internal Revenue Code of 1986, to distribute to qualifying food shelves. A
food shelf qualifies under this section if:
(1) it is a nonprofit corporation, or is affiliated with a nonprofit corporation, as defined
in section 501(c)(3) of the Internal Revenue Code of 1986new text begin or a federally recognized Tribal
nationnew text end ;
(2) it distributes standard food orders without charge to needy individuals. The standard
food order must consist of at least a two-day supply or six pounds per person of nutritionally
balanced food items;
(3) it does not limit food distributions to individuals of a particular religious affiliation,
race, or other criteria unrelated to need or to requirements necessary to administration of a
fair and orderly distribution system;
(4) it does not use the money received or the food distribution program to foster or
advance religious or political views; and
(5) it has a stable address and directly serves individuals.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256J.08, subdivision 21, is amended to read:
Subd. 21.
Date of application.
"Date of application" means the date on which the county
agency receives an applicant's deleted text begin signeddeleted text end applicationnew text begin as a signed written application, an
application submitted by telephone, or an application submitted through Internet telepresencenew text end .
Sec. 12.
Minnesota Statutes 2020, section 256J.09, subdivision 3, is amended to read:
Subd. 3.
Submitting application form.
(a) A county agency must offer, in person or
by mail, the application forms prescribed by the commissioner as soon as a person makes
a written or oral inquiry. At that time, the county agency must:
(1) inform the person that assistance begins deleted text begin withdeleted text end new text begin onnew text end the datenew text begin thatnew text end the deleted text begin signeddeleted text end application
is received by the county agency new text begin either as a signed written application; an application
submitted by telephone; or an application submitted through Internet telepresence; new text end or new text begin on
new text end the datenew text begin thatnew text end all eligibility criteria are met, whichever is later;
new text begin
(2) inform a person that the person may submit the application by telephone or through
Internet telepresence;
new text end
new text begin
(3) inform a person that when the person submits the application by telephone or through
Internet telepresence, the county agency must receive a signed written application within
30 days of the date that the person submitted the application by telephone or through Internet
telepresence;
new text end
deleted text begin (2)deleted text end new text begin (4)new text end inform the person that any delay in submitting the application will reduce the
amount of assistance paid for the month of application;
deleted text begin (3)deleted text end new text begin (5)new text end inform a person that the person may submit the application before an interview;
deleted text begin (4)deleted text end new text begin (6)new text end explain the information that will be verified during the application process by
the county agency as provided in section 256J.32;
deleted text begin (5)deleted text end new text begin (7)new text end inform a person about the county agency's average application processing time
and explain how the application will be processed under subdivision 5;
deleted text begin (6)deleted text end new text begin (8)new text end explain how to contact the county agency if a person's application information
changes and how to withdraw the application;
deleted text begin (7)deleted text end new text begin (9)new text end inform a person that the next step in the application process is an interview and
what a person must do if the application is approved including, but not limited to, attending
orientation under section 256J.45 and complying with employment and training services
requirements in sections 256J.515 to 256J.57;
deleted text begin (8)deleted text end new text begin (10)new text end inform the person that deleted text begin thedeleted text end new text begin annew text end interview must be conductednew text begin . The interview may
be conductednew text end face-to-face in the county officenew text begin or at a location mutually agreed uponnew text end , through
Internet telepresence, or deleted text begin at a location mutually agreed upondeleted text end new text begin by telephonenew text end ;
deleted text begin
(9) inform a person who has received MFIP or DWP in the past 12 months of the option
to have a face-to-face, Internet telepresence, or telephone interview;
deleted text end
deleted text begin (10)deleted text end new text begin (11)new text end explain the child care and transportation services that are available under
paragraph (c) to enable caregivers to attend the interview, screening, and orientation; and
deleted text begin (11)deleted text end new text begin (12)new text end identify any language barriers and arrange for translation assistance during
appointments, including, but not limited to, screening under subdivision 3a, orientation
under section 256J.45, and assessment under section 256J.521.
(b) Upon receipt of a signed application, the county agency must stamp the date of receipt
on the face of the application. The county agency must process the application within the
time period required under subdivision 5. An applicant may withdraw the application at
any time by giving written or oral notice to the county agency. The county agency must
issue a written notice confirming the withdrawal. The notice must inform the applicant of
the county agency's understanding that the applicant has withdrawn the application and no
longer wants to pursue it. When, within ten days of the date of the agency's notice, an
applicant informs a county agency, in writing, that the applicant does not wish to withdraw
the application, the county agency must reinstate the application and finish processing the
application.
(c) Upon a participant's request, the county agency must arrange for transportation and
child care or reimburse the participant for transportation and child care expenses necessary
to enable participants to attend the screening under subdivision 3a and orientation under
section 256J.45.
Sec. 13.
Minnesota Statutes 2020, section 256J.30, subdivision 8, is amended to read:
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the
reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the
county agency must immediately deleted text begin return the incomplete form and clearly state what the
caregiver must do for the form to be completedeleted text end new text begin contact the caregiver by phone or in writing
to acquire the necessary information to complete the formnew text end .
(c) The automated eligibility system must send a notice of proposed termination of
assistance to the assistance unit if a complete MFIP household report form is not received
by a county agency. The automated notice must be mailed to the caregiver by approximately
the 16th of the month. When a caregiver submits an incomplete form on or after the date a
notice of proposed termination has been sent, the termination is valid unless the caregiver
submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered
to have continued its application for assistance if a complete MFIP household report form
is received within a calendar month after the month in which the form was due and assistance
shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements
under subdivision 5 when any of the following factors cause a caregiver to fail to provide
the county agency with a completed MFIP household report form before the end of the
month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form
when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the
part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable
care which prevents the caregiver from providing a completed MFIP household report form
before the end of the month in which the form is due.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2021.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256J.35, is amended to read:
256J.35 AMOUNT OF ASSISTANCE PAYMENT.
Except as provided in paragraphs (a) to (d), the amount of an assistance payment is equal
to the difference between the MFIP standard of need or the Minnesota family wage level
in section 256J.24 and countable income.
(a) Beginning July 1, 2015, MFIP assistance units are eligible for an MFIP housing
assistance grant of deleted text begin $110deleted text end new text begin $150new text end per month, unless:
(1) the housing assistance unit is currently receiving public and assisted rental subsidies
provided through the Department of Housing and Urban Development (HUD) and is subject
to section 256J.37, subdivision 3a; or
(2) the assistance unit is a child-only case under section 256J.88.
(b) When MFIP eligibility exists for the month of application, the amount of the assistance
payment for the month of application must be prorated from the date of application or the
date all other eligibility factors are met for that applicant, whichever is later. This provision
applies when an applicant loses at least one day of MFIP eligibility.
(c) MFIP overpayments to an assistance unit must be recouped according to section
256P.08, subdivision 6.
(d) An initial assistance payment must not be made to an applicant who is not eligible
on the date payment is made.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256J.45, subdivision 1, is amended to read:
Subdivision 1.
County agency to provide orientation.
A county agency must provide
deleted text begin a face-to-facedeleted text end new text begin annew text end orientation to each MFIP caregiver unless the caregiver is:
(1) a single parent, or one parent in a two-parent family, employed at least 35 hours per
week; or
(2) a second parent in a two-parent family who is employed for 20 or more hours per
week provided the first parent is employed at least 35 hours per week.
The county agency must inform caregivers who are not exempt under clause (1) or (2) that
failure to attend the orientation is considered an occurrence of noncompliance with program
requirements, and will result in the imposition of a sanction under section 256J.46. If the
client complies with the orientation requirement prior to the first day of the month in which
the grant reduction is proposed to occur, the orientation sanction shall be lifted.
Sec. 16.
Minnesota Statutes 2020, section 256J.626, subdivision 1, is amended to read:
Subdivision 1.
Consolidated fund.
The consolidated fund is established to support
counties and tribes in meeting their duties under this chapter. Counties and tribes must use
funds from the consolidated fund to develop programs and services that are designed to
improve participant outcomes as measured in section 256J.751, subdivision 2. Counties new text begin and
tribes that administer MFIP eligibility new text end may use the funds for any allowable expenditures
under subdivision 2, including case management. Tribes new text begin that do not administer MFIP
eligibility new text end may use the funds for any allowable expenditures under subdivision 2, including
case management, except those in subdivision 2, paragraph (a), clauses (1) and (6). new text begin All
payments made through the MFIP consolidated fund to support a caregiver's pursuit of
greater economic stability does not count when determining a family's available income.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256J.95, subdivision 5, is amended to read:
Subd. 5.
Submitting application form.
The eligibility date for the diversionary work
program begins deleted text begin withdeleted text end new text begin onnew text end the date new text begin that new text end the deleted text begin signeddeleted text end combined application form (CAF) is received
by the county agency new text begin either as a signed written application; an application submitted by
telephone; or an application submitted through Internet telepresence; new text end or new text begin on new text end the date new text begin that
new text end diversionary work program eligibility criteria are met, whichever is later. new text begin The county agency
must inform an applicant that when the applicant submits the application by telephone or
through Internet telepresence, the county agency must receive a signed written application
within 30 days of the date that the applicant submitted the application by telephone or
through Internet telepresence. new text end The county agency must inform the applicant that any delay
in submitting the application will reduce the benefits paid for the month of application. The
county agency must inform a person that an application may be submitted before the person
has an interview appointment. Upon receipt of a signed application, the county agency must
stamp the date of receipt on the face of the application. The applicant may withdraw the
application at any time prior to approval by giving written or oral notice to the county
agency. The county agency must follow the notice requirements in section 256J.09,
subdivision 3, when issuing a notice confirming the withdrawal.
Sec. 18.
Minnesota Statutes 2020, section 256N.02, subdivision 16, is amended to read:
Subd. 16.
Permanent legal and physical custody.
"Permanent legal and physical
custody" meansnew text begin : (1)new text end a new text begin full new text end transfer of permanent legal and physical custody new text begin of a child ordered
by a Minnesota juvenile court under section 260C.515, subdivision 4, new text end to a relative deleted text begin ordered
by a Minnesota juvenile court under section 260C.515, subdivision 4,deleted text end new text begin who is not the child's
parent as defined in section 260C.007, subdivision 25;new text end or new text begin (2) new text end for a child under jurisdiction
of a tribal court, a judicial determination under a similar provision in tribal code which
means that a relative will assume the duty and authority to provide care, control, and
protection of a child who is residing in foster care, and to make decisions regarding the
child's education, health care, and general welfare until adulthood.new text begin To establish eligibility
for Northstar kinship assistance, permanent legal and physical custody does not include
joint legal custody, joint physical custody, or joint legal and joint physical custody of a child
shared by the child's parent and relative custodian.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256N.02, subdivision 17, is amended to read:
Subd. 17.
Reassessment.
"Reassessment" means an update of a previous assessment
through the process under section 256N.24 for a child who has been continuously eligible
for Northstar Care for Children, or when a child identified as an at-risk child (Level A)
under deleted text begin guardianship ordeleted text end adoption assistance has manifested the disability upon which eligibility
for the agreement was based according to section 256N.25, subdivision 3, paragraph (b).
A reassessment may be used to update an initial assessment, a special assessment, or a
previous reassessment.
Sec. 20.
Minnesota Statutes 2020, section 256N.22, subdivision 1, is amended to read:
Subdivision 1.
General eligibility requirements.
(a) To be eligible for Northstar kinship
assistance under this section, there must be a judicial determination under section 260C.515,
subdivision 4, that a transfer of permanent legal and physical custody to a relative new text begin who is
not the child's parent new text end is in the child's best interest. For a child under jurisdiction of a tribal
court, a judicial determination under a similar provision in tribal code indicating that a
relative will assume the duty and authority to provide care, control, and protection of a child
who is residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood, and that this is in the child's best interest is
considered equivalent. new text begin A child whose parent shares legal, physical, or legal and physical
custody of the child with a relative custodian is not eligible for Northstar kinship assistance.
new text end Additionally, a child must:
(1) have been removed from the child's home pursuant to a voluntary placement
agreement or court order;
(2)(i) have resided with the prospective relative custodian who has been a licensed child
foster parent for at least six consecutive months; or
(ii) have received from the commissioner an exemption from the requirement in item
(i) that the prospective relative custodian has been a licensed child foster parent for at least
six consecutive months, based on a determination that:
(A) an expedited move to permanency is in the child's best interest;
(B) expedited permanency cannot be completed without provision of Northstar kinship
assistance;
(C) the prospective relative custodian is uniquely qualified to meet the child's needs, as
defined in section 260C.212, subdivision 2, on a permanent basis;
(D) the child and prospective relative custodian meet the eligibility requirements of this
section; and
(E) efforts were made by the legally responsible agency to place the child with the
prospective relative custodian as a licensed child foster parent for six consecutive months
before permanency, or an explanation why these efforts were not in the child's best interests;
(3) meet the agency determinations regarding permanency requirements in subdivision
2;
(4) meet the applicable citizenship and immigration requirements in subdivision 3;
(5) have been consulted regarding the proposed transfer of permanent legal and physical
custody to a relative, if the child is at least 14 years of age or is expected to attain 14 years
of age prior to the transfer of permanent legal and physical custody; and
(6) have a written, binding agreement under section 256N.25 among the caregiver or
caregivers, the financially responsible agency, and the commissioner established prior to
transfer of permanent legal and physical custody.
(b) In addition to the requirements in paragraph (a), the child's prospective relative
custodian or custodians must meet the applicable background study requirements in
subdivision 4.
(c) To be eligible for title IV-E Northstar kinship assistance, a child must also meet any
additional criteria in section 473(d) of the Social Security Act. The sibling of a child who
meets the criteria for title IV-E Northstar kinship assistance in section 473(d) of the Social
Security Act is eligible for title IV-E Northstar kinship assistance if the child and sibling
are placed with the same prospective relative custodian or custodians, and the legally
responsible agency, relatives, and commissioner agree on the appropriateness of the
arrangement for the sibling. A child who meets all eligibility criteria except those specific
to title IV-E Northstar kinship assistance is entitled to Northstar kinship assistance paid
through funds other than title IV-E.
Sec. 21.
Minnesota Statutes 2020, section 256N.23, subdivision 2, is amended to read:
Subd. 2.
Special needs determination.
(a) A child is considered a child with special
needs under this section if the requirements in paragraphs (b) to (g) are met.
(b) There must be a determination that the child must not or should not be returned to
the home of the child's parents as evidenced by:
(1) a court-ordered termination of parental rights;
(2) a petition to terminate parental rights;
(3) consent of new text begin the child's new text end parent to adoption accepted by the court under chapter 260Cnew text begin
or, in the case of a child receiving Northstar kinship assistance payments under section
256N.22, consent of the child's parent to the child's adoption executed under chapter 259new text end ;
(4) in circumstances when tribal law permits the child to be adopted without a termination
of parental rights, a judicial determination by a tribal court indicating the valid reason why
the child cannot or should not return home;
(5) a voluntary relinquishment under section 259.25 deleted text begin or 259.47deleted text end or, if relinquishment
occurred in another state, the applicable laws in that state; or
(6) the death of the legal parent or parents if the child has two legal parents.
(c) There exists a specific factor or condition of which it is reasonable to conclude that
the child cannot be placed with adoptive parents without providing adoption assistance as
evidenced by:
(1) a determination by the Social Security Administration that the child meets all medical
or disability requirements of title XVI of the Social Security Act with respect to eligibility
for Supplemental Security Income benefits;
(2) a documented physical, mental, emotional, or behavioral disability not covered under
clause (1);
(3) a member of a sibling group being adopted at the same time by the same parent;
(4) an adoptive placement in the home of a parent who previously adopted a sibling for
whom they receive adoption assistance; or
(5) documentation that the child is an at-risk child.
(d) A reasonable but unsuccessful effort must have been made to place the child with
adoptive parents without providing adoption assistance as evidenced by:
(1) a documented search for an appropriate adoptive placement; or
(2) a determination by the commissioner that a search under clause (1) is not in the best
interests of the child.
(e) The requirement for a documented search for an appropriate adoptive placement
under paragraph (d), including the registration of the child with the state adoption exchange
and other recruitment methods under paragraph (f), must be waived if:
(1) the child is being adopted by a relative and it is determined by the child-placing
agency that adoption by the relative is in the best interests of the child;
(2) the child is being adopted by a foster parent with whom the child has developed
significant emotional ties while in the foster parent's care as a foster child and it is determined
by the child-placing agency that adoption by the foster parent is in the best interests of the
child; or
(3) the child is being adopted by a parent that previously adopted a sibling of the child,
and it is determined by the child-placing agency that adoption by this parent is in the best
interests of the child.
For an Indian child covered by the Indian Child Welfare Act, a waiver must not be
granted unless the child-placing agency has complied with the placement preferences required
by the Indian Child Welfare Act, United States Code, title 25, section 1915(a).
(f) To meet the requirement of a documented search for an appropriate adoptive placement
under paragraph (d), clause (1), the child-placing agency minimally must:
(1) conduct a relative search as required by section 260C.221 and give consideration to
placement with a relative, as required by section 260C.212, subdivision 2;
(2) comply with the placement preferences required by the Indian Child Welfare Act
when the Indian Child Welfare Act, United States Code, title 25, section 1915(a), applies;
(3) locate prospective adoptive families by registering the child on the state adoption
exchange, as required under section 259.75; and
(4) if registration with the state adoption exchange does not result in the identification
of an appropriate adoptive placement, the agency must employ additional recruitment
methods prescribed by the commissioner.
(g) Once the legally responsible agency has determined that placement with an identified
parent is in the child's best interests and made full written disclosure about the child's social
and medical history, the agency must ask the prospective adoptive parent if the prospective
adoptive parent is willing to adopt the child without receiving adoption assistance under
this section. If the identified parent is either unwilling or unable to adopt the child without
adoption assistance, the legally responsible agency must provide documentation as prescribed
by the commissioner to fulfill the requirement to make a reasonable effort to place the child
without adoption assistance. If the identified parent is willing to adopt the child without
adoption assistance, the parent must provide a written statement to this effect to the legally
responsible agency and the statement must be maintained in the permanent adoption record
of the legally responsible agency. For children under guardianship of the commissioner,
the legally responsible agency shall submit a copy of this statement to the commissioner to
be maintained in the permanent adoption record.
Sec. 22.
Minnesota Statutes 2020, section 256N.23, subdivision 6, is amended to read:
Subd. 6.
Exclusions.
The commissioner must not enter into an adoption assistance
agreement with the following individuals:
(1) a child's biological parent or stepparent;
(2) a child's relative under section 260C.007, subdivision 26b or 27, with whom the
child resided immediately prior to child welfare involvement unless:
(i) the child was in the custody of a Minnesota county or tribal agency pursuant to an
order under chapter 260C or equivalent provisions of tribal code and the agency had
placement and care responsibility for permanency planning for the child; and
(ii) the child is under guardianship of the commissioner of human services according to
the requirements of section 260C.325, subdivision 1 or 3, or is a ward of a Minnesota tribal
court after termination of parental rights, suspension of parental rights, or a finding by the
tribal court that the child cannot safely return to the care of the parent;
(3) an individual adopting a child who is the subject of a direct adoptive placement under
section 259.47 or the equivalent in tribal code;
(4) a child's legal custodian or guardian who is now adopting the childnew text begin , except for a
relative custodian as defined in section 256N.02, subdivision 19, who is currently receiving
Northstar kinship assistance benefits on behalf of the childnew text end ; or
(5) an individual who is adopting a child who is not a citizen or resident of the United
States and was either adopted in another country or brought to the United States for the
purposes of adoption.
Sec. 23.
Minnesota Statutes 2020, section 256N.24, subdivision 1, is amended to read:
Subdivision 1.
Assessment.
(a) Each child eligible under sections 256N.21, 256N.22,
and 256N.23, must be assessed to determine the benefits the child may receive under section
256N.26, in accordance with the assessment tool, process, and requirements specified in
subdivision 2.
(b) If an agency applies the emergency foster care rate for initial placement under section
256N.26, the agency may wait up to 30 days to complete the initial assessment.
(c) Unless otherwise specified in paragraph (d), a child must be assessed at the basic
level, level B, or one of ten supplemental difficulty of care levels, levels C to L.
(d) An assessment must not be completed for:
(1) a child eligible for Northstar deleted text begin kinship assistance under section 256N.22 ordeleted text end adoption
assistance under section 256N.23 who is determined to be an at-risk child. A child under
this clause must be assigned level A under section 256N.26, subdivision 1; and
(2) a child transitioning into Northstar Care for Children under section 256N.28,
subdivision 7, unless the commissioner determines an assessment is appropriate.
Sec. 24.
Minnesota Statutes 2020, section 256N.24, subdivision 8, is amended to read:
Subd. 8.
Completing the special assessment.
(a) The special assessment must be
completed in consultation with the child's caregiver. Face-to-face contact with the caregiver
is not required to complete the special assessment.
(b) If a new special assessment is required prior to the effective date of the Northstar
kinship assistance agreement, it must be completed by the financially responsible agency,
in consultation with the legally responsible agency if different. If the prospective relative
custodian is unable or unwilling to cooperate with the special assessment process, the child
shall be assigned the basic level, level B under section 256N.26, subdivision 3deleted text begin , unless the
child is known to be an at-risk child, in which case, the child shall be assigned level A under
section 256N.26, subdivision 1deleted text end .
(c) If a special assessment is required prior to the effective date of the adoption assistance
agreement, it must be completed by the financially responsible agency, in consultation with
the legally responsible agency if different. If there is no financially responsible agency, the
special assessment must be completed by the agency designated by the commissioner. If
the prospective adoptive parent is unable or unwilling to cooperate with the special
assessment process, the child must be assigned the basic level, level B under section 256N.26,
subdivision 3, unless the child is known to be an at-risk child, in which case, the child shall
be assigned level A under section 256N.26, subdivision 1.
(d) Notice to the prospective relative custodians or prospective adoptive parents must
be provided as specified in subdivision 13.
Sec. 25.
Minnesota Statutes 2020, section 256N.24, subdivision 11, is amended to read:
Subd. 11.
Completion of reassessment.
(a) The reassessment must be completed in
consultation with the child's caregiver. Face-to-face contact with the caregiver is not required
to complete the reassessment.
(b) For foster children eligible under section 256N.21, reassessments must be completed
by the financially responsible agency, in consultation with the legally responsible agency
if different.
(c) If reassessment is required after the effective date of the Northstar kinship assistance
agreement, the reassessment must be completed by the financially responsible agency.
(d) If a reassessment is required after the effective date of the adoption assistance
agreement, it must be completed by the financially responsible agency or, if there is no
financially responsible agency, the agency designated by the commissioner.
(e) If the child's caregiver is unable or unwilling to cooperate with the reassessment, the
child must be assessed at level B under section 256N.26, subdivision 3, unless the child has
deleted text begin andeleted text end new text begin a Northstarnew text end adoption assistance deleted text begin or Northstar kinship assistancedeleted text end agreement deleted text begin in placedeleted text end and
is known to be an at-risk child, in which case the child must be assessed at level A under
section 256N.26, subdivision 1.
Sec. 26.
Minnesota Statutes 2020, section 256N.24, subdivision 12, is amended to read:
Subd. 12.
Approval of initial assessments, special assessments, and reassessments.
(a)
Any agency completing initial assessments, special assessments, or reassessments must
designate one or more supervisors or other staff to examine and approve assessments
completed by others in the agency under subdivision 2. The person approving an assessment
must not be the case manager or staff member completing that assessment.
(b) In cases where a special assessment or reassessment for deleted text begin guardiandeleted text end new text begin Northstar kinshipnew text end
assistance and adoption assistance is required under subdivision 8 or 11, the commissioner
shall review and approve the assessment as part of the eligibility determination process
outlined in section 256N.22, subdivision 7, for Northstar kinship assistance, or section
256N.23, subdivision 7, for adoption assistance. The assessment determines the maximum
deleted text begin fordeleted text end new text begin ofnew text end the negotiated agreement amount under section 256N.25.
(c) The new rate is effective the calendar month that the assessment is approved, or the
effective date of the agreement, whichever is later.
Sec. 27.
Minnesota Statutes 2020, section 256N.24, subdivision 14, is amended to read:
Subd. 14.
Assessment tool determines rate of benefits.
The assessment tool established
by the commissioner in subdivision 2 determines the monthly benefit level for children in
foster care. The monthly payment for deleted text begin guardiandeleted text end new text begin Northstar kinshipnew text end assistance or adoption
assistance may be negotiated up to the monthly benefit level under foster care for those
children eligible for a payment under section 256N.26, subdivision 1.
Sec. 28.
Minnesota Statutes 2020, section 256N.25, subdivision 1, is amended to read:
Subdivision 1.
Agreement; Northstar kinship assistance; adoption assistance.
(a) In
order to receive Northstar kinship assistance or adoption assistance benefits on behalf of
an eligible child, a written, binding agreement between the caregiver or caregivers, the
financially responsible agency, or, if there is no financially responsible agency, the agency
designated by the commissioner, and the commissioner must be established prior to
finalization of the adoption or a transfer of permanent legal and physical custody. The
agreement must be negotiated with the caregiver or caregivers under subdivision 2 and
renegotiated under subdivision 3, if applicable.
(b) The agreement must be on a form approved by the commissioner and must specify
the following:
(1) duration of the agreement;
(2) the nature and amount of any payment, services, and assistance to be provided under
such agreement;
(3) the child's eligibility for Medicaid services;
(4) the terms of the payment, including any child care portion as specified in section
256N.24, subdivision 3;
(5) eligibility for reimbursement of nonrecurring expenses associated with adopting or
obtaining permanent legal and physical custody of the child, to the extent that the total cost
does not exceed $2,000 per childnew text begin pursuant to subdivision 1anew text end ;
(6) that the agreement must remain in effect regardless of the state of which the adoptive
parents or relative custodians are residents at any given time;
(7) provisions for modification of the terms of the agreement, including renegotiation
of the agreement;
(8) the effective date of the agreement; and
(9) the successor relative custodian or custodians for Northstar kinship assistance, when
applicable. The successor relative custodian or custodians may be added or changed by
mutual agreement under subdivision 3.
(c) The caregivers, the commissioner, and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, must sign
the agreement. A copy of the signed agreement must be given to each party. Once signed
by all parties, the commissioner shall maintain the official record of the agreement.
(d) The effective date of the Northstar kinship assistance agreement must be the date of
the court order that transfers permanent legal and physical custody to the relative. The
effective date of the adoption assistance agreement is the date of the finalized adoption
decree.
(e) Termination or disruption of the preadoptive placement or the foster care placement
prior to assignment of custody makes the agreement with that caregiver void.
Sec. 29.
Minnesota Statutes 2020, section 256N.25, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Reimbursement of nonrecurring expenses. new text end
new text begin
(a) The commissioner of human
services must reimburse a relative custodian with a fully executed Northstar kinship assistance
benefit agreement for costs that the relative custodian incurs while seeking permanent legal
and physical custody of a child who is the subject of a Northstar kinship assistance benefit
agreement. The commissioner must reimburse a relative custodian for expenses that are
reasonable and necessary that the relative incurs during the transfer of permanent legal and
physical custody of a child to the relative custodian, subject to a maximum of $2,000. To
be eligible for reimbursement, the expenses must directly relate to the legal transfer of
permanent legal and physical custody of the child to the relative custodian, must not have
been incurred by the relative custodian in violation of state or federal law, and must not
have been reimbursed from other sources or funds. The relative custodian must submit
reimbursement requests to the commissioner within 21 months of the date of the child's
finalized transfer of permanent legal and physical custody, and the relative custodian must
follow all requirements and procedures that the commissioner prescribes.
new text end
new text begin
(b) The commissioner of human services must reimburse an adoptive parent for costs
that the adoptive parent incurs in an adoption of a child with special needs according to
section 256N.23, subdivision 2. The commissioner must reimburse an adoptive parent for
expenses that are reasonable and necessary for the adoption of the child to occur, subject
to a maximum of $2,000. To be eligible for reimbursement, the expenses must directly relate
to the legal adoption of the child, must not have been incurred by the adoptive parent in
violation of state or federal law, and must not have been reimbursed from other sources or
funds.
new text end
new text begin
(1) Children who have special needs but who are not citizens or residents of the United
States and were either adopted in another country or brought to this country for the purposes
of adoption are categorically ineligible for the reimbursement program in this section, except
when the child meets the eligibility criteria in this section after the dissolution of the child's
international adoption.
new text end
new text begin
(2) An adoptive parent, in consultation with the responsible child-placing agency, may
request reimbursement of nonrecurring adoption expenses by submitting a complete
application to the commissioner that follows the commissioner's requirements and procedures
on forms that the commissioner prescribes.
new text end
new text begin
(3) The commissioner must determine a child's eligibility for adoption expense
reimbursement under title IV-E of the Social Security Act, United States Code, title 42,
sections 670 to 679c. If the commissioner determines that a child is eligible, the commissioner
of human services must fully execute the agreement for nonrecurring adoption expense
reimbursement by signing the agreement. For a child to be eligible, the commissioner must
have fully executed the agreement for nonrecurring adoption expense reimbursement prior
to finalizing a child's adoption.
new text end
new text begin
(4) An adoptive parent who has a fully executed Northstar adoption assistance agreement
is not required to submit a separate application for reimbursement of nonrecurring adoption
expenses for the child who is the subject of the Northstar adoption assistance agreement.
new text end
new text begin
(5) If the commissioner has determined the child to be eligible, the adoptive parent must
submit reimbursement requests to the commissioner within 21 months of the date of the
child's adoption decree, and the adoptive parent must follow requirements and procedures
that the commissioner prescribes.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256P.02, subdivision 1a, is amended to read:
Subd. 1a.
Exemption.
Participants who qualify for child care assistance programs under
chapter 119B are exempt from this sectionnew text begin , except that the personal property identified in
subdivision 2 is counted toward the asset limit of the child care assistance program under
chapter 119Bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256P.02, subdivision 2, is amended to read:
Subd. 2.
Personal property limitations.
The equity value of an assistance unit's personal
property listed in clauses (1) to deleted text begin (4)deleted text end new text begin (5)new text end must not exceed $10,000 for applicants and
participants. For purposes of this subdivision, personal property is limited to:
(1) cash;
(2) bank accounts;
(3) liquid stocks and bonds that can be readily accessed without a financial penalty; deleted text begin and
deleted text end
(4) vehicles not excluded under subdivision 3deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) the full value of business accounts used to pay expenses not related to the business.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256P.04, subdivision 4, is amended to read:
Subd. 4.
Factors to be verified.
(a) The agency shall verify the following at application:
(1) identity of adults;
(2) age, if necessary to determine eligibility;
(3) immigration status;
(4) income;
(5) spousal support and child support payments made to persons outside the household;
(6) vehicles;
(7) checking and savings accountsnew text begin , including but not limited to any business accounts
used to pay expenses not related to the businessnew text end ;
(8) inconsistent information, if related to eligibility;
(9) residence;
(10) Social Security number; and
(11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, clause (7), are not required to verify the information
in paragraph (a), clause (10). When a Social Security number is not provided to the agency
for verification, this requirement is satisfied when each member of the assistance unit
cooperates with the procedures for verification of Social Security numbers, issuance of
duplicate cards, and issuance of new numbers which have been established jointly between
the Social Security Administration and the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256P.05, is amended to read:
256P.05 SELF-EMPLOYMENT EARNINGS.
Subdivision 1.
Exempted programs.
Participants who qualify for deleted text begin child care assistance
programs under chapter 119B,deleted text end Minnesota supplemental aid under chapter 256Ddeleted text begin ,deleted text end and housing
support under chapter 256I on the basis of eligibility for Supplemental Security Income are
exempt from this section.new text begin Participants who qualify for child care assistance programs under
chapter 119B are exempt from subdivision 3.
new text end
Subd. 2.
Self-employment income determinations.
new text begin Applicants and participants must
choose one of the methods described in this subdivision for determining self-employment
earned income. new text end An agency must determine self-employment income, which is either:
(1) one-half of gross earnings from self-employment; or
(2) taxable income as determined from an Internal Revenue Service tax form that has
been filed with the Internal Revenue Service deleted text begin within the lastdeleted text end new text begin for the most recentnew text end yearnew text begin and
according to guidance provided for the Supplemental Nutrition Assistance Programnew text end . A
12-month average using deleted text begin netdeleted text end taxable income shall be used to budget monthly income.
Subd. 3.
Self-employment budgeting.
(a) The self-employment budget period begins
in the month of application or in the first month of self-employment. deleted text begin Applicants and
participants must choose one of the methods described in subdivision 2 for determining
self-employment earned income.
deleted text end
(b) Applicants and participants who elect to use taxable income as described in
subdivision 2, clause (2), to determine self-employment income must continue to use this
method until recertification, unless there is an unforeseen significant change in gross income
equaling a decline in gross income of the amount equal to or greater than the earned income
disregard as defined in section 256P.03 from the income used to determine the benefit for
the current month.
(c) For applicants and participants who elect to use one-half of gross earnings as described
in subdivision 2, clause (1), to determine self-employment income, earnings must be counted
as income in the month received.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256P.06, subdivision 3, is amended to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winnings;
(vii) unemployment insurance incomenew text begin that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
new text end
new text begin
(A) 18 years of age and enrolled in a secondary school; or
new text end
new text begin (B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-timenew text end ;
(viii) retirement, survivors, and disability insurance payments;
(ix) nonrecurring income over $60 per quarter unless earmarked and used for the purpose
for which it is intended. Income and use of this income is subject to verification requirements
under section 256P.04;
(x) retirement benefits;
(xi) cash assistance benefits, as defined by each program in chapters 119B, 256D, 256I,
and 256J;
(xii) tribal per capita payments unless excluded by federal and state law;
(xiii) income and payments from service and rehabilitation programs that meet or exceed
the state's minimum wage rate;
(xiv) income from members of the United States armed forces unless excluded from
income taxes according to federal or state law;
(xv) all child support payments for programs under chapters 119B, 256D, and 256I;
(xvi) the amount of child support received that exceeds $100 for assistance units with
one child and $200 for assistance units with two or more children for programs under chapter
256J; and
(xvii) spousal support.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2020, section 259.22, subdivision 4, is amended to read:
Subd. 4.
Time for filing petition.
A petition shall be filed not later than 12 months after
a child is placed in a prospective adoptive home. If a petition is not filed by that time, the
agency that placed the child, or, in a direct adoptive placement, the agency that is supervising
the placement shall file with the district court in the county where the prospective adoptive
parent resides a motion for an order and a report recommending one of the following:
(1) that the time for filing a petition be extended because of the child's special needs as
defined under title IV-E of the Social Security Act, United States Code, title 42, section
673;
(2) that, based on a written plan for completing filing of the petition, including a specific
timeline, to which the prospective adoptive parents have agreed, the time for filing a petition
be extended long enough to complete the plan because such an extension is in the best
interests of the child and additional time is needed for the child to adjust to the adoptive
home; or
(3) that the child be removed from the prospective adoptive home.
The prospective adoptive parent must reimburse an agency for the cost of preparing and
filing the motion and report under this section, unless the costs are reimbursed by the
commissioner under section 259.73 or deleted text begin 259A.70deleted text end new text begin 256N.25, subdivision 1anew text end .
Sec. 36.
Minnesota Statutes 2020, section 259.241, is amended to read:
259.241 ADULT ADOPTION.
(a) Any adult person may be adopted, regardless of the adult person's residence. A
resident of Minnesota may petition the court of record having jurisdiction of adoption
proceedings to adopt an individual who has reached the age of 18 years or older.
(b) The consent of the person to be adopted shall be the only consent necessary, according
to section 259.24. The consent of an adult in the adult person's own adoption is invalid if
the adult is considered to be a vulnerable adult under section 626.5572, subdivision 21, or
if the person consenting to the adoption is determined not competent to give consent.
new text begin
(c) Notwithstanding paragraph (b), a person in extended foster care under section
260C.451 may consent to the person's own adoption as long as the court with jurisdiction
finds the person competent to give consent.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The decree of adoption establishes a parent-child relationship between the adopting
parent or parents and the person adopted, including the right to inherit, and also terminates
the parental rights deleted text begin and sibling relationshipdeleted text end between the adopted person and the adopted
person's birth parents deleted text begin and siblingsdeleted text end according to section 259.59.
deleted text begin (d)deleted text end new text begin (e)new text end If the adopted person requests a change of name, the adoption decree shall order
the name change.
Sec. 37.
Minnesota Statutes 2020, section 259.35, subdivision 1, is amended to read:
Subdivision 1.
Parental responsibilities.
Prior to commencing an investigation of the
suitability of proposed adoptive parents, a child-placing agency shall give the individuals
the following written notice in all capital letters at least one-eighth inch high:
"Minnesota Statutes, section 259.59, provides that upon legally adopting a child, adoptive
parents assume all the rights and responsibilities of birth parents. The responsibilities include
providing for the child's financial support and caring for health, emotional, and behavioral
problems. Except for subsidized adoptions under Minnesota Statutes, chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ,
or any other provisions of law that expressly apply to adoptive parents and children, adoptive
parents are not eligible for state or federal financial subsidies besides those that a birth
parent would be eligible to receive for a child. Adoptive parents may not terminate their
parental rights to a legally adopted child for a reason that would not apply to a birth parent
seeking to terminate rights to a child. An individual who takes guardianship of a child for
the purpose of adopting the child shall, upon taking guardianship from the child's country
of origin, assume all the rights and responsibilities of birth and adoptive parents as stated
in this paragraph."
Sec. 38.
Minnesota Statutes 2020, section 259.53, subdivision 4, is amended to read:
Subd. 4.
Preadoption residence.
No petition shall be grantednew text begin under this chapternew text end until
the child deleted text begin shall havedeleted text end new text begin hasnew text end livednew text begin fornew text end three months in the proposed new text begin adoptive new text end home, subject to a
right of visitation by the commissioner or an agency or their authorized representatives.
Sec. 39.
Minnesota Statutes 2020, section 259.73, is amended to read:
259.73 REIMBURSEMENT OF NONRECURRING ADOPTION EXPENSES.
An individual may apply for reimbursement for costs incurred in an adoption of a child
with special needs under section deleted text begin 259A.70deleted text end new text begin 256N.25, subdivision 1anew text end .
Sec. 40.
Minnesota Statutes 2020, section 259.75, subdivision 5, is amended to read:
Subd. 5.
Withdrawal of registration.
A child's registration shall be withdrawn when
the exchange service has been notified in writing by the local social service agency or the
licensed child-placing agency that the child has been placed in an adoptive home deleted text begin ordeleted text end new text begin ,new text end has
diednew text begin , or is no longer under the guardianship of the commissioner and is no longer seeking
an adoptive homenew text end .
Sec. 41.
Minnesota Statutes 2020, section 259.75, subdivision 6, is amended to read:
Subd. 6.
Periodic review of status.
new text begin (a) new text end The deleted text begin exchange servicedeleted text end new text begin commissionernew text end shall
deleted text begin semiannually checkdeleted text end new text begin reviewnew text end thenew text begin state adoption exchangenew text end status of deleted text begin listeddeleted text end children deleted text begin for whom
inquiries have been receiveddeleted text end new text begin identified under subdivision 2, including a child whose
registration was withdrawn pursuant to subdivision 5. The commissioner may determine
that a child who is unregistered, or whose registration has been deferred, must be registered
and require the authorized child-placing agency to register the child with the state adoption
exchange within ten working days of the commissioner's determinationnew text end .
new text begin (b)new text end Periodic deleted text begin checksdeleted text end new text begin reviewsnew text end shall be made by the deleted text begin servicedeleted text end new text begin commissionernew text end to determine the
progress toward adoption of deleted text begin those children and the status ofdeleted text end children registered deleted text begin but never
listeddeleted text end in the deleted text begin exchange book because of placement in an adoptive home prior to or at the
time of registrationdeleted text end new text begin state adoption exchangenew text end .
Sec. 42.
Minnesota Statutes 2020, section 259.75, subdivision 9, is amended to read:
Subd. 9.
Rules; staff.
The commissioner of human services shall make rules as necessary
to administer this section and shall employ necessary staff to carry out the purposes of this
section.new text begin The commissioner may contract for services to carry out the purposes of this section.
new text end
Sec. 43.
Minnesota Statutes 2020, section 259.83, subdivision 1a, is amended to read:
Subd. 1a.
Social and medical history.
(a) If a person aged 19 years and over who was
adopted on or after August 1, 1994, or the adoptive parent requests the detailed nonidentifying
social and medical history of the adopted person's birth family that was provided at the time
of the adoption, agencies must provide the information to the adopted person or adoptive
parent on thenew text begin applicablenew text end form required under deleted text begin sectiondeleted text end new text begin sectionsnew text end 259.43new text begin and 260C.212,
subdivision 15new text end .
(b) If an adopted person aged 19 years and over or the adoptive parent requests the
agency to contact the adopted person's birth parents to request current nonidentifying social
and medical history of the adopted person's birth family, agencies must use thenew text begin applicablenew text end
form required under deleted text begin sectiondeleted text end new text begin sectionsnew text end 259.43new text begin and 260C.212, subdivision 15,new text end when obtaining
the information for the adopted person or adoptive parent.
Sec. 44.
Minnesota Statutes 2020, section 259A.75, subdivision 1, is amended to read:
Subdivision 1.
General information.
(a) Subject to the procedures required by the
commissioner and the provisions of this section, a Minnesota countynew text begin or Tribal agencynew text end shall
receive a reimbursement from the commissioner equal to 100 percent of the reasonable and
appropriate cost for contracted adoption placement services identified for a specific child
that are not reimbursed under other federal or state funding sources.
(b) The commissioner may spend up to $16,000 for each purchase of service contract.
Only one contract per child per adoptive placement is permitted. Funds encumbered and
obligated under the contract for the child remain available until the terms of the contract
are fulfilled or the contract is terminated.
(c) The commissioner shall set aside an amount not to exceed five percent of the total
amount of the fiscal year appropriation from the state for the adoption assistance program
to reimburse a Minnesota county or tribal social services placing agency for child-specific
adoption placement services. When adoption assistance payments for children's needs exceed
95 percent of the total amount of the fiscal year appropriation from the state for the adoption
assistance program, the amount of reimbursement available to placing agencies for adoption
services is reduced correspondingly.
Sec. 45.
Minnesota Statutes 2020, section 259A.75, subdivision 2, is amended to read:
Subd. 2.
Purchase of service contract child eligibility criteria.
deleted text begin (a)deleted text end A child who is the
subject of a purchase of service contract must:
(1) have the goal of adoption, which may include an adoption in accordance with tribal
law;
(2) be under the guardianship of the commissioner of human services or be a ward of
tribal court pursuant to section 260.755, subdivision 20; and
(3) meet all of the special needs criteria according to section deleted text begin 259A.10, subdivision 2deleted text end new text begin
256N.23, subdivision 2new text end .
deleted text begin
(b) A child under the guardianship of the commissioner must have an identified adoptive
parent and a fully executed adoption placement agreement according to section 260C.613,
subdivision 1, paragraph (a).
deleted text end
Sec. 46.
Minnesota Statutes 2020, section 259A.75, subdivision 3, is amended to read:
Subd. 3.
Agency eligibility criteria.
(a) A Minnesota countynew text begin or Tribalnew text end social services
agency shall receive reimbursement for child-specific adoption placement services for an
eligible child that it purchases from a private adoption agency licensed in Minnesota or any
other state or tribal social services agency.
(b) Reimbursement for adoption services is available only for services provided prior
to the date of the adoption decree.
Sec. 47.
Minnesota Statutes 2020, section 259A.75, subdivision 4, is amended to read:
Subd. 4.
Application and eligibility determination.
(a) Anew text begin Minnesotanew text end countynew text begin or Tribalnew text end
social services agency may request reimbursement of costs for adoption placement services
by submitting a complete purchase of service application, according to the requirements
and procedures and on forms prescribed by the commissioner.
(b) The commissioner shall determine eligibility for reimbursement of adoption placement
services. If determined eligible, the commissioner of human services shall sign the purchase
of service agreement, making this a fully executed contract. No reimbursement under this
section shall be made to an agency for services provided prior to the fully executed contract.
(c) Separate purchase of service agreements shall be made, and separate records
maintained, on each child. Only one agreement per child per adoptive placement is permitted.
For siblings who are placed together, services shall be planned and provided to best maximize
efficiency of the contracted hours.
Sec. 48.
Minnesota Statutes 2020, section 260C.007, subdivision 22a, is amended to read:
Subd. 22a.
Licensed residential family-based substance use disorder treatment
program.
"Licensed residential family-based substance use disorder treatment program"
means a residential treatment facility that provides the parent or guardian with parenting
skills training, parent education, or individual and family counseling, under an organizational
structure and treatment framework that involves understanding, recognizing, and responding
to the effects of all types of trauma according to recognized principles of a trauma-informed
approach and trauma-specific interventions to address the consequences of trauma and
facilitate healing. The residential program must be licensed by the Department of Human
Services under deleted text begin chapterdeleted text end new text begin chaptersnew text end 245A and deleted text begin sections 245G.01 to 245G.16, 245G.19, and
245G.21deleted text end new text begin 245G or Tribally licensed or approvednew text end as a residential substance use disorder
treatment program specializing in the treatment of clients with children.
Sec. 49.
Minnesota Statutes 2020, section 260C.212, subdivision 1, is amended to read:
Subdivision 1.
Out-of-home placement; plan.
(a) An out-of-home placement plan shall
be prepared within 30 days after any child is placed in foster care by court order or a
voluntary placement agreement between the responsible social services agency and the
child's parent pursuant to section 260C.227 or chapter 260D.
(b) An out-of-home placement plan means a written document which is prepared by the
responsible social services agency jointly with the parent or parents or guardian of the child
and in consultation with the child's guardian ad litem, the child's tribe, if the child is an
Indian child, the child's foster parent or representative of the foster care facility, and, where
appropriate, the child. When a child is age 14 or older, the child may include two other
individuals on the team preparing the child's out-of-home placement plan. The child may
select one member of the case planning team to be designated as the child's advisor and to
advocate with respect to the application of the reasonable and prudent parenting standards.
The responsible social services agency may reject an individual selected by the child if the
agency has good cause to believe that the individual would not act in the best interest of the
child. For a child in voluntary foster care for treatment under chapter 260D, preparation of
the out-of-home placement plan shall additionally include the child's mental health treatment
provider. For a child 18 years of age or older, the responsible social services agency shall
involve the child and the child's parents as appropriate. As appropriate, the plan shall be:
(1) submitted to the court for approval under section 260C.178, subdivision 7;
(2) ordered by the court, either as presented or modified after hearing, under section
260C.178, subdivision 7, or 260C.201, subdivision 6; and
(3) signed by the parent or parents or guardian of the child, the child's guardian ad litem,
a representative of the child's tribe, the responsible social services agency, and, if possible,
the child.
(c) The out-of-home placement plan shall be explained to all persons involved in its
implementation, including the child who has signed the plan, and shall set forth:
(1) a description of the foster care home or facility selected, including how the
out-of-home placement plan is designed to achieve a safe placement for the child in the
least restrictive, most family-like, setting available which is in close proximity to the home
of the parent or parents or guardian of the child when the case plan goal is reunification,
and how the placement is consistent with the best interests and special needs of the child
according to the factors under subdivision 2, paragraph (b);
(2) the specific reasons for the placement of the child in foster care, and when
reunification is the plan, a description of the problems or conditions in the home of the
parent or parents which necessitated removal of the child from home and the changes the
parent or parents must make for the child to safely return home;
(3) a description of the services offered and provided to prevent removal of the child
from the home and to reunify the family including:
(i) the specific actions to be taken by the parent or parents of the child to eliminate or
correct the problems or conditions identified in clause (2), and the time period during which
the actions are to be taken; and
(ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made to
achieve a safe and stable home for the child including social and other supportive services
to be provided or offered to the parent or parents or guardian of the child, the child, and the
residential facility during the period the child is in the residential facility;
(4) a description of any services or resources that were requested by the child or the
child's parent, guardian, foster parent, or custodian since the date of the child's placement
in the residential facility, and whether those services or resources were provided and if not,
the basis for the denial of the services or resources;
(5) the visitation plan for the parent or parents or guardian, other relatives as defined in
section 260C.007, subdivision 26b or 27, and siblings of the child if the siblings are not
placed together in foster care, and whether visitation is consistent with the best interest of
the child, during the period the child is in foster care;
(6) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize adoption as the permanency plan for the child through reasonable efforts
to place the child for adoption. At a minimum, the documentation must include consideration
of whether adoption is in the best interests of the child, child-specific recruitment efforts
such as relative search and the use of state, regional, and national adoption exchanges to
facilitate orderly and timely placements in and outside of the state. A copy of this
documentation shall be provided to the court in the review required under section 260C.317,
subdivision 3, paragraph (b);
(7) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize the transfer of permanent legal and physical custody to a relative as the
permanency plan for the child. This documentation must support the requirements of the
kinship placement agreement under section 256N.22 and must include the reasonable efforts
used to determine that it is not appropriate for the child to return home or be adopted, and
reasons why permanent placement with a relative through a Northstar kinship assistance
arrangement is in the child's best interest; how the child meets the eligibility requirements
for Northstar kinship assistance payments; agency efforts to discuss adoption with the child's
relative foster parent and reasons why the relative foster parent chose not to pursue adoption,
if applicable; and agency efforts to discuss with the child's parent or parents the permanent
transfer of permanent legal and physical custody or the reasons why these efforts were not
made;
(8) efforts to ensure the child's educational stability while in foster care for a child who
attained the minimum age for compulsory school attendance under state law and is enrolled
full time in elementary or secondary school, or instructed in elementary or secondary
education at home, or instructed in an independent study elementary or secondary program,
or incapable of attending school on a full-time basis due to a medical condition that is
documented and supported by regularly updated information in the child's case plan.
Educational stability efforts include:
(i) efforts to ensure that the child remains in the same school in which the child was
enrolled prior to placement or upon the child's move from one placement to another, including
efforts to work with the local education authorities to ensure the child's educational stability
and attendance; or
(ii) if it is not in the child's best interest to remain in the same school that the child was
enrolled in prior to placement or move from one placement to another, efforts to ensure
immediate and appropriate enrollment for the child in a new school;
(9) the educational records of the child including the most recent information available
regarding:
(i) the names and addresses of the child's educational providers;
(ii) the child's grade level performance;
(iii) the child's school record;
(iv) a statement about how the child's placement in foster care takes into account
proximity to the school in which the child is enrolled at the time of placement; and
(v) any other relevant educational information;
(10) the efforts by the responsible social services agency to ensure the oversight and
continuity of health care services for the foster child, including:
(i) the plan to schedule the child's initial health screens;
(ii) how the child's known medical problems and identified needs from the screens,
including any known communicable diseases, as defined in section 144.4172, subdivision
2, shall be monitored and treated while the child is in foster care;
(iii) how the child's medical information shall be updated and shared, including the
child's immunizations;
(iv) who is responsible to coordinate and respond to the child's health care needs,
including the role of the parent, the agency, and the foster parent;
(v) who is responsible for oversight of the child's prescription medications;
(vi) how physicians or other appropriate medical and nonmedical professionals shall be
consulted and involved in assessing the health and well-being of the child and determine
the appropriate medical treatment for the child; and
(vii) the responsibility to ensure that the child has access to medical care through either
medical insurance or medical assistance;
(11) the health records of the child including information available regarding:
(i) the names and addresses of the child's health care and dental care providers;
(ii) a record of the child's immunizations;
(iii) the child's known medical problems, including any known communicable diseases
as defined in section 144.4172, subdivision 2;
(iv) the child's medications; and
(v) any other relevant health care information such as the child's eligibility for medical
insurance or medical assistance;
(12) an independent living plan for a child 14 years of age or older, developed in
consultation with the child. The child may select one member of the case planning team to
be designated as the child's advisor and to advocate with respect to the application of the
reasonable and prudent parenting standards in subdivision 14. The plan should include, but
not be limited to, the following objectives:
(i) educational, vocational, or employment planning;
(ii) health care planning and medical coverage;
(iii) transportation including, where appropriate, assisting the child in obtaining a driver's
license;
(iv) money management, including the responsibility of the responsible social services
agency to ensure that the child annually receives, at no cost to the child, a consumer report
as defined under section 13C.001 and assistance in interpreting and resolving any inaccuracies
in the report;
(v) planning for housing;
(vi) social and recreational skills;
(vii) establishing and maintaining connections with the child's family and community;
and
(viii) regular opportunities to engage in age-appropriate or developmentally appropriate
activities typical for the child's age group, taking into consideration the capacities of the
individual child;
(13) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
and assessment information, specific services relating to meeting the mental health care
needs of the child, and treatment outcomes;
(14) for a child 14 years of age or older, a signed acknowledgment that describes the
child's rights regarding education, health care, visitation, safety and protection from
exploitation, and court participation; receipt of the documents identified in section 260C.452;
and receipt of an annual credit report. The acknowledgment shall state that the rights were
explained in an age-appropriate manner to the child; and
(15) for a child placed in a qualified residential treatment program, the plan must include
the requirements in section 260C.708.
(d) The parent or parents or guardian and the child each shall have the right to legal
counsel in the preparation of the case plan and shall be informed of the right at the time of
placement of the child. The child shall also have the right to a guardian ad litem. If unable
to employ counsel from their own resources, the court shall appoint counsel upon the request
of the parent or parents or the child or the child's legal guardian. The parent or parents may
also receive assistance from any person or social services agency in preparation of the case
plan.
After the plan has been agreed upon by the parties involved or approved or ordered by
the court, the foster parents shall be fully informed of the provisions of the case plan and
shall be provided a copy of the plan.
Uponnew text begin the child'snew text end discharge from foster care, thenew text begin responsible social services agency must
provide the child'snew text end parent, adoptive parent, or permanent legal and physical custodian, deleted text begin as
appropriate,deleted text end and the child, if deleted text begin appropriate, must be provideddeleted text end new text begin the child is 14 years of age or
older,new text end with a current copy of the child's health and education record.new text begin If a child meets the
conditions in subdivision 15, paragraph (b), the agency must also provide the child with the
child's social and medical history. The responsible social services agency may give a copy
of the child's health and education record and social and medical history to a child who is
younger than 14 years of age, if it is appropriate and if subdivision 15, paragraph (b), applies.
new text end
Sec. 50.
Minnesota Statutes 2020, section 260C.212, subdivision 2, is amended to read:
Subd. 2.
Placement decisions based on best interests of the child.
(a) The policy of
the state of Minnesota is to ensure that the child's best interests are met by requiring an
individualized determination of the needs of the child and of how the selected placement
will serve the needs of the child being placed. The authorized child-placing agency shall
place a child, released by court order or by voluntary release by the parent or parents, in a
family foster home selected by considering placement with relatives and important friends
in the following order:
(1) with an individual who is related to the child by blood, marriage, or adoptionnew text begin ,
including the legal parent, guardian, or custodian of the child's siblingsnew text end ; or
(2) with an individual who is an important friend with whom the child has resided or
had significant contact.
For an Indian child, the agency shall follow the order of placement preferences in the Indian
Child Welfare Act of 1978, United States Code, title 25, section 1915.
(b) Among the factors the agency shall consider in determining the needs of the child
are the following:
(1) the child's current functioning and behaviors;
(2) the medical needs of the child;
(3) the educational needs of the child;
(4) the developmental needs of the child;
(5) the child's history and past experience;
(6) the child's religious and cultural needs;
(7) the child's connection with a community, school, and faith community;
(8) the child's interests and talents;
(9) the child's relationship to current caretakers, parents, siblings, and relatives;
(10) the reasonable preference of the child, if the court, or the child-placing agency in
the case of a voluntary placement, deems the child to be of sufficient age to express
preferences; and
(11) for an Indian child, the best interests of an Indian child as defined in section 260.755,
subdivision 2a.
(c) Placement of a child cannot be delayed or denied based on race, color, or national
origin of the foster parent or the child.
(d) Siblings should be placed together for foster care and adoption at the earliest possible
time unless it is documented that a joint placement would be contrary to the safety or
well-being of any of the siblings or unless it is not possible after reasonable efforts by the
responsible social services agency. In cases where siblings cannot be placed together, the
agency is required to provide frequent visitation or other ongoing interaction between
siblings unless the agency documents that the interaction would be contrary to the safety
or well-being of any of the siblings.
(e) Except for emergency placement as provided for in section 245A.035, the following
requirements must be satisfied before the approval of a foster or adoptive placement in a
related or unrelated home: (1) a completed background study under section 245C.08; and
(2) a completed review of the written home study required under section 260C.215,
subdivision 4, clause (5), or 260C.611, to assess the capacity of the prospective foster or
adoptive parent to ensure the placement will meet the needs of the individual child.
(f) The agency must determine whether colocation with a parent who is receiving services
in a licensed residential family-based substance use disorder treatment program is in the
child's best interests according to paragraph (b) and include that determination in the child's
case plan under subdivision 1. The agency may consider additional factors not identified
in paragraph (b). The agency's determination must be documented in the child's case plan
before the child is colocated with a parent.
(g) The agency must establish a juvenile treatment screening team under section 260C.157
to determine whether it is necessary and appropriate to recommend placing a child in a
qualified residential treatment program, as defined in section 260C.007, subdivision 26d.
Sec. 51.
Minnesota Statutes 2020, section 260C.212, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Social and medical history. new text end
new text begin
(a) The responsible social services agency must
complete each child's social and medical history using forms developed by the commissioner.
The responsible social services agency must work with each child's birth family, foster
family, medical and treatment providers, and school to ensure that there is a detailed and
up-to-date social and medical history of the child on forms provided by the commissioner.
new text end
new text begin
(b) If the child continues to be in placement out of the home of the parent or guardian
from whom the child was removed, reasonable efforts by the responsible social services
agency to complete the child's social and medical history must begin no later than the child's
permanency progress review hearing required under section 260C.204 or six months after
the child's placement in foster care, whichever occurs earlier.
new text end
new text begin
(c) In a child's social and medical history, the responsible social services agency must
include background information and health history specific to the child, the child's birth
parents, and the child's other birth relatives. Applicable background and health information
about the child includes the child's current health condition, behavior, and demeanor;
placement history; education history; sibling information; and birth, medical, dental, and
immunization information. Redacted copies of pertinent records, assessments, and evaluations
must be attached to the child's social and medical history. Applicable background information
about the child's birth parents and other birth relatives includes general background
information; education and employment history; physical health and mental health history;
and reasons for the child's placement.
new text end
Sec. 52.
Minnesota Statutes 2020, section 260C.219, subdivision 5, is amended to read:
Subd. 5.
Children reaching age of majority; copies of records.
new text begin Regardless of new text end whethernew text begin
a child isnew text end under state guardianship deleted text begin or notdeleted text end , if a child leaves foster care by reason of having
attained the age of majority under state law, the child must be given at no cost a copy of
the child's social and medical history, as deleted text begin defineddeleted text end new text begin describednew text end in section deleted text begin 259.43,deleted text end new text begin 260C.212,
subdivision 15, including the child's healthnew text end and education report.
Sec. 53.
Minnesota Statutes 2020, section 260C.503, subdivision 2, is amended to read:
Subd. 2.
Termination of parental rights.
(a) The responsible social services agency
must ask the county attorney to immediately file a termination of parental rights petition
when:
(1) the child has been subjected to egregious harm as defined in section 260C.007,
subdivision 14;
(2) the child is determined to be the sibling of a child who was subjected to egregious
harm;
(3) the child is an abandoned infant as defined in section 260C.301, subdivision 2,
paragraph (a), clause (2);
(4) the child's parent has lost parental rights to another child through an order involuntarily
terminating the parent's rights;
(5) the parent has committed sexual abuse as defined in section 260E.03, against the
child or another child of the parent;
(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or
(7) another child of the parent is the subject of an order involuntarily transferring
permanent legal and physical custody of the child to a relative under this chapter or a similar
law of another jurisdiction;
The county attorney shall file a termination of parental rights petition unless the conditions
of paragraph (d) are met.
(b) When the termination of parental rights petition is filed under this subdivision, the
responsible social services agency shall identify, recruit, and approve an adoptive family
for the child. If a termination of parental rights petition has been filed by another party, the
responsible social services agency shall be joined as a party to the petition.
(c) If criminal charges have been filed against a parent arising out of the conduct alleged
to constitute egregious harm, the county attorney shall determine which matter should
proceed to trial first, consistent with the best interests of the child and subject to the
defendant's right to a speedy trial.
(d) The requirement of paragraph (a) does not apply if the responsible social services
agency and the county attorney determine and file with the court:
(1) a petition for transfer of permanent legal and physical custody to a relative under
sections 260C.505 and 260C.515, subdivision deleted text begin 3deleted text end new text begin 4new text end , including a determination that adoption
is not in the child's best interests and that transfer of permanent legal and physical custody
is in the child's best interests; or
(2) a petition under section 260C.141 alleging the child, and where appropriate, the
child's siblings, to be in need of protection or services accompanied by a case plan prepared
by the responsible social services agency documenting a compelling reason why filing a
termination of parental rights petition would not be in the best interests of the child.
Sec. 54.
Minnesota Statutes 2020, section 260C.515, subdivision 3, is amended to read:
Subd. 3.
Guardianship; commissioner.
The court may new text begin issue an new text end order new text begin that the child is
under the new text end guardianship deleted text begin todeleted text end new text begin ofnew text end the commissioner of human services under the following
procedures and conditions:
(1) there is an identified prospective adoptive parent agreed to by the responsible social
services agency deleted text begin havingdeleted text end new text begin that hasnew text end legal custody of the child pursuant to court order under this
chapter and that prospective adoptive parent has agreed to adopt the child;
(2) the court accepts the parent's voluntary consent to adopt in writing on a form
prescribed by the commissioner, executed before two competent witnesses and confirmed
by the consenting parent before the court or executed before the court. The consent shall
contain notice that consent given under this chapter:
(i) is irrevocable upon acceptance by the court unless fraud is established and an order
is issued permitting revocation as stated in clause (9) unless the matter is governed by the
Indian Child Welfare Act, United States Code, title 25, section 1913(c); and
(ii) will result in an order that the child is under the guardianship of the commissioner
of human services;
(3) a consent executed and acknowledged outside of this state, either in accordance with
the law of this state or in accordance with the law of the place where executed, is valid;
(4) the court must review the matter at least every 90 days under section 260C.317;
(5) a consent to adopt under this subdivision vests guardianship of the child with the
commissioner of human services and makes the child a ward of the commissioner of human
services under section 260C.325;
(6) the court must forward to the commissioner a copy of the consent to adopt, together
with a certified copy of the order transferring guardianship to the commissioner;
(7) if an adoption is not finalized by the identified prospective adoptive parent within
six months of the execution of the consent to adopt under this clause, the responsible social
services agency shall pursue adoptive placement in another home unless the court finds in
a hearing under section 260C.317 that the failure to finalize is not due to either an action
or a failure to act by the prospective adoptive parent;
(8) notwithstanding clause (7), the responsible social services agency must pursue
adoptive placement in another home as soon as the agency determines that finalization of
the adoption with the identified prospective adoptive parent is not possible, that the identified
prospective adoptive parent is not willing to adopt the child, or that the identified prospective
adoptive parent is not cooperative in completing the steps necessary to finalize the adoptionnew text begin .
The court may order a termination of parental rights under subdivision 2new text end ; and
(9) unless otherwise required by the Indian Child Welfare Act, United States Code, title
25, section 1913(c), a consent to adopt executed under this section shall be irrevocable upon
acceptance by the court except upon order permitting revocation issued by the same court
after written findings that consent was obtained by fraud.
Sec. 55.
Minnesota Statutes 2020, section 260C.605, subdivision 1, is amended to read:
Subdivision 1.
Requirements.
(a) Reasonable efforts to finalize the adoption of a child
under the guardianship of the commissioner shall be made by the responsible social services
agency responsible for permanency planning for the child.
(b) Reasonable efforts to make a placement in a home according to the placement
considerations under section 260C.212, subdivision 2, with a relative or foster parent who
will commit to being the permanent resource for the child in the event the child cannot be
reunified with a parent are required under section 260.012 and may be made concurrently
with reasonable, or if the child is an Indian child, active efforts to reunify the child with the
parent.
(c) Reasonable efforts under paragraph (b) must begin as soon as possible when the
child is in foster care under this chapter, but not later than the hearing required under section
260C.204.
(d) Reasonable efforts to finalize the adoption of the child include:
(1) using age-appropriate engagement strategies to plan for adoption with the child;
(2) identifying an appropriate prospective adoptive parent for the child by updating the
child's identified needs using the factors in section 260C.212, subdivision 2;
(3) making an adoptive placement that meets the child's needs by:
(i) completing or updating the relative search required under section 260C.221 and giving
notice of the need for an adoptive home for the child to:
(A) relatives who have kept the agency or the court apprised of their whereabouts and
who have indicated an interest in adopting the child; or
(B) relatives of the child who are located in an updated search;
(ii) an updated search is required whenever:
(A) there is no identified prospective adoptive placement for the child notwithstanding
a finding by the court that the agency made diligent efforts under section 260C.221, in a
hearing required under section 260C.202;
(B) the child is removed from the home of an adopting parent; or
(C) the court determines a relative search by the agency is in the best interests of the
child;
(iii) engaging the child's foster parent and the child's relatives identified as an adoptive
resource during the search conducted under section 260C.221, to commit to being the
prospective adoptive parent of the child; or
(iv) when there is no identified prospective adoptive parent:
(A) registering the child on the state adoption exchange as required in section 259.75
unless the agency documents to the court an exception to placing the child on the state
adoption exchange reported to the commissioner;
(B) reviewing all families with approved adoption home studies associated with the
responsible social services agency;
(C) presenting the child to adoption agencies and adoption personnel who may assist
with finding an adoptive home for the child;
(D) using newspapers and other media to promote the particular child;
(E) using a private agency under grant contract with the commissioner to provide adoption
services for intensive child-specific recruitment efforts; and
(F) making any other efforts or using any other resources reasonably calculated to identify
a prospective adoption parent for the child;
(4) updating and completing the social and medical history required under sections
deleted text begin 259.43deleted text end new text begin 260C.212, subdivision 15,new text end and 260C.609;
(5) making, and keeping updated, appropriate referrals required by section 260.851, the
Interstate Compact on the Placement of Children;
(6) giving notice regarding the responsibilities of an adoptive parent to any prospective
adoptive parent as required under section 259.35;
(7) offering the adopting parent the opportunity to apply for or decline adoption assistance
under chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ;
(8) certifying the child for adoption assistance, assessing the amount of adoption
assistance, and ascertaining the status of the commissioner's decision on the level of payment
if the adopting parent has applied for adoption assistance;
(9) placing the child with siblings. If the child is not placed with siblings, the agency
must document reasonable efforts to place the siblings together, as well as the reason for
separation. The agency may not cease reasonable efforts to place siblings together for final
adoption until the court finds further reasonable efforts would be futile or that placement
together for purposes of adoption is not in the best interests of one of the siblings; and
(10) working with the adopting parent to file a petition to adopt the child and with the
court administrator to obtain a timely hearing to finalize the adoption.
Sec. 56.
Minnesota Statutes 2020, section 260C.607, subdivision 6, is amended to read:
Subd. 6.
Motion and hearing to order adoptive placement.
(a) At any time after the
district court orders the child under the guardianship of the commissioner of human services,
but not later than 30 days after receiving notice required under section 260C.613, subdivision
1, paragraph (c), that the agency has made an adoptive placement, a relative or the child's
foster parent may file a motion for an order for adoptive placement of a child who is under
the guardianship of the commissioner if the relative or the child's foster parent:
(1) has an adoption home study under section 259.41 approving the relative or foster
parent for adoption and has been a resident of Minnesota for at least six months before filing
the motion; the court may waive the residency requirement for the moving party if there is
a reasonable basis to do so; or
(2) is not a resident of Minnesota, but has an approved adoption home study by an agency
licensed or approved to complete an adoption home study in the state of the individual's
residence and the study is filed with the motion for adoptive placement.
(b) The motion shall be filed with the court conducting reviews of the child's progress
toward adoption under this section. The motion and supporting documents must make a
prima facie showing that the agency has been unreasonable in failing to make the requested
adoptive placement. The motion must be served according to the requirements for motions
under the Minnesota Rules of Juvenile Protection Procedure and shall be made on all
individuals and entities listed in subdivision 2.
(c) If the motion and supporting documents do not make a prima facie showing for the
court to determine whether the agency has been unreasonable in failing to make the requested
adoptive placement, the court shall dismiss the motion. If the court determines a prima facie
basis is made, the court shall set the matter for evidentiary hearing.
(d) At the evidentiary hearing, the responsible social services agency shall proceed first
with evidence about the reason for not making the adoptive placement proposed by the
moving party. The moving party then has the burden of proving by a preponderance of the
evidence that the agency has been unreasonable in failing to make the adoptive placement.
(e) At the conclusion of the evidentiary hearing, if the court finds that the agency has
been unreasonable in failing to make the adoptive placement and that the relative or the
child's foster parent is the most suitable adoptive home to meet the child's needs using the
factors in section 260C.212, subdivision 2, paragraph (b), the court may order the responsible
social services agency to make an adoptive placement in the home of the relative or the
child's foster parent.
(f) If, in order to ensure that a timely adoption may occur, the court orders the responsible
social services agency to make an adoptive placement under this subdivision, the agency
shall:
(1) make reasonable efforts to obtain a fully executed adoption placement agreement;
(2) work with the moving party regarding eligibility for adoption assistance as required
under chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ; and
(3) if the moving party is not a resident of Minnesota, timely refer the matter for approval
of the adoptive placement through the Interstate Compact on the Placement of Children.
(g) Denial or granting of a motion for an order for adoptive placement after an evidentiary
hearing is an order which may be appealed by the responsible social services agency, the
moving party, the child, when age ten or over, the child's guardian ad litem, and any
individual who had a fully executed adoption placement agreement regarding the child at
the time the motion was filed if the court's order has the effect of terminating the adoption
placement agreement. An appeal shall be conducted according to the requirements of the
Rules of Juvenile Protection Procedure.
Sec. 57.
Minnesota Statutes 2020, section 260C.609, is amended to read:
260C.609 SOCIAL AND MEDICAL HISTORY.
deleted text begin
(a) The responsible social services agency shall work with the birth family of the child,
foster family, medical and treatment providers, and the child's school to ensure there is a
detailed, thorough, and currently up-to-date social and medical history of the child as required
under section 259.43 on the forms required by the commissioner.
deleted text end
deleted text begin
(b) When the child continues in foster care, the agency's reasonable efforts to complete
the history shall begin no later than the permanency progress review hearing required under
section 260C.204 or six months after the child's placement in foster care.
deleted text end
deleted text begin (c)deleted text end new text begin (a)new text end Thenew text begin responsible social servicesnew text end agency shall thoroughly discuss the child's history
with the deleted text begin adoptingdeleted text end new text begin prospective adoptivenew text end parent of the child and shall give anew text begin redactednew text end copy
of deleted text begin the report ofdeleted text end the child's social and medical historynew text begin as described in section 260C.212,
subdivision 15, including redacted attachments,new text end to the deleted text begin adoptingdeleted text end new text begin prospective adoptivenew text end parent.new text begin
If the prospective adoptive parent does not pursue adoption of the child, the prospective
adoptive parent must return the child's social and medical history and redacted attachments
to the agency. The responsible social services agency may givenew text end anew text begin redactednew text end copy of the child's
social and medical history deleted text begin may also be givendeleted text end to the childdeleted text begin , as appropriatedeleted text end new text begin according to section
260C.212, subdivision 1new text end .
deleted text begin (d)deleted text end new text begin (b)new text end The report shall not include information that identifies birth relatives. Redacted
copies of allnew text begin ofnew text end the child's relevant evaluations, assessments, and records must be attached
to the social and medical history.
new text begin
(c) The agency must submit the child's social and medical history to the Department of
Human Services at the time that the agency submits the child's adoption placement agreement.
Pursuant to section 260C.623, subdivision 4, the child's social and medical history must be
submitted to the court at the time the adoption petition is filed with the court.
new text end
Sec. 58.
Minnesota Statutes 2020, section 260C.615, is amended to read:
260C.615 DUTIES OF COMMISSIONER.
Subdivision 1.
Duties.
(a) For any child who is under the guardianship of the
commissioner, the commissioner has the exclusive rights to consent to:
(1) the medical care plan for the treatment of a child who is at imminent risk of death
or who has a chronic disease that, in a physician's judgment, will result in the child's death
in the near future including a physician's order not to resuscitate or intubate the child; and
(2) the child donating a part of the child's body to another person while the child is living;
the decision to donate a body part under this clause shall take into consideration the child's
wishes and the child's culture.
(b) In addition to the exclusive rights under paragraph (a), the commissioner has a duty
to:
(1) process any complete and accurate request for home study and placement through
the Interstate Compact on the Placement of Children under section 260.851;
(2) process any complete and accurate application for adoption assistance forwarded by
the responsible social services agency according to chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ;
(3) deleted text begin complete the execution ofdeleted text end new text begin review and processnew text end an adoption placement agreement
forwarded to the commissioner by the responsible social services agency and return it to
the agency in a timely fashion; and
(4) maintain records as required in chapter 259.
Subd. 2.
Duties not reserved.
All duties, obligations, and consents not specifically
reserved to the commissioner in this section are delegated to the responsible social services
agencynew text begin , subject to supervision by the commissioner under section 393.07new text end .
Sec. 59. new text begin GRANT TO MINNESOTA ASSOCIATION FOR VOLUNTEER
ADMINISTRATION.
new text end
new text begin
The commissioner of human services shall establish a onetime grant to the Minnesota
Association for Volunteer Administration to administer needs-based volunteerism subgrants
for underresourced nonprofit organizations in greater Minnesota to support the organizations'
efforts to address and minimize disparities in access to human services through increased
volunteerism. Successful subgrant applicants must demonstrate that the populations served
by the subgrantee are underserved or suffer from or are at risk of homelessness, hunger,
poverty, lack of access to health care, or deficits in education. The Minnesota Association
for Volunteer Administration shall give priority to organizations that are serving the needs
of vulnerable populations. By December 15, 2023, the Minnesota Association for Volunteer
Administration shall report data on outcomes of the subgrants and make recommendations
for improving and sustaining volunteer efforts statewide to the chairs and ranking minority
members of the legislative committees and divisions with jurisdiction over human services.
new text end
Sec. 60. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
TRANSFER FUNDS FOR EARLY LEARNING SCHOLARSHIPS.
new text end
new text begin
The commissioner of human services shall allocate $73,000,000 in fiscal year 2022 and
$73,000,000 in fiscal year 2023 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the child care and development block
grant, to be transferred to the commissioner of education for the early learning scholarship
program under Minnesota Statutes, section 124D.165. For purposes of expending federal
resources, the commissioner of human services shall consult with the commissioner of
education to ensure that the transferred resources are deployed to support prioritized groups
of children, including but not limited to the groups identified in Minnesota Statutes, section
124D.165, while identifying and implementing any other oversight and reporting necessary
to maintain compliance with the federal child care and development block grant
accountability and data collection requirements in United States Code, title 42, section
9858i.
new text end
Sec. 61. new text begin FEDERAL PANDEMIC EMERGENCY ASSISTANCE ALLOCATION;
EMERGENCY ASSISTANCE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under section 9201 of the federal American
Rescue Plan Act, Public Law 117-2, for pandemic emergency assistance, the commissioner
of human services shall allocate $10,000,000 in fiscal year 2022 for emergency assistance
grants according to paragraph (b).
new text end
new text begin
(b) The commissioner shall distribute funds to counties to provide emergency assistance
grants to families with children under Minnesota Statutes, section 256J.626. The emergency
assistance grants under this section must be available for:
new text end
new text begin
(1) rent or mortgage, including arrears;
new text end
new text begin
(2) utility bills, including arrears;
new text end
new text begin
(3) food;
new text end
new text begin
(4) clothing needed for work or school;
new text end
new text begin
(5) public transportation and vehicle repairs; and
new text end
new text begin
(6) school-related equipment needs.
new text end
new text begin
(c) Notwithstanding any county policies to the contrary, applicants are eligible for grants,
subject to applicable maximum payments, for a security deposit, or if they are in arrears for
rent, mortgage, or contract for deed payments.
new text end
Sec. 62. new text begin FEDERAL PANDEMIC EMERGENCY ASSISTANCE ALLOCATION;
MFIP CONSOLIDATED FUND.
new text end
new text begin
From the amount that Minnesota received under section 9201 of the federal American
Rescue Plan Act, Public Law 117-2, for pandemic emergency assistance, the commissioner
of human services shall allocate $4,327,000 in fiscal year 2023 to counties according to
Minnesota Statutes, section 256J.626.
new text end
Sec. 63. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b, 6c,
7, 8, 9, and 18; 256D.052, subdivision 3; and 259A.70
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, except that the repeal
of Minnesota Statutes, section 259A.70 is effective July 1, 2021.
new text end
ARTICLE 10
CHILD CARE ASSISTANCE
Section 1.
Minnesota Statutes 2020, section 119B.11, subdivision 2a, is amended to read:
Subd. 2a.
Recovery of overpayments.
(a) An amount of child care assistance paid to a
recipientnew text begin or providernew text end in excess of the payment due is recoverable by the county agency
under paragraphs (b) and (c), even when the overpayment was caused by deleted text begin agency error ordeleted text end
circumstances outside the responsibility and control of the family or provider.new text begin Overpayments
designated solely as agency error, and not the result of acts or omissions on the part of a
provider or recipient, must not be established or collected.
new text end
(b) An overpayment must be recouped or recovered from the family if the overpayment
benefited the family by causing the family to pay less for child care expenses than the family
otherwise would have been required to pay under child care assistance program requirements.
If the family remains eligible for child care assistance, the overpayment must be recovered
through recoupment as identified in Minnesota Rules, part 3400.0187, except that the
overpayments must be calculated and collected on a service period basis. If the family no
longer remains eligible for child care assistance, the county may choose to initiate efforts
to recover overpayments from the family for overpayment less than $50. If the overpayment
is greater than or equal to $50, the county shall seek voluntary repayment of the overpayment
from the family. If the county is unable to recoup the overpayment through voluntary
repayment, the county shall initiate civil court proceedings to recover the overpayment
unless the county's costs to recover the overpayment will exceed the amount of the
overpayment. A family with an outstanding debt under this subdivision is not eligible for
child care assistance until: (1) the debt is paid in full; or (2) satisfactory arrangements are
made with the county to retire the debt consistent with the requirements of this chapter and
Minnesota Rules, chapter 3400, and the family is in compliance with the arrangements.
(c) The county must recover an overpayment from a provider if the overpayment did
not benefit the family by causing it to receive more child care assistance or to pay less for
child care expenses than the family otherwise would have been eligible to receive or required
to pay under child care assistance program requirements, and benefited the provider by
causing the provider to receive more child care assistance than otherwise would have been
paid on the family's behalf under child care assistance program requirements. If the provider
continues to care for children receiving child care assistance, the overpayment must be
recovered through reductions in child care assistance payments for services as described in
an agreement with the county. The provider may not charge families using that provider
more to cover the cost of recouping the overpayment. If the provider no longer cares for
children receiving child care assistance, the county may choose to initiate efforts to recover
overpayments of less than $50 from the provider. If the overpayment is greater than or equal
to $50, the county shall seek voluntary repayment of the overpayment from the provider.
If the county is unable to recoup the overpayment through voluntary repayment, the county
shall initiate civil court proceedings to recover the overpayment unless the county's costs
to recover the overpayment will exceed the amount of the overpayment. A provider with
an outstanding debt under this subdivision is not eligible to care for children receiving child
care assistance until:
(1) the debt is paid in full; or
(2) satisfactory arrangements are made with the county to retire the debt consistent with
the requirements of this chapter and Minnesota Rules, chapter 3400, and the provider is in
compliance with the arrangements.
(d) When both the family and the provider acted together to intentionally cause the
overpayment, both the family and the provider are jointly liable for the overpayment
regardless of who benefited from the overpayment. The county must recover the overpayment
as provided in paragraphs (b) and (c). When the family or the provider is in compliance
with a repayment agreement, the party in compliance is eligible to receive child care
assistance or to care for children receiving child care assistance despite the other party's
noncompliance with repayment arrangements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.13, subdivision 1, is amended to read:
Subdivision 1.
Subsidy restrictions.
(a) The maximum rate paid for child care assistance
in any county or county price cluster under the child care fund shall be the greater of the
25th percentile of the deleted text begin 2018deleted text end new text begin 2021new text end child care provider rate survey or the rates in effect at the
time of the update. For a child care provider located within the boundaries of a city located
in two or more of the counties of Benton, Sherburne, and Stearns, the maximum rate paid
for child care assistance shall be equal to the maximum rate paid in the county with the
highest maximum reimbursement rates or the provider's charge, whichever is less. The
commissioner may: (1) assign a county with no reported provider prices to a similar price
cluster; and (2) consider county level access when determining final price clusters.
(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
(d) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.
(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:
(1) the daily rate for one day of care;
(2) the weekly rate for one week of care by the child's primary provider; and
(3) two daily rates during two weeks of care by a child's secondary provider.
(f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
(g) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.
(h) All maximum provider rates changes shall be implemented on the Monday following
the effective date of the maximum provider rate.
(i) deleted text begin Beginning September 21, 2020,deleted text end The maximum registration fee paid for child care
assistance in any county or county price cluster under the child care fund shall be the greater
of the 25th percentile of the deleted text begin 2018deleted text end new text begin 2021new text end child care provider rate survey or the registration
fee in effect at the time of the update. Maximum registration fees must be set for licensed
family child care and for child care centers. For a child care provider located in the boundaries
of a city located in two or more of the counties of Benton, Sherburne, and Stearns, the
maximum registration fee paid for child care assistance shall be equal to the maximum
registration fee paid in the county with the highest maximum registration fee or the provider's
charge, whichever is less.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 3.
Minnesota Statutes 2020, section 119B.13, subdivision 6, is amended to read:
Subd. 6.
Provider payments.
(a) A provider shall bill only for services documented
according to section 119B.125, subdivision 6. The provider shall bill for services provided
within ten days of the end of the service period. Payments under the child care fund shall
be made within 21 days of receiving a complete bill from the provider. Counties or the state
may establish policies that make payments on a more frequent basis.
(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.
(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of deleted text begin sixdeleted text end new text begin threenew text end months from the date the provider is issued
an authorization of care and billing form.new text begin For a family at application, if a provider provided
child care during a time period without receiving an authorization of care and a billing form,
a county may only make child care assistance payments to the provider retroactively from
the date that child care began, or from the date that the family's eligibility began under
section 119B.09, subdivision 7, or from the date that the family meets authorization
requirements, not to exceed six months from the date that the provider is issued an
authorization of care and billing form, whichever is later.
new text end
(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;
(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;
(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;
(4) the provider is operating after:
(i) an order of suspension of the provider's license issued by the commissioner;
(ii) an order of revocation of the provider's license; or
(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;
(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request;
(6) the provider gives false child care price information; or
(7) the provider fails to report decreases in a child's attendance as required under section
119B.125, subdivision 9.
(e) For purposes of paragraph (d), clauses (3), (5), (6), and (7), the county or the
commissioner may withhold the provider's authorization or payment for a period of time
not to exceed three months beyond the time the condition has been corrected.
(f) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.
new text begin
(g) The commissioner shall not withhold a provider's authorization or payment under
paragraph (d) where the provider's alleged misconduct is the result of the provider relying
upon representations from the commissioner, local agency, or licensor that the provider had
been in compliance with the rules and regulations necessary to maintain the provider's
authorization.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except that the language
in paragraph (g) is effective retroactively from July 1, 2020.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245E.07, subdivision 1, is amended to read:
Subdivision 1.
Grounds for and methods of monetary recovery.
(a) The department
may obtain monetary recovery from a provider who has been improperly paid by the child
care assistance program, regardless of whether the error was intentional deleted text begin or county errordeleted text end .
new text begin Overpayments designated solely as agency error, and not the result of acts or omissions on
the part of a provider or recipient, must not be established or collected. new text end The department
does not need to establish a pattern as a precondition of monetary recovery of erroneous or
false billing claims, duplicate billing claims, or billing claims based on false statements or
financial misconduct.
(b) The department shall obtain monetary recovery from providers by the following
means:
(1) permitting voluntary repayment of money, either in lump-sum payment or installment
payments;
(2) using any legal collection process;
(3) deducting or withholding program payments; or
(4) utilizing the means set forth in chapter 16D.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 5. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
BASIC SLIDING FEE CHILD CARE ASSISTANCE PROGRAM.
new text end
new text begin
The commissioner of human services shall allocate $14,574,000 in fiscal year 2022,
$14,574,000 in fiscal year 2023, and $14,574,000 in fiscal year 2024 from the amount
Minnesota received under the American Rescue Plan Act, Public Law 117-2, section 2201,
for the child care and development block grant, for the basic sliding fee child care assistance
program under Minnesota Statutes, section 119B.03. This is a onetime allocation.
new text end
ARTICLE 11
CHILD PROTECTION
Section 1.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intakedeleted text begin , except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9deleted text end .
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245.4882, subdivision 1, is amended to read:
Subdivision 1.
Availability of residential treatment services.
County boards must
provide or contract for enough residential treatment services to meet the needs of each child
with severe emotional disturbance residing in the county and needing this level of care.
Length of stay is based on the child's residential treatment need and shall be deleted text begin subject to the
six-month review process established in section 260C.203, and for children in voluntary
placement for treatment, the court review process in section 260D.06deleted text end new text begin reviewed every 90
daysnew text end . Services must be appropriate to the child's age and treatment needs and must be made
available as close to the county as possible. Residential treatment must be designed to:
(1) help the child improve family living and social interaction skills;
(2) help the child gain the necessary skills to return to the community;
(3) stabilize crisis admissions; and
(4) work with families throughout the placement to improve the ability of the families
to care for children with severe emotional disturbance in the home.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245.4885, subdivision 1, is amended to read:
Subdivision 1.
Admission criteria.
(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a deleted text begin treatment foster care setting,deleted text end residential treatment facilitydeleted text begin ,deleted text end or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if deleted text begin publicdeleted text end new text begin countynew text end funds are used to pay for the new text begin child's new text end services.
(b) The deleted text begin responsible social services agencydeleted text end new text begin county boardnew text end shall determine the appropriate
level of care for a child when county-controlled funds are used to pay for the child's deleted text begin services
or placementdeleted text end new text begin residential treatment under this chapter, including residential treatment provided
new text end in a qualified residential treatment deleted text begin facility under chapter deleted text end deleted text begin 260Cdeleted text end deleted text begin and licensed by the
commissioner under chapter deleted text end deleted text begin 245Adeleted text end deleted text begin . In accordance with section 260C.157, a juvenile treatment
screening team shall conduct a screening before the team may recommend whether to place
a child in a qualified residential treatmentdeleted text end program as defined in section 260C.007,
subdivision 26d. When a deleted text begin social services agencydeleted text end new text begin county boardnew text end does not have responsibility
for a child's placement and the child is enrolled in a prepaid health program under section
256B.69, the enrolled child's contracted health plan must determine the appropriate level
of carenew text begin for the childnew text end . When Indian Health Services funds or funds of a tribally owned facility
funded under the Indian Self-Determination and Education Assistance Act, Public Law
93-638, are to be usednew text begin for a childnew text end , the Indian Health Services or 638 tribal health facility
must determine the appropriate level of carenew text begin for the childnew text end . When more than one entity bears
responsibility fornew text begin a child'snew text end coverage, the entities shall coordinate level of care determination
activitiesnew text begin for the childnew text end to the extent possible.
(c) The deleted text begin responsible social services agency must make the level of care determination
available to the juvenile treatment screening team, as permitted under chapter deleted text end deleted text begin 13deleted text end deleted text begin . The level
of care determination shall inform the juvenile treatment screening team process and the
assessment in section 260C.704 when considering whether to place the child in a qualified
residential treatment program. When the responsible social services agency is not involved
in determining a child's placement, thedeleted text end child's level of care determination shall determine
whether the proposed treatment:
(1) is necessary;
(2) is appropriate to the child's individual treatment needs;
(3) cannot be effectively provided in the child's home; and
(4) provides a length of stay as short as possible consistent with the individual child's
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the deleted text begin responsible social services
agencydeleted text end new text begin county boardnew text end or other entity may not determine that a screening deleted text begin under section
260C.157 ordeleted text end new text begin ,new text end referralnew text begin ,new text end or admission to a treatment foster care setting or residential treatment
facility is not appropriate solely because services were not first provided to the child in a
less restrictive setting and the child failed to make progress toward or meet treatment goals
in the less restrictive setting. The level of care determination must be based on a diagnostic
assessment deleted text begin that includes a functional assessmentdeleted text end new text begin of a child new text end which evaluatesnew text begin the child'snew text end
family, school, and community living situations; and an assessment of the child's need for
care out of the home using a validated tool which assesses a child's functional status and
assigns an appropriate level of carenew text begin to the childnew text end . The validated tool must be approved by
the commissioner of human services. If a diagnostic assessment deleted text begin including a functionaldeleted text end
deleted text begin assessmentdeleted text end has been completed by a mental health professional within the past 180 days, a
new diagnostic assessment need not be completed unless in the opinion of the current treating
mental health professional the child's mental health status has changed markedly since the
assessment was completed. The child's parent shall be notified if an assessment will not be
completed and of the reasons. A copy of the notice shall be placed in the child's file.
Recommendations developed as part of the level of care determination process shall include
specific community services needed by the child and, if appropriate, the child's family, and
shall indicate whether deleted text begin or notdeleted text end these services are available and accessible to the child andnew text begin the
child'snew text end family.new text begin The child and the child's family must be invited to any meeting at which the
level of care determination is discussed and decisions regarding residential treatment are
made. The child and the child's family may invite other relatives, friends, or advocates to
attend these meetings.
new text end
(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual family
community support plan is being developed by the case manager, if assigned.
(f) deleted text begin When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 unless a court
terminates the parent's rights or court orders restrict the parent from participating in case
planning, visitation, or parental responsibilities.
deleted text end
deleted text begin (g)deleted text end The level of care determination, and placement decision, and recommendations for
mental health services must be documented in the child's record, as required in deleted text begin chapterdeleted text end new text begin
chaptersnew text end 260Cnew text begin and 260Dnew text end .
new text begin
(g) Discharge planning for the child to return to the community must include identification
of and referrals to appropriate home and community supports to meet the needs of the child
and family. Discharge planning must begin within 30 days after the child enters residential
treatment and be updated every 60 days.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin
At risk of becoming a victim of sex trafficking or commercial sexual
exploitation.
new text end
new text begin
For the purposes of section 245A.25, a youth who is "at risk of becoming a
victim of sex trafficking or commercial sexual exploitation" means a youth who meets the
criteria established by the commissioner of human services for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Children's residential facility. new text end
new text begin
"Children's residential facility" means a
residential program licensed under this chapter or chapter 241 according to the applicable
standards in Minnesota Rules, parts 2960.0010 to 2960.0710.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6d. new text end
new text begin Foster family setting. new text end
new text begin
"Foster family setting" has the meaning given in
Minnesota Rules, part 2960.3010, subpart 23, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6e. new text end
new text begin Foster residence setting. new text end
new text begin
"Foster residence setting" has the meaning given
in Minnesota Rules, part 2960.3010, subpart 26, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 18a. new text end
new text begin Trauma. new text end
new text begin
For the purposes of section 245A.25, "trauma" means an event,
series of events, or set of circumstances experienced by an individual as physically or
emotionally harmful or life-threatening and has lasting adverse effects on the individual's
functioning and mental, physical, social, emotional, or spiritual well-being. Trauma includes
the cumulative emotional or psychological harm of group traumatic experiences transmitted
across generations within a community that are often associated with racial and ethnic
population groups that have suffered major intergenerational losses.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Victim of sex trafficking or commercial sexual exploitation. new text end
new text begin
For the purposes
of section 245A.25, "victim of sex trafficking or commercial sexual exploitation" means a
person who meets the definitions in section 260C.007, subdivision 31, clauses (4) and (5).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Youth. new text end
new text begin
For the purposes of section 245A.25, "youth" means a child as defined
in section 260C.007, subdivision 4, and includes individuals under 21 years of age who are
in foster care pursuant to section 260C.451.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 245A.041, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin
First date of working in a facility or setting; documentation
requirements.
new text end
new text begin
Children's residential facility and foster residence setting license holders
must document the first date that a person who is a background study subject begins working
in the license holder's facility or setting. If the license holder does not maintain documentation
of each background study subject's first date of working in the facility or setting in the
license holder's personnel files, the license holder must provide documentation to the
commissioner that contains the first date that each background study subject began working
in the license holder's program upon the commissioner's request.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 12.
new text begin
[245A.25] RESIDENTIAL PROGRAM CERTIFICATIONS FOR
COMPLIANCE WITH THE FAMILY FIRST PREVENTION SERVICES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Certification scope and applicability. new text end
new text begin
(a) This section establishes the
requirements that a children's residential facility or child foster residence setting must meet
to be certified for the purposes of Title IV-E funding requirements as:
new text end
new text begin
(1) a qualified residential treatment program;
new text end
new text begin
(2) a residential setting specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) a residential setting specializing in providing prenatal, postpartum, or parenting
support for youth; or
new text end
new text begin
(4) a supervised independent living setting for youth who are 18 years of age or older.
new text end
new text begin
(b) This section does not apply to a foster family setting in which the license holder
resides in the foster home.
new text end
new text begin
(c) Children's residential facilities licensed as detention settings according to Minnesota
Rules, parts 2960.0230 to 2960.0290, or secure programs according to Minnesota Rules,
parts 2960.0300 to 2960.0420, may not be certified under this section.
new text end
new text begin
(d) For purposes of this section, "license holder" means an individual, organization, or
government entity that was issued a children's residential facility or foster residence setting
license by the commissioner of human services under this chapter or by the commissioner
of corrections under chapter 241.
new text end
new text begin
(e) Certifications issued under this section for foster residence settings may only be
issued by the commissioner of human services and are not delegated to county or private
licensing agencies under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Program certification types and requests for certification. new text end
new text begin
(a) By July 1,
2021, the commissioner of human services must offer certifications to license holders for
the following types of programs:
new text end
new text begin
(1) qualified residential treatment programs;
new text end
new text begin
(2) residential settings specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) residential settings specializing in providing prenatal, postpartum, or parenting
support for youth; and
new text end
new text begin
(4) supervised independent living settings for youth who are 18 years of age or older.
new text end
new text begin
(b) An applicant or license holder must submit a request for certification under this
section on a form and in a manner prescribed by the commissioner of human services. The
decision of the commissioner of human services to grant or deny a certification request is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Trauma-informed care. new text end
new text begin
(a) Programs certified under subdivision 4 or 5 must
provide services to a person according to a trauma-informed model of care that meets the
requirements of this subdivision, except that programs certified under subdivision 5 are not
required to meet the requirements of paragraph (e).
new text end
new text begin
(b) For the purposes of this section, "trauma-informed care" means care that:
new text end
new text begin
(1) acknowledges the effects of trauma on a person receiving services and on the person's
family;
new text end
new text begin
(2) modifies services to respond to the effects of trauma on the person receiving services;
new text end
new text begin
(3) emphasizes skill and strength-building rather than symptom management; and
new text end
new text begin
(4) focuses on the physical and psychological safety of the person receiving services
and the person's family.
new text end
new text begin
(c) The license holder must have a process for identifying the signs and symptoms of
trauma in a youth and must address the youth's needs related to trauma. This process must
include:
new text end
new text begin
(1) screening for trauma by completing a trauma-specific screening tool with each youth
upon the youth's admission or obtaining the results of a trauma-specific screening tool that
was completed with the youth within 30 days prior to the youth's admission to the program;
and
new text end
new text begin
(2) ensuring that trauma-based interventions targeting specific trauma-related symptoms
are available to each youth when needed to assist the youth in obtaining services. For
qualified residential treatment programs, this must include the provision of services in
paragraph (e).
new text end
new text begin
(d) The license holder must develop and provide services to each youth according to the
principles of trauma-informed care including:
new text end
new text begin
(1) recognizing the impact of trauma on a youth when determining the youth's service
needs and providing services to the youth;
new text end
new text begin
(2) allowing each youth to participate in reviewing and developing the youth's
individualized treatment or service plan;
new text end
new text begin
(3) providing services to each youth that are person-centered and culturally responsive;
and
new text end
new text begin
(4) adjusting services for each youth to address additional needs of the youth.
new text end
new text begin
(e) In addition to the other requirements of this subdivision, qualified residential treatment
programs must use a trauma-based treatment model that includes:
new text end
new text begin
(1) assessing each youth to determine if the youth needs trauma-specific treatment
interventions;
new text end
new text begin
(2) identifying in each youth's treatment plan how the program will provide
trauma-specific treatment interventions to the youth;
new text end
new text begin
(3) providing trauma-specific treatment interventions to a youth that target the youth's
specific trauma-related symptoms; and
new text end
new text begin
(4) training all clinical staff of the program on trauma-specific treatment interventions.
new text end
new text begin
(f) At the license holder's program, the license holder must provide a physical, social,
and emotional environment that:
new text end
new text begin
(1) promotes the physical and psychological safety of each youth;
new text end
new text begin
(2) avoids aspects that may be retraumatizing;
new text end
new text begin
(3) responds to trauma experienced by each youth and the youth's other needs; and
new text end
new text begin
(4) includes designated spaces that are available to each youth for engaging in sensory
and self-soothing activities.
new text end
new text begin
(g) The license holder must base the program's policies and procedures on
trauma-informed principles. In the program's policies and procedures, the license holder
must:
new text end
new text begin
(1) describe how the program provides services according to a trauma-informed model
of care;
new text end
new text begin
(2) describe how the program's environment fulfills the requirements of paragraph (f);
new text end
new text begin
(3) prohibit the use of aversive consequences for a youth's violation of program rules
or any other reason;
new text end
new text begin
(4) describe the process for how the license holder incorporates trauma-informed
principles and practices into the organizational culture of the license holder's program; and
new text end
new text begin
(5) if the program is certified to use restrictive procedures under Minnesota Rules, part
2960.0710, describe how the program uses restrictive procedures only when necessary for
a youth in a manner that addresses the youth's history of trauma and avoids causing the
youth additional trauma.
new text end
new text begin
(h) Prior to allowing a staff person to have direct contact, as defined in section 245C.02,
subdivision 11, with a youth and annually thereafter, the license holder must train each staff
person about:
new text end
new text begin
(1) concepts of trauma-informed care and how to provide services to each youth according
to these concepts; and
new text end
new text begin
(2) impacts of each youth's culture, race, gender, and sexual orientation on the youth's
behavioral health and traumatic experiences.
new text end
new text begin Subd. 4. new text end
new text begin Qualified residential treatment programs; certification requirements. new text end
new text begin
(a)
To be certified as a qualified residential treatment program, a license holder must meet:
new text end
new text begin
(1) the definition of a qualified residential treatment program in section 260C.007,
subdivision 26d;
new text end
new text begin
(2) the requirements for providing trauma-informed care and using a trauma-based
treatment model in subdivision 3; and
new text end
new text begin
(3) the requirements of this subdivision.
new text end
new text begin
(b) For each youth placed in the license holder's program, the license holder must
collaborate with the responsible social services agency and other appropriate parties to
implement the youth's out-of-home placement plan and the youth's short-term and long-term
mental health and behavioral health goals in the assessment required by sections 260C.212,
subdivision 1; 260C.704; and 260C.708.
new text end
new text begin
(c) A qualified residential treatment program must use a trauma-based treatment model
that meets all of the requirements of subdivision 3 that is designed to address the needs,
including clinical needs, of youth with serious emotional or behavioral disorders or
disturbances. The license holder must develop, document, and review a treatment plan for
each youth according to the requirements of Minnesota Rules, parts 2960.0180, subpart 2,
item B; and 2960.0190, subpart 2.
new text end
new text begin
(d) The following types of staff must be on-site according to the program's treatment
model and must be available 24 hours a day and seven days a week to provide care within
the scope of their practice:
new text end
new text begin
(1) a registered nurse or licensed practical nurse licensed by the Minnesota Board of
Nursing to practice professional nursing or practical nursing as defined in section 148.171,
subdivisions 14 and 15; and
new text end
new text begin
(2) other licensed clinical staff to meet each youth's clinical needs.
new text end
new text begin
(e) A qualified residential treatment program must be accredited by one of the following
independent, not-for-profit organizations:
new text end
new text begin
(1) the Commission on Accreditation of Rehabilitation Facilities (CARF);
new text end
new text begin
(2) the Joint Commission;
new text end
new text begin
(3) the Council on Accreditation (COA); or
new text end
new text begin
(4) another independent, not-for-profit accrediting organization approved by the Secretary
of the United States Department of Health and Human Services.
new text end
new text begin
(f) The license holder must facilitate participation of a youth's family members in the
youth's treatment program, consistent with the youth's best interests and according to the
youth's out-of-home placement plan required by sections 260C.212, subdivision 1; and
260C.708.
new text end
new text begin
(g) The license holder must contact and facilitate outreach to each youth's family
members, including the youth's siblings, and must document outreach to the youth's family
members in the youth's file, including the contact method and each family member's contact
information. In the youth's file, the license holder must record and maintain the contact
information for all known biological family members and fictive kin of the youth.
new text end
new text begin
(h) The license holder must document in the youth's file how the program integrates
family members into the treatment process for the youth, including after the youth's discharge
from the program, and how the program maintains the youth's connections to the youth's
siblings.
new text end
new text begin
(i) The program must provide discharge planning and family-based aftercare support to
each youth for at least six months after the youth's discharge from the program. When
providing aftercare to a youth, the program must have monthly contact with the youth and
the youth's caregivers to promote the youth's engagement in aftercare services and to regularly
evaluate the family's needs. The program's monthly contact with the youth may be
face-to-face, by telephone, or virtual.
new text end
new text begin
(j) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (b) to (i).
new text end
new text begin Subd. 5. new text end
new text begin
Residential settings specializing in providing care and supportive services
for youth who have been or are at risk of becoming victims of sex trafficking or
commercial sexual exploitation; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing care and supportive services for youth who have
been or are at risk of becoming victims of sex trafficking or commercial sexual exploitation,
a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) Settings certified according to this subdivision are exempt from the requirements of
section 245A.04, subdivision 11, paragraph (b).
new text end
new text begin
(c) The program must use a trauma-informed model of care that meets all of the applicable
requirements of subdivision 3, and that is designed to address the needs, including emotional
and mental health needs, of youth who have been or are at risk of becoming victims of sex
trafficking or commercial sexual exploitation.
new text end
new text begin
(d) The program must provide high-quality care and supportive services for youth who
have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation and must:
new text end
new text begin
(1) offer a safe setting to each youth designed to prevent ongoing and future trafficking
of the youth;
new text end
new text begin
(2) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(3) assist each youth with accessing medical, mental health, legal, advocacy, and family
services based on the youth's individual needs;
new text end
new text begin
(4) provide each youth with relevant educational, life skills, and employment supports
based on the youth's individual needs;
new text end
new text begin
(5) offer a trafficking prevention education curriculum and provide support for each
youth at risk of future sex trafficking or commercial sexual exploitation; and
new text end
new text begin
(6) engage with the discharge planning process for each youth and the youth's family.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (c) and (d).
new text end
new text begin
(f) The license holder must ensure that each staff person who has direct contact, as
defined in section 245C.02, subdivision 11, with a youth served by the license holder's
program completes a human trafficking training approved by the Department of Human
Services' Children and Family Services Administration before the staff person has direct
contact with a youth served by the program and annually thereafter. For programs certified
prior to January 1, 2022, the license holder must ensure that each staff person at the license
holder's program completes the initial training by January 1, 2022.
new text end
new text begin Subd. 6. new text end
new text begin
Residential settings specializing in providing prenatal, postpartum, or
parenting supports for youth; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing prenatal, postpartum, or parenting supports for
youth, a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) The license holder must collaborate with the responsible social services agency and
other appropriate parties to implement each youth's out-of-home placement plan required
by section 260C.212, subdivision 1.
new text end
new text begin
(c) The license holder must specialize in providing prenatal, postpartum, or parenting
supports for youth and must:
new text end
new text begin
(1) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(2) assist each youth with accessing postpartum services during the same period of time
that a woman is considered pregnant for the purposes of medical assistance eligibility under
section 256B.055, subdivision 6, including providing each youth with:
new text end
new text begin
(i) sexual and reproductive health services and education; and
new text end
new text begin
(ii) a postpartum mental health assessment and follow-up services; and
new text end
new text begin
(3) discharge planning that includes the youth and the youth's family.
new text end
new text begin
(d) On or before the date of a child's initial physical presence at the facility, the license
holder must provide education to the child's parent related to safe bathing and reducing the
risk of sudden unexpected infant death and abusive head trauma from shaking infants and
young children. The license holder must use the educational material developed by the
commissioner of human services to comply with this requirement. At a minimum, the
education must address:
new text end
new text begin
(1) instruction that: (i) a child or infant should never be left unattended around water;
(ii) a tub should be filled with only two to four inches of water for infants; and (iii) an infant
should never be put into a tub when the water is running; and
new text end
new text begin
(2) the risk factors related to sudden unexpected infant death and abusive head trauma
from shaking infants and young children and means of reducing the risks, including the
safety precautions identified in section 245A.1435 and the risks of co-sleeping.
new text end
new text begin
The license holder must document the parent's receipt of the education and keep the
documentation in the parent's file. The documentation must indicate whether the parent
agrees to comply with the safeguards described in this paragraph. If the parent refuses to
comply, program staff must provide additional education to the parent as described in the
parental supervision plan. The parental supervision plan must include the intervention,
frequency, and staff responsible for the duration of the parent's participation in the program
or until the parent agrees to comply with the safeguards described in this paragraph.
new text end
new text begin
(e) On or before the date of a child's initial physical presence at the facility, the license
holder must document the parent's capacity to meet the health and safety needs of the child
while on the facility premises considering the following factors:
new text end
new text begin
(1) the parent's physical and mental health;
new text end
new text begin
(2) the parent being under the influence of drugs, alcohol, medications, or other chemicals;
new text end
new text begin
(3) the child's physical and mental health; and
new text end
new text begin
(4) any other information available to the license holder indicating that the parent may
not be able to adequately care for the child.
new text end
new text begin
(f) The license holder must have written procedures specifying the actions that staff shall
take if a parent is or becomes unable to adequately care for the parent's child.
new text end
new text begin
(g) If the parent refuses to comply with the safeguards described in paragraph (d) or is
unable to adequately care for the child, the license holder must develop a parental supervision
plan in conjunction with the parent. The plan must account for any factors in paragraph (e)
that contribute to the parent's inability to adequately care for the child. The plan must be
dated and signed by the staff person who completed the plan.
new text end
new text begin
(h) The license holder must have written procedures addressing whether the program
permits a parent to arrange for supervision of the parent's child by another youth in the
program. If permitted, the facility must have a procedure that requires staff approval of the
supervision arrangement before the supervision by the nonparental youth occurs. The
procedure for approval must include an assessment of the nonparental youth's capacity to
assume the supervisory responsibilities using the criteria in paragraph (e). The license holder
must document the license holder's approval of the supervisory arrangement and the
assessment of the nonparental youth's capacity to supervise the child and must keep this
documentation in the file of the parent whose child is being supervised by the nonparental
youth.
new text end
new text begin
(i) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (h).
new text end
new text begin Subd. 7. new text end
new text begin
Supervised independent living settings for youth 18 years of age or older;
certification requirements.
new text end
new text begin
(a) To be certified as a supervised independent living setting
for youth who are 18 years of age or older, a license holder must meet the requirements of
this subdivision.
new text end
new text begin
(b) A license holder must provide training, counseling, instruction, supervision, and
assistance for independent living according to the youth's needs.
new text end
new text begin
(c) A license holder may provide services to assist the youth with locating housing,
money management, meal preparation, shopping, health care, transportation, and any other
support services necessary to meet the youth's needs and improve the youth's ability to
conduct such tasks independently.
new text end
new text begin
(d) The service plan for the youth must contain an objective of independent living skills.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (d).
new text end
new text begin Subd. 8. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) For a program licensed by the commissioner
of human services, the commissioner of human services may review a program's compliance
with certification requirements by conducting an inspection, a licensing review, or an
investigation of the program. The commissioner may issue a correction order to the license
holder for a program's noncompliance with the certification requirements of this section.
For a program licensed by the commissioner of human services, a license holder must make
a request for reconsideration of a correction order according to section 245A.06, subdivision
2.
new text end
new text begin
(b) For a program licensed by the commissioner of corrections, the commissioner of
human services may review the program's compliance with the requirements for a certification
issued under this section biennially and may issue a correction order identifying the program's
noncompliance with the requirements of this section. The correction order must state the
following:
new text end
new text begin
(1) the conditions that constitute a violation of a law or rule;
new text end
new text begin
(2) the specific law or rule violated; and
new text end
new text begin
(3) the time allowed for the program to correct each violation.
new text end
new text begin
(c) For a program licensed by the commissioner of corrections, if a license holder believes
that there are errors in the correction order of the commissioner of human services, the
license holder may ask the Department of Human Services to reconsider the parts of the
correction order that the license holder alleges are in error. To submit a request for
reconsideration, the license holder must send a written request for reconsideration by United
States mail to the commissioner of human services. The request for reconsideration must
be postmarked within 20 calendar days of the date that the correction order was received
by the license holder and must:
new text end
new text begin
(1) specify the parts of the correction order that are alleged to be in error;
new text end
new text begin
(2) explain why the parts of the correction order are in error; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
A request for reconsideration does not stay any provisions or requirements of the correction
order. The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin
(d) Nothing in this subdivision prohibits the commissioner of human services from
decertifying a license holder according to subdivision 9 prior to issuing a correction order.
new text end
new text begin Subd. 9. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner of human services may rescind a
certification issued under this section if a license holder fails to comply with the certification
requirements in this section.
new text end
new text begin
(b) The license holder may request reconsideration of a decertification by notifying the
commissioner of human services by certified mail or personal service. The license holder
must request reconsideration of a decertification in writing. If the license holder sends the
request for reconsideration of a decertification by certified mail, the license holder must
send the request by United States mail to the commissioner of human services and the
request must be postmarked within 20 calendar days after the license holder received the
notice of decertification. If the license holder requests reconsideration of a decertification
by personal service, the request for reconsideration must be received by the commissioner
of human services within 20 calendar days after the license holder received the notice of
decertification. When submitting a request for reconsideration of a decertification, the license
holder must submit a written argument or evidence in support of the request for
reconsideration.
new text end
new text begin
(c) The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 10. new text end
new text begin Variances. new text end
new text begin
The commissioner of human services may grant variances to the
requirements in this section that do not affect a youth's health or safety or compliance with
federal requirements for Title IV-E funding if the conditions in section 245A.04, subdivision
9, are met.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256.01, subdivision 14b, is amended to read:
Subd. 14b.
American Indian child welfare projects.
(a) The commissioner of human
services may authorize projects to initiate tribal delivery of child welfare services to American
Indian children and their parents and custodians living on the reservation. The commissioner
has authority to solicit and determine which tribes may participate in a project. Grants may
be issued to Minnesota Indian tribes to support the projects. The commissioner may waive
existing state rules as needed to accomplish the projects. The commissioner may authorize
projects to use alternative methods of (1) screening, investigating, and assessing reports of
child maltreatment, and (2) administrative reconsideration, administrative appeal, and
judicial appeal of maltreatment determinations, provided the alternative methods used by
the projects comply with the provisions of section 256.045 and chapter 260E that deal with
the rights of individuals who are the subjects of reports or investigations, including notice
and appeal rights and data practices requirements. The commissioner shall only authorize
alternative methods that comply with the public policy under section 260E.01. The
commissioner may seek any federal approval necessary to carry out the projects as well as
seek and use any funds available to the commissioner, including use of federal funds,
foundation funds, existing grant funds, and other funds. The commissioner is authorized to
advance state funds as necessary to operate the projects. Federal reimbursement applicable
to the projects is appropriated to the commissioner for the purposes of the projects. The
projects must be required to address responsibility for safety, permanency, and well-being
of children.
(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.
(c) In order to qualify for an American Indian child welfare project, a tribe must:
(1) be one of the existing tribes with reservation land in Minnesota;
(2) have a tribal court with jurisdiction over child custody proceedings;
(3) have a substantial number of children for whom determinations of maltreatment have
occurred;
(4)(i) have capacity to respond to reports of abuse and neglect under chapter 260E; or
(ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
(5) provide a wide range of services to families in need of child welfare services; deleted text begin and
deleted text end
(6) have a tribal-state title IV-E agreement in effectnew text begin ; and
new text end
new text begin (7) enter into host Tribal contracts pursuant to section 256.0112, subdivision 6new text end .
(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:
(1) assessment and prevention of child abuse and neglect;
(2) family preservation;
(3) facilitative, supportive, and reunification services;
(4) out-of-home placement for children removed from the home for child protective
purposes; and
(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.
(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under chapter 260E for those children during the time within
which the tribal project is in effect and funded. The commissioner shall work with tribes
and affected counties to develop procedures for data collection, evaluation, and clarification
of ongoing role and financial responsibilities of the county and tribe for child welfare services
prior to initiation of the project. Children who have not been identified by the tribe as
participating in the project shall remain the responsibility of the county. Nothing in this
section shall alter responsibilities of the county for law enforcement or court services.
(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:
(1) the child must be receiving child protective services;
(2) the child must be in foster care; or
(3) the child's parents must have had parental rights suspended or terminated.
Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.
(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.
(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.
(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256.0112, subdivision 6, is amended to read:
Subd. 6.
Contracting within and across county lines; lead county contractsnew text begin ; lead
Tribal contractsnew text end .
Paragraphs (a) to (e) govern contracting within and across county lines
and lead county contracts.new text begin Paragraphs (a) to (e) govern contracting within and across
reservation boundaries and lead Tribal contracts for initiative tribes under section 256.01,
subdivision 14b. For purposes of this subdivision, "local agency" includes a tribe or a county
agency.
new text end
(a) Once a local agency and an approved vendor execute a contract that meets the
requirements of this subdivision, the contract governs all other purchases of service from
the vendor by all other local agencies for the term of the contract. The local agency that
negotiated and entered into the contract becomes the leadnew text begin tribe ornew text end county for the contract.
(b) When the local agency in the countynew text begin or reservationnew text end where a vendor is located wants
to purchase services from that vendor and the vendor has no contract with the local agency
or any othernew text begin tribe ornew text end county, the local agency must negotiate and execute a contract with
the vendor.
(c) When a local agency deleted text begin in one countydeleted text end wants to purchase services from a vendor located
in another countynew text begin or reservationnew text end , it must notify the local agency in the countynew text begin or reservationnew text end
where the vendor is located. Within 30 days of being notified, the local agency in the vendor's
countynew text begin or reservationnew text end must:
(1) if it has a contract with the vendor, send a copy to the inquiring new text begin local new text end agency;
(2) if there is a contract with the vendor for which another local agency is the lead new text begin tribe
or new text end county, identify the lead new text begin tribe or new text end county to the inquiring agency; or
(3) if no local agency has a contract with the vendor, inform the inquiring agency whether
it will negotiate a contract and become the lead new text begin tribe or new text end county. If the agency where the
vendor is located will not negotiate a contract with the vendor because of concerns related
to clients' health and safety, the agency must share those concerns with the inquiringnew text begin localnew text end
agency.
(d) If the local agency in the county where the vendor is located declines to negotiate a
contract with the vendor or fails to respond within 30 days of receiving the notification
under paragraph (c), the inquiring agency is authorized to negotiate a contract and must
notify the local agency that declined or failed to respond.
(e) When the inquiring deleted text begin countydeleted text end new text begin local agencynew text end under paragraph (d) becomes the lead new text begin tribe
or new text end county for a contract and the contract expires and needs to be renegotiated, that new text begin tribe or
new text end county must again follow the requirements under paragraph (c) and notify the local agency
where the vendor is located. The local agency where the vendor is located has the option
of becoming the lead new text begin tribe or new text end county for the new contract. If the local agency does not
exercise the option, paragraph (d) applies.
(f) This subdivision does not affect the requirement to seek county concurrence under
section 256B.092, subdivision 8a, when the services are to be purchased for a person with
a developmental disability or under section 245.4711, subdivision 3, when the services to
be purchased are for an adult with serious and persistent mental illness.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260C.007, subdivision 26c, is amended to read:
Subd. 26c.
Qualified individual.
new text begin (a) new text end "Qualified individual" means a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is deleted text begin notdeleted text end new text begin qualified to conduct the assessment approved
by the commissioner. The qualified individual must not benew text end an employee of the responsible
social services agency deleted text begin and who is notdeleted text end new text begin or an individualnew text end connected to or affiliated with any
placement setting in which a responsible social services agency has placed children.
new text begin
(b) When the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, applies to a child, the county must contact the child's tribe without delay to
give the tribe the option to designate a qualified individual who is a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is not employed by the responsible social services
agency and who is not connected to or affiliated with any placement setting in which a
responsible social services agency has placed children. Only a federal waiver that
demonstrates maintained objectivity may allow a responsible social services agency employee
or Tribal employee affiliated with any placement setting in which the responsible social
services agency has placed children to be designated the qualified individual.
new text end
Sec. 16.
Minnesota Statutes 2020, section 260C.007, subdivision 31, is amended to read:
Subd. 31.
Sexually exploited youth.
"Sexually exploited youth" means an individual
who:
(1) is alleged to have engaged in conduct which would, if committed by an adult, violate
any federal, state, or local law relating to being hired, offering to be hired, or agreeing to
be hired by another individual to engage in sexual penetration or sexual conduct;
(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
609.3451, 609.3453, 609.352, 617.246, or 617.247;
(3) is a victim of a crime described in United States Code, title 18, section 2260; 2421;
2422; 2423; 2425; 2425A; or 2256; deleted text begin or
deleted text end
(4) is a sex trafficking victim as defined in section 609.321, subdivision 7bdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is a victim of commercial sexual exploitation as defined in United States Code, title
22, section 7102(11)(A) and (12).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 260C.157, subdivision 3, is amended to read:
Subd. 3.
Juvenile treatment screening team.
(a) The responsible social services agency
shall establish a juvenile treatment screening team to conduct screenings under this chapternew text begin
and chapter 260D,new text end deleted text begin and section 245.487, subdivision 3,deleted text end for a child to receive treatment for
an emotional disturbance, a developmental disability, or related condition in a residential
treatment facility licensed by the commissioner of human services under chapter 245A, or
licensed or approved by a tribe. A screening team is not required for a child to be in: (1) a
residential facility specializing in prenatal, postpartum, or parenting support; (2) a facility
specializing in high-quality residential care and supportive services to children and youth
who deleted text begin aredeleted text end new text begin have been or are at risk of becoming victims ofnew text end deleted text begin sex-traffickingdeleted text end new text begin sex trafficking
new text end deleted text begin victims or are at risk of becoming sex-trafficking victimsdeleted text end new text begin or commercial sexual exploitationnew text end ;
(3) supervised settings for youthnew text begin who arenew text end 18 years deleted text begin olddeleted text end new text begin of agenew text end or oldernew text begin andnew text end living
independently; or (4) a licensed residential family-based treatment facility for substance
abuse consistent with section 260C.190. Screenings are also not required when a child must
be placed in a facility due to an emotional crisis or other mental health emergency.
(b) The responsible social services agency shall conduct screenings within 15 days of a
request for a screening, unless the screening is for the purpose of residential treatment and
the child is enrolled in a prepaid health program under section 256B.69, in which case the
agency shall conduct the screening within ten working days of a request. The responsible
social services agency shall convene the new text begin juvenile treatment screening new text end team, which may be
constituted under section 245.4885 or 256B.092 or Minnesota Rules, parts 9530.6600 to
9530.6655. The team shall consist of social workers; persons with expertise in the treatment
of juveniles who are emotionally deleted text begin disableddeleted text end new text begin disturbednew text end , chemically dependent, or have a
developmental disability; and the child's parent, guardian, or permanent legal custodian.
The team may include the child's relatives as defined in section 260C.007, subdivisions 26b
and 27, the child's foster care provider, and professionals who are a resource to the child's
family such as teachers, medical or mental health providers, and clergy, as appropriate,
consistent with the family and permanency team as defined in section 260C.007, subdivision
16a. Prior to forming the team, the responsible social services agency must consult with new text begin the
child's parents,new text end the child if the child is age 14 or older, deleted text begin the child's parents,deleted text end and, if applicable,
the child's tribe new text begin to obtain recommendations regarding which individuals to include on the
team andnew text end to ensure that the team is family-centered and will act in the child's best deleted text begin interestdeleted text end
new text begin interestsnew text end . If the child, child's parents, or legal guardians raise concerns about specific relatives
or professionals, the team should not include those individuals. This provision does not
apply to paragraph (c).
(c) If the agency provides notice to tribes under section 260.761, and the child screened
is an Indian child, the responsible social services agency must make a rigorous and concerted
effort to include a designated representative of the Indian child's tribe on the juvenile
treatment screening team, unless the child's tribal authority declines to appoint a
representative. The Indian child's tribe may delegate its authority to represent the child to
any other federally recognized Indian tribe, as defined in section 260.755, subdivision 12.
The provisions of the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, and the Minnesota Indian Family Preservation Act, sections 260.751 to
260.835, apply to this section.
(d) If the court, prior to, or as part of, a final disposition or other court order, proposes
to place a child with an emotional disturbance or developmental disability or related condition
in residential treatment, the responsible social services agency must conduct a screening.
If the team recommends treating the child in a qualified residential treatment program, the
agency must follow the requirements of sections 260C.70 to 260C.714.
The court shall ascertain whether the child is an Indian child and shall notify the
responsible social services agency and, if the child is an Indian child, shall notify the Indian
child's tribe as paragraph (c) requires.
(e) When the responsible social services agency is responsible for placing and caring
for the child and the screening team recommends placing a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the agency must: (1)
begin the assessment and processes required in section 260C.704 without delay; and (2)
conduct a relative search according to section 260C.221 to assemble the child's family and
permanency team under section 260C.706. Prior to notifying relatives regarding the family
and permanency team, the responsible social services agency must consult with new text begin the child's
parents andnew text end the child if the child is age 14 or olderdeleted text begin , the child's parentsdeleted text end and, if applicable, the
child's tribe to ensure that the agency is providing notice to individuals who will act in the
child's best deleted text begin interestdeleted text end new text begin interestsnew text end . The child and the child's parents may identify a culturally
competent qualified individual to complete the child's assessment. The agency shall make
efforts to refer the assessment to the identified qualified individual. The assessment may
not be delayed for the purpose of having the assessment completed by a specific qualified
individual.
(f) When a screening team determines that a child does not need treatment in a qualified
residential treatment program, the screening team must:
(1) document the services and supports that will prevent the child's foster care placement
and will support the child remaining at home;
(2) document the services and supports that the agency will arrange to place the child
in a family foster home; or
(3) document the services and supports that the agency has provided in any other setting.
(g) When the Indian child's tribe or tribal health care services provider or Indian Health
Services provider proposes to place a child for the primary purpose of treatment for an
emotional disturbance, a developmental disability, or co-occurring emotional disturbance
and chemical dependency, the Indian child's tribe or the tribe delegated by the child's tribe
shall submit necessary documentation to the county juvenile treatment screening team,
which must invite the Indian child's tribe to designate a representative to the screening team.
(h) The responsible social services agency must conduct and document the screening in
a format approved by the commissioner of human services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 18.
Minnesota Statutes 2020, section 260C.163, subdivision 3, is amended to read:
Subd. 3.
Appointment of counsel.
(a) The child, parent, guardian or custodian has the
right to effective assistance of counsel in connection with a proceeding in juvenile court as
provided in this subdivision.
(b) Except in proceedings where the sole basis for the petition is habitual truancy, if the
child desires counsel but is unable to employ it, the court shall appoint counsel to represent
the child who is ten years of age or older under section 611.14, clause (4), or other counsel
at public expense.
(c) deleted text begin Except in proceedings where the sole basis for the petition is habitual truancy, if the
parent, guardian, or custodian desires counsel but is unable to employ it, the court shall
appoint counsel to represent the parent, guardian, or custodian in any case in which it feels
that such an appointment is appropriate if the person would be financially unable to obtain
counsel under the guidelines set forth in section 611.17.deleted text end new text begin In all child protection proceedings
where a child risks removal from the care of the child's parent, guardian, or custodian,
including a child in need of protection or services petition, an action pursuing removal of
a child from the child's home, a termination of parental rights petition, or a petition for
permanent out-of-home placement, if the parent, guardian, or custodian desires counsel and
is eligible for counsel under section 611.17, the court shall appoint counsel to represent
each parent, guardian, or custodian prior to the first hearing on the petition and at all stages
of the proceedings.new text end Court appointed counsel shall be at county expense as outlined in
paragraph (h).
(d) In any proceeding where the subject of a petition for a child in need of protection or
services is ten years of age or older, the responsible social services agency shall, within 14
days after filing the petition or at the emergency removal hearing under section 260C.178,
subdivision 1, if the child is present, fully and effectively inform the child of the child's
right to be represented by appointed counsel upon request and shall notify the court as to
whether the child desired counsel. Information provided to the child shall include, at a
minimum, the fact that counsel will be provided without charge to the child, that the child's
communications with counsel are confidential, and that the child has the right to participate
in all proceedings on a petition, including the opportunity to personally attend all hearings.
The responsible social services agency shall also, within 14 days of the child's tenth birthday,
fully and effectively inform the child of the child's right to be represented by counsel if the
child reaches the age of ten years while the child is the subject of a petition for a child in
need of protection or services or is a child under the guardianship of the commissioner.
(e) In any proceeding where the sole basis for the petition is habitual truancy, the child,
parent, guardian, and custodian do not have the right to appointment of a public defender
or other counsel at public expense. However, before any out-of-home placement, including
foster care or inpatient treatment, can be ordered, the court must appoint a public defender
or other counsel at public expense in accordance with this subdivision.
(f) Counsel for the child shall not also act as the child's guardian ad litem.
(g) In any proceeding where the subject of a petition for a child in need of protection or
services is not represented by an attorney, the court shall determine the child's preferences
regarding the proceedings, including informing the child of the right to appointed counsel
and asking whether the child desires counsel, if the child is of suitable age to express a
preference.
(h) Court-appointed counsel for the parent, guardian, or custodian under this subdivision
is at county expense. If the county has contracted with counsel deleted text begin meeting qualifications under
paragraph (i)deleted text end , the court shall appoint the counsel retained by the county, unless a conflict
of interest exists. If a conflict exists, after consulting with the chief judge of the judicial
district or the judge's designee, the county shall contract with competent counsel to provide
the necessary representation. The court may appoint only one counsel at public expense for
the first court hearing to represent the interests of the parents, guardians, and custodians,
unless, at any time during the proceedings upon petition of a party, the court determines
and makes written findings on the record that extraordinary circumstances exist that require
counsel to be appointed to represent a separate interest of other parents, guardians, or
custodians subject to the jurisdiction of the juvenile court.
deleted text begin
(i) Counsel retained by the county under paragraph (h) must meet the qualifications
deleted text end
deleted text begin
established by the Judicial Council in at least one of the following: (1) has a minimum of
deleted text end
deleted text begin
two years' experience handling child protection cases; (2) has training in handling child
deleted text end
deleted text begin
protection cases from a course or courses approved by the Judicial Council; or (3) is
deleted text end
deleted text begin
supervised by an attorney who meets the minimum qualifications under clause (1) or (2).
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 260C.212, subdivision 1a, is amended to read:
Subd. 1a.
Out-of-home placement plan update.
(a) Within 30 days of placing the child
in foster care, the agency must file thenew text begin child'snew text end initial out-of-home placement plan with the
court. After filing thenew text begin child'snew text end initial out-of-home placement plan, the agency shall update
and file thenew text begin child'snew text end out-of-home placement plan with the court as follows:
(1) when the agency moves a child to a different foster care setting, the agency shall
inform the court within 30 days of the new text begin child's new text end placement change or court-ordered trial home
visit. The agency must file the new text begin child's new text end updated out-of-home placement plan with the court
at the next required review hearing;
(2) when the agency places a child in a qualified residential treatment program as defined
in section 260C.007, subdivision 26d, or moves a child from one qualified residential
treatment program to a different qualified residential treatment program, the agency must
update thenew text begin child'snew text end out-of-home placement plan within 60 days. To meet the requirements
of section 260C.708, the agency must file thenew text begin child'snew text end out-of-home placement plan deleted text begin with the
court as part of the 60-day hearing anddeleted text end new text begin along with the agency's report seeking the court's
approval of the child's placement at a qualified residential treatment program under section
260C.71. After the court issues an order, the agencynew text end must update thenew text begin child's out-of-home
placementnew text end plan deleted text begin after the court hearingdeleted text end to document the court's approval or disapproval of
the child's placement in a qualified residential treatment program;
(3) when the agency places a child with the child's parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190, the agency
must identify the treatment programnew text begin where the child will be placednew text end in the child's out-of-home
placement plan prior to the child's placement. The agency must file thenew text begin child'snew text end out-of-home
placement plan with the court at the next required review hearing; and
(4) under sections 260C.227 and 260C.521, the agency must update thenew text begin child'snew text end
out-of-home placement plan and file thenew text begin child's out-of-home placementnew text end plan with the court.
(b) When none of the items in paragraph (a) apply, the agency must update thenew text begin child'snew text end
out-of-home placement plan no later than 180 days after the child's initial placement and
every six months thereafter, consistent with section 260C.203, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 20.
Minnesota Statutes 2020, section 260C.212, subdivision 13, is amended to read:
Subd. 13.
Protecting missing and runaway children and youth at risk of sex
traffickingnew text begin or commercial sexual exploitationnew text end .
(a) The local social services agency shall
expeditiously locate any child missing from foster care.
(b) The local social services agency shall report immediately, but no later than 24 hours,
after receiving information on a missing or abducted child to the local law enforcement
agency for entry into the National Crime Information Center (NCIC) database of the Federal
Bureau of Investigation, and to the National Center for Missing and Exploited Children.
(c) The local social services agency shall not discharge a child from foster care or close
the social services case until diligent efforts have been exhausted to locate the child and the
court terminates the agency's jurisdiction.
(d) The local social services agency shall determine the primary factors that contributed
to the child's running away or otherwise being absent from care and, to the extent possible
and appropriate, respond to those factors in current and subsequent placements.
(e) The local social services agency shall determine what the child experienced while
absent from care, including screening the child to determine if the child is a possible sex
traffickingnew text begin or commercial sexual exploitationnew text end victim as defined in section deleted text begin 609.321,
subdivision 7bdeleted text end new text begin 260C.007, subdivision 31new text end .
(f) The local social services agency shall report immediately, but no later than 24 hours,
to the local law enforcement agency any reasonable cause to believe a child is, or is at risk
of being, a sex traffickingnew text begin or commercial sexual exploitationnew text end victim.
(g) The local social services agency shall determine appropriate services as described
in section 145.4717 with respect to any child for whom the local social services agency has
responsibility for placement, care, or supervision when the local social services agency has
reasonable cause to believenew text begin thatnew text end the child is, or is at risk of being, a sex traffickingnew text begin or
commercial sexual exploitationnew text end victim.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 260C.4412, is amended to read:
260C.4412 PAYMENT FOR RESIDENTIAL PLACEMENTS.
(a) When a child is placed in a foster care group residential setting under Minnesota
Rules, parts 2960.0020 to 2960.0710, a foster residence licensed under chapter 245A that
meets the standards of Minnesota Rules, parts 2960.3200 to 2960.3230, or a children's
residential facility licensed or approved by a tribe, foster care maintenance payments must
be made on behalf of the child to cover the cost of providing food, clothing, shelter, daily
supervision, school supplies, child's personal incidentals and supports, reasonable travel for
visitation, or other transportation needs associated with the items listed. Daily supervision
in the group residential setting includes routine day-to-day direction and arrangements to
ensure the well-being and safety of the child. It may also include reasonable costs of
administration and operation of the facility.
(b) The commissioner of human services shall specify the title IV-E administrative
procedures under section 256.82 for each of the following residential program settings:
(1) residential programs licensed under chapter 245A or licensed by a tribe, including:
(i) qualified residential treatment programs as defined in section 260C.007, subdivision
26d;
(ii) program settings specializing in providing prenatal, postpartum, or parenting supports
for youth; and
(iii) program settings providing high-quality residential care and supportive services to
children and youth who are, or are at risk of becoming, sex trafficking victims;
(2) licensed residential family-based substance use disorder treatment programs as
defined in section 260C.007, subdivision 22a; and
(3) supervised settings in which a foster child age 18 or older may live independently,
consistent with section 260C.451.
new text begin
(c) A lead contract under section 256.0112, subdivision 6, is not required to establish
the foster care maintenance payment in paragraph (a) for foster residence settings licensed
under chapter 245A that meet the standards of Minnesota Rules, parts 2960.3200 to
2960.3230. The foster care maintenance payment for these settings must be consistent with
section 256N.26, subdivision 3, and subject to the annual revision as specified in section
256N.26, subdivision 9.
new text end
Sec. 22.
Minnesota Statutes 2020, section 260C.452, is amended to read:
260C.452 SUCCESSFUL TRANSITION TO ADULTHOOD.
Subdivision 1.
Scopenew text begin ; purposenew text end .
new text begin
(a) For purposes of this section, "youth" means a person
who is at least 14 years of age and under 23 years of age.
new text end
new text begin (b) new text end This section pertains to a deleted text begin childdeleted text end new text begin youthnew text end whonew text begin :
new text end
new text begin (1)new text end isnew text begin in foster care and is 14 years of age or older, including a youth who isnew text end under the
guardianship of the commissioner of human servicesdeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (2)new text end has a permanency disposition of permanent custody to the agencydeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (3)new text end will leave foster care deleted text begin at 18 to 21 years of age.deleted text end new text begin when the youth is 18 years of age or
older and under 21 years of age;
new text end
new text begin
(4) has left foster care and was placed at a permanent adoptive placement when the youth
was 16 years of age or older;
new text end
new text begin
(5) is 16 years of age or older, has left foster care, and was placed with a relative to
whom permanent legal and physical custody of the youth has been transferred; or
new text end
new text begin
(6) was reunified with the youth's primary caretaker when the youth was 14 years of age
or older and under 18 years of age.
new text end
new text begin
(c) The purpose of this section is to provide support to a youth who is transitioning to
adulthood by providing services to the youth concerning:
new text end
new text begin
(1) education;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) daily living skills such as financial literacy training and driving instruction, preventive
health activities including promoting abstinence from substance use and smoking, and
nutrition education and pregnancy prevention;
new text end
new text begin
(4) forming meaningful, permanent connections with caring adults;
new text end
new text begin
(5) engaging in age-appropriate and developmentally appropriate activities under section
260C.212, subdivision 14, and positive youth development;
new text end
new text begin
(6) financial, housing, counseling, and other services to assist a youth over 18 years of
age in achieving self-sufficiency and accepting personal responsibility for the transition
from adolescence to adulthood; and
new text end
new text begin
(7) making vouchers available for education and training.
new text end
new text begin
(d) The responsible social services agency may provide support and case management
services to a youth as defined in paragraph (a) until the youth reaches 23 years of age.
According to section 260C.451, a youth's placement in a foster care setting will end when
the youth reaches 21 years of age.
new text end
new text begin Subd. 1a. new text end
new text begin Case management services. new text end
new text begin
Case management services include the
responsibility for planning, coordinating, authorizing, monitoring, and evaluating services
for a youth and shall be provided to a youth by the responsible social services agency or
the contracted agency. Case management services include the out-of-home placement plan
under section 260C.212, subdivision 1, when the youth is in out-of-home placement.
new text end
Subd. 2.
Independent living plan.
When the deleted text begin childdeleted text end new text begin youthnew text end is 14 years of age or oldernew text begin and
is receiving support from the responsible social services agency under this sectionnew text end , the
responsible social services agency, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall complete thenew text begin
youth'snew text end independent living plan according to section 260C.212, subdivision 1, paragraph
(c), clause (12)new text begin , regardless of the youth's current placement statusnew text end .
deleted text begin Subd. 3. deleted text end
deleted text begin Notification. deleted text end
deleted text begin
Six months before the child is expected to be discharged from
foster care, the responsible social services agency shall provide written notice to the child
regarding the right to continued access to services for certain children in foster care past 18
years of age and of the right to appeal a denial of social services under section 256.045.
deleted text end
Subd. 4.
Administrative or court review of placements.
(a) When the deleted text begin childdeleted text end new text begin youthnew text end is
14 years of age or older, the court, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall review thenew text begin
youth'snew text end independent living plan according to section 260C.203, paragraph (d).
(b) The responsible social services agency shall file a copy of the notification deleted text begin required
in subdivision 3deleted text end new text begin of foster care benefits for a youth who is 18 years of age or older according
to section 260C.451, subdivision 1,new text end with the court. If the responsible social services agency
does not file the notice by the time the deleted text begin childdeleted text end new text begin youthnew text end is 17-1/2 years of age, the court shall
require the responsible social services agency to file the notice.
(c) new text begin When a youth is 18 years of age or older, new text end the court shall ensure that the responsible
social services agency assists the deleted text begin childdeleted text end new text begin youthnew text end in obtaining the following documents before
the deleted text begin childdeleted text end new text begin youthnew text end leaves foster care: a Social Security card; an official or certified copy of the
deleted text begin child'sdeleted text end new text begin youth'snew text end birth certificate; a state identification card or driver's license, tribal enrollment
identification card, green card, or school visa; health insurance information; the deleted text begin child'sdeleted text end new text begin
youth'snew text end school, medical, and dental records; a contact list of the deleted text begin child'sdeleted text end new text begin youth'snew text end medical,
dental, and mental health providers; and contact information for the deleted text begin child'sdeleted text end new text begin youth'snew text end siblings,
if the siblings are in foster care.
(d) For a deleted text begin childdeleted text end new text begin youthnew text end who will be discharged from foster care at 18 years of age or older
new text begin because the youth is not eligible for extended foster care benefits or chooses to leave foster
carenew text end , the responsible social services agency must develop a personalized transition plan as
directed by the deleted text begin childdeleted text end new text begin youthnew text end during the deleted text begin 90-daydeleted text end new text begin 180-daynew text end period immediately prior to the
expected date of discharge. The transition plan must be as detailed as the deleted text begin childdeleted text end new text begin youthnew text end elects
and include specific options, including but not limited to:
(1) affordable housing with necessary supports that does not include a homeless shelter;
(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;
(3) education, including application to the Education and Training Voucher Program;
(4) local opportunities for mentors and continuing support servicesdeleted text begin , including the Healthy
Transitions and Homeless Prevention program, if availabledeleted text end ;
(5) workforce supports and employment services;
(6) a copy of the deleted text begin child'sdeleted text end new text begin youth'snew text end consumer credit report as defined in section 13C.001
and assistance in interpreting and resolving any inaccuracies in the report, at no cost to the
deleted text begin childdeleted text end new text begin youthnew text end ;
(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
deleted text begin childdeleted text end new text begin youthnew text end if the deleted text begin childdeleted text end new text begin youthnew text end becomes unable to participate in decisions;
(8) appropriate contact information through 21 years of age if the deleted text begin childdeleted text end new text begin youthnew text end needs
information or help dealing with a crisis situation; and
(9) official documentation that the youth was previously in foster care.
Subd. 5.
Notice of termination of deleted text begin foster caredeleted text end new text begin social servicesnew text end .
(a) deleted text begin Whendeleted text end new text begin Beforenew text end a deleted text begin childdeleted text end new text begin
youth who is 18 years of age or oldernew text end leaves foster care deleted text begin at 18 years of age or olderdeleted text end , the
responsible social services agency shall give the deleted text begin childdeleted text end new text begin youthnew text end written notice that foster care
shall terminate 30 days from the datenew text begin thatnew text end the notice is sentnew text begin by the agency according to
section 260C.451, subdivision 8new text end .
deleted text begin
(b) The child or the child's guardian ad litem may file a motion asking the court to review
the responsible social services agency's determination within 15 days of receiving the notice.
The child shall not be discharged from foster care until the motion is heard. The responsible
social services agency shall work with the child to transition out of foster care.
deleted text end
deleted text begin
(c) The written notice of termination of benefits shall be on a form prescribed by the
commissioner and shall give notice of the right to have the responsible social services
agency's determination reviewed by the court under this section or sections 260C.203,
260C.317, and 260C.515, subdivision 5 or 6. A copy of the termination notice shall be sent
to the child and the child's attorney, if any, the foster care provider, the child's guardian ad
litem, and the court. The responsible social services agency is not responsible for paying
foster care benefits for any period of time after the child leaves foster care.
deleted text end
new text begin
(b) Before case management services will end for a youth who is at least 18 years of
age and under 23 years of age, the responsible social services agency shall give the youth:
(1) written notice that case management services for the youth shall terminate; and (2)
written notice that the youth has the right to appeal the termination of case management
services under section 256.045, subdivision 3, by responding in writing within ten days of
the date that the agency mailed the notice. The termination notice must include information
about services for which the youth is eligible and how to access the services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 260C.704, is amended to read:
260C.704 REQUIREMENTS FOR THE QUALIFIED INDIVIDUAL'S
ASSESSMENT OF THE CHILD FOR PLACEMENT IN A QUALIFIED
RESIDENTIAL TREATMENT PROGRAM.
(a) A qualified individual must complete an assessment of the child prior to deleted text begin or withindeleted text end
deleted text begin 30 days ofdeleted text end the child's placement in a qualified residential treatment program in a format
approved by the commissioner of human servicesdeleted text begin , anddeleted text end new text begin unless, due to a crisis, the child must
immediately be placed in a qualified residential treatment program. When a child must
immediately be placed in a qualified residential treatment program without an assessment,
the qualified individual must complete the child's assessment within 30 days of the child's
placement. The qualified individualnew text end must:
(1) assess the child's needs and strengths, using an age-appropriate, evidence-based,
validated, functional assessment approved by the commissioner of human services;
(2) determine whether the child's needs can be met by the child's family members or
through placement in a family foster home; or, if not, determine which residential setting
would provide the child with the most effective and appropriate level of care to the child
in the least restrictive environment;
(3) develop a list of short- and long-term mental and behavioral health goals for the
child; and
(4) work with the child's family and permanency team using culturally competent
practices.
new text begin
If a level of care determination was conducted under section 245.4885, that information
must be shared with the qualified individual and the juvenile treatment screening team.
new text end
(b) The child and the child's parents, when appropriate, may request that a specific
culturally competent qualified individual complete the child's assessment. The agency shall
make efforts to refer the child to the identified qualified individual to complete the
assessment. The assessment must not be delayed for a specific qualified individual to
complete the assessment.
(c) The qualified individual must provide the assessment, when complete, to the
responsible social services agencydeleted text begin , the child's parents or legal guardians, the guardian ad
litem, and the courtdeleted text end new text begin . If the assessment recommends placement of the child in a qualified
residential treatment facility, the agency must distribute the assessment to the child's parent
or legal guardian and file the assessment with the court reportnew text end as required in section 260C.71new text begin ,
subdivision 2. If the assessment does not recommend placement in a qualified residential
treatment facility, the agency must provide a copy of the assessment to the parents or legal
guardians and the guardian ad litem and file the assessment determination with the court at
the next required hearing as required in section 260C.71, subdivision 5new text end . If court rules and
chapter 13 permit disclosure of the results of the child's assessment, the agency may share
the results of the child's assessment with the child's foster care provider, other members of
the child's family, and the family and permanency team. The agency must not share the
child's private medical data with the family and permanency team unless: (1) chapter 13
permits the agency to disclose the child's private medical data to the family and permanency
team; or (2) the child's parent has authorized the agency to disclose the child's private medical
data to the family and permanency team.
(d) For an Indian child, the assessment of the child must follow the order of placement
preferences in the Indian Child Welfare Act of 1978, United States Code, title 25, section
1915.
(e) In the assessment determination, the qualified individual must specify in writing:
(1) the reasons why the child's needs cannot be met by the child's family or in a family
foster home. A shortage of family foster homes is not an acceptable reason for determining
that a family foster home cannot meet a child's needs;
(2) why the recommended placement in a qualified residential treatment program will
provide the child with the most effective and appropriate level of care to meet the child's
needs in the least restrictive environment possible and how placing the child at the treatment
program is consistent with the short-term and long-term goals of the child's permanency
plan; and
(3) if the qualified individual's placement recommendation is not the placement setting
that the parent, family and permanency team, child, or tribe prefer, the qualified individual
must identify the reasons why the qualified individual does not recommend the parent's,
family and permanency team's, child's, or tribe's placement preferences. The out-of-home
placement plan under section 260C.708 must also include reasons why the qualified
individual did not recommend the preferences of the parents, family and permanency team,
child, or tribe.
(f) If the qualified individual determines that the child's family or a family foster home
or other less restrictive placement may meet the child's needs, the agency must move the
child out of the qualified residential treatment program and transition the child to a less
restrictive setting within 30 days of the determination.new text begin If the responsible social services
agency has placement authority of the child, the agency must make a plan for the child's
placement according to section 260C.212, subdivision 2. The agency must file the child's
assessment determination with the court at the next required hearing.
new text end
new text begin
(g) If the qualified individual recommends placing the child in a qualified residential
treatment program and if the responsible social services agency has placement authority of
the child, the agency shall make referrals to appropriate qualified residential treatment
programs and, upon acceptance by an appropriate program, place the child in an approved
or certified qualified residential treatment program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 24.
Minnesota Statutes 2020, section 260C.706, is amended to read:
260C.706 FAMILY AND PERMANENCY TEAM REQUIREMENTS.
(a) When the responsible social services agency's juvenile treatment screening team, as
defined in section 260C.157, recommends placing the child in a qualified residential treatment
program, the agency must assemble a family and permanency team within ten days.
(1) The team must include all appropriate biological family members, the child's parents,
legal guardians or custodians, foster care providers, and relatives as defined in section
260C.007, subdivisions deleted text begin 26cdeleted text end new text begin 26bnew text end and 27, and professionals, as appropriate, who are a resource
to the child's family, such as teachers, medical or mental health providers, or clergy.
(2) When a child is placed in foster care prior to the qualified residential treatment
program, the agency shall include relatives responding to the relative search notice as
required under section 260C.221 on this team, unless the juvenile court finds that contacting
a specific relative would deleted text begin endangerdeleted text end new text begin present a safety or health risk tonew text end the parent, guardian,
child, sibling, or any other family member.
(3) When a qualified residential treatment program is the child's initial placement setting,
the responsible social services agency must engage with the child and the child's parents to
determine the appropriate family and permanency team members.
(4) When the permanency goal is to reunify the child with the child's parent or legal
guardian, the purpose of the relative search and focus of the family and permanency team
is to preserve family relationships and identify and develop supports for the child and parents.
(5) The responsible agency must make a good faith effort to identify and assemble all
appropriate individuals to be part of the child's family and permanency team and request
input from the parents regarding relative search efforts consistent with section 260C.221.
The out-of-home placement plan in section 260C.708 must include all contact information
for the team members, as well as contact information for family members or relatives who
are not a part of the family and permanency team.
(6) If the child is age 14 or older, the team must include members of the family and
permanency team that the child selects in accordance with section 260C.212, subdivision
1, paragraph (b).
(7) Consistent with section 260C.221, a responsible social services agency may disclose
relevant and appropriate private data about the child to relatives in order for the relatives
to participate in caring and planning for the child's placement.
(8) If the child is an Indian child under section 260.751, the responsible social services
agency must make active efforts to include the child's tribal representative on the family
and permanency team.
(b) The family and permanency team shall meet regarding the assessment required under
section 260C.704 to determine whether it is necessary and appropriate to place the child in
a qualified residential treatment program and to participate in case planning under section
260C.708.
(c) When reunification of the child with the child's parent or legal guardian is the
permanency plan, the family and permanency team shall support the parent-child relationship
by recognizing the parent's legal authority, consulting with the parent regarding ongoing
planning for the child, and assisting the parent with visiting and contacting the child.
(d) When the agency's permanency plan is to transfer the child's permanent legal and
physical custody to a relative or for the child's adoption, the team shall:
(1) coordinate with the proposed guardian to provide the child with educational services,
medical care, and dental care;
(2) coordinate with the proposed guardian, the agency, and the foster care facility to
meet the child's treatment needs after the child is placed in a permanent placement with the
proposed guardian;
(3) plan to meet the child's need for safety, stability, and connection with the child's
family and community after the child is placed in a permanent placement with the proposed
guardian; and
(4) in the case of an Indian child, communicate with the child's tribe to identify necessary
and appropriate services for the child, transition planning for the child, the child's treatment
needs, and how to maintain the child's connections to the child's community, family, and
tribe.
(e) The agency shall invite the family and permanency team to participate in case planning
and the agency shall give the team notice of court reviews under sections 260C.152 and
260C.221 until: (1) the child is reunited with the child's parents; or (2) the child's foster care
placement ends and the child is in a permanent placement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 25.
Minnesota Statutes 2020, section 260C.708, is amended to read:
260C.708 OUT-OF-HOME PLACEMENT PLAN FOR QUALIFIED
RESIDENTIAL TREATMENT PROGRAM PLACEMENTS.
(a) When the responsible social services agency places a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the out-of-home
placement plan must include:
(1) the case plan requirements in section deleted text begin 260.212, subdivision 1deleted text end new text begin 260C.212new text end ;
(2) the reasonable and good faith efforts of the responsible social services agency to
identify and include all of the individuals required to be on the child's family and permanency
team under section 260C.007;
(3) all contact information for members of the child's family and permanency team and
for other relatives who are not part of the family and permanency team;
(4) evidence that the agency scheduled meetings of the family and permanency team,
including meetings relating to the assessment required under section 260C.704, at a time
and place convenient for the family;
new text begin
(5) evidence that the family and permanency team is involved in the assessment required
under section 260C.704 to determine the appropriateness of the child's placement in a
qualified residential treatment program;
new text end
new text begin
(6) the family and permanency team's placement preferences for the child in the
assessment required under section 260C.704. When making a decision about the child's
placement preferences, the family and permanency team must recognize:
new text end
new text begin
(i) that the agency should place a child with the child's siblings unless a court finds that
placing a child with the child's siblings is not possible due to a child's specialized placement
needs or is otherwise contrary to the child's best interests; and
new text end
new text begin
(ii) that the agency should place an Indian child according to the requirements of the
Indian Child Welfare Act, the Minnesota Family Preservation Act under sections 260.751
to 260.835, and section 260C.193, subdivision 3, paragraph (g);
new text end
deleted text begin (5)deleted text end new text begin (7)new text end when reunification of the child with the child's parent or legal guardian is the
agency's goal, evidence demonstrating that the parent or legal guardian provided input about
the members of the family and permanency team under section 260C.706;
deleted text begin (6)deleted text end new text begin (8)new text end when the agency's permanency goal is to reunify the child with the child's parent
or legal guardian, the out-of-home placement plan must identify services and supports that
maintain the parent-child relationship and the parent's legal authority, decision-making, and
responsibility for ongoing planning for the child. In addition, the agency must assist the
parent with visiting and contacting the child;
deleted text begin (7)deleted text end new text begin (9)new text end when the agency's permanency goal is to transfer permanent legal and physical
custody of the child to a proposed guardian or to finalize the child's adoption, the case plan
must document the agency's steps to transfer permanent legal and physical custody of the
child or finalize adoption, as required in section 260C.212, subdivision 1, paragraph (c),
clauses (6) and (7); and
deleted text begin (8)deleted text end new text begin (10)new text end the qualified individual's recommendation regarding the child's placement in a
qualified residential treatment program and the court approval or disapproval of the placement
as required in section 260C.71.
(b) If the placement preferences of the family and permanency team, child, and tribe, if
applicable, are not consistent with the placement setting that the qualified individual
recommends, the case plan must include the reasons why the qualified individual did not
recommend following the preferences of the family and permanency team, child, and the
tribe.
(c) The agency must file the out-of-home placement plan with the court as part of the
60-day deleted text begin hearingdeleted text end new text begin court ordernew text end under section 260C.71.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 260C.71, is amended to read:
260C.71 COURT APPROVAL REQUIREMENTS.
new text begin Subdivision 1. new text end
new text begin Judicial review. new text end
new text begin
When the responsible social services agency has legal
authority to place a child at a qualified residential treatment facility under section 260C.007,
subdivision 21a, and the child's assessment under section 260C.704 recommends placing
the child in a qualified residential treatment facility, the agency shall place the child at a
qualified residential facility. Within 60 days of placing the child at a qualified residential
treatment facility, the agency must obtain a court order finding that the child's placement
is appropriate and meets the child's individualized needs.
new text end
new text begin Subd. 2. new text end
new text begin Qualified residential treatment program; agency report to court. new text end
new text begin
(a) The
responsible social services agency shall file a written report with the court after receiving
the qualified individual's assessment as specified in section 260C.704 prior to the child's
placement or within 35 days of the date of the child's placement in a qualified residential
treatment facility. The written report shall contain or have attached:
new text end
new text begin
(1) the child's name, date of birth, race, gender, and current address;
new text end
new text begin
(2) the names, races, dates of birth, residence, and post office address of the child's
parents or legal custodian, or guardian;
new text end
new text begin
(3) the name and address of the qualified residential treatment program, including a
chief administrator of the facility;
new text end
new text begin
(4) a statement of the facts that necessitated the child's foster care placement;
new text end
new text begin
(5) the child's out-of-home placement plan under section 260C.212, subdivision 1,
including the requirements in section 260C.708;
new text end
new text begin
(6) if the child is placed in an out-of-state qualified residential treatment program, the
compelling reasons why the child's needs cannot be met by an in-state placement;
new text end
new text begin
(7) the qualified individual's assessment of the child under section 260C.704, paragraph
(c), in a format approved by the commissioner;
new text end
new text begin
(8) if, at the time required for the report under this subdivision, the child's parent or legal
guardian, a child who is ten years of age or older, the family and permanency team, or a
tribe disagrees with the recommended qualified residential treatment program placement,
information regarding the disagreement and to the extent possible, the basis for the
disagreement in the report; and
new text end
new text begin
(9) any other information that the responsible social services agency, child's parent, legal
custodian or guardian, child, or, in the case of an Indian child, tribe would like the court to
consider.
new text end
new text begin
(b) The agency shall file the written report under paragraph (a) with the court and serve
on the parties a request for a hearing or a court order without a hearing.
new text end
new text begin
(c) The agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the court review requirements of this section and the child and child's
parent's or legal guardian's right to submit information to the court:
new text end
new text begin
(1) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the reporting date and the date by which the agency must receive
information from the child and child's parent so that the agency is able to submit the report
required by this subdivision to the court;
new text end
new text begin
(2) the agency must inform the child's parent or legal guardian, and a child who is ten
years of age or older that the court will hold a hearing upon the request of the child or the
child's parent; and
new text end
new text begin
(3) the agency must inform the child's parent or legal guardian, and a child who is ten
years of age or older that they have the right to request a hearing and the right to present
information to the court for the court's review under this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Court hearing. new text end
new text begin
(a) The court shall hold a hearing when a party or a child who
is ten years of age or older requests a hearing.
new text end
new text begin
(b) In all other circumstances, the court has the discretion to hold a hearing or issue an
order without a hearing.
new text end
new text begin Subd. 4. new text end
new text begin Court findings and order. new text end
(a) Within 60 days from the beginning of each
placement in a qualified residential treatment programnew text begin when the qualified individual's
assessment of the child recommends placing the child in a qualified residential treatment
programnew text end , the court mustnew text begin consider the qualified individual's assessment of the child under
section 260C.704 and issue an order tonew text end :
deleted text begin
(1) consider the qualified individual's assessment of whether it is necessary and
appropriate to place the child in a qualified residential treatment program under section
260C.704;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a family foster home can meet the child's needs, whether it is
necessary and appropriate to place a child in a qualified residential treatment program that
is the least restrictive environment possible, and whether the child's placement is consistent
with the child's short and long term goals as specified in the permanency plan; and
deleted text begin (3)deleted text end new text begin (2)new text end approve or disapprove of the child's placement.
(b) deleted text begin In the out-of-home placement plan, the agency must document the court's approval
or disapproval of the placement, as specified in section 260C.708.deleted text end new text begin If the court disapproves
of the child's placement in a qualified residential treatment program, the responsible social
services agency shall: (1) remove the child from the qualified residential treatment program
within 30 days of the court's order; and (2) make a plan for the child's placement that is
consistent with the child's best interests under section 260C.212, subdivision 2.
new text end
new text begin Subd. 5. new text end
new text begin Court review and approval not required. new text end
new text begin
When the responsible social services
agency has legal authority to place a child under section 260C.007, subdivision 21a, and
the qualified individual's assessment of the child does not recommend placing the child in
a qualified residential treatment program, the court is not required to hold a hearing and the
court is not required to issue an order. Pursuant to section 260C.704, paragraph (f), the
responsible social services agency shall make a plan for the child's placement consistent
with the child's best interests under section 260C.212, subdivision 2. The agency must file
the agency's assessment determination for the child with the court at the next required
hearing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 260C.712, is amended to read:
260C.712 ONGOING REVIEWS AND PERMANENCY HEARING
REQUIREMENTS.
As long as a child remains placed in a qualified residential treatment program, the
responsible social services agency shall submit evidence at each administrative review under
section 260C.203; each court review under sections 260C.202, 260C.203, deleted text begin anddeleted text end 260C.204new text begin ,
260D.06, 260D.07, and 260D.08new text end ; and each permanency hearing under section 260C.515,
260C.519, deleted text begin ordeleted text end 260C.521,new text begin or 260D.07new text end that:
(1) demonstrates that an ongoing assessment of the strengths and needs of the child
continues to support the determination that the child's needs cannot be met through placement
in a family foster home;
(2) demonstrates that the placement of the child in a qualified residential treatment
program provides the most effective and appropriate level of care for the child in the least
restrictive environment;
(3) demonstrates how the placement is consistent with the short-term and long-term
goals for the child, as specified in the child's permanency plan;
(4) documents how the child's specific treatment or service needs will be met in the
placement;
(5) documents the length of time that the agency expects the child to need treatment or
services; deleted text begin and
deleted text end
(6) documents the responsible social services agency's efforts to prepare the child to
return home or to be placed with a fit and willing relative, legal guardian, adoptive parent,
or foster familydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) if the child is placed in a qualified residential treatment program out-of-state,
documents the compelling reasons for placing the child out-of-state, and the reasons that
the child's needs cannot be met by an in-state placement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 260C.714, is amended to read:
260C.714 REVIEW OF EXTENDED QUALIFIED RESIDENTIAL TREATMENT
PROGRAM PLACEMENTS.
(a) When a responsible social services agency places a child in a qualified residential
treatment program for more than 12 consecutive months or 18 nonconsecutive months or,
in the case of a child who is under 13 years of age, for more than six consecutive or
nonconsecutive months, the agency must submit: (1) the signed approval by the county
social services director of the responsible social services agency; and (2) the evidence
supporting the child's placement at the most recent court review or permanency hearing
under section 260C.712deleted text begin , paragraph (b)deleted text end .
(b) The commissioner shall specify the procedures and requirements for the agency's
review and approval of a child's extended qualified residential treatment program placement.
The commissioner may consult with counties, tribes, child-placing agencies, mental health
providers, licensed facilities, the child, the child's parents, and the family and permanency
team members to develop case plan requirements and engage in periodic reviews of the
case plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 260D.01, is amended to read:
260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.
(a) Sections 260D.01 to 260D.10, may be cited as the "child in voluntary foster care for
treatment" provisions of the Juvenile Court Act.
(b) The juvenile court has original and exclusive jurisdiction over a child in voluntary
foster care for treatment upon the filing of a report or petition required under this chapter.
All obligations of thenew text begin responsible social servicesnew text end agency to a child and family in foster care
contained in chapter 260C not inconsistent with this chapter are also obligations of the
agency with regard to a child in foster care for treatment under this chapter.
(c) This chapter shall be construed consistently with the mission of the children's mental
health service system as set out in section 245.487, subdivision 3, and the duties of an agency
under sections 256B.092 and 260C.157 and Minnesota Rules, parts 9525.0004 to 9525.0016,
to meet the needs of a child with a developmental disability or related condition. This
chapter:
(1) establishes voluntary foster care through a voluntary foster care agreement as the
means for an agency and a parent to provide needed treatment when the child must be in
foster care to receive necessary treatment for an emotional disturbance or developmental
disability or related condition;
(2) establishes court review requirements for a child in voluntary foster care for treatment
due to emotional disturbance or developmental disability or a related condition;
(3) establishes the ongoing responsibility of the parent as legal custodian to visit the
child, to plan together with the agency for the child's treatment needs, to be available and
accessible to the agency to make treatment decisions, and to obtain necessary medical,
dental, and other care for the child; deleted text begin and
deleted text end
(4) applies to voluntary foster care when the child's parent and the agency agree that the
child's treatment needs require foster care either:
(i) due to a level of care determination by the agency's screening team informed by thenew text begin
child'snew text end diagnostic and functional assessment under section 245.4885; or
(ii) due to a determination regarding the level of services needed bynew text begin the child bynew text end the
responsible social deleted text begin services'deleted text end new text begin services agency'snew text end screening team under section 256B.092, and
Minnesota Rules, parts 9525.0004 to 9525.0016deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) includes the requirements for a child's placement in sections 260C.70 to 260C.714,
when the juvenile treatment screening team recommends placing a child in a qualified
residential treatment program except as modified by this chapter.
new text end
(d) This chapter does not apply when there is a current determination under chapter
260E that the child requires child protective services or when the child is in foster care for
any reason other than treatment for the child's emotional disturbance or developmental
disability or related condition. When there is a determination under chapter 260E that the
child requires child protective services based on an assessment that there are safety and risk
issues for the child that have not been mitigated through the parent's engagement in services
or otherwise, or when the child is in foster care for any reason other than the child's emotional
disturbance or developmental disability or related condition, the provisions of chapter 260C
apply.
(e) The paramount consideration in all proceedings concerning a child in voluntary foster
care for treatment is the safety, health, and the best interests of the child. The purpose of
this chapter is:
(1) to ensurenew text begin thatnew text end a child with a disability is provided the services necessary to treat or
ameliorate the symptoms of the child's disability;
(2) to preserve and strengthen the child's family ties whenever possible and in the child's
best interests, approving the child's placement away from the child's parents only when the
child's need for care or treatment requires deleted text begin itdeleted text end new text begin out-of-home placementnew text end and the child cannot
be maintained in the home of the parent; and
(3) to ensurenew text begin thatnew text end the child's parent retains legal custody of the child and associated
decision-making authority unless the child's parent willfully fails or is unable to make
decisions that meet the child's safety, health, and best interests. The court may not find that
the parent willfully fails or is unable to make decisions that meet the child's needs solely
because the parent disagrees with the agency's choice of foster care facility, unless the
agency files a petition under chapter 260C, and establishes by clear and convincing evidence
that the child is in need of protection or services.
(f) The legal parent-child relationship shall be supported under this chapter by maintaining
the parent's legal authority and responsibility for ongoing planning for the child and by the
agency's assisting the parent, deleted text begin wheredeleted text end new text begin whennew text end necessary, to exercise the parent's ongoing right
and obligation to visit or to have reasonable contact with the child. Ongoing planning means:
(1) actively participating in the planning and provision of educational services, medical,
and dental care for the child;
(2) actively planning and participating with the agency and the foster care facility for
the child's treatment needs; deleted text begin and
deleted text end
(3) planning to meet the child's need for safety, stability, and permanency, and the child's
need to stay connected to the child's family and communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) engaging with the responsible social services agency to ensure that the family and
permanency team under section 260C.706 consists of appropriate family members. For
purposes of voluntary placement of a child in foster care for treatment under chapter 260D,
prior to forming the child's family and permanency team, the responsible social services
agency must consult with the child's parents and the child if the child is 14 years of age or
older, and if applicable, the child's tribe to obtain recommendations regarding which
individuals to include on the team and to ensure that the team is family-centered and will
act in the child's best interests. If the child or the child's parent or legal guardian raises
concerns about specific relatives or professionals, the team should not include those
individuals on the team unless the individual is a treating professional or an important
connection to the youth as outlined in the case or crisis plan. For voluntary placements under
this chapter in a qualified residential treatment program, as defined in section 260C.007,
subdivision 26d, for purposes of engaging in a relative search as provided in section
260C.221, the county agency must consult with the child's parent or legal guardian, the
child if the child is 14 years of age or older, and, if applicable, the tribe, to obtain
recommendations regarding which adult relatives should be notified. If the child, parent,
or legal guardian raises concerns about specific relatives, the county agency must not notify
them.
new text end
(g) The provisions of section 260.012 to ensure placement prevention, family
reunification, and all active and reasonable effort requirements of that section apply. This
chapter shall be construed consistently with the requirements of the Indian Child Welfare
Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the
Minnesota Indian Family Preservation Act, sections 260.751 to 260.835.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 30.
Minnesota Statutes 2020, section 260D.05, is amended to read:
260D.05 ADMINISTRATIVE REVIEW OF CHILD IN VOLUNTARY FOSTER
CARE FOR TREATMENT.
The administrative reviews required under section 260C.203 must be conducted for a
child in voluntary foster care for treatment, except that the initial administrative review
must take place prior to the submission of the report to the court required under section
260D.06, subdivision 2.new text begin When a child is placed in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d, the responsible social services agency
must submit evidence to the court as specified in section 260C.712.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 260D.06, subdivision 2, is amended to read:
Subd. 2.
Agency report to court; court review.
The agency shall obtain judicial review
by reporting to the court according to the following procedures:
(a) A written report shall be forwarded to the court within 165 days of the date of the
voluntary placement agreement. The written report shall contain or have attached:
(1) a statement of facts that necessitate the child's foster care placement;
(2) the child's name, date of birth, race, gender, and current address;
(3) the names, race, date of birth, residence, and post office addresses of the child's
parents or legal custodian;
(4) a statement regarding the child's eligibility for membership or enrollment in an Indian
tribe and the agency's compliance with applicable provisions of sections 260.751 to 260.835;
(5) the names and addresses of the foster parents or chief administrator of the facility in
which the child is placed, if the child is not in a family foster home or group home;
(6) a copy of the out-of-home placement plan required under section 260C.212,
subdivision 1;
(7) a written summary of the proceedings of any administrative review required under
section 260C.203; deleted text begin and
deleted text end
(8) new text begin evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d; and
new text end
new text begin (9) new text end any other information the agency, parent or legal custodian, the child or the foster
parent, or other residential facility wants the court to consider.
(b) In the case of a child in placement due to emotional disturbance, the written report
shall include as an attachment, the child's individual treatment plan developed by the child's
treatment professional, as provided in section 245.4871, subdivision 21, or the child's
standard written plan, as provided in section 125A.023, subdivision 3, paragraph (e).
(c) In the case of a child in placement due to developmental disability or a related
condition, the written report shall include as an attachment, the child's individual service
plan, as provided in section 256B.092, subdivision 1b; the child's individual program plan,
as provided in Minnesota Rules, part 9525.0004, subpart 11; the child's waiver care plan;
or the child's standard written plan, as provided in section 125A.023, subdivision 3, paragraph
(e).
(d) The agency must inform the child, age 12 or older, the child's parent, and the foster
parent or foster care facility of the reporting and court review requirements of this section
and of their right to submit information to the court:
(1) if the child or the child's parent or the foster care provider wants to send information
to the court, the agency shall advise those persons of the reporting date and the date by
which the agency must receive the information they want forwarded to the court so the
agency is timely able submit it with the agency's report required under this subdivision;
(2) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care facility that they have the right to be heard in person by the court and how to
exercise that right;
(3) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care provider that an in-court hearing will be held if requested by the child, the parent,
or the foster care provider; and
(4) if, at the time required for the report under this section, a child, age 12 or older,
disagrees about the foster care facility or services provided under the out-of-home placement
plan required under section 260C.212, subdivision 1, the agency shall include information
regarding the child's disagreement, and to the extent possible, the basis for the child's
disagreement in the report required under this section.
(e) After receiving the required report, the court has jurisdiction to make the following
determinations and must do so within ten days of receiving the forwarded report, whether
a hearing is requested:
(1) whether the voluntary foster care arrangement is in the child's best interests;
(2) whether the parent and agency are appropriately planning for the child; and
(3) in the case of a child age 12 or older, who disagrees with the foster care facility or
services provided under the out-of-home placement plan, whether it is appropriate to appoint
counsel and a guardian ad litem for the child using standards and procedures under section
260C.163.
(f) Unless requested by a parent, representative of the foster care facility, or the child,
no in-court hearing is required in order for the court to make findings and issue an order as
required in paragraph (e).
(g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit, individualized findings to support its determination. The
individualized findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported under paragraph (d).
(h) The court shall send a copy of the order to the county attorney, the agency, parent,
child, age 12 or older, and the foster parent or foster care facility.
(i) The court shall also send the parent, the child, age 12 or older, the foster parent, or
representative of the foster care facility notice of the permanency review hearing required
under section 260D.07, paragraph (e).
(j) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent are not appropriately planning for the child,
the court shall notify the agency, the parent, the foster parent or foster care facility, the child,
age 12 or older, and the county attorney of the court's determinations and the basis for the
court's determinations. In this case, the court shall set the matter for hearing and appoint a
guardian ad litem for the child under section 260C.163, subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 260D.07, is amended to read:
260D.07 REQUIRED PERMANENCY REVIEW HEARING.
(a) When the court has found that the voluntary arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child pursuant to the report
submitted under section 260D.06, and the child continues in voluntary foster care as defined
in section 260D.02, subdivision 10, for 13 months from the date of the voluntary foster care
agreement, or has been in placement for 15 of the last 22 months, the agency must:
(1) terminate the voluntary foster care agreement and return the child home; or
(2) determine whether there are compelling reasons to continue the voluntary foster care
arrangement and, if the agency determines there are compelling reasons, seek judicial
approval of its determination; or
(3) file a petition for the termination of parental rights.
(b) When the agency is asking for the court's approval of its determination that there are
compelling reasons to continue the child in the voluntary foster care arrangement, the agency
shall file a "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" and ask the court to proceed under this section.
(c) The "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" shall be drafted or approved by the county attorney and be under oath. The
petition shall include:
(1) the date of the voluntary placement agreement;
(2) whether the petition is due to the child's developmental disability or emotional
disturbance;
(3) the plan for the ongoing care of the child and the parent's participation in the plan;
(4) a description of the parent's visitation and contact with the child;
(5) the date of the court finding that the foster care placement was in the best interests
of the child, if required under section 260D.06, or the date the agency filed the motion under
section 260D.09, paragraph (b);
(6) the agency's reasonable efforts to finalize the permanent plan for the child, including
returning the child to the care of the child's family; deleted text begin and
deleted text end
(7) a citation to this chapter as the basis for the petitiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d.
new text end
(d) An updated copy of the out-of-home placement plan required under section 260C.212,
subdivision 1, shall be filed with the petition.
(e) The court shall set the date for the permanency review hearing no later than 14 months
after the child has been in placement or within 30 days of the petition filing date when the
child has been in placement 15 of the last 22 months. The court shall serve the petition
together with a notice of hearing by United States mail on the parent, the child age 12 or
older, the child's guardian ad litem, if one has been appointed, the agency, the county
attorney, and counsel for any party.
(f) The court shall conduct the permanency review hearing on the petition no later than
14 months after the date of the voluntary placement agreement, within 30 days of the filing
of the petition when the child has been in placement 15 of the last 22 months, or within 15
days of a motion to terminate jurisdiction and to dismiss an order for foster care under
chapter 260C, as provided in section 260D.09, paragraph (b).
(g) At the permanency review hearing, the court shall:
(1) inquire of the parent if the parent has reviewed the "Petition for Permanency Review
Regarding a Child in Voluntary Foster Care for Treatment," whether the petition is accurate,
and whether the parent agrees to the continued voluntary foster care arrangement as being
in the child's best interests;
(2) inquire of the parent if the parent is satisfied with the agency's reasonable efforts to
finalize the permanent plan for the child, including whether there are services available and
accessible to the parent that might allow the child to safely be with the child's family;
(3) inquire of the parent if the parent consents to the court entering an order that:
(i) approves the responsible agency's reasonable efforts to finalize the permanent plan
for the child, which includes ongoing future planning for the safety, health, and best interests
of the child; and
(ii) approves the responsible agency's determination that there are compelling reasons
why the continued voluntary foster care arrangement is in the child's best interests; and
(4) inquire of the child's guardian ad litem and any other party whether the guardian or
the party agrees that:
(i) the court should approve the responsible agency's reasonable efforts to finalize the
permanent plan for the child, which includes ongoing and future planning for the safety,
health, and best interests of the child; and
(ii) the court should approve of the responsible agency's determination that there are
compelling reasons why the continued voluntary foster care arrangement is in the child's
best interests.
(h) At a permanency review hearing under this section, the court may take the following
actions based on the contents of the sworn petition and the consent of the parent:
(1) approve the agency's compelling reasons that the voluntary foster care arrangement
is in the best interests of the child; and
(2) find that the agency has made reasonable efforts to finalize the permanent plan for
the child.
(i) A child, age 12 or older, may object to the agency's request that the court approve its
compelling reasons for the continued voluntary arrangement and may be heard on the reasons
for the objection. Notwithstanding the child's objection, the court may approve the agency's
compelling reasons and the voluntary arrangement.
(j) If the court does not approve the voluntary arrangement after hearing from the child
or the child's guardian ad litem, the court shall dismiss the petition. In this case, either:
(1) the child must be returned to the care of the parent; or
(2) the agency must file a petition under section 260C.141, asking for appropriate relief
under sections 260C.301 or 260C.503 to 260C.521.
(k) When the court approves the agency's compelling reasons for the child to continue
in voluntary foster care for treatment, and finds that the agency has made reasonable efforts
to finalize a permanent plan for the child, the court shall approve the continued voluntary
foster care arrangement, and continue the matter under the court's jurisdiction for the purposes
of reviewing the child's placement every 12 months while the child is in foster care.
(l) A finding that the court approves the continued voluntary placement means the agency
has continued legal authority to place the child while a voluntary placement agreement
remains in effect. The parent or the agency may terminate a voluntary agreement as provided
in section 260D.10. Termination of a voluntary foster care placement of an Indian child is
governed by section 260.765, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 260D.08, is amended to read:
260D.08 ANNUAL REVIEW.
(a) After the court conducts a permanency review hearing under section 260D.07, the
matter must be returned to the court for further review of the responsible social services
reasonable efforts to finalize the permanent plan for the child and the child's foster care
placement at least every 12 months while the child is in foster care. The court shall give
notice to the parent and child, age 12 or older, and the foster parents of the continued review
requirements under this section at the permanency review hearing.
(b) Every 12 months, the court shall determine whether the agency made reasonable
efforts to finalize the permanency plan for the child, which means the exercise of due
diligence by the agency to:
(1) ensure that the agreement for voluntary foster care is the most appropriate legal
arrangement to meet the child's safety, health, and best interests and to conduct a genuine
examination of whether there is another permanency disposition order under chapter 260C,
including returning the child home, that would better serve the child's need for a stable and
permanent home;
(2) engage and support the parent in continued involvement in planning and decision
making for the needs of the child;
(3) strengthen the child's ties to the parent, relatives, and community;
(4) implement the out-of-home placement plan required under section 260C.212,
subdivision 1, and ensure that the plan requires the provision of appropriate services to
address the physical health, mental health, and educational needs of the child; deleted text begin and
deleted text end
new text begin
(5) submit evidence to the court as specified in section 260C.712 when a child is placed
in a qualified residential treatment program setting as defined in section 260C.007,
subdivision 26d; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end ensure appropriate planning for the child's safe, permanent, and independent
living arrangement after the child's 18th birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 34.
Minnesota Statutes 2020, section 260D.14, is amended to read:
260D.14 SUCCESSFUL TRANSITION TO ADULTHOOD FOR deleted text begin CHILDRENdeleted text end new text begin
YOUTHnew text end IN VOLUNTARY PLACEMENT.
Subdivision 1.
Case planning.
When deleted text begin the childdeleted text end new text begin a youthnew text end is 14 years of age or older, the
responsible social services agency shall ensurenew text begin thatnew text end a deleted text begin childdeleted text end new text begin youthnew text end in foster care under this
chapter is provided with the case plan requirements in section 260C.212, subdivisions 1
and 14.
Subd. 2.
Notification.
The responsible social services agency shall providenew text begin a youth withnew text end
written notice of deleted text begin the right to continued access to services for certain children in foster care
past 18 years of age under section 260C.452, subdivision 3deleted text end new text begin foster care benefits that a youth
who is 18 years of age or older may continue to receive according to section 260C.451,
subdivision 1new text end , and of the right to appeal a denial of social services under section 256.045.
The notice must be provided to the deleted text begin childdeleted text end new text begin youthnew text end six months before the deleted text begin child'sdeleted text end new text begin youth'snew text end 18th
birthday.
Subd. 3.
Administrative or court reviews.
When deleted text begin the childdeleted text end new text begin a youthnew text end is deleted text begin 17deleted text end new text begin 14new text end years of
age or older, the administrative review or court hearing must include a review of the
responsible social services agency's support for the deleted text begin child'sdeleted text end new text begin youth'snew text end successful transition to
adulthood as required in section 260C.452, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 35.
Minnesota Statutes 2020, section 260E.36, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Sex trafficking and sexual exploitation training requirement. new text end
new text begin
As required
by the Child Abuse Prevention and Treatment Act amendments through Public Law 114-22
and to implement Public Law 115-123, all child protection social workers and social services
staff who have responsibility for child protective duties under this chapter or chapter 260C
shall complete training implemented by the commissioner of human services regarding sex
trafficking and sexual exploitation of children and youth.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 36. new text begin DIRECTION TO THE COMMISSIONER; INITIAL IMPLEMENTATION
OF COURT-APPOINTED COUNSEL IN CHILD PROTECTION PROCEEDINGS.
new text end
new text begin
The commissioner of human services shall collect data from counties regarding
court-appointed counsel under Minnesota Statutes, section 260C.163, subdivision 3, including
but not limited to:
new text end
new text begin
(1) data documenting the presence of court-appointed counsel for qualifying parents,
guardians, or custodians at each emergency protective hearing;
new text end
new text begin
(2) total annual court-appointed parent representation expenditures for each county; and
new text end
new text begin
(3) additional demographic information that would assist counties in obtaining title IV-E
reimbursement.
new text end
new text begin
The commissioner must complete and submit a report on the data in this section and efforts
to assist counties with implementation of required court-appointment of counsel under
Minnesota Statutes, section 260C.163, subdivision 3, to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services and judiciary
policy and finance on or before July 1, 2022.
new text end
Sec. 37. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
AFTERCARE SUPPORTS.
new text end
new text begin
The commissioner of human services shall consult with stakeholders to develop policies
regarding aftercare supports for the transition of a child from a qualified residential treatment
program as defined in Minnesota Statutes, section 260C.007, subdivision 26d, to reunification
with the child's parent or legal guardian, including potential placement in a less restrictive
setting prior to reunification that aligns with the child's permanency plan and person-centered
support plan, when applicable. The policies must be consistent with Minnesota Rules, part
2960.0190, and Minnesota Statutes, section 245A.25, subdivision 4, paragraph (i), and
address the coordination of the qualified residential treatment program discharge planning
and aftercare supports where needed, the county social services case plan, and services from
community-based providers, to maintain the child's progress with behavioral health goals
as defined in the child's treatment plan. The commissioner must complete development of
the policy guidance by December 31, 2022.
new text end
Sec. 38. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; COSTS
TO STATE, COUNTIES, AND PROVIDERS FOR IMPLEMENTATION OF THE
FAMILY FIRST PRESERVATION SERVICES ACT.
new text end
new text begin
The commissioner of human services shall contract with an appropriate vendor to study
the increased costs incurred by the state, counties, and providers to implement the
requirements of the federal Family First Preservation Services Act in Minnesota. Identified
costs should include, but are not limited to, reductions in Title IV-E payments to lead
agencies; additional staff needs for the state, lead agencies, and providers; implementation
of the federal Qualified Residential Treatment Program placement requirements and new
prevention services by the state, lead agencies, and providers; costs incurred by residential
facility providers to become certified as a qualified residential treatment program and to
maintain certification standards; and other costs that are directly or indirectly related to
implementation of the federal Family First Prevention Services Act. The study should also
include known or estimates of increased federal funding that the state or lead agencies could
receive through expanded Title IV-E reimbursements. The commissioner shall provide a
report on these costs to the chairs and ranking minority members of the legislative committees
with jurisdiction over human services by January 15, 2024.
new text end
Sec. 39. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
OMBUDSPERSON FOR FAMILIES REORGANIZATION STUDY.
new text end
new text begin
The commissioner of human services shall evaluate different options to reorganize the
Office of Ombudsperson for Families under Minnesota Statutes, section 257.0755, into at
least two separate offices, and develop and recommend a corresponding legislative proposal
for introduction in the 2022 regular legislative session. The proposal shall also include any
recommended reorganization of the community-specific boards under Minnesota Statutes,
section 257.0768. The commissioner shall submit a copy of the legislative proposal and a
letter describing the reasons for recommending the proposal, the analysis that led to the
recommended proposal, other reorganization options that were considered, and any fiscal
impacts or considerations, to the chairs and ranking minority members of the legislative
committees with jurisdiction over the Office of Ombudsperson for Families.
new text end
Sec. 40. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 245.4871, subdivision 32a,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
ARTICLE 12
CHILD PROTECTION POLICY
Section 1.
Minnesota Statutes 2020, section 256.741, is amended by adding a subdivision
to read:
new text begin Subd. 12a. new text end
new text begin Appeals of good cause determinations. new text end
new text begin
According to section 256.045, an
individual may appeal the determination or redetermination of good cause under this section.
To initiate an appeal of a good cause determination or redetermination, the individual must
make a request for a state agency hearing in writing within 30 calendar days after the date
that a notice of denial for good cause is mailed or otherwise transmitted to the individual.
Until a human services judge issues a decision under section 256.0451, subdivision 22, the
child support agency shall cease all child support enforcement efforts and shall not report
the individual's noncooperation to public assistance agencies.
new text end
Sec. 2.
Minnesota Statutes 2020, section 256.741, is amended by adding a subdivision to
read:
new text begin Subd. 12b. new text end
new text begin Reporting noncooperation. new text end
new text begin
The public authority may issue a notice of the
individual's noncooperation to each public assistance agency providing public assistance
to the individual if:
new text end
new text begin
(1) 30 calendar days have passed since the later of the initial county denial or the date
of the denial following the state agency hearing; or
new text end
new text begin
(2) the individual has not cooperated with the child support agency as required in
subdivision 5.
new text end
Sec. 3.
Minnesota Statutes 2020, section 260E.06, subdivision 1, is amended to read:
Subdivision 1.
Mandatory reporters.
(a) A person who knows or has reason to believe
a child is being maltreated, as defined in section 260E.03, or has been maltreated within
the preceding three years shall immediately report the information to the local welfare
agency, agency responsible for assessing or investigating the report, police department,
county sheriff, tribal social services agency, or tribal police department if the person is:
(1) a professional or professional's delegate who is engaged in the practice of the healing
arts, social services, hospital administration, psychological or psychiatric treatment, child
care, education, correctional supervision, probation and correctional services, or law
enforcement; deleted text begin or
deleted text end
(2) employed as a member of the clergy and received the information while engaged in
ministerial duties, provided that a member of the clergy is not required by this subdivision
to report information that is otherwise privileged under section 595.02, subdivision 1,
paragraph (c)new text begin ; or
new text end
new text begin (3) 18 years of age or older and employed as an athletic director, coach, or assistant
coach for a public or private youth recreation program. This clause does not apply to
volunteersnew text end .
(b) "Practice of social services" for the purposes of this subdivision includes but is not
limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.
Sec. 4.
Minnesota Statutes 2020, section 260E.06, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Training. new text end
new text begin
The local welfare agency must offer training to a person required to
make a report under this section. The training may be offered online or in person and must
provide an explanation of the legal obligations of a mandatory reporter, consequences for
failure to report, and instruction on how to detect and report suspected maltreatment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall deleted text begin conduct adeleted text end new text begin havenew text end face-to-face contact with the child reported to be maltreated
and with the child's primary caregiver sufficient to complete a safety assessment and ensure
the immediate safety of the child.
(b) The face-to-face contact with the child and primary caregiver shall occur immediately
if sexual abuse or substantial child endangerment is alleged and within five calendar days
for all other reports. If the alleged offender was not already interviewed as the primary
caregiver, the local welfare agency shall also conduct a face-to-face interview with the
alleged offender in the early stages of the assessment or investigation.new text begin Face-to-face contact
with the child and primary caregiver in response to a report alleging sexual abuse or
substantial child endangerment may be postponed for no more than five calendar days if
the child is residing in a location that is confirmed to restrict contact with the alleged offender
as established in guidelines issued by the commissioner, or if the local welfare agency is
pursuing a court order for the child's caregiver to produce the child for questioning under
section 260E.22, subdivision 5.
new text end
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statement. The
alleged offender may submit supporting documentation relevant to the assessment or
investigation.
Sec. 6.
Minnesota Statutes 2020, section 518.157, subdivision 1, is amended to read:
Subdivision 1.
Implementation; administration.
new text begin (a) new text end By January 1, 1998, the chief
judge of each judicial district or a designee shall implement one or more parent education
programs within the judicial district for the purpose of educating parents about the impact
that divorce, the restructuring of families, and judicial proceedings have upon children and
families; methods for preventing parenting time conflicts; and dispute resolution options.
The chief judge of each judicial district or a designee may require that children attend a
separate education program designed to deal with the impact of divorce upon children as
part of the parent education program. Each parent education program must enable persons
to have timely and reasonable access to education sessions.
new text begin
(b) The chief judge of each judicial district shall ensure that the judicial district's website
includes information on the parent education program or programs required under this
section.
new text end
Sec. 7.
Minnesota Statutes 2020, section 518.157, subdivision 3, is amended to read:
Subd. 3.
Attendance.
new text begin (a) new text end In a proceeding under this chapter where new text begin the parties have not
agreed to new text end custody or new text begin a new text end parenting time deleted text begin is contesteddeleted text end new text begin schedulenew text end , new text begin the court shall ordernew text end the parents
of a minor child deleted text begin shall attenddeleted text end new text begin to attend or take onlinenew text end a minimum of eight hours in an
orientation and education program that meets the minimum standards promulgated by the
Minnesota Supreme Court.
new text begin (b)new text end In all other proceedings involving custody, support, or parenting time the court may
order the parents of a minor child to attend a parent education program.
new text begin (c)new text end The program shall provide the court with names of persons who fail to attend the
parent education program as ordered by the court. Persons who are separated or contemplating
involvement in a dissolution, paternity, custody, or parenting time proceeding may attend
a parent education program without a court order.
new text begin (d)new text end Unless otherwise ordered by the court, participation in a parent education program
must begin new text begin before an initial case management conference and new text end within 30 days after the first
filing with the court or as soon as practicable after that time based on the reasonable
availability of classes for the program for the parent. Parent education programs must offer
an opportunity to participate at all phases of a pending or postdecree proceeding.
new text begin (e)new text end Upon request of a party and a showing of good cause, the court may excuse the party
from attending the program. If past or present domestic abuse, as defined in chapter 518B,
is alleged, the court shall not require the parties to attend the same parent education sessions
and shall enter an order setting forth the manner in which the parties may safely participate
in the program.
new text begin
(f) Before an initial case management conference for a proceeding under this chapter
where the parties have not agreed to custody or parenting time, the court shall notify the
parties of their option to resolve disagreements, including the development of a parenting
plan, through the use of private mediation.
new text end
Sec. 8.
Minnesota Statutes 2020, section 518.68, subdivision 2, is amended to read:
Subd. 2.
Contents.
The required notices must be substantially as follows:
IMPORTANT NOTICE
1. PAYMENTS TO PUBLIC AGENCY
According to Minnesota Statutes, section 518A.50, payments ordered for maintenance
and support must be paid to the public agency responsible for child support enforcement
as long as the person entitled to receive the payments is receiving or has applied for
public assistance or has applied for support and maintenance collection services. MAIL
PAYMENTS TO:
2. DEPRIVING ANOTHER OF CUSTODIAL OR PARENTAL RIGHTS -- A FELONY
A person may be charged with a felony who conceals a minor child or takes, obtains,
retains, or fails to return a minor child from or to the child's parent (or person with
custodial or visitation rights), according to Minnesota Statutes, section 609.26. A copy
of that section is available from any district court clerk.
3. NONSUPPORT OF A SPOUSE OR CHILD -- CRIMINAL PENALTIES
A person who fails to pay court-ordered child support or maintenance may be charged
with a crime, which may include misdemeanor, gross misdemeanor, or felony charges,
according to Minnesota Statutes, section 609.375. A copy of that section is available
from any district court clerk.
4. RULES OF SUPPORT, MAINTENANCE, PARENTING TIME
(a) Payment of support or spousal maintenance is to be as ordered, and the giving of
gifts or making purchases of food, clothing, and the like will not fulfill the obligation.
(b) Payment of support must be made as it becomes due, and failure to secure or denial
of parenting time is NOT an excuse for nonpayment, but the aggrieved party must seek
relief through a proper motion filed with the court.
(c) Nonpayment of support is not grounds to deny parenting time. The party entitled to
receive support may apply for support and collection services, file a contempt motion,
or obtain a judgment as provided in Minnesota Statutes, section 548.091.
(d) The payment of support or spousal maintenance takes priority over payment of debts
and other obligations.
(e) A party who accepts additional obligations of support does so with the full knowledge
of the party's prior obligation under this proceeding.
(f) Child support or maintenance is based on annual income, and it is the responsibility
of a person with seasonal employment to budget income so that payments are made
throughout the year as ordered.
(g) Reasonable parenting time guidelines are contained in Appendix B, which is available
from the court administrator.
(h) The nonpayment of support may be enforced through the denial of student grants;
interception of state and federal tax refunds; suspension of driver's, recreational, and
occupational licenses; referral to the department of revenue or private collection agencies;
seizure of assets, including bank accounts and other assets held by financial institutions;
reporting to credit bureaus; deleted text begin interest charging,deleted text end income withholdingdeleted text begin ,deleted text end and contempt
proceedings; and other enforcement methods allowed by law.
(i) The public authority may suspend or resume collection of the amount allocated for
child care expenses if the conditions of Minnesota Statutes, section 518A.40, subdivision
4, are met.
(j) The public authority may remove or resume a medical support offset if the conditions
of Minnesota Statutes, section 518A.41, subdivision 16, are met.
deleted text begin
(k) The public authority may suspend or resume interest charging on child support
judgments if the conditions of Minnesota Statutes, section 548.091, subdivision 1a, are met.
deleted text end
5. MODIFYING CHILD SUPPORT
If either the obligor or obligee is laid off from employment or receives a pay reduction,
child support may be modified, increased, or decreased. Any modification will only take
effect when it is ordered by the court, and will only relate back to the time that a motion
is filed. Either the obligor or obligee may file a motion to modify child support, and may
request the public agency for help. UNTIL A MOTION IS FILED, THE CHILD
SUPPORT OBLIGATION WILL CONTINUE AT THE CURRENT LEVEL. THE
COURT IS NOT PERMITTED TO REDUCE SUPPORT RETROACTIVELY.
6. PARENTAL RIGHTS FROM MINNESOTA STATUTES, SECTION 518.17,
SUBDIVISION 3
Unless otherwise provided by the Court:
(a) Each party has the right of access to, and to receive copies of, school, medical, dental,
religious training, and other important records and information about the minor children.
Each party has the right of access to information regarding health or dental insurance
available to the minor children. Presentation of a copy of this order to the custodian of
a record or other information about the minor children constitutes sufficient authorization
for the release of the record or information to the requesting party.
(b) Each party shall keep the other informed as to the name and address of the school
of attendance of the minor children. Each party has the right to be informed by school
officials about the children's welfare, educational progress and status, and to attend
school and parent teacher conferences. The school is not required to hold a separate
conference for each party.
(c) In case of an accident or serious illness of a minor child, each party shall notify the
other party of the accident or illness, and the name of the health care provider and the
place of treatment.
(d) Each party has the right of reasonable access and telephone contact with the minor
children.
7. WAGE AND INCOME DEDUCTION OF SUPPORT AND MAINTENANCE
Child support and/or spousal maintenance may be withheld from income, with or without
notice to the person obligated to pay, when the conditions of Minnesota Statutes, section
518A.53 have been met. A copy of those sections is available from any district court
clerk.
8. CHANGE OF ADDRESS OR RESIDENCE
Unless otherwise ordered, each party shall notify the other party, the court, and the public
authority responsible for collection, if applicable, of the following information within
ten days of any change: the residential and mailing address, telephone number, driver's
license number, Social Security number, and name, address, and telephone number of
the employer.
9. COST OF LIVING INCREASE OF SUPPORT AND MAINTENANCE
Basic support and/or spousal maintenance may be adjusted every two years based upon
a change in the cost of living (using Department of Labor Consumer Price Index ..........,
unless otherwise specified in this order) when the conditions of Minnesota Statutes,
section 518A.75, are met. Cost of living increases are compounded. A copy of Minnesota
Statutes, section 518A.75, and forms necessary to request or contest a cost of living
increase are available from any district court clerk.
10. JUDGMENTS FOR UNPAID SUPPORT
If a person fails to make a child support payment, the payment owed becomes a judgment
against the person responsible to make the payment by operation of law on or after the
date the payment is due, and the person entitled to receive the payment or the public
agency may obtain entry and docketing of the judgment WITHOUT NOTICE to the
person responsible to make the payment under Minnesota Statutes, section 548.091.
deleted text begin Interest begins to accrue on a payment or installment of child support whenever the
unpaid amount due is greater than the current support due, according to Minnesota
Statutes, section 548.091, subdivision 1a.
deleted text end
11. JUDGMENTS FOR UNPAID MAINTENANCE
new text begin (a) new text end A judgment for unpaid spousal maintenance may be entered when the conditions of
Minnesota Statutes, section 548.091, are met. A copy of that section is available from
any district court clerk.
new text begin
(b) The public authority is not responsible for calculating interest on any judgment for
unpaid spousal maintenance. When providing services in IV-D cases, as defined in
Minnesota Statutes, section 518A.26, subdivision 10, the public authority will only
collect interest on spousal maintenance if spousal maintenance is reduced to a sum
certain judgment.
new text end
12. ATTORNEY FEES AND COLLECTION COSTS FOR ENFORCEMENT OF CHILD
SUPPORT
A judgment for attorney fees and other collection costs incurred in enforcing a child
support order will be entered against the person responsible to pay support when the
conditions of Minnesota Statutes, section 518A.735, are met. A copy of Minnesota
Statutes, sections 518.14 and 518A.735 and forms necessary to request or contest these
attorney fees and collection costs are available from any district court clerk.
13. PARENTING TIME EXPEDITOR PROCESS
On request of either party or on its own motion, the court may appoint a parenting time
expeditor to resolve parenting time disputes under Minnesota Statutes, section 518.1751.
A copy of that section and a description of the expeditor process is available from any
district court clerk.
14. PARENTING TIME REMEDIES AND PENALTIES
Remedies and penalties for the wrongful denial of parenting time are available under
Minnesota Statutes, section 518.175, subdivision 6. These include compensatory parenting
time; civil penalties; bond requirements; contempt; and reversal of custody. A copy of
that subdivision and forms for requesting relief are available from any district court
clerk.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 9.
Minnesota Statutes 2020, section 518A.29, is amended to read:
518A.29 CALCULATION OF GROSS INCOME.
(a) Subject to the exclusions and deductions in this section, gross income includes any
form of periodic payment to an individual, including, but not limited to, salaries, wages,
commissions, self-employment income under section 518A.30, workers' compensation,
unemployment benefits, annuity payments, military and naval retirement, pension and
disability payments, spousal maintenance received under a previous order or the current
proceeding, Social Security or veterans benefits provided for a joint child under section
518A.31, and potential income under section 518A.32. Salaries, wages, commissions, or
other compensation paid by third parties shall be based upon gross income before
participation in an employer-sponsored benefit plan that allows an employee to pay for a
benefit or expense using pretax dollars, such as flexible spending plans and health savings
accounts. No deductions shall be allowed for contributions to pensions, 401-K, IRA, or
other retirement benefits.
(b) Gross income does not include compensation received by a party for employment
in excess of a 40-hour work week, provided that:
(1) child support is ordered in an amount at least equal to the guideline amount based
on gross income not excluded under this clause; and
(2) the party demonstrates, and the court finds, that:
(i) the excess employment began after the filing of the petition for dissolution or legal
separation or a petition related to custody, parenting time, or support;
(ii) the excess employment reflects an increase in the work schedule or hours worked
over that of the two years immediately preceding the filing of the petition;
(iii) the excess employment is voluntary and not a condition of employment;
(iv) the excess employment is in the nature of additional, part-time or overtime
employment compensable by the hour or fraction of an hour; and
(v) the party's compensation structure has not been changed for the purpose of affecting
a support or maintenance obligation.
(c) Expense reimbursements or in-kind payments received by a parent in the course of
employment, self-employment, or operation of a business shall be counted as income if
they reduce personal living expenses.
(d) Gross income may be calculated on either an annual or monthly basis. Weekly income
shall be translated to monthly income by multiplying the weekly income by 4.33.
(e) Gross income does not include a child support payment received by a party. It is a
rebuttable presumption that adoption assistance payments, Northstar kinship assistance
payments, and foster care subsidies are not gross income.
(f) Gross income does not include the income of the obligor's spouse and the obligee's
spouse.
(g) deleted text begin Child support ordeleted text end Spousal maintenance payments ordered by a court for a deleted text begin nonjoint
child ordeleted text end former spouse or ordered payable to the other party as part of the current proceeding
are deducted from other periodic payments received by a party for purposes of determining
gross income.
(h) Gross income does not include public assistance benefits received under section
256.741 or other forms of public assistance based on need.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 10.
Minnesota Statutes 2020, section 518A.33, is amended to read:
518A.33 DEDUCTION FROM INCOME FOR NONJOINT CHILDREN.
(a) When either or both parents are legally responsible for a nonjoint child, a deduction
for this obligation shall be calculated under this section deleted text begin if:deleted text end new text begin .
new text end
deleted text begin
(1) the nonjoint child primarily resides in the parent's household; and
deleted text end
deleted text begin
(2) the parent is not obligated to pay basic child support for the nonjoint child to the
other parent or a legal custodian of the child under an existing child support order.
deleted text end
(b) deleted text begin The court shall use the guidelines under section 518A.35 to determine the basic child
support obligation for the nonjoint child or children by using the gross income of the parent
for whom the deduction is being calculated and the number of nonjoint children primarily
residing in the parent's household. If the number of nonjoint children to be used for the
determination is greater than two, the determination must be made using the number two
instead of the greater number.deleted text end new text begin Court-ordered child support for a nonjoint child shall be
deducted from the payor's gross income.
new text end
(c) deleted text begin The deduction for nonjoint children is 50 percent of the guideline amount determined
under paragraph (b).deleted text end new text begin When a parent is legally responsible for a nonjoint child and the parent
is not obligated to pay basic child support for the nonjoint child to the other parent or a legal
custodian under an existing child support order, a deduction shall be calculated. The court
shall use the basic support guideline table under section 518A.35 to determine this deduction
by using the gross income of the parent for whom the deduction is being calculated, minus
any deduction under paragraph (b) and the number of eligible nonjoint children, up to six
children. The deduction for nonjoint children is 75 percent of the guideline amount
determined under this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 518A.35, subdivision 1, is amended to read:
Subdivision 1.
Determination of support obligation.
(a) The guideline in this section
is a rebuttable presumption and shall be used in any judicial or administrative proceeding
to establish or modify a support obligation under this chapter.
(b) The basic child support obligation shall be determined by referencing the guideline
for the appropriate number of joint children and the combined parental income for
determining child support of the parents.
(c) If a child is not in the custody of either parent and a support order is sought against
one or both parents, the basic child support obligation shall be determined by referencing
the guideline for the appropriate number of joint children, and the parent's individual parental
income for determining child support, not the combined parental incomes for determining
child support of the parents. Unless a parent has court-ordered parenting time, the parenting
expense adjustment formula under section 518A.34 must not be applied.
(d) If a child is deleted text begin in custody of either parentdeleted text end new text begin not residing with the parent that has
court-ordered or statutory custodynew text end and a support order is sought deleted text begin by the public authoritydeleted text end
under section 256.87new text begin against one or both parentsnew text end , deleted text begin unless the parent against whom the support
order is sought has court-ordered parenting time,deleted text end the new text begin basicnew text end support obligation must be
determined by referencing the guideline for the appropriate number of joint children and
the parent's individual income without application of the parenting expense adjustment
formula under section 518A.34.
(e) For combined parental incomes for determining child support exceeding deleted text begin $15,000deleted text end new text begin
$20,000new text end per month, the presumed basic child support obligations shall be as for parents
with combined parental income for determining child support of deleted text begin $15,000deleted text end new text begin $20,000new text end per month.
A basic child support obligation in excess of this level may be demonstrated for those reasons
set forth in section 518A.43.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2020, section 518A.35, subdivision 2, is amended to read:
Subd. 2.
Basic support; guideline.
Unless otherwise agreed to by the parents and
approved by the court, when establishing basic support, the court must order that basic
support be divided between the parents based on their proportionate share of the parents'
combined monthly parental income for determining child support (PICS). Basic support
must be computed using the following guideline:
| Combined Parental |
Number of Children |
|||||
| Income for Determining Child Support |
One |
Two |
Three |
Four |
Five |
Six |
| $0- deleted text begin $799 deleted text end new text begin $1,399 new text end |
$50 |
deleted text begin
$50 deleted text end new text begin $60 new text end |
deleted text begin
$75 deleted text end new text begin $70 new text end |
deleted text begin
$75 deleted text end new text begin $80 new text end |
deleted text begin
$100 deleted text end new text begin $90 new text end |
$100 |
|
deleted text begin
800- 899 deleted text end |
deleted text begin
80 deleted text end |
deleted text begin
129 deleted text end |
deleted text begin
149 deleted text end |
deleted text begin
173 deleted text end |
deleted text begin
201 deleted text end |
deleted text begin
233 deleted text end |
|
deleted text begin
900- 999 deleted text end |
deleted text begin
90 deleted text end |
deleted text begin
145 deleted text end |
deleted text begin
167 deleted text end |
deleted text begin
194 deleted text end |
deleted text begin
226 deleted text end |
deleted text begin
262 deleted text end |
|
deleted text begin
1,000- 1,099 deleted text end |
deleted text begin
116 deleted text end |
deleted text begin
161 deleted text end |
deleted text begin
186 deleted text end |
deleted text begin
216 deleted text end |
deleted text begin
251 deleted text end |
deleted text begin
291 deleted text end |
|
deleted text begin
1,100- 1,199 deleted text end |
deleted text begin
145 deleted text end |
deleted text begin
205 deleted text end |
deleted text begin
237 deleted text end |
deleted text begin
275 deleted text end |
deleted text begin
320 deleted text end |
deleted text begin
370 deleted text end |
|
deleted text begin
1,200- 1,299 deleted text end |
deleted text begin
177 deleted text end |
deleted text begin
254 deleted text end |
deleted text begin
294 deleted text end |
deleted text begin
341 deleted text end |
deleted text begin
396 deleted text end |
deleted text begin
459 deleted text end |
|
deleted text begin
1,300- 1,399 deleted text end |
deleted text begin
212 deleted text end |
deleted text begin
309 deleted text end |
deleted text begin
356 deleted text end |
deleted text begin
414 deleted text end |
deleted text begin
480 deleted text end |
deleted text begin
557 deleted text end |
| 1,400- 1,499 |
deleted text begin
251 deleted text end new text begin 60 new text end |
deleted text begin
368 deleted text end new text begin 75 new text end |
deleted text begin
425 deleted text end new text begin 85 new text end |
deleted text begin
493 deleted text end new text begin 100 new text end |
deleted text begin
573 deleted text end new text begin 110 new text end |
deleted text begin
664 deleted text end new text begin 120 new text end |
| 1,500- 1,599 |
deleted text begin
292 deleted text end new text begin 75 new text end |
deleted text begin
433 deleted text end new text begin 90 new text end |
deleted text begin
500 deleted text end new text begin 105 new text end |
deleted text begin
580 deleted text end new text begin 125 new text end |
deleted text begin
673 deleted text end new text begin 135 new text end |
deleted text begin
780 deleted text end new text begin 145 new text end |
| 1,600- 1,699 |
deleted text begin
337 deleted text end new text begin 90 new text end |
deleted text begin
502 deleted text end new text begin 110 new text end |
deleted text begin
580 deleted text end new text begin 130 new text end |
deleted text begin
673 deleted text end new text begin 150 new text end |
deleted text begin
781 deleted text end new text begin 160 new text end |
deleted text begin
905 deleted text end new text begin 170 new text end |
| 1,700- 1,799 |
deleted text begin
385 deleted text end new text begin 110 new text end |
deleted text begin
577 deleted text end new text begin 130 new text end |
deleted text begin
666 deleted text end new text begin 155 new text end |
deleted text begin
773 deleted text end new text begin 175 new text end |
deleted text begin
897 deleted text end new text begin 185 new text end |
deleted text begin
1,040 deleted text end new text begin 195 new text end |
| 1,800- 1,899 |
deleted text begin
436 deleted text end new text begin 130 new text end |
deleted text begin
657 deleted text end new text begin 150 new text end |
deleted text begin
758 deleted text end new text begin 180 new text end |
deleted text begin
880 deleted text end new text begin 200 new text end |
deleted text begin
1,021 deleted text end new text begin 210 new text end |
deleted text begin
1,183 deleted text end new text begin 220 new text end |
| 1,900- 1,999 |
deleted text begin
490 deleted text end new text begin 150 new text end |
deleted text begin
742 deleted text end new text begin 175 new text end |
deleted text begin
856 deleted text end new text begin 205 new text end |
deleted text begin
994 deleted text end new text begin 235 new text end |
deleted text begin
1,152 deleted text end new text begin 245 new text end |
deleted text begin
1,336 deleted text end new text begin 255 new text end |
| 2,000- 2,099 |
deleted text begin
516 deleted text end new text begin 170 new text end |
deleted text begin
832 deleted text end new text begin 200 new text end |
deleted text begin
960 deleted text end new text begin 235 new text end |
deleted text begin
1,114 deleted text end new text begin 270 new text end |
deleted text begin
1,292 deleted text end new text begin 285 new text end |
deleted text begin
1,498 deleted text end new text begin 295 new text end |
| 2,100- 2,199 |
deleted text begin
528 deleted text end new text begin 190 new text end |
deleted text begin
851 deleted text end new text begin 225 new text end |
deleted text begin
981 deleted text end new text begin 265 new text end |
deleted text begin
1,139 deleted text end new text begin 305 new text end |
deleted text begin
1,320 deleted text end new text begin 325 new text end |
deleted text begin
1,531 deleted text end new text begin 335 new text end |
| 2,200- 2,299 |
deleted text begin
538 deleted text end new text begin 215 new text end |
deleted text begin
867 deleted text end new text begin 255 new text end |
deleted text begin
1,000 deleted text end new text begin 300 new text end |
deleted text begin
1,160 deleted text end new text begin 345 new text end |
deleted text begin
1,346 deleted text end new text begin 367 new text end |
deleted text begin
1,561 deleted text end new text begin 379 new text end |
| 2,300- 2,399 |
deleted text begin
546 deleted text end new text begin 240 new text end |
deleted text begin
881 deleted text end new text begin 285 new text end |
deleted text begin
1,016 deleted text end new text begin 335 new text end |
deleted text begin
1,179 deleted text end new text begin 385 new text end |
deleted text begin
1,367 deleted text end new text begin 409 new text end |
deleted text begin
1,586 deleted text end new text begin 423 new text end |
| 2,400- 2,499 |
deleted text begin
554 deleted text end new text begin 265 new text end |
deleted text begin
893 deleted text end new text begin 315 new text end |
deleted text begin
1,029 deleted text end new text begin 370 new text end |
deleted text begin
1,195 deleted text end new text begin 425 new text end |
deleted text begin
1,385 deleted text end new text begin 451 new text end |
deleted text begin
1,608 deleted text end new text begin 467 new text end |
| 2,500- 2,599 |
deleted text begin
560 deleted text end new text begin 290 new text end |
deleted text begin
903 deleted text end new text begin 350 new text end |
deleted text begin
1,040 deleted text end new text begin 408 new text end |
deleted text begin
1,208 deleted text end new text begin 465 new text end |
deleted text begin
1,400 deleted text end new text begin 493 new text end |
deleted text begin
1,625 deleted text end new text begin 511 new text end |
| 2,600- 2,699 |
deleted text begin
570 deleted text end new text begin 315 new text end |
deleted text begin
920 deleted text end new text begin 385 new text end |
deleted text begin
1,060 deleted text end new text begin 446 new text end |
deleted text begin
1,230 deleted text end new text begin 505 new text end |
deleted text begin
1,426 deleted text end new text begin 535 new text end |
deleted text begin
1,655 deleted text end new text begin 555 new text end |
| 2,700- 2,799 |
deleted text begin
580 deleted text end new text begin 340 new text end |
deleted text begin
936 deleted text end new text begin 420 new text end |
deleted text begin
1,078 deleted text end new text begin 484 new text end |
deleted text begin
1,251 deleted text end new text begin 545 new text end |
deleted text begin
1,450 deleted text end new text begin 577 new text end |
deleted text begin
1,683 deleted text end new text begin 599 new text end |
| 2,800- 2,899 |
deleted text begin
589 deleted text end new text begin 365 new text end |
deleted text begin
950 deleted text end new text begin 455 new text end |
deleted text begin
1,094 deleted text end new text begin 522 new text end |
deleted text begin
1,270 deleted text end new text begin 585 new text end |
deleted text begin
1,472 deleted text end new text begin 619 new text end |
deleted text begin
1,707 deleted text end new text begin 643 new text end |
| 2,900- 2,999 |
deleted text begin
596 deleted text end new text begin 390 new text end |
deleted text begin
963 deleted text end new text begin 490 new text end |
deleted text begin
1,109 deleted text end new text begin 560 new text end |
deleted text begin
1,287 deleted text end new text begin 625 new text end |
deleted text begin
1,492 deleted text end new text begin 661 new text end |
deleted text begin
1,730 deleted text end new text begin 687 new text end |
| 3,000- 3,099 |
deleted text begin
603 deleted text end new text begin 415 new text end |
deleted text begin
975 deleted text end new text begin 525 new text end |
deleted text begin
1,122 deleted text end new text begin 598 new text end |
deleted text begin
1,302 deleted text end new text begin 665 new text end |
deleted text begin
1,509 deleted text end new text begin 703 new text end |
deleted text begin
1,749 deleted text end new text begin 731 new text end |
| 3,100- 3,199 |
deleted text begin
613 deleted text end new text begin 440 new text end |
deleted text begin
991 deleted text end new text begin 560 new text end |
deleted text begin
1,141 deleted text end new text begin 636 new text end |
deleted text begin
1,324 deleted text end new text begin 705 new text end |
deleted text begin
1,535 deleted text end new text begin 745 new text end |
deleted text begin
1,779 deleted text end new text begin 775 new text end |
| 3,200- 3,299 |
deleted text begin
623 deleted text end new text begin 465 new text end |
deleted text begin
1,007 deleted text end new text begin 595 new text end |
deleted text begin
1,158 deleted text end new text begin 674 new text end |
deleted text begin
1,344 deleted text end new text begin 745 new text end |
deleted text begin
1,558 deleted text end new text begin 787 new text end |
deleted text begin
1,807 deleted text end new text begin 819 new text end |
| 3,300- 3,399 |
deleted text begin
636 deleted text end new text begin 485 new text end |
deleted text begin
1,021 deleted text end new text begin 630 new text end |
deleted text begin
1,175 deleted text end new text begin 712 new text end |
deleted text begin
1,363 deleted text end new text begin 785 new text end |
deleted text begin
1,581 deleted text end new text begin 829 new text end |
deleted text begin
1,833 deleted text end new text begin 863 new text end |
| 3,400- 3,499 |
deleted text begin
650 deleted text end new text begin 505 new text end |
deleted text begin
1,034 deleted text end new text begin 665 new text end |
deleted text begin
1,190 deleted text end new text begin 750 new text end |
deleted text begin
1,380 deleted text end new text begin 825 new text end |
deleted text begin
1,601 deleted text end new text begin 871 new text end |
deleted text begin
1,857 deleted text end new text begin 907 new text end |
| 3,500- 3,599 |
deleted text begin
664 deleted text end new text begin 525 new text end |
deleted text begin
1,047 deleted text end new text begin 695 new text end |
deleted text begin
1,204 deleted text end new text begin 784 new text end |
deleted text begin
1,397 deleted text end new text begin 861 new text end |
deleted text begin
1,621 deleted text end new text begin 910 new text end |
deleted text begin
1,880 deleted text end new text begin 948 new text end |
| 3,600- 3,699 |
deleted text begin
677 deleted text end new text begin 545 new text end |
deleted text begin
1,062 deleted text end new text begin 725 new text end |
deleted text begin
1,223 deleted text end new text begin 818 new text end |
deleted text begin
1,418 deleted text end new text begin 897 new text end |
deleted text begin
1,646 deleted text end new text begin 949 new text end |
deleted text begin
1,909 deleted text end new text begin 989 new text end |
| 3,700- 3,799 |
deleted text begin
691 deleted text end new text begin 565 new text end |
deleted text begin
1,077 deleted text end new text begin 755 new text end |
deleted text begin
1,240 deleted text end new text begin 852 new text end |
deleted text begin
1,439 deleted text end new text begin 933 new text end |
deleted text begin
1,670 deleted text end new text begin 988 new text end |
deleted text begin
1,937 deleted text end new text begin 1,030 new text end |
| 3,800- 3,899 |
deleted text begin
705 deleted text end new text begin 585 new text end |
deleted text begin
1,081 deleted text end new text begin 785 new text end |
deleted text begin
1,257 deleted text end new text begin 886 new text end |
deleted text begin
1,459 deleted text end new text begin 969 new text end |
deleted text begin
1,693 deleted text end new text begin 1,027 new text end |
deleted text begin
1,963 deleted text end new text begin 1,071 new text end |
| 3,900- 3,999 |
deleted text begin
719 deleted text end new text begin 605 new text end |
deleted text begin
1,104 deleted text end new text begin 815 new text end |
deleted text begin
1,273 deleted text end new text begin 920 new text end |
deleted text begin
1,478 deleted text end new text begin 1,005 new text end |
deleted text begin
1,715 deleted text end new text begin 1,065 new text end |
deleted text begin
1,988 deleted text end new text begin 1,111 new text end |
| 4,000- 4,099 |
deleted text begin
732 deleted text end new text begin 625 new text end |
deleted text begin
1,116 deleted text end new text begin 845 new text end |
deleted text begin
1,288 deleted text end new text begin 954 new text end |
deleted text begin
1,496 deleted text end new text begin 1,041 new text end |
deleted text begin
1,736 deleted text end new text begin 1,103 new text end |
deleted text begin
2,012 deleted text end new text begin 1,151 new text end |
| 4,100- 4,199 |
deleted text begin
746 deleted text end new text begin 645 new text end |
deleted text begin
1,132 deleted text end new text begin 875 new text end |
deleted text begin
1,305 deleted text end new text begin 988 new text end |
deleted text begin
1,516 deleted text end new text begin 1,077 new text end |
deleted text begin
1,759 deleted text end new text begin 1,142 new text end |
deleted text begin
2,039 deleted text end new text begin 1,191 new text end |
| 4,200- 4,299 |
deleted text begin
760 deleted text end new text begin 665 new text end |
deleted text begin
1,147 deleted text end new text begin 905 new text end |
deleted text begin
1,322 deleted text end new text begin 1,022 new text end |
deleted text begin
1,536 deleted text end new text begin 1,113 new text end |
deleted text begin
1,781 deleted text end new text begin 1,180 new text end |
deleted text begin
2,064 deleted text end new text begin 1,230 new text end |
| 4,300- 4,399 |
deleted text begin
774 deleted text end new text begin 685 new text end |
deleted text begin
1,161 deleted text end new text begin 935 new text end |
deleted text begin
1,338 deleted text end new text begin 1,056 new text end |
deleted text begin
1,554 deleted text end new text begin 1,149 new text end |
deleted text begin
1,802 deleted text end new text begin 1,218 new text end |
deleted text begin
2,088 deleted text end new text begin 1,269 new text end |
| 4,400- 4,499 |
deleted text begin
787 deleted text end new text begin 705 new text end |
deleted text begin
1,175 deleted text end new text begin 965 new text end |
deleted text begin
1,353 deleted text end new text begin 1,090 new text end |
deleted text begin
1,572 deleted text end new text begin 1,185 new text end |
deleted text begin
1,822 deleted text end new text begin 1,256 new text end |
deleted text begin
2,111 deleted text end new text begin 1,308 new text end |
| 4,500- 4,599 |
deleted text begin
801 deleted text end new text begin 724 new text end |
deleted text begin
1,184 deleted text end new text begin 993 new text end |
deleted text begin
1,368 deleted text end new text begin 1,122 new text end |
deleted text begin
1,589 deleted text end new text begin 1,219 new text end |
deleted text begin
1,841 deleted text end new text begin 1,292 new text end |
deleted text begin
2,133 deleted text end new text begin 1,345 new text end |
| 4,600- 4,699 |
deleted text begin
808 deleted text end new text begin 743 new text end |
deleted text begin
1,200 deleted text end new text begin 1,021 new text end |
deleted text begin
1,386 deleted text end new text begin 1,154 new text end |
deleted text begin
1,608 deleted text end new text begin 1,253 new text end |
deleted text begin
1,864 deleted text end new text begin 1,328 new text end |
deleted text begin
2,160 deleted text end new text begin 1,382 new text end |
| 4,700- 4,799 |
deleted text begin
814 deleted text end new text begin 762 new text end |
deleted text begin
1,215 deleted text end new text begin 1,049 new text end |
deleted text begin
1,402 deleted text end new text begin 1,186 new text end |
deleted text begin
1,627 deleted text end new text begin 1,287 new text end |
deleted text begin
1,887 deleted text end new text begin 1,364 new text end |
deleted text begin
2,186 deleted text end new text begin 1,419 new text end |
| 4,800- 4,899 |
deleted text begin
820 deleted text end new text begin 781 new text end |
deleted text begin
1,231 deleted text end new text begin 1,077 new text end |
deleted text begin
1,419 deleted text end new text begin 1,218 new text end |
deleted text begin
1,645 deleted text end new text begin 1,321 new text end |
deleted text begin
1,908 deleted text end new text begin 1,400 new text end |
deleted text begin
2,212 deleted text end new text begin 1,456 new text end |
| 4,900- 4,999 |
deleted text begin
825 deleted text end new text begin 800 new text end |
deleted text begin
1,246 deleted text end new text begin 1,105 new text end |
deleted text begin
1,435 deleted text end new text begin 1,250 new text end |
deleted text begin
1,663 deleted text end new text begin 1,354 new text end |
deleted text begin
1,930 deleted text end new text begin 1,435 new text end |
deleted text begin
2,236 deleted text end new text begin 1,493 new text end |
| 5,000- 5,099 |
deleted text begin
831 deleted text end new text begin 818 new text end |
deleted text begin
1,260 deleted text end new text begin 1,132 new text end |
deleted text begin
1,450 deleted text end new text begin 1,281 new text end |
deleted text begin
1,680 deleted text end new text begin 1,387 new text end |
deleted text begin
1,950 deleted text end new text begin 1,470 new text end |
deleted text begin
2,260 deleted text end new text begin 1,529 new text end |
| 5,100- 5,199 |
deleted text begin
837 deleted text end new text begin 835 new text end |
deleted text begin
1,275 deleted text end new text begin 1,159 new text end |
deleted text begin
1,468 deleted text end new text begin 1,312 new text end |
deleted text begin
1,701 deleted text end new text begin 1,420 new text end |
deleted text begin
1,975 deleted text end new text begin 1,505 new text end |
deleted text begin
2,289 deleted text end new text begin 1,565 new text end |
| 5,200- 5,299 |
deleted text begin
843 deleted text end new text begin 852 new text end |
deleted text begin
1,290 deleted text end new text begin 1,186 new text end |
deleted text begin
1,485 deleted text end new text begin 1,343 new text end |
deleted text begin
1,722 deleted text end new text begin 1,453 new text end |
deleted text begin
1,999 deleted text end new text begin 1,540 new text end |
deleted text begin
2,317 deleted text end new text begin 1,601 new text end |
| 5,300- 5,399 |
deleted text begin
849 deleted text end new text begin 869 new text end |
deleted text begin
1,304 deleted text end new text begin 1,213 new text end |
deleted text begin
1,502 deleted text end new text begin 1,374 new text end |
deleted text begin
1,743 deleted text end new text begin 1,486 new text end |
deleted text begin
2,022 deleted text end new text begin 1,575 new text end |
deleted text begin
2,345 deleted text end new text begin 1,638 new text end |
| 5,400- 5,499 |
deleted text begin
854 deleted text end new text begin 886 new text end |
deleted text begin
1,318 deleted text end new text begin 1,240 new text end |
deleted text begin
1,518 deleted text end new text begin 1,405 new text end |
deleted text begin
1,763 deleted text end new text begin 1,519 new text end |
deleted text begin
2,046 deleted text end new text begin 1,610 new text end |
deleted text begin
2,372 deleted text end new text begin 1,674 new text end |
| 5,500- 5,599 |
deleted text begin
860 deleted text end new text begin 903 new text end |
deleted text begin
1,331 deleted text end new text begin 1,264 new text end |
deleted text begin
1,535 deleted text end new text begin 1,434 new text end |
deleted text begin
1,782 deleted text end new text begin 1,550 new text end |
deleted text begin
2,068 deleted text end new text begin 1,643 new text end |
deleted text begin
2,398 deleted text end new text begin 1,708 new text end |
| 5,600- 5,699 |
deleted text begin
866 deleted text end new text begin 920 new text end |
deleted text begin
1,346 deleted text end new text begin 1,288 new text end |
deleted text begin
1,551 deleted text end new text begin 1,463 new text end |
deleted text begin
1,801 deleted text end new text begin 1,581 new text end |
deleted text begin
2,090 deleted text end new text begin 1,676 new text end |
deleted text begin
2,424 deleted text end new text begin 1,743 new text end |
| 5,700- 5,799 |
deleted text begin
873 deleted text end new text begin 937 new text end |
deleted text begin
1,357 deleted text end new text begin 1,312 new text end |
deleted text begin
1,568 deleted text end new text begin 1,492 new text end |
deleted text begin
1,819 deleted text end new text begin 1,612 new text end |
deleted text begin
2,111 deleted text end new text begin 1,709 new text end |
deleted text begin
2,449 deleted text end new text begin 1,777 new text end |
| 5,800- 5,899 |
deleted text begin
881 deleted text end new text begin 954 new text end |
deleted text begin
1,376 deleted text end new text begin 1,336 new text end |
deleted text begin
1,583 deleted text end new text begin 1,521 new text end |
deleted text begin
1,837 deleted text end new text begin 1,643 new text end |
deleted text begin
2,132 deleted text end new text begin 1,742 new text end |
deleted text begin
2,473 deleted text end new text begin 1,811 new text end |
| 5,900- 5,999 |
deleted text begin
888 deleted text end new text begin 971 new text end |
deleted text begin
1,390 deleted text end new text begin 1,360 new text end |
deleted text begin
1,599 deleted text end new text begin 1,550 new text end |
deleted text begin
1,855 deleted text end new text begin 1,674 new text end |
deleted text begin
2,152 deleted text end new text begin 1,775 new text end |
deleted text begin
2,497 deleted text end new text begin 1,846 new text end |
| 6,000- 6,099 |
deleted text begin
895 deleted text end new text begin 988 new text end |
deleted text begin
1,404 deleted text end new text begin 1,383 new text end |
deleted text begin
1,604 deleted text end new text begin 1,577 new text end |
deleted text begin
1,872 deleted text end new text begin 1,703 new text end |
deleted text begin
2,172 deleted text end new text begin 1,805 new text end |
deleted text begin
2,520 deleted text end new text begin 1,877 new text end |
| 6,100- 6,199 |
deleted text begin
902 deleted text end new text begin 993 new text end |
deleted text begin
1,419 deleted text end new text begin 1,391 new text end |
deleted text begin
1,631 deleted text end new text begin 1,586 new text end |
deleted text begin
1,892 deleted text end new text begin 1,713 new text end |
deleted text begin
2,195 deleted text end new text begin 1,815 new text end |
deleted text begin
2,546 deleted text end new text begin 1,887 new text end |
| 6,200- 6,299 |
deleted text begin
909 deleted text end new text begin 999 new text end |
deleted text begin
1,433 deleted text end new text begin 1,399 new text end |
deleted text begin
1,645 deleted text end new text begin 1,594 new text end |
deleted text begin
1,912 deleted text end new text begin 1,722 new text end |
deleted text begin
2,217 deleted text end new text begin 1,825 new text end |
deleted text begin
2,572 deleted text end new text begin 1,898 new text end |
| 6,300- 6,399 |
deleted text begin
916 deleted text end new text begin 1,005 new text end |
deleted text begin
1,448 deleted text end new text begin 1,406 new text end |
deleted text begin
1,664 deleted text end new text begin 1,603 new text end |
deleted text begin
1,932 deleted text end new text begin 1,732 new text end |
deleted text begin
2,239 deleted text end new text begin 1,836 new text end |
deleted text begin
2,597 deleted text end new text begin 1,909 new text end |
| 6,400- 6,499 |
deleted text begin
923 deleted text end new text begin 1,010 new text end |
deleted text begin
1,462 deleted text end new text begin 1,414 new text end |
deleted text begin
1,682 deleted text end new text begin 1,612 new text end |
deleted text begin
1,951 deleted text end new text begin 1,741 new text end |
deleted text begin
2,260 deleted text end new text begin 1,846 new text end |
deleted text begin
2,621 deleted text end new text begin 1,920 new text end |
| 6,500- 6,599 |
deleted text begin
930 deleted text end new text begin 1,016 new text end |
deleted text begin
1,476 deleted text end new text begin 1,422 new text end |
deleted text begin
1,697 deleted text end new text begin 1,621 new text end |
deleted text begin
1,970 deleted text end new text begin 1,751 new text end |
deleted text begin
2,282 deleted text end new text begin 1,856 new text end |
deleted text begin
2,646 deleted text end new text begin 1,931 new text end |
| 6,600- 6,699 |
deleted text begin
936 deleted text end new text begin 1,021 new text end |
deleted text begin
1,490 deleted text end new text begin 1,430 new text end |
deleted text begin
1,713 deleted text end new text begin 1,630 new text end |
deleted text begin
1,989 deleted text end new text begin 1,761 new text end |
deleted text begin
2,305 deleted text end new text begin 1,866 new text end |
deleted text begin
2,673 deleted text end new text begin 1,941 new text end |
| 6,700- 6,799 |
deleted text begin
943 deleted text end new text begin 1,027 new text end |
deleted text begin
1,505 deleted text end new text begin 1,438 new text end |
deleted text begin
1,730 deleted text end new text begin 1,639 new text end |
deleted text begin
2,009 deleted text end new text begin 1,770 new text end |
deleted text begin
2,328 deleted text end new text begin 1,876 new text end |
deleted text begin
2,700 deleted text end new text begin 1,951 new text end |
| 6,800- 6,899 |
deleted text begin
950 deleted text end new text begin 1,032 new text end |
deleted text begin
1,519 deleted text end new text begin 1,445 new text end |
deleted text begin
1,746 deleted text end new text begin 1,648 new text end |
deleted text begin
2,028 deleted text end new text begin 1,780 new text end |
deleted text begin
2,350 deleted text end new text begin 1,887 new text end |
deleted text begin
2,727 deleted text end new text begin 1,962 new text end |
| 6,900- 6,999 |
deleted text begin
957 deleted text end new text begin 1,038 new text end |
deleted text begin
1,533 deleted text end new text begin 1,453 new text end |
deleted text begin
1,762 deleted text end new text begin 1,657 new text end |
deleted text begin
2,047 deleted text end new text begin 1,790 new text end |
deleted text begin
2,379 deleted text end new text begin 1,897 new text end |
deleted text begin
2,747 deleted text end new text begin 1,973 new text end |
| 7,000- 7,099 |
deleted text begin
963 deleted text end new text begin 1,044 new text end |
deleted text begin
1,547 deleted text end new text begin 1,462 new text end |
deleted text begin
1,778 deleted text end new text begin 1,666 new text end |
deleted text begin
2,065 deleted text end new text begin 1,800 new text end |
deleted text begin
2,394 deleted text end new text begin 1,908 new text end |
deleted text begin
2,753 deleted text end new text begin 1,984 new text end |
| 7,100- 7,199 |
deleted text begin
970 deleted text end new text begin 1,050 new text end |
deleted text begin
1,561 deleted text end new text begin 1,470 new text end |
deleted text begin
1,795 deleted text end new text begin 1,676 new text end |
deleted text begin
2,085 deleted text end new text begin 1,810 new text end |
deleted text begin
2,417 deleted text end new text begin 1,918 new text end |
deleted text begin
2,758 deleted text end new text begin 1,995 new text end |
| 7,200- 7,299 |
deleted text begin
974 deleted text end new text begin 1,056 new text end |
deleted text begin
1,574 deleted text end new text begin 1,479 new text end |
deleted text begin
1,812 deleted text end new text begin 1,686 new text end |
deleted text begin
2,104 deleted text end new text begin 1,821 new text end |
deleted text begin
2,439 deleted text end new text begin 1,930 new text end |
deleted text begin
2,764 deleted text end new text begin 2,007 new text end |
| 7,300- 7,399 |
deleted text begin
980 deleted text end new text begin 1,063 new text end |
deleted text begin
1,587 deleted text end new text begin 1,488 new text end |
deleted text begin
1,828 deleted text end new text begin 1,696 new text end |
deleted text begin
2,123 deleted text end new text begin 1,832 new text end |
deleted text begin
2,462 deleted text end new text begin 1,942 new text end |
deleted text begin
2,769 deleted text end new text begin 2,019 new text end |
| 7,400- 7,499 |
deleted text begin
989 deleted text end new text begin 1,069 new text end |
deleted text begin
1,600 deleted text end new text begin 1,496 new text end |
deleted text begin
1,844 deleted text end new text begin 1,706 new text end |
deleted text begin
2,142 deleted text end new text begin 1,843 new text end |
deleted text begin
2,483 deleted text end new text begin 1,953 new text end |
deleted text begin
2,775 deleted text end new text begin 2,032 new text end |
| 7,500- 7,599 |
deleted text begin
998 deleted text end new text begin 1,075 new text end |
deleted text begin
1,613 deleted text end new text begin 1,505 new text end |
deleted text begin
1,860 deleted text end new text begin 1,716 new text end |
deleted text begin
2,160 deleted text end new text begin 1,854 new text end |
deleted text begin
2,505 deleted text end new text begin 1,965 new text end |
deleted text begin
2,781 deleted text end new text begin 2,043 new text end |
| 7,600- 7,699 |
deleted text begin
1,006 deleted text end new text begin 1,081 new text end |
deleted text begin
1,628 deleted text end new text begin 1,514 new text end |
deleted text begin
1,877 deleted text end new text begin 1,725 new text end |
deleted text begin
2,180 deleted text end new text begin 1,863 new text end |
deleted text begin
2,528 deleted text end new text begin 1,975 new text end |
deleted text begin
2,803 deleted text end new text begin 2,054 new text end |
| 7,700- 7,799 |
deleted text begin
1,015 deleted text end new text begin 1,087 new text end |
deleted text begin
1,643 deleted text end new text begin 1,522 new text end |
deleted text begin
1,894 deleted text end new text begin 1,735 new text end |
deleted text begin
2,199 deleted text end new text begin 1,874 new text end |
deleted text begin
2,550 deleted text end new text begin 1,986 new text end |
deleted text begin
2,833 deleted text end new text begin 2,066 new text end |
| 7,800- 7,899 |
deleted text begin
1,023 deleted text end new text begin 1,093 new text end |
deleted text begin
1,658 deleted text end new text begin 1,531 new text end |
deleted text begin
1,911 deleted text end new text begin 1,745 new text end |
deleted text begin
2,218 deleted text end new text begin 1,885 new text end |
deleted text begin
2,572 deleted text end new text begin 1,998 new text end |
deleted text begin
2,864 deleted text end new text begin 2,078 new text end |
| 7,900- 7,999 |
deleted text begin
1,032 deleted text end new text begin 1,099 new text end |
deleted text begin
1,673 deleted text end new text begin 1,540 new text end |
deleted text begin
1,928 deleted text end new text begin 1,755 new text end |
deleted text begin
2,237 deleted text end new text begin 1,896 new text end |
deleted text begin
2,594 deleted text end new text begin 2,009 new text end |
deleted text begin
2,894 deleted text end new text begin 2,090 new text end |
| 8,000- 8,099 |
deleted text begin
1,040 deleted text end new text begin 1,106 new text end |
deleted text begin
1,688 deleted text end new text begin 1,548 new text end |
deleted text begin
1,944 deleted text end new text begin 1,765 new text end |
deleted text begin
2,256 deleted text end new text begin 1,907 new text end |
deleted text begin
2,616 deleted text end new text begin 2,021 new text end |
deleted text begin
2,925 deleted text end new text begin 2,102 new text end |
| 8,100- 8,199 |
deleted text begin
1,048 deleted text end new text begin 1,112 new text end |
deleted text begin
1,703 deleted text end new text begin 1,557 new text end |
deleted text begin
1,960 deleted text end new text begin 1,775 new text end |
deleted text begin
2,274 deleted text end new text begin 1,917 new text end |
deleted text begin
2,637 deleted text end new text begin 2,032 new text end |
deleted text begin
2,955 deleted text end new text begin 2,114 new text end |
| 8,200- 8,299 |
deleted text begin
1,056 deleted text end new text begin 1,118 new text end |
deleted text begin
1,717 deleted text end new text begin 1,566 new text end |
deleted text begin
1,976 deleted text end new text begin 1,785 new text end |
deleted text begin
2,293 deleted text end new text begin 1,928 new text end |
deleted text begin
2,658 deleted text end new text begin 2,044 new text end |
deleted text begin
2,985 deleted text end new text begin 2,126 new text end |
| 8,300 -8,399 |
deleted text begin
1,064 deleted text end new text begin 1,124 new text end |
deleted text begin
1,731 deleted text end new text begin 1,574 new text end |
deleted text begin
1,992 deleted text end new text begin 1,795 new text end |
deleted text begin
2,311 deleted text end new text begin 1,939 new text end |
deleted text begin
2,679 deleted text end new text begin 2,055 new text end |
deleted text begin
3,016 deleted text end new text begin 2,137 new text end |
| 8,400- 8,499 |
deleted text begin
1,072 deleted text end new text begin 1,131 new text end |
deleted text begin
1,746 deleted text end new text begin 1,583 new text end |
deleted text begin
2,008 deleted text end new text begin 1,804 new text end |
deleted text begin
2,328 deleted text end new text begin 1,949 new text end |
deleted text begin
2,700 deleted text end new text begin 2,066 new text end |
deleted text begin
3,046 deleted text end new text begin 2,149 new text end |
| 8,500- 8,599 |
deleted text begin
1,080 deleted text end new text begin 1,137 new text end |
deleted text begin
1,760 deleted text end new text begin 1,592 new text end |
deleted text begin
2,023 deleted text end new text begin 1,814 new text end |
deleted text begin
2,346 deleted text end new text begin 1,960 new text end |
deleted text begin
2,720 deleted text end new text begin 2,078 new text end |
deleted text begin
3,077 deleted text end new text begin 2,161 new text end |
| 8,600- 8,699 |
deleted text begin
1,092 deleted text end new text begin 1,143 new text end |
deleted text begin
1,780 deleted text end new text begin 1,600 new text end |
deleted text begin
2,047 deleted text end new text begin 1,824 new text end |
deleted text begin
2,374 deleted text end new text begin 1,970 new text end |
deleted text begin
2,752 deleted text end new text begin 2,089 new text end |
deleted text begin
3,107 deleted text end new text begin 2,173 new text end |
| 8,700- 8,799 |
deleted text begin
1,105 deleted text end new text begin 1,149 new text end |
deleted text begin
1,801 deleted text end new text begin 1,609 new text end |
deleted text begin
2,071 deleted text end new text begin 1,834 new text end |
deleted text begin
2,401 deleted text end new text begin 1,981 new text end |
deleted text begin
2,784 deleted text end new text begin 2,100 new text end |
deleted text begin
3,138 deleted text end new text begin 2,185 new text end |
| 8,800- 8,899 |
deleted text begin
1,118 deleted text end new text begin 1,155 new text end |
deleted text begin
1,822 deleted text end new text begin 1,618 new text end |
deleted text begin
2,094 deleted text end new text begin 1,844 new text end |
deleted text begin
2,429 deleted text end new text begin 1,992 new text end |
deleted text begin
2,816 deleted text end new text begin 2,112 new text end |
deleted text begin
3,168 deleted text end new text begin 2,197 new text end |
| 8,900- 8,999 |
deleted text begin
1,130 deleted text end new text begin 1,162 new text end |
deleted text begin
1,842 deleted text end new text begin 1,626 new text end |
deleted text begin
2,118 deleted text end new text begin 1,854 new text end |
deleted text begin
2,456 deleted text end new text begin 2,003 new text end |
deleted text begin
2,848 deleted text end new text begin 2,124 new text end |
deleted text begin
3,199 deleted text end new text begin 2,209 new text end |
| 9,000- 9,099 |
deleted text begin
1,143 deleted text end new text begin 1,168 new text end |
deleted text begin
1,863 deleted text end new text begin 1,635 new text end |
deleted text begin
2,142 deleted text end new text begin 1,864 new text end |
deleted text begin
2,484 deleted text end new text begin 2,014 new text end |
deleted text begin
2,880 deleted text end new text begin 2,135 new text end |
deleted text begin
3,223 deleted text end new text begin 2,221 new text end |
| 9,100- 9,199 |
deleted text begin
1,156 deleted text end new text begin 1,174 new text end |
deleted text begin
1,884 deleted text end new text begin 1,644 new text end |
deleted text begin
2,166 deleted text end new text begin 1,874 new text end |
deleted text begin
2,512 deleted text end new text begin 2,024 new text end |
deleted text begin
2,912 deleted text end new text begin 2,146 new text end |
deleted text begin
3,243 deleted text end new text begin 2,232 new text end |
| 9,200- 9,299 |
deleted text begin
1,168 deleted text end new text begin 1,180 new text end |
deleted text begin
1,904 deleted text end new text begin 1,652 new text end |
deleted text begin
2,190 deleted text end new text begin 1,884 new text end |
deleted text begin
2,539 deleted text end new text begin 2,035 new text end |
deleted text begin
2,944 deleted text end new text begin 2,158 new text end |
deleted text begin
3,263 deleted text end new text begin 2,244 new text end |
| 9,300- 9,399 |
deleted text begin
1,181 deleted text end new text begin 1,186 new text end |
deleted text begin
1,925 deleted text end new text begin 1,661 new text end |
deleted text begin
2,213 deleted text end new text begin 1,893 new text end |
deleted text begin
2,567 deleted text end new text begin 2,045 new text end |
deleted text begin
2,976 deleted text end new text begin 2,168 new text end |
deleted text begin
3,284 deleted text end new text begin 2,255 new text end |
| 9,400- 9,499 |
deleted text begin
1,194 deleted text end new text begin 1,193 new text end |
deleted text begin
1,946 deleted text end new text begin 1,670 new text end |
deleted text begin
2,237 deleted text end new text begin 1,903 new text end |
deleted text begin
2,594 deleted text end new text begin 2,056 new text end |
deleted text begin
3,008 deleted text end new text begin 2,179 new text end |
deleted text begin
3,304 deleted text end new text begin 2,267 new text end |
| 9,500- 9,599 |
deleted text begin
1,207 deleted text end new text begin 1,199 new text end |
deleted text begin
1,967 deleted text end new text begin 1,678 new text end |
deleted text begin
2,261 deleted text end new text begin 1,913 new text end |
deleted text begin
2,622 deleted text end new text begin 2,066 new text end |
deleted text begin
3,031 deleted text end new text begin 2,190 new text end |
deleted text begin
3,324 deleted text end new text begin 2,278 new text end |
| 9,600- 9,699 |
deleted text begin
1,219 deleted text end new text begin 1,205 new text end |
deleted text begin
1,987 deleted text end new text begin 1,687 new text end |
deleted text begin
2,285 deleted text end new text begin 1,923 new text end |
deleted text begin
2,650 deleted text end new text begin 2,077 new text end |
deleted text begin
3,050 deleted text end new text begin 2,202 new text end |
deleted text begin
3,345 deleted text end new text begin 2,290 new text end |
| 9,700- 9,799 |
deleted text begin
1,232 deleted text end new text begin 1,211 new text end |
deleted text begin
2,008 deleted text end new text begin 1,696 new text end |
deleted text begin
2,309 deleted text end new text begin 1,933 new text end |
deleted text begin
2,677 deleted text end new text begin 2,088 new text end |
deleted text begin
3,069 deleted text end new text begin 2,214 new text end |
deleted text begin
3,365 deleted text end new text begin 2,302 new text end |
| 9,800- 9,899 |
deleted text begin
1,245 deleted text end new text begin 1,217 new text end |
deleted text begin
2,029 deleted text end new text begin 1,704 new text end |
deleted text begin
2,332 deleted text end new text begin 1,943 new text end |
deleted text begin
2,705 deleted text end new text begin 2,099 new text end |
deleted text begin
3,087 deleted text end new text begin 2,225 new text end |
deleted text begin
3,385 deleted text end new text begin 2,314 new text end |
| 9,900- 9,999 |
deleted text begin
1,257 deleted text end new text begin 1,224 new text end |
deleted text begin
2,049 deleted text end new text begin 1,713 new text end |
deleted text begin
2,356 deleted text end new text begin 1,953 new text end |
deleted text begin
2,732 deleted text end new text begin 2,110 new text end |
deleted text begin
3,106 deleted text end new text begin 2,237 new text end |
deleted text begin
3,406 deleted text end new text begin 2,326 new text end |
| 10,000-10,099 |
deleted text begin
1,270 deleted text end new text begin 1,230 new text end |
deleted text begin
2,070 deleted text end new text begin 1,722 new text end |
deleted text begin
2,380 deleted text end new text begin 1,963 new text end |
deleted text begin
2,760 deleted text end new text begin 2,121 new text end |
deleted text begin
3,125 deleted text end new text begin 2,248 new text end |
deleted text begin
3,426 deleted text end new text begin 2,338 new text end |
| 10,100-10,199 |
deleted text begin
1,283 deleted text end new text begin 1,236 new text end |
deleted text begin
2,091 deleted text end new text begin 1,730 new text end |
deleted text begin
2,404 deleted text end new text begin 1,973 new text end |
deleted text begin
2,788 deleted text end new text begin 2,131 new text end |
deleted text begin
3,144 deleted text end new text begin 2,259 new text end |
deleted text begin
3,446 deleted text end new text begin 2,350 new text end |
| 10,200-10,299 |
deleted text begin
1,295 deleted text end new text begin 1,242 new text end |
deleted text begin
2,111 deleted text end new text begin 1,739 new text end |
deleted text begin
2,428 deleted text end new text begin 1,983 new text end |
deleted text begin
2,815 deleted text end new text begin 2,142 new text end |
deleted text begin
3,162 deleted text end new text begin 2,270 new text end |
deleted text begin
3,467 deleted text end new text begin 2,361 new text end |
| 10,300-10,399 |
deleted text begin
1,308 deleted text end new text begin 1,248 new text end |
deleted text begin
2,132 deleted text end new text begin 1,748 new text end |
deleted text begin
2,451 deleted text end new text begin 1,992 new text end |
deleted text begin
2,843 deleted text end new text begin 2,152 new text end |
deleted text begin
3,181 deleted text end new text begin 2,281 new text end |
deleted text begin
3,487 deleted text end new text begin 2,373 new text end |
| 10,400-10,499 |
deleted text begin
1,321 deleted text end new text begin 1,254 new text end |
deleted text begin
2,153 deleted text end new text begin 1,756 new text end |
deleted text begin
2,475 deleted text end new text begin 2,002 new text end |
deleted text begin
2,870 deleted text end new text begin 2,163 new text end |
deleted text begin
3,200 deleted text end new text begin 2,292 new text end |
deleted text begin
3,507 deleted text end new text begin 2,384 new text end |
| 10,500-10,599 |
deleted text begin
1,334 deleted text end new text begin 1,261 new text end |
deleted text begin
2,174 deleted text end new text begin 1,765 new text end |
deleted text begin
2,499 deleted text end new text begin 2,012 new text end |
deleted text begin
2,898 deleted text end new text begin 2,173 new text end |
deleted text begin
3,218 deleted text end new text begin 2,304 new text end |
deleted text begin
3,528 deleted text end new text begin 2,396 new text end |
| 10,600-10,699 |
deleted text begin
1,346 deleted text end new text begin 1,267 new text end |
deleted text begin
2,194 deleted text end new text begin 1,774 new text end |
deleted text begin
2,523 deleted text end new text begin 2,022 new text end |
deleted text begin
2,921 deleted text end new text begin 2,184 new text end |
deleted text begin
3,237 deleted text end new text begin 2,316 new text end |
deleted text begin
3,548 deleted text end new text begin 2,409 new text end |
| 10,700-10,799 |
deleted text begin
1,359 deleted text end new text begin 1,273 new text end |
deleted text begin
2,215 deleted text end new text begin 1,782 new text end |
deleted text begin
2,547 deleted text end new text begin 2,032 new text end |
deleted text begin
2,938 deleted text end new text begin 2,195 new text end |
deleted text begin
3,256 deleted text end new text begin 2,327 new text end |
deleted text begin
3,568 deleted text end new text begin 2,420 new text end |
| 10,800-10,899 |
deleted text begin
1,372 deleted text end new text begin 1,279 new text end |
deleted text begin
2,236 deleted text end new text begin 1,791 new text end |
deleted text begin
2,570 deleted text end new text begin 2,042 new text end |
deleted text begin
2,955 deleted text end new text begin 2,206 new text end |
deleted text begin
3,274 deleted text end new text begin 2,338 new text end |
deleted text begin
3,589 deleted text end new text begin 2,432 new text end |
| 10,900-10,999 |
deleted text begin
1,384 deleted text end new text begin 1,285 new text end |
deleted text begin
2,256 deleted text end new text begin 1,800 new text end |
deleted text begin
2,594 deleted text end new text begin 2,052 new text end |
deleted text begin
2,972 deleted text end new text begin 2,217 new text end |
deleted text begin
3,293 deleted text end new text begin 2,349 new text end |
deleted text begin
3,609 deleted text end new text begin 2,444 new text end |
| 11,000-11,099 |
deleted text begin
1,397 deleted text end new text begin 1,292 new text end |
deleted text begin
2,277 deleted text end new text begin 1,808 new text end |
deleted text begin
2,618 deleted text end new text begin 2,061 new text end |
deleted text begin
2,989 deleted text end new text begin 2,226 new text end |
deleted text begin
3,312 deleted text end new text begin 2,360 new text end |
deleted text begin
3,629 deleted text end new text begin 2,455 new text end |
| 11,100-11,199 |
deleted text begin
1,410 deleted text end new text begin 1,298 new text end |
deleted text begin
2,294 deleted text end new text begin 1,817 new text end |
deleted text begin
2,642 deleted text end new text begin 2,071 new text end |
deleted text begin
3,006 deleted text end new text begin 2,237 new text end |
deleted text begin
3,331 deleted text end new text begin 2,372 new text end |
deleted text begin
3,649 deleted text end new text begin 2,467 new text end |
| 11,200-11,299 |
deleted text begin
1,422 deleted text end new text begin 1,304 new text end |
deleted text begin
2,306 deleted text end new text begin 1,826 new text end |
deleted text begin
2,666 deleted text end new text begin 2,081 new text end |
deleted text begin
3,023 deleted text end new text begin 2,248 new text end |
deleted text begin
3,349 deleted text end new text begin 2,384 new text end |
deleted text begin
3,667 deleted text end new text begin 2,479 new text end |
| 11,300-11,399 |
deleted text begin
1,435 deleted text end new text begin 1,310 new text end |
deleted text begin
2,319 deleted text end new text begin 1,834 new text end |
deleted text begin
2,689 deleted text end new text begin 2,091 new text end |
deleted text begin
3,040 deleted text end new text begin 2,259 new text end |
deleted text begin
3,366 deleted text end new text begin 2,395 new text end |
deleted text begin
3,686 deleted text end new text begin 2,491 new text end |
| 11,400-11,499 |
deleted text begin
1,448 deleted text end new text begin 1,316 new text end |
deleted text begin
2,331 deleted text end new text begin 1,843 new text end |
deleted text begin
2,713 deleted text end new text begin 2,101 new text end |
deleted text begin
3,055 deleted text end new text begin 2,270 new text end |
deleted text begin
3,383 deleted text end new text begin 2,406 new text end |
deleted text begin
3,705 deleted text end new text begin 2,503 new text end |
| 11,500-11,599 |
deleted text begin
1,461 deleted text end new text begin 1,323 new text end |
deleted text begin
2,344 deleted text end new text begin 1,852 new text end |
deleted text begin
2,735 deleted text end new text begin 2,111 new text end |
deleted text begin
3,071 deleted text end new text begin 2,280 new text end |
deleted text begin
3,400 deleted text end new text begin 2,417 new text end |
deleted text begin
3,723 deleted text end new text begin 2,514 new text end |
| 11,600-11,699 |
deleted text begin
1,473 deleted text end new text begin 1,329 new text end |
deleted text begin
2,356 deleted text end new text begin 1,860 new text end |
deleted text begin
2,748 deleted text end new text begin 2,121 new text end |
deleted text begin
3,087 deleted text end new text begin 2,291 new text end |
deleted text begin
3,417 deleted text end new text begin 2,428 new text end |
deleted text begin
3,742 deleted text end new text begin 2,526 new text end |
| 11,700-11,799 |
deleted text begin
1,486 deleted text end new text begin 1,335 new text end |
deleted text begin
2,367 deleted text end new text begin 1,869 new text end |
deleted text begin
2,762 deleted text end new text begin 2,131 new text end |
deleted text begin
3,102 deleted text end new text begin 2,302 new text end |
deleted text begin
3,435 deleted text end new text begin 2,439 new text end |
deleted text begin
3,761 deleted text end new text begin 2,537 new text end |
| 11,800-11,899 |
deleted text begin
1,499 deleted text end new text begin 1,341 new text end |
deleted text begin
2,378 deleted text end new text begin 1,878 new text end |
deleted text begin
2,775 deleted text end new text begin 2,141 new text end |
deleted text begin
3,116 deleted text end new text begin 2,313 new text end |
deleted text begin
3,452 deleted text end new text begin 2,451 new text end |
deleted text begin
3,780 deleted text end new text begin 2,549 new text end |
| 11,900-11,999 |
deleted text begin
1,511 deleted text end new text begin 1,347 new text end |
deleted text begin
2,389 deleted text end new text begin 1,886 new text end |
deleted text begin
2,788 deleted text end new text begin 2,150 new text end |
deleted text begin
3,131 deleted text end new text begin 2,323 new text end |
deleted text begin
3,469 deleted text end new text begin 2,463 new text end |
deleted text begin
3,798 deleted text end new text begin 2,561 new text end |
| 12,000-12,099 |
deleted text begin
1,524 deleted text end new text begin 1,354 new text end |
deleted text begin
2,401 deleted text end new text begin 1,895 new text end |
deleted text begin
2,801 deleted text end new text begin 2,160 new text end |
deleted text begin
3,146 deleted text end new text begin 2,333 new text end |
deleted text begin
3,485 deleted text end new text begin 2,474 new text end |
deleted text begin
3,817 deleted text end new text begin 2,573 new text end |
| 12,100-12,199 |
deleted text begin
1,537 deleted text end new text begin 1,360 new text end |
deleted text begin
2,412 deleted text end new text begin 1,904 new text end |
deleted text begin
2,814 deleted text end new text begin 2,170 new text end |
deleted text begin
3,160 deleted text end new text begin 2,344 new text end |
deleted text begin
3,501 deleted text end new text begin 2,485 new text end |
deleted text begin
3,836 deleted text end new text begin 2,585 new text end |
| 12,200-12,299 |
deleted text begin
1,549 deleted text end new text begin 1,366 new text end |
deleted text begin
2,423 deleted text end new text begin 1,912 new text end |
deleted text begin
2,828 deleted text end new text begin 2,180 new text end |
deleted text begin
3,175 deleted text end new text begin 2,355 new text end |
deleted text begin
3,517 deleted text end new text begin 2,497 new text end |
deleted text begin
3,854 deleted text end new text begin 2,597 new text end |
| 12,300-12,399 |
deleted text begin
1,562 deleted text end new text begin 1,372 new text end |
deleted text begin
2,434 deleted text end new text begin 1,921 new text end |
deleted text begin
2,841 deleted text end new text begin 2,190 new text end |
deleted text begin
3,190 deleted text end new text begin 2,366 new text end |
deleted text begin
3,534 deleted text end new text begin 2,509 new text end |
deleted text begin
3,871 deleted text end new text begin 2,609 new text end |
| 12,400-12,499 |
deleted text begin
1,575 deleted text end new text begin 1,378 new text end |
deleted text begin
2,445 deleted text end new text begin 1,930 new text end |
deleted text begin
2,854 deleted text end new text begin 2,200 new text end |
deleted text begin
3,205 deleted text end new text begin 2,377 new text end |
deleted text begin
3,550 deleted text end new text begin 2,520 new text end |
deleted text begin
3,889 deleted text end new text begin 2,621 new text end |
| 12,500-12,599 |
deleted text begin
1,588 deleted text end new text begin 1,385 new text end |
deleted text begin
2,456 deleted text end new text begin 1,938 new text end |
deleted text begin
2,867 deleted text end new text begin 2,210 new text end |
deleted text begin
3,219 deleted text end new text begin 2,387 new text end |
deleted text begin
3,566 deleted text end new text begin 2,531 new text end |
deleted text begin
3,907 deleted text end new text begin 2,633 new text end |
| 12,600-12,699 |
deleted text begin
1,600 deleted text end new text begin 1,391 new text end |
deleted text begin
2,467 deleted text end new text begin 1,947 new text end |
deleted text begin
2,880 deleted text end new text begin 2,220 new text end |
deleted text begin
3,234 deleted text end new text begin 2,397 new text end |
deleted text begin
3,582 deleted text end new text begin 2,542 new text end |
deleted text begin
3,924 deleted text end new text begin 2,644 new text end |
| 12,700-12,799 |
deleted text begin
1,613 deleted text end new text begin 1,397 new text end |
deleted text begin
2,478 deleted text end new text begin 1,956 new text end |
deleted text begin
2,894 deleted text end new text begin 2,230 new text end |
deleted text begin
3,249 deleted text end new text begin 2,408 new text end |
deleted text begin
3,598 deleted text end new text begin 2,553 new text end |
deleted text begin
3,942 deleted text end new text begin 2,656 new text end |
| 12,800-12,899 |
deleted text begin
1,626 deleted text end new text begin 1,403 new text end |
deleted text begin
2,489 deleted text end new text begin 1,964 new text end |
deleted text begin
2,907 deleted text end new text begin 2,240 new text end |
deleted text begin
3,264 deleted text end new text begin 2,419 new text end |
deleted text begin
3,615 deleted text end new text begin 2,565 new text end |
deleted text begin
3,960 deleted text end new text begin 2,668 new text end |
| 12,900-12,999 |
deleted text begin
1,638 deleted text end new text begin 1,409 new text end |
deleted text begin
2,500 deleted text end new text begin 1,973 new text end |
deleted text begin
2,920 deleted text end new text begin 2,250 new text end |
deleted text begin
3,278 deleted text end new text begin 2,430 new text end |
deleted text begin
3,631 deleted text end new text begin 2,576 new text end |
deleted text begin
3,977 deleted text end new text begin 2,680 new text end |
| 13,000-13,099 |
deleted text begin
1,651 deleted text end new text begin 1,416 new text end |
deleted text begin
2,512 deleted text end new text begin 1,982 new text end |
deleted text begin
2,933 deleted text end new text begin 2,259 new text end |
deleted text begin
3,293 deleted text end new text begin 2,440 new text end |
deleted text begin
3,647 deleted text end new text begin 2,587 new text end |
deleted text begin
3,995 deleted text end new text begin 2,691 new text end |
| 13,100-13,199 |
deleted text begin
1,664 deleted text end new text begin 1,422 new text end |
deleted text begin
2,523 deleted text end new text begin 1,990 new text end |
deleted text begin
2,946 deleted text end new text begin 2,269 new text end |
deleted text begin
3,308 deleted text end new text begin 2,451 new text end |
deleted text begin
3,663 deleted text end new text begin 2,599 new text end |
deleted text begin
4,012 deleted text end new text begin 2,703 new text end |
| 13,200-13,299 |
deleted text begin
1,676 deleted text end new text begin 1,428 new text end |
deleted text begin
2,534 deleted text end new text begin 1,999 new text end |
deleted text begin
2,960 deleted text end new text begin 2,279 new text end |
deleted text begin
3,322 deleted text end new text begin 2,462 new text end |
deleted text begin
3,679 deleted text end new text begin 2,610 new text end |
deleted text begin
4,030 deleted text end new text begin 2,715 new text end |
| 13,300-13,399 |
deleted text begin
1,689 deleted text end new text begin 1,434 new text end |
deleted text begin
2,545 deleted text end new text begin 2,008 new text end |
deleted text begin
2,973 deleted text end new text begin 2,289 new text end |
deleted text begin
3,337 deleted text end new text begin 2,473 new text end |
deleted text begin
3,696 deleted text end new text begin 2,622 new text end |
deleted text begin
4,048 deleted text end new text begin 2,727 new text end |
| 13,400-13,499 |
deleted text begin
1,702 deleted text end new text begin 1,440 new text end |
deleted text begin
2,556 deleted text end new text begin 2,016 new text end |
deleted text begin
2,986 deleted text end new text begin 2,299 new text end |
deleted text begin
3,352 deleted text end new text begin 2,484 new text end |
deleted text begin
3,712 deleted text end new text begin 2,633 new text end |
deleted text begin
4,065 deleted text end new text begin 2,739 new text end |
| 13,500-13,599 |
deleted text begin
1,715 deleted text end new text begin 1,446 new text end |
deleted text begin
2,567 deleted text end new text begin 2,025 new text end |
deleted text begin
2,999 deleted text end new text begin 2,309 new text end |
deleted text begin
3,367 deleted text end new text begin 2,494 new text end |
deleted text begin
3,728 deleted text end new text begin 2,644 new text end |
deleted text begin
4,083 deleted text end new text begin 2,751 new text end |
| 13,600-13,699 |
deleted text begin
1,727 deleted text end new text begin 1,453 new text end |
deleted text begin
2,578 deleted text end new text begin 2,034 new text end |
deleted text begin
3,012 deleted text end new text begin 2,318 new text end |
deleted text begin
3,381 deleted text end new text begin 2,504 new text end |
deleted text begin
3,744 deleted text end new text begin 2,655 new text end |
deleted text begin
4,100 deleted text end new text begin 2,762 new text end |
| 13,700-13,799 |
deleted text begin
1,740 deleted text end new text begin 1,459 new text end |
deleted text begin
2,589 deleted text end new text begin 2,042 new text end |
deleted text begin
3,026 deleted text end new text begin 2,328 new text end |
deleted text begin
3,396 deleted text end new text begin 2,515 new text end |
deleted text begin
3,760 deleted text end new text begin 2,666 new text end |
deleted text begin
4,118 deleted text end new text begin 2,773 new text end |
| 13,800-13,899 |
deleted text begin
1,753 deleted text end new text begin 1,465 new text end |
deleted text begin
2,600 deleted text end new text begin 2,051 new text end |
deleted text begin
3,039 deleted text end new text begin 2,338 new text end |
deleted text begin
3,411 deleted text end new text begin 2,526 new text end |
deleted text begin
3,777 deleted text end new text begin 2,677 new text end |
deleted text begin
4,136 deleted text end new text begin 2,784 new text end |
| 13,900-13,999 |
deleted text begin
1,765 deleted text end new text begin 1,471 new text end |
deleted text begin
2,611 deleted text end new text begin 2,060 new text end |
deleted text begin
3,052 deleted text end new text begin 2,348 new text end |
deleted text begin
3,425 deleted text end new text begin 2,537 new text end |
deleted text begin
3,793 deleted text end new text begin 2,688 new text end |
deleted text begin
4,153 deleted text end new text begin 2,795 new text end |
| 14,000-14,099 |
deleted text begin
1,778 deleted text end new text begin 1,477 new text end |
deleted text begin
2,623 deleted text end new text begin 2,068 new text end |
deleted text begin
3,065 deleted text end new text begin 2,358 new text end |
deleted text begin
3,440 deleted text end new text begin 2,547 new text end |
deleted text begin
3,809 deleted text end new text begin 2,699 new text end |
deleted text begin
4,171 deleted text end new text begin 2,807 new text end |
| 14,100-14,199 |
deleted text begin
1,791 deleted text end new text begin 1,484 new text end |
deleted text begin
2,634 deleted text end new text begin 2,077 new text end |
deleted text begin
3,078 deleted text end new text begin 2,368 new text end |
deleted text begin
3,455 deleted text end new text begin 2,558 new text end |
deleted text begin
3,825 deleted text end new text begin 2,711 new text end |
deleted text begin
4,189 deleted text end new text begin 2,819 new text end |
| 14,200-14,299 |
deleted text begin
1,803 deleted text end new text begin 1,490 new text end |
deleted text begin
2,645 deleted text end new text begin 2,086 new text end |
deleted text begin
3,092 deleted text end new text begin 2,378 new text end |
deleted text begin
3,470 deleted text end new text begin 2,569 new text end |
deleted text begin
3,841 deleted text end new text begin 2,722 new text end |
deleted text begin
4,206 deleted text end new text begin 2,831 new text end |
| 14,300-14,399 |
deleted text begin
1,816 deleted text end new text begin 1,496 new text end |
deleted text begin
2,656 deleted text end new text begin 2,094 new text end |
deleted text begin
3,105 deleted text end new text begin 2,388 new text end |
deleted text begin
3,484 deleted text end new text begin 2,580 new text end |
deleted text begin
3,858 deleted text end new text begin 2,734 new text end |
deleted text begin
4,224 deleted text end new text begin 2,843 new text end |
| 14,400-14,499 |
deleted text begin
1,829 deleted text end new text begin 1,502 new text end |
deleted text begin
2,667 deleted text end new text begin 2,103 new text end |
deleted text begin
3,118 deleted text end new text begin 2,398 new text end |
deleted text begin
3,499 deleted text end new text begin 2,590 new text end |
deleted text begin
3,874 deleted text end new text begin 2,746 new text end |
deleted text begin
4,239 deleted text end new text begin 2,855 new text end |
| 14,500-14,599 |
deleted text begin
1,842 deleted text end new text begin 1,508 new text end |
deleted text begin
2,678 deleted text end new text begin 2,111 new text end |
deleted text begin
3,131 deleted text end new text begin 2,407 new text end |
deleted text begin
3,514 deleted text end new text begin 2,600 new text end |
deleted text begin
3,889 deleted text end new text begin 2,757 new text end |
deleted text begin
4,253 deleted text end new text begin 2,867 new text end |
| 14,600-14,699 |
deleted text begin
1,854 deleted text end new text begin 1,515 new text end |
deleted text begin
2,689 deleted text end new text begin 2,120 new text end |
deleted text begin
3,144 deleted text end new text begin 2,417 new text end |
deleted text begin
3,529 deleted text end new text begin 2,611 new text end |
deleted text begin
3,902 deleted text end new text begin 2,768 new text end |
deleted text begin
4,268 deleted text end new text begin 2,879 new text end |
| 14,700-14,799 |
deleted text begin
1,864 deleted text end new text begin 1,521 new text end |
deleted text begin
2,700 deleted text end new text begin 2,129 new text end |
deleted text begin
3,158 deleted text end new text begin 2,427 new text end |
deleted text begin
3,541 deleted text end new text begin 2,622 new text end |
deleted text begin
3,916 deleted text end new text begin 2,780 new text end |
deleted text begin
4,282 deleted text end new text begin 2,891 new text end |
| 14,800-14,899 |
deleted text begin
1,872 deleted text end new text begin 1,527 new text end |
deleted text begin
2,711 deleted text end new text begin 2,138 new text end |
deleted text begin
3,170 deleted text end new text begin 2,437 new text end |
deleted text begin
3,553 deleted text end new text begin 2,633 new text end |
deleted text begin
3,929 deleted text end new text begin 2,792 new text end |
deleted text begin
4,297 deleted text end new text begin 2,903 new text end |
| 14,900-14,999 |
deleted text begin
1,879 deleted text end new text begin 1,533 new text end |
deleted text begin
2,722 deleted text end new text begin 2,146 new text end |
deleted text begin
3,181 deleted text end new text begin 2,447 new text end |
deleted text begin
3,565 deleted text end new text begin 2,643 new text end |
deleted text begin
3,942 deleted text end new text begin 2,802 new text end |
deleted text begin
4,311 deleted text end new text begin 2,914 new text end |
| 15,000deleted text begin , or the amount in effect under subd. 4 deleted text end new text begin -15,099 new text end |
deleted text begin
1,883 deleted text end new text begin 1,539 new text end |
deleted text begin
2,727 deleted text end new text begin 2,155 new text end |
deleted text begin
3,186 deleted text end new text begin 2,457 new text end |
deleted text begin
3,571 deleted text end new text begin 2,654 new text end |
deleted text begin
3,949 deleted text end new text begin 2,813 new text end |
deleted text begin
4,319 deleted text end new text begin 2,926 new text end |
|
new text begin
15,100-15,199 new text end |
new text begin
1,545 new text end |
new text begin
2,163 new text end |
new text begin
2,466 new text end |
new text begin
2,664 new text end |
new text begin
2,825 new text end |
new text begin
2,937 new text end |
|
new text begin
15,200-15,299 new text end |
new text begin
1,551 new text end |
new text begin
2,171 new text end |
new text begin
2,476 new text end |
new text begin
2,675 new text end |
new text begin
2,836 new text end |
new text begin
2,949 new text end |
|
new text begin
15,300-15,399 new text end |
new text begin
1,557 new text end |
new text begin
2,180 new text end |
new text begin
2,486 new text end |
new text begin
2,685 new text end |
new text begin
2,847 new text end |
new text begin
2,961 new text end |
|
new text begin
15,400-15,499 new text end |
new text begin
1,563 new text end |
new text begin
2,188 new text end |
new text begin
2,495 new text end |
new text begin
2,695 new text end |
new text begin
2,858 new text end |
new text begin
2,973 new text end |
|
new text begin
15,500-15,599 new text end |
new text begin
1,569 new text end |
new text begin
2,197 new text end |
new text begin
2,505 new text end |
new text begin
2,706 new text end |
new text begin
2,869 new text end |
new text begin
2,985 new text end |
|
new text begin
15,600-15,699 new text end |
new text begin
1,575 new text end |
new text begin
2,205 new text end |
new text begin
2,514 new text end |
new text begin
2,716 new text end |
new text begin
2,880 new text end |
new text begin
2,996 new text end |
|
new text begin
15,700-15,799 new text end |
new text begin
1,581 new text end |
new text begin
2,214 new text end |
new text begin
2,524 new text end |
new text begin
2,727 new text end |
new text begin
2,891 new text end |
new text begin
3,008 new text end |
|
new text begin
15,800-15,899 new text end |
new text begin
1,587 new text end |
new text begin
2,222 new text end |
new text begin
2,534 new text end |
new text begin
2,737 new text end |
new text begin
2,902 new text end |
new text begin
3,019 new text end |
|
new text begin
15,900-15,999 new text end |
new text begin
1,593 new text end |
new text begin
2,230 new text end |
new text begin
2,543 new text end |
new text begin
2,747 new text end |
new text begin
2,913 new text end |
new text begin
3,030 new text end |
|
new text begin
16,000-16,099 new text end |
new text begin
1,599 new text end |
new text begin
2,239 new text end |
new text begin
2,553 new text end |
new text begin
2,758 new text end |
new text begin
2,924 new text end |
new text begin
3,042 new text end |
|
new text begin
16,100-16,199 new text end |
new text begin
1,605 new text end |
new text begin
2,247 new text end |
new text begin
2,562 new text end |
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new text begin
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new text begin
20,000 and over or the amount in effect under subdivision 4 new text end |
new text begin
1,839 new text end |
new text begin
2,575 new text end |
new text begin
2,935 new text end |
new text begin
3,170 new text end |
new text begin
3,359 new text end |
new text begin
3,492 new text end |
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 13.
Minnesota Statutes 2020, section 518A.39, subdivision 7, is amended to read:
Subd. 7.
Child care exception.
Child care support must be based on the actual child
care expenses. The court may provide that a decrease in the amount of the child care based
on a decrease in the actual child care expenses is effective as of the date the expense is
decreased.new text begin Under section 518A.40, subdivision 4, paragraph (d), a decrease in the amount
of child care support shall be effective as of the date the expenses terminated unless otherwise
found by the court.
new text end
Sec. 14.
Minnesota Statutes 2020, section 518A.40, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Child care cost information. new text end
new text begin
(a) Upon the request of the obligor when child
care support is ordered to be paid, unless there is a protective or restraining order issued by
the court regarding one of the parties or on behalf of a joint child, or the obligee is a
participant in the Safe at Home program:
new text end
new text begin
(1) the obligee must give the child care provider the name and address of the obligor
and must give the obligor the name, address, and telephone number of the child care provider;
new text end
new text begin
(2) by February 1 of each year, the obligee must provide the obligor with verification
from the child care provider that indicates the total child care expenses paid for the previous
year; and
new text end
new text begin
(3) when there is a change in the child care provider, the type of child care provider, or
the age group of the child, the obligee must provide updated information to the obligor
within 30 calendar days. If the obligee fails to provide the annual verification from the
provider or updated information, the obligor may request the verification from the provider.
new text end
new text begin
(b) When the obligee is no longer incurring child care expenses, the obligee must notify
the obligor, and the public authority if it provides child support services, that the child care
expenses ended and on which date. If the public authority is providing services, the public
authority must follow the procedure outlined in subdivision 4.
new text end
Sec. 15.
Minnesota Statutes 2020, section 518A.40, subdivision 4, is amended to read:
Subd. 4.
Change in child care.
(a) When a court order provides for child care expenses,
and child care support is not assigned under section 256.741, the public authority, if the
public authority provides child support enforcement services, may suspend collecting the
amount allocated for child care expenses when either party informs the public authority that
no child care deleted text begin costsdeleted text end new text begin expensesnew text end are being incurred and:
(1) the public authority verifies the accuracy of the information with the obligee; or
(2) the obligee fails to respond within 30 days of the date of a written request from the
public authority for information regarding child care costs. A written or oral response from
the obligee that child care costs are being incurred is sufficient for the public authority to
continue collecting child care expenses.
The suspension is effective as of the first day of the month following the date that the public
authority either verified the information with the obligee or the obligee failed to respond.
The public authority will resume collecting child care expenses when either party provides
information that child care costs are incurred, or when a child care support assignment takes
effect under section 256.741, subdivision 4. The resumption is effective as of the first day
of the month after the date that the public authority received the information.
(b) If the parties provide conflicting information to the public authority regarding whether
child care expenses are being incurred, the public authority will continue or resume collecting
child care expenses. Either party, by motion to the court, may challenge the suspension,
continuation, or resumption of the collection of child care expenses under this subdivision.
If the public authority suspends collection activities for the amount allocated for child care
expenses, all other provisions of the court order remain in effect.
(c) In cases where there is a substantial increase or decrease in child care expenses, the
parties may modify the order under section 518A.39.
new text begin
(d) In cases where child care expenses have terminated, the parties may modify the order
under section 518A.39.
new text end
new text begin
(e) When the public authority is providing child support services, the parties may contact
the public authority about the option of a stipulation to modify or terminate the child care
support amount.
new text end
Sec. 16.
Minnesota Statutes 2020, section 518A.42, is amended to read:
518A.42 ABILITY TO PAY; SELF-SUPPORT ADJUSTMENT.
Subdivision 1.
Ability to pay.
(a) It is a rebuttable presumption that a child support
order should not exceed the obligor's ability to pay. To determine the amount of child support
the obligor has the ability to pay, the court shall follow the procedure set out in this section.
(b) The court shall calculate the obligor's income available for support by subtracting a
monthly self-support reserve equal to 120 percent of the federal poverty guidelines for one
person from the obligor's deleted text begin gross incomedeleted text end new text begin parental income for determining child support (PICS)new text end .
If the obligor's income available for support calculated under this paragraph is equal to or
greater than the obligor's support obligation calculated under section 518A.34, the court
shall order child support under section 518A.34.
(c) If the obligor's income available for support calculated under paragraph (b) is more
than the minimum support amount under subdivision 2, but less than the guideline amount
under section 518A.34, then the court shall apply a reduction to the child support obligation
in the following order, until the support order is equal to the obligor's income available for
support:
(1) medical support obligation;
(2) child care support obligation; and
(3) basic support obligation.
(d) If the obligor's income available for support calculated under paragraph (b) is equal
to or less than the minimum support amount under subdivision 2 or if the obligor's gross
income is less than 120 percent of the federal poverty guidelines for one person, the minimum
support amount under subdivision 2 applies.
Subd. 2.
Minimum basic support amount.
(a) If the basic support amount applies, the
court must order the following amount as the minimum basic support obligation:
(1) for one deleted text begin or two childrendeleted text end new text begin childnew text end , the obligor's basic support obligation is $50 per month;
(2) new text begin for two children, the obligor's basic support obligation is $60 per month;
new text end
new text begin (3) new text end for three deleted text begin or fourdeleted text end children, the obligor's basic support obligation is deleted text begin $75deleted text end new text begin $70new text end per month;
deleted text begin and
deleted text end
new text begin
(4) for four children, the obligor's basic support obligation is $80 per month;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end for five deleted text begin or moredeleted text end children, the obligor's basic support obligation is deleted text begin $100deleted text end new text begin $90new text end per
monthdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) for six or more children, the obligor's basic support obligation is $100 per month.
new text end
(b) If the court orders the obligor to pay the minimum basic support amount under this
subdivision, the obligor is presumed unable to pay child care support and medical support.
deleted text begin
If the court finds the obligor receives no income and completely lacks the ability to earn
income, the minimum basic support amount under this subdivision does not apply.
deleted text end
Subd. 3.
Exception.
new text begin (a) new text end This section does not apply to an obligor who is incarcerated.
new text begin
(b) If the court finds the obligor receives no income and completely lacks the ability to
earn income, the minimum basic support amount under this subdivision does not apply.
new text end
new text begin
(c) If the obligor's basic support amount is reduced below the minimum basic support
amount due to the application of the parenting expense adjustment, the minimum basic
support amount under this subdivision does not apply and the lesser amount is the guideline
basic support.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 17.
Minnesota Statutes 2020, section 518A.43, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Increase in income of custodial parent. new text end
new text begin
In a modification of support under
section 518A.39, the court may deviate from the presumptive child support obligation under
section 518A.34 when the only change in circumstances is an increase to the custodial
parent's income and:
new text end
new text begin
(1) the basic support increases;
new text end
new text begin
(2) the parties' combined gross income is $6,000 or less; or
new text end
new text begin
(3) the obligor's income is $2,000 or less.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 18.
Minnesota Statutes 2020, section 518A.685, is amended to read:
518A.685 CONSUMER REPORTING AGENCY; REPORTING ARREARS.
(a) If a public authority determines that an obligor has not paid the current monthly
support obligation plus any required arrearage payment for three months, the public authority
deleted text begin mustdeleted text end new text begin maynew text end report this information to a consumer reporting agency.
(b) Before reporting that an obligor is in arrears for court-ordered child support, the
public authority must:
(1) provide written notice to the obligor that the public authority intends to report the
arrears to a consumer reporting agency; and
(2) mail the written notice to the obligor's last known mailing address at least 30 days
before the public authority reports the arrears to a consumer reporting agency.
(c) The obligor may, within 21 days of receipt of the notice, do the following to prevent
the public authority from reporting the arrears to a consumer reporting agency:
(1) pay the arrears in full; deleted text begin or
deleted text end
(2) request an administrative review. An administrative review is limited to issues of
mistaken identity, a pending legal action involving the arrears, or an incorrect arrears
balancedeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) enter into a written payment agreement pursuant to section 518A.69 that is approved
by a court, a child support magistrate, or the public authority responsible for child support
enforcement.
new text end
(d) A public authority that reports arrearage information under this section must make
monthly reports to a consumer reporting agency. The monthly report must be consistent
with credit reporting industry standards for child support.
(e) For purposes of this section, "consumer reporting agency" has the meaning given in
section 13C.001, subdivision 4, and United States Code, title 15, section 1681a(f).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 19.
new text begin
[518A.80] MOTION TO TRANSFER TO TRIBAL COURT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Case participant" means a person who is a party to the case.
new text end
new text begin
(c) "District court" means a district court of the state of Minnesota.
new text end
new text begin
(d) "Party" means a person or entity named or admitted as a party or seeking to be
admitted as a party in the district court action, including the county IV-D agency, regardless
of whether the person or entity is named in the caption.
new text end
new text begin
(e) "Tribal court" means a tribal court of a federally recognized Indian tribe located in
Minnesota that is receiving funding from the federal government to operate a child support
program under United States Code, title 42, chapter 7, subchapter IV, part D, sections 654
to 669b.
new text end
new text begin
(f) "Tribal IV-D agency" has the meaning given in Code of Federal Regulations, title
45, part 309.05.
new text end
new text begin
(g) "Title IV-D child support case" has the meaning given in section 518A.26, subdivision
10.
new text end
new text begin Subd. 2. new text end
new text begin Actions eligible for transfer. new text end
new text begin
Under this section, a postjudgment child support,
custody, or parenting time action is eligible for transfer to a Tribal court. This section does
not apply to a child protection action or a dissolution action involving a child.
new text end
new text begin Subd. 3. new text end
new text begin Motion to transfer. new text end
new text begin
(a) A party's or Tribal IV-D agency's motion to transfer a
child support, custody, or parenting time action to a Tribal court shall include:
new text end
new text begin
(1) the address of each case participant;
new text end
new text begin
(2) the Tribal affiliation of each case participant, if applicable;
new text end
new text begin
(3) the name, Tribal affiliation if applicable, and date of birth of each living minor or
dependent child of a case participant who is subject to the action; and
new text end
new text begin
(4) the legal and factual basis for the court to find that the district court and a Tribal
court have concurrent jurisdiction in the case.
new text end
new text begin
(b) A party or Tribal IV-D agency bringing a motion to transfer a child support, custody,
or parenting time action to a Tribal court must file the motion with the district court and
serve the required documents on each party and the Tribal IV-D agency, regardless of
whether the Tribal IV-D agency is a party to the action.
new text end
new text begin
(c) A party's or Tribal IV-D agency's motion to transfer a child support, custody, or
parenting time action to a Tribal court must be accompanied by an affidavit setting forth
facts in support of the motion.
new text end
new text begin
(d) When a party other than the Tribal IV-D agency has filed a motion to transfer a child
support, custody, or parenting time action to a Tribal court, an affidavit of the Tribal IV-D
agency stating whether the Tribal IV-D agency provides services to a party must be filed
and served on each party within 15 days from the date of service of the motion to transfer
the action.
new text end
new text begin Subd. 4. new text end
new text begin Order to transfer to Tribal court. new text end
new text begin
(a) Unless a district court holds a hearing
under subdivision 6, upon motion of a party or a Tribal IV-D agency, a district court must
transfer a postjudgment child support, custody, or parenting time action to a Tribal court
when the district court finds that:
new text end
new text begin
(1) the district court and Tribal court have concurrent jurisdiction of the action;
new text end
new text begin
(2) a case participant in the action is receiving services from the Tribal IV-D agency;
and
new text end
new text begin
(3) no party or Tribal IV-D agency files and serves a timely objection to transferring the
action to a Tribal court.
new text end
new text begin
(b) When the district court finds that each requirement of this subdivision is satisfied,
the district court is not required to hold a hearing on the motion to transfer the action to a
Tribal court. The district court's order transferring the action to a Tribal court must include
written findings that describe how each requirement of this subdivision is met.
new text end
new text begin Subd. 5. new text end
new text begin Objection to motion to transfer. new text end
new text begin
(a) To object to a motion to transfer a child
support, custody, or parenting time action to a Tribal court, a party or Tribal IV-D agency
must file with the court and serve on each party and the Tribal IV-D agency a responsive
motion objecting to the motion to transfer within 30 days of the motion to transfer's date of
service.
new text end
new text begin
(b) If a party or Tribal IV-D agency files with the district court and properly serves a
timely objection to the motion to transfer a child support, custody, or parenting time action
to a Tribal court, the district court must hold a hearing on the motion.
new text end
new text begin Subd. 6. new text end
new text begin Hearing. new text end
new text begin
If a district court holds a hearing under this section, the district court
must evaluate and make written findings about all relevant factors, including:
new text end
new text begin
(1) whether an issue requires interpretation of Tribal law, including the Tribal constitution,
statutes, bylaws, ordinances, resolutions, treaties, or case law;
new text end
new text begin
(2) whether the action involves Tribal traditional or cultural matters;
new text end
new text begin
(3) whether the tribe is a party to the action;
new text end
new text begin
(4) whether Tribal sovereignty, jurisdiction, or territory is an issue in the action;
new text end
new text begin
(5) the Tribal membership status of each case participant in the action;
new text end
new text begin
(6) where the claim arises that forms the basis of the action;
new text end
new text begin
(7) the location of the residence of each case participant in the action and each child
who is a subject of the action;
new text end
new text begin
(8) whether the parties have by contract chosen a forum or the law to be applied in the
event of a dispute;
new text end
new text begin
(9) the timing of any motion to transfer the action to a Tribal court, each party's
expenditure of time and resources, the court's expenditure of time and resources, and the
district court's scheduling order;
new text end
new text begin
(10) which court will hear and decide the action more expeditiously;
new text end
new text begin
(11) the burden on each party if the court transfers the action to a Tribal court, including
costs, access to and admissibility of evidence, and matters of procedure; and
new text end
new text begin
(12) any other factor that the court determines to be relevant.
new text end
new text begin Subd. 7. new text end
new text begin Future exercise of jurisdiction. new text end
new text begin
Nothing in this section shall be construed to
limit the district court's exercise of jurisdiction when the Tribal court waives jurisdiction,
transfers the action back to district court, or otherwise declines to exercise jurisdiction over
the action.
new text end
new text begin Subd. 8. new text end
new text begin Transfer to Red Lake Nation Tribal Court. new text end
new text begin
When a party or Tribal IV-D
agency brings a motion to transfer a child support, custody, or parenting time action to the
Red Lake Nation Tribal Court, the court must transfer the action to the Red Lake Nation
Tribal Court if the case participants and child resided within the boundaries of the Red Lake
Reservation for six months preceding the motion to transfer the action to the Red Lake
Nation Tribal Court.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
Minnesota Statutes 2020, section 548.091, subdivision 1a, is amended to read:
Subd. 1a.
Child support judgment by operation of law.
deleted text begin (a)deleted text end Any payment or installment
of support required by a judgment or decree of dissolution or legal separation, determination
of parentage, an order under chapter 518C, an order under section 256.87, or an order under
section 260B.331 or 260C.331, that is not paid or withheld from the obligor's income as
required under section 518A.53, or which is ordered as child support by judgment, decree,
or order by a court in any other state, is a judgment by operation of law on and after the
date it is due, is entitled to full faith and credit in this state and any other state, and shall be
entered and docketed by the court administrator on the filing of affidavits as provided in
subdivision 2a. deleted text begin Except as otherwise provided by paragraphs (b) and (e), interest accrues
from the date the unpaid amount due is greater than the current support due at the annual
rate provided in section 549.09, subdivision 1, not to exceed an annual rate of 18 percent.deleted text end
A payment or installment of support that becomes a judgment by operation of law between
the date on which a party served notice of a motion for modification under section 518A.39,
subdivision 2, and the date of the court's order on modification may be modified under that
subdivision.new text begin Interest does not accrue on a judgment for child support, confinement and
pregnancy expenses, or genetic testing fees.
new text end
deleted text begin
(b) Notwithstanding the provisions of section 549.09, upon motion to the court and upon
proof by the obligor of 12 consecutive months of complete and timely payments of both
current support and court-ordered paybacks of a child support debt or arrearage, the court
may order interest on the remaining debt or arrearage to stop accruing. Timely payments
are those made in the month in which they are due. If, after that time, the obligor fails to
make complete and timely payments of both current support and court-ordered paybacks
of child support debt or arrearage, the public authority or the obligee may move the court
for the reinstatement of interest as of the month in which the obligor ceased making complete
and timely payments.
deleted text end
deleted text begin
The court shall provide copies of all orders issued under this section to the public
authority. The state court administrator shall prepare and make available to the court and
the parties forms to be submitted by the parties in support of a motion under this paragraph.
deleted text end
deleted text begin
(c) Notwithstanding the provisions of section 549.09, upon motion to the court, the court
may order interest on a child support debt or arrearage to stop accruing where the court
finds that the obligor is:
deleted text end
deleted text begin
(1) unable to pay support because of a significant physical or mental disability;
deleted text end
deleted text begin
(2) a recipient of Supplemental Security Income (SSI), Title II Older Americans Survivor's
Disability Insurance (OASDI), other disability benefits, or public assistance based upon
need; or
deleted text end
deleted text begin
(3) institutionalized or incarcerated for at least 30 days for an offense other than
nonsupport of the child or children involved, and is otherwise financially unable to pay
support.
deleted text end
deleted text begin
(d) If the conditions in paragraph (c) no longer exist, upon motion to the court, the court
may order interest accrual to resume retroactively from the date of service of the motion to
resume the accrual of interest.
deleted text end
deleted text begin
(e) Notwithstanding section 549.09, the public authority must suspend the charging of
interest when:
deleted text end
deleted text begin
(1) the obligor makes a request to the public authority that the public authority suspend
the charging of interest;
deleted text end
deleted text begin
(2) the public authority provides full IV-D child support services; and
deleted text end
deleted text begin
(3) the obligor has made, through the public authority, 12 consecutive months of complete
and timely payments of both current support and court-ordered paybacks of a child support
debt or arrearage.
deleted text end
deleted text begin
Timely payments are those made in the month in which they are due.
deleted text end
deleted text begin
Interest charging must be suspended on the first of the month following the date of the
written notice of the public authority's action to suspend the charging of interest. If, after
interest charging has been suspended, the obligor fails to make complete and timely payments
of both current support and court-ordered paybacks of child support debt or arrearage, the
public authority may resume the charging of interest as of the first day of the month in which
the obligor ceased making complete and timely payments.
deleted text end
deleted text begin
The public authority must provide written notice to the parties of the public authority's
action to suspend or resume the charging of interest. The notice must inform the parties of
the right to request a hearing to contest the public authority's action. The notice must be
sent by first class mail to the parties' last known addresses.
deleted text end
deleted text begin
A party may contest the public authority's action to suspend or resume the charging of
interest if the party makes a written request for a hearing within 30 days of the date of written
notice. If a party makes a timely request for a hearing, the public authority must schedule
a hearing and send written notice of the hearing to the parties by mail to the parties' last
known addresses at least 14 days before the hearing. The hearing must be conducted in
district court or in the expedited child support process if section 484.702 applies. The district
court or child support magistrate must determine whether suspending or resuming the interest
charging is appropriate and, if appropriate, the effective date.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 548.091, subdivision 2a, is amended to read:
Subd. 2a.
Entry and docketing of child support judgment.
(a) On or after the date an
unpaid amount becomes a judgment by operation of law under subdivision 1a, the obligee
or the public authority may file with the court administrator:
(1) a statement identifying, or a copy of, the judgment or decree of dissolution or legal
separation, determination of parentage, order under chapter 518B or 518C, an order under
section 256.87, an order under section 260B.331 or 260C.331, or judgment, decree, or order
for child support by a court in any other state, which provides for periodic installments of
child support, or a judgment or notice of attorney fees and collection costs under section
518A.735;
(2) an affidavit of default. The affidavit of default must state the full name, occupation,
place of residence, and last known post office address of the obligor, the name of the obligee,
the date or dates payment was due and not received and judgment was obtained by operation
of law, the total amount of the judgments to be entered and docketed; and
(3) an affidavit of service of a notice of intent to enter and docket judgment and to recover
attorney fees and collection costs on the obligor, in person or by first class mail at the
obligor's last known post office address. Service is completed upon mailing in the manner
designated. Where applicable, a notice of interstate lien in the form promulgated under
United States Code, title 42, section 652(a), is sufficient to satisfy the requirements of clauses
(1) and (2).
(b) A judgment entered and docketed under this subdivision has the same effect and is
subject to the same procedures, defenses, and proceedings as any other judgment in district
court, and may be enforced or satisfied in the same manner as judgments under section
548.09, except as otherwise provided.
new text begin
(c) A judgment entered and docketed under this subdivision is not subject to interest
charging or accrual.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 548.091, subdivision 3b, is amended to read:
Subd. 3b.
Child support judgment administrative renewals.
Child support judgments
may be renewed by service of notice upon the debtor. Service must be by first class mail at
the last known address of the debtor, with service deemed complete upon mailing in the
manner designated, or in the manner provided for the service of civil process. Upon the
filing of the notice and proof of service, the court administrator shall administratively renew
the judgment for child support without any additional filing fee in the same court file as the
original child support judgment. The judgment must be renewed in an amount equal to the
unpaid principal plus the deleted text begin accrueddeleted text end unpaid interestnew text begin accrued prior to August 1, 2022new text end . Child
support judgments may be renewed multiple times until paid.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 23.
Minnesota Statutes 2020, section 548.091, subdivision 9, is amended to read:
Subd. 9.
Payoff statement.
The public authority shall issue to the obligor, attorneys,
lenders, and closers, or their agents, a payoff statement setting forth conclusively the amount
necessary to satisfy the lien. Payoff statements must be issued within three business days
after receipt of a request by mail, personal delivery, telefacsimile, or electronic mail
transmission, and must be delivered to the requester by telefacsimile or electronic mail
transmission if requested and if appropriate technology is available to the public authority.new text begin
If the payoff statement includes amounts for unpaid maintenance, the statement shall specify
that the public authority does not calculate accrued interest and that an interest balance in
addition to the payoff statement may be owed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 24.
Minnesota Statutes 2020, section 548.091, subdivision 10, is amended to read:
Subd. 10.
Release of lien.
Upon payment of the new text begin child support new text end amount due, the public
authority shall execute and deliver a satisfaction of the judgment lien within five business
days.new text begin The public authority is not responsible for satisfaction of judgments for unpaid
maintenance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 25.
Minnesota Statutes 2020, section 549.09, subdivision 1, is amended to read:
Subdivision 1.
When owed; rate.
(a) When a judgment or award is for the recovery of
money, including a judgment for the recovery of taxes, interest from the time of the verdict,
award, or report until judgment is finally entered shall be computed by the court administrator
or arbitrator as provided in paragraph (c) and added to the judgment or award.
(b) Except as otherwise provided by contract or allowed by law, preverdict, preaward,
or prereport interest on pecuniary damages shall be computed as provided in paragraph (c)
from the time of the commencement of the action or a demand for arbitration, or the time
of a written notice of claim, whichever occurs first, except as provided herein. The action
must be commenced within two years of a written notice of claim for interest to begin to
accrue from the time of the notice of claim. If either party serves a written offer of settlement,
the other party may serve a written acceptance or a written counteroffer within 30 days.
After that time, interest on the judgment or award shall be calculated by the judge or arbitrator
in the following manner. The prevailing party shall receive interest on any judgment or
award from the time of commencement of the action or a demand for arbitration, or the time
of a written notice of claim, or as to special damages from the time when special damages
were incurred, if later, until the time of verdict, award, or report only if the amount of its
offer is closer to the judgment or award than the amount of the opposing party's offer. If
the amount of the losing party's offer was closer to the judgment or award than the prevailing
party's offer, the prevailing party shall receive interest only on the amount of the settlement
offer or the judgment or award, whichever is less, and only from the time of commencement
of the action or a demand for arbitration, or the time of a written notice of claim, or as to
special damages from when the special damages were incurred, if later, until the time the
settlement offer was made. Subsequent offers and counteroffers supersede the legal effect
of earlier offers and counteroffers. For the purposes of clause (2), the amount of settlement
offer must be allocated between past and future damages in the same proportion as determined
by the trier of fact. Except as otherwise provided by contract or allowed by law, preverdict,
preaward, or prereport interest shall not be awarded on the following:
(1) judgments, awards, or benefits in workers' compensation cases, but not including
third-party actions;
(2) judgments or awards for future damages;
(3) punitive damages, fines, or other damages that are noncompensatory in nature;
(4) judgments or awards not in excess of the amount specified in section 491A.01; and
(5) that portion of any verdict, award, or report which is founded upon interest, or costs,
disbursements, attorney fees, or other similar items added by the court or arbitrator.
(c)(1)(i) For a judgment or award of $50,000 or less or a judgment or award for or against
the state or a political subdivision of the state, regardless of the amount, or a judgment or
award in a family court action, new text begin except for a child support judgment, new text end regardless of the amount,
the interest shall be computed as simple interest per annum. The rate of interest shall be
based on the secondary market yield of one year United States Treasury bills, calculated on
a bank discount basis as provided in this section.
On or before the 20th day of December of each year the state court administrator shall
determine the rate from the one-year constant maturity treasury yield for the most recent
calendar month, reported on a monthly basis in the latest statistical release of the board of
governors of the Federal Reserve System. This yield, rounded to the nearest one percent,
or four percent, whichever is greater, shall be the annual interest rate during the succeeding
calendar year. The state court administrator shall communicate the interest rates to the court
administrators and sheriffs for use in computing the interest on verdicts and shall make the
interest rates available to arbitrators.
This item applies to any section that references section 549.09 by citation for the purposes
of computing an interest rate on any amount owed to or by the state or a political subdivision
of the state, regardless of the amount.
(ii) The court, in a family court action, may order a lower interest rate or no interest rate
if the parties agree or if the court makes findings explaining why application of a lower
interest rate or no interest rate is necessary to avoid causing an unfair hardship to the debtor.
This item does not apply to child support or spousal maintenance judgments subject to
section 548.091.
(2) For a judgment or award over $50,000, other than a judgment or award for or against
the state or a political subdivision of the state or a judgment or award in a family court
action, the interest rate shall be ten percent per year until paid.
(3) When a judgment creditor, or the judgment creditor's attorney or agent, has received
a payment after entry of judgment, whether the payment is made voluntarily by or on behalf
of the judgment debtor, or is collected by legal process other than execution levy where a
proper return has been filed with the court administrator, the judgment creditor, or the
judgment creditor's attorney, before applying to the court administrator for an execution
shall file with the court administrator an affidavit of partial satisfaction. The affidavit must
state the dates and amounts of payments made upon the judgment after the most recent
affidavit of partial satisfaction filed, if any; the part of each payment that is applied to taxable
disbursements and to accrued interest and to the unpaid principal balance of the judgment;
and the accrued, but the unpaid interest owing, if any, after application of each payment.
new text begin
(4) Interest shall not accrue on child support judgments.
new text end
(d) This section does not apply to arbitrations between employers and employees under
chapter 179 or 179A. An arbitrator is neither required to nor prohibited from awarding
interest under chapter 179 or under section 179A.16 for essential employees.
(e) For purposes of this subdivision:
(1) "state" includes a department, board, agency, commission, court, or other entity in
the executive, legislative, or judicial branch of the state; and
(2) "political subdivision" includes a town, statutory or home rule charter city, county,
school district, or any other political subdivision of the state.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
ARTICLE 13
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2020, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of out-of-home placement. A child is not required to have case
management services to receive respite care services;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minorities;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services under section 245.4901;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(18) evidence-informed interventions for youth and young adults who are at risk of
developing a mood disorder or are experiencing an emerging mood disorder, including
major depression and bipolar disorders, and a public awareness campaign on the signs and
symptoms of mood disorders in youth and young adults.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
Sec. 2.
Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs)new text begin that satisfy all federal requirements necessary for CCBHCs certified under this
section to be eligible for reimbursement under medical assistance, without service area
limits based on geographic area or regionnew text end . new text begin The commissioner shall consult with CCBHC
stakeholders before establishing and implementing changes in the certification process and
requirements.new text end Entities that choose to be CCBHCs must:
deleted text begin
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
deleted text end
new text begin
(1) comply with state licensing requirements and other requirements issued by the
commissioner;
new text end
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization servicesnew text begin , through existing
mobile crisis servicesnew text end ; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veteransdeleted text begin ;deleted text end new text begin . CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
new text end
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be certified as mental health clinics under section 245.69, subdivision 2;
(9) comply with standards new text begin established by the commissioner new text end relating to deleted text begin mental health
services in Minnesota Rules, parts 9505.0370 to 9505.0372deleted text end new text begin CCBHC screenings, assessments,
and evaluationsnew text end ;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under deleted text begin sectionsdeleted text end new text begin sectionnew text end
256B.0624 deleted text begin and 256B.0944deleted text end ;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If deleted text begin an entitydeleted text end new text begin a certified CCBHCnew text end is unable to provide one or more of the services listed
in paragraph (a), clauses (6) to (17), the deleted text begin commissioner may certify the entity as adeleted text end CCBHCdeleted text begin ,
if the entity has a currentdeleted text end new text begin maynew text end contract with another entity that has the required authority
to provide that service and that meets deleted text begin federal CCBHCdeleted text end new text begin the followingnew text end criteria as a designated
collaborating organizationdeleted text begin , or, to the extent allowed by the federal CCBHC criteria, the
commissioner may approve a referral arrangement. The CCBHC must meet federal
requirements regarding the type and scope of services to be provided directly by the CCBHC.deleted text end new text begin :
new text end
new text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
new text end
new text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end
new text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end
new text begin
(4) the entity meets any additional requirements issued by the commissioner.
new text end
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirementsnew text begin
for services reimbursed under medical assistancenew text end . If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
Sec. 3.
Minnesota Statutes 2020, section 245.735, subdivision 5, is amended to read:
Subd. 5.
Information systems support.
The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with new text begin state and new text end federal requirements.
Sec. 4.
Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Demonstration entities. new text end
new text begin
The commissioner may operate the demonstration
program established by section 223 of the Protecting Access to Medicare Act if federal
funding for the demonstration program remains available from the United States Department
of Health and Human Services. To the extent practicable, the commissioner shall align the
requirements of the demonstration program with the requirements under this section for
CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to
participate as a billing provider in both the CCBHC federal demonstration and the benefit
for CCBHCs under the medical assistance program.
new text end
Sec. 5.
Minnesota Statutes 2020, section 246.54, subdivision 1b, is amended to read:
Subd. 1b.
Community behavioral health hospitals.
A county's payment of the cost of
care provided at state-operated community-based behavioral health hospitalsnew text begin for adults and
childrennew text end shall be according to the following schedule:
(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and
(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.
Sec. 6.
new text begin
[254B.17] SCHOOL-LINKED SUBSTANCE ABUSE GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services shall establish a
school-linked substance abuse grant program to provide early identification of and
intervention for secondary school students with substance use disorder needs, and to build
the capacity of secondary schools to support students with substance use disorder needs in
the classroom.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicant. new text end
new text begin
(a) An eligible applicant for a school-linked substance
abuse grant is an entity or individual that is:
new text end
new text begin
(1) licensed under chapter 245G and in compliance with the general requirements in
chapters 245A, 245C, and 260E, section 626.557, and Minnesota Rules, chapter 9544; or
new text end
new text begin
(2) an alcohol and drug counselor licensed under chapter 148F and in compliance with
section 245G.11, subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Allowable grant activities and related expenses. new text end
new text begin
(a) Allowable grant activities
and related expenses may include but are not limited to:
new text end
new text begin
(1) identifying and diagnosing substance use disorders of students;
new text end
new text begin
(2) delivering substance use disorder treatment and services to students and their families,
including via telemedicine;
new text end
new text begin
(3) supporting families in meeting their child's needs, including navigating health care,
social service, and juvenile justice systems;
new text end
new text begin
(4) providing transportation for students receiving school-linked substance use disorder
treatment services when school is not in session;
new text end
new text begin
(5) building the capacity of schools to meet the needs of students with substance use
disorder concerns, including school staff development activities for licensed and nonlicensed
staff; and
new text end
new text begin
(6) purchasing equipment, connection charges, on-site coordination, setup fees, and site
fees in order to deliver school-linked substance use disorder treatment services via
telemedicine.
new text end
new text begin
(b) Grantees shall obtain all available third-party reimbursement sources as a condition
of receiving a grant. For purposes of the grant program, a third-party reimbursement source
excludes a public school as defined in section 120A.20, subdivision 1. Grantees shall serve
each student regardless of the student's health coverage status or ability to pay.
new text end
new text begin
(c) Prior to issuing a request for proposals for grants under this section, the commissioner
shall award grants to eligible applicants that are currently providing substance use disorder
treatment services in secondary schools or that are currently providing school-linked mental
health services but have the demonstrated capacity to provide allowable substance use
disorder treatment services in secondary schools.
new text end
new text begin Subd. 4. new text end
new text begin Data collection and outcome measurement. new text end
new text begin
Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked
substance use disorder treatment grant program.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0624, subdivision 7, is amended to read:
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 11;
(2) staff must be qualified as defined in subdivision 8; and
(3) services must be delivered according to the treatment plan and include face-to-face
contact with the recipient by qualified staff for further assessment, help with referrals,
updating of the crisis stabilization treatment plan, supportive counseling, skills training,
and collaboration with other service providers in the community.
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
(c) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves no more than four adult residents, and one or more individuals are present at the
setting to receive residential crisis stabilization services, the residential staff must include,
for at least eight hours per day, at least one individual who meets the qualifications in
subdivision 8, paragraph (a), clause (1) or (2).new text begin The commissioner shall establish a statewide
per diem rate for crisis stabilization services provided under this paragraph to medical
assistance enrollees. The rate for a provider shall not exceed the rate charged by that provider
for the same service to other payers. Payment shall not be made to more than one entity for
each individual for services provided under this paragraph on a given day. The commissioner
shall set rates prospectively for the annual rate period. The commissioner shall require
providers to submit annual cost reports on a uniform cost reporting form and shall use
submitted cost reports to inform the rate-setting process. The commissioner shall recalculate
the statewide per diem every year.
new text end
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, subdivision 5m, is amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
(b) The commissioner shall deleted text begin establish standards and methodologies for adeleted text end new text begin reimburse
CCBHCs on a per-visit basis under the new text end prospective payment system for medical assistance
payments deleted text begin for services delivered by a CCBHC, in accordance with guidance issued by the
Centers for Medicare and Medicaid Servicesdeleted text end new text begin as described in paragraph (c)new text end . The commissioner
shall include a quality deleted text begin bonusdeleted text end new text begin incentivenew text end payment in the prospective payment system deleted text begin based
on federal criteriadeleted text end new text begin as described in paragraph (e)new text end . There is no county share for medical
assistance services when reimbursed through the CCBHC prospective payment system.
(c) deleted text begin Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:deleted text end new text begin The commissioner shall ensure that the prospective
payment system for CCBHC payments under medical assistance meets the following
requirements:
new text end
new text begin
(1) the prospective payment rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
costs for CCBHCs divided by the total annual number of CCBHC visits. For calculating
the payment rate, total annual visits include visits covered by medical assistance and visits
not covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
new text end
new text begin
(2) payment shall be limited to one payment per day per medical assistance enrollee for
each CCBHC visit eligible for reimbursement. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
new text end
new text begin
(3) new payment rates set by the commissioner for newly certified CCBHCs under
section 245.735, subdivision 3, shall be based on rates for established CCBHCs with a
similar scope of services. If no comparable CCBHC exists, the commissioner shall establish
a clinic-specific rate using audited historical cost report data adjusted for the estimated cost
of delivering CCBHC services, including the estimated cost of providing the full scope of
services and the projected change in visits resulting from the change in scope;
new text end
deleted text begin (1)deleted text end new text begin (4)new text end the commissioner shall rebase CCBHC rates deleted text begin at leastdeleted text end new text begin oncenew text end every three yearsnew text begin and
12 months following an initial rate or a rate change due to a change in the scope of services,
whichever is earliernew text end ;
deleted text begin (2)deleted text end new text begin (5)new text end the commissioner shall provide for a 60-day appeals process new text begin after notice of the
results new text end of the rebasing;
deleted text begin
(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
deleted text end
deleted text begin (4)deleted text end new text begin (6)new text end the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
deleted text begin (5)deleted text end new text begin (7)new text end payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap paymentsnew text begin . The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the prospective payment system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafternew text end ;
deleted text begin
(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services;
deleted text end
deleted text begin (7)deleted text end new text begin (8)new text end the prospective payment rate for each CCBHC shall be deleted text begin adjusted annuallydeleted text end new text begin updated
new text end bynew text begin trending each provider-specific rate bynew text end the Medicare Economic Index deleted text begin as defined for the
federal section 223 CCBHC demonstrationdeleted text end new text begin for primary care services. This update shall
occur each year in between rebasing periods determined by the commissioner in accordance
with clause (4). CCBHCs must provide data on costs and visits to the state annually using
the CCBHC cost report established by the commissionernew text end ; and
new text begin
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Rate adjustments for changes in scope shall occur no more than
once per year in between rebasing periods per CCBHC and are effective on the date of the
annual CCBHC rate update.
new text end
deleted text begin
(8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
for changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner in consultation with CCBHCs.
deleted text end
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
new text begin
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
new text end
new text begin
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the prospective payment system described in
paragraph (c);
new text end
new text begin
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
new text end
new text begin
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
new text end
new text begin
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
new text end
new text begin
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
new text end
new text begin
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
new text end
new text begin
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
new text end
new text begin
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0759, subdivision 2, is amended to read:
Subd. 2.
Provider participation.
new text begin (a) Outpatient new text end substance use disorder treatment
providers may elect to participate in the demonstration project and meet the requirements
of subdivision 3. To participate, a provider must notify the commissioner of the provider's
intent to participate in a format required by the commissioner and enroll as a demonstration
project provider.
new text begin
(b) Programs licensed by the Department of Human Services as a residential treatment
program according to section 245G.21 that receive payment under this chapter must enroll
as demonstration project providers and meet the requirements of subdivision 3 by June 30,
2025. Programs that do not meet the requirements of this paragraph are ineligible for payment
for services provided under section 256B.0625.
new text end
new text begin
(c) Programs licensed by the Department of Human Services as a withdrawal management
program according to chapter 245F that receive payment under this chapter must enroll as
demonstration project providers and meet the requirements of subdivision 3 by June 30,
2025. Programs that do not meet the requirements of this paragraph are ineligible for payment
for services provided under section 256B.0625.
new text end
new text begin
(d) Out-of-state residential substance use disorder treatment programs that receive
payment under this chapter must enroll as demonstration project providers and meet the
requirements of subdivision 3 by June 30, 2025. Programs that do not meet the requirements
of this paragraph are ineligible for payment for services provided under section 256B.0625.
new text end
new text begin
(e) Tribally licensed programs may elect to participate in the demonstration project and
meet the requirements of subdivision 3. The Department of Human Services must consult
with Tribal nations to discuss participation in the substance use disorder demonstration
project.
new text end
new text begin
(f) All rate enhancements for services rendered by voluntarily enrolled demonstration
providers enrolled before July 1, 2021, are applicable only to dates of service on or after
the effective date of the provider's enrollment in the demonstration project, except as
authorized under paragraph (g). The commissioner shall recoup any rate enhancements paid
under paragraph (g) to a provider that does not meet the requirements of subdivision 3 by
July 1, 2021.
new text end
new text begin
(g) The commissioner may allow providers enrolled before July 1, 2021, to receive any
applicable rate enhancements authorized under subdivision 4 for services provided on dates
of service no earlier than July 22, 2020, for fee-for-service enrollees and no earlier than
January 1, 2021, to managed care enrollees if the provider meets all of the following
requirements:
new text end
new text begin
(1) the provider attests that during the time period for which the provider is seeking the
rate enhancement, the provider took meaningful steps and had a reasonable plan approved
by the commissioner to meet the demonstration project requirements in subdivision 3;
new text end
new text begin
(2) the provider submits attestation and evidence, including all information requested
by the commissioner, of meeting the requirements of subdivision 3 to the commissioner in
a format required by the commissioner; and
new text end
new text begin
(3) the commissioner received the provider's application for enrollment on or before
June 1, 2021.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later, except paragraphs (f) and (g) are effective the day following final
enactment. The commissioner shall notify the revisor of statutes when federal approval is
obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0759, subdivision 4, is amended to read:
Subd. 4.
Provider payment rates.
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirements and provide evidence
of formal referral arrangements with providers delivering step-up or step-down levels of
care.new text begin Providers that have enrolled in the demonstration project but have not met the provider
standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase in this
subdivision until the date that the provider meets the provider standards in subdivision 3.
Services provided from July 1, 2022, to the date that the provider meets the provider standards
under subdivision 3 shall be reimbursed at rates according to section 254B.05, subdivision
5, paragraph (b).
new text end
new text begin
(b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the provider does not meet the requirements
in paragraph (a). Payments withheld from the provider must be made once the commissioner
determines that the requirements in paragraph (a) are met.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clause (8), provided on or after July 1, 2020, payment rates must be increased
by deleted text begin 15deleted text end new text begin 35new text end percent over the rates in effect on December 31, 2019.
deleted text begin (c)deleted text end new text begin (d)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clauses (1), (6), and (7), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by deleted text begin tendeleted text end new text begin 30new text end percent over the rates
in effect on December 31, 2020.
deleted text begin (d)deleted text end new text begin (e)new text end Effective January 1, 2021, and contingent on annual federal approval, managed
care plans and county-based purchasing plans must reimburse providers of the substance
use disorder services meeting the criteria described in paragraph (a) who are employed by
or under contract with the plan an amount that is at least equal to the fee-for-service base
rate payment for the substance use disorder services described in paragraphs deleted text begin (b)deleted text end new text begin (c)new text end and deleted text begin (c)deleted text end new text begin
(d)new text end . The commissioner must monitor the effect of this requirement on the rate of access to
substance use disorder services and residential substance use disorder rates. Capitation rates
paid to managed care organizations and county-based purchasing plans must reflect the
impact of this requirement. This paragraph expires if federal approval is not received at any
time as required under this paragraph.
deleted text begin (e)deleted text end new text begin (f)new text end Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph deleted text begin (d)deleted text end new text begin (e)new text end applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph deleted text begin (d)deleted text end new text begin (e)new text end is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, except paragraphs (c) and (d) are effective January 1, 2022, or upon
federal approval, whichever is later. The commissioner shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Medium intensity residential program participation. new text end
new text begin
Medium intensity
residential programs that qualify to participate in the demonstration project shall use the
specified base payment rate of $132.90 per day, and shall be eligible for the rate increases
specified in subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from July 1, 2020.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Public access. new text end
new text begin
The state shall post the final documents, for example, monitoring
reports, close out report, approved evaluation design, interim evaluation report, and
summative evaluation report, on the state's Medicaid website within 30 calendar days of
approval by CMS.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Federal approval; demonstration project extension. new text end
new text begin
The commissioner shall
seek all necessary federal authority to extend the demonstration and must submit the request
for extension by the federally required date of June 30, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Demonstration project evaluation work group. new text end
new text begin
Beginning October 1, 2021,
the commissioner shall assemble a work group of relevant stakeholders, including but not
limited to demonstration project participants and the Minnesota Association of Resources
for Recovery and Chemical Health, that shall meet at least quarterly for the duration of the
demonstration to evaluate the long-term sustainability of any improvements to quality or
access to substance use disorder treatment services caused by participation in the
demonstration project. The work group shall also determine how to implement successful
outcomes of the demonstration project once the project expires.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.0947, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20deleted text end new text begin who are eight years of age or older and under 26 years of agenew text end with
a serious mental illness or co-occurring mental illness and substance abuse addiction who
require intensive services to prevent admission to an inpatient psychiatric hospital or
placement in a residential treatment facility or who require intensive services to step down
from inpatient or residential care to community-based care.
(b) "Co-occurring mental illness and substance abuse addiction" means a dual diagnosis
of at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.
(c) "Diagnostic assessment" has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1, and for this section must incorporate a determination of
the youth's necessary level of care using a standardized functional assessment instrument
approved and periodically updated by the commissioner.
(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.
(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.
(g) "Medication education services" means services provided individually or in groups,
which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer who:
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
(2) assists younger peers to identify and achieve specific life goals;
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
(6) meets the following criteria:
(i) is at least 22 years of age;
(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;
(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;
(iv) has at least a high school diploma or equivalent;
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
(vii) must be free of substance use problems for at least one year.
(i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
(j) "Substance use disorders" means one or more of the disorders defined in the diagnostic
and statistical manual of mental disorders, current edition.
(k) "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
(l) "Treatment team" means all staff who provide services to recipients under this section.
(m) "Family peer specialist" means a staff person qualified under section 256B.0616.
Sec. 16.
Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is deleted text begin age 16, 17, 18, 19, or 20deleted text end new text begin eight years of age or older and under 26 years of agenew text end ; deleted text begin and
deleted text end
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
abuse addiction, for which intensive nonresidential rehabilitative mental health services are
needed;
(3) has received a level-of-care determination, using an instrument approved by the
commissioner, that indicates a need for intensive integrated intervention without 24-hour
medical monitoring and a need for extensive collaboration among multiple providers;
(4) has a functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system deleted text begin within the next two yearsdeleted text end new text begin during adulthoodnew text end ; and
(5) has had a recent diagnostic assessment, as provided in Minnesota Rules, part
9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.
Sec. 17.
Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must be provided by a provider entity as provided in subdivision 4.
new text begin
(b) The treatment team must have specialized training in providing services to the specific
age group of youth that the team serves. An individual treatment team must serve youth
who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14
years of age or older and under 26 years of age.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end The treatment team for intensive nonresidential rehabilitative mental health
services comprises both permanently employed core team members and client-specific team
members as follows:
(1) The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients. Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must include, but is not limited to:
(i) an independently licensed mental health professional, qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, who serves as team leader to provide administrative
direction and clinical supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a peer specialist as defined in subdivision 2, paragraph (h).
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialist;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v) a mental health practitioner, as defined in section 245.4871, subdivision 26;
(vi) a case management service provider, as defined in section 245.4871, subdivision 4;
(vii) a housing access specialist; and
(viii) a family peer specialist as defined in subdivision 2, paragraph (m).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance abuse counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
deleted text begin (c)deleted text end new text begin (d)new text end The clinical supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the clinical supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.
deleted text begin (d)deleted text end new text begin (e)new text end The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
deleted text begin (e)deleted text end new text begin (f)new text end The treatment team shall serve no more than 80 clients at any one time. Should
local demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
deleted text begin (f)deleted text end new text begin (g)new text end Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider shall have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to ensure the health and safety of clients.
deleted text begin (g)deleted text end new text begin (h)new text end The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
deleted text begin (h)deleted text end new text begin (i)new text end A regional treatment team may serve multiple counties.
Sec. 18.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e)new text begin The treatment team must completenew text end an individual treatment plan new text begin for each client and
the individual treatment plan new text end must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 19.
Minnesota Statutes 2020, section 297E.02, subdivision 3, is amended to read:
Subd. 3.
Collection; disposition.
(a) Taxes imposed by this section are due and payable
to the commissioner when the gambling tax return is required to be filed. Distributors must
file their monthly sales figures with the commissioner on a form prescribed by the
commissioner. Returns covering the taxes imposed under this section must be filed with
the commissioner on or before the 20th day of the month following the close of the previous
calendar month. The commissioner shall prescribe the content, format, and manner of returns
or other documents pursuant to section 270C.30. The proceeds, along with the revenue
received from all license fees and other fees under sections 349.11 to 349.191, 349.211,
and 349.213, must be paid to the commissioner of management and budget for deposit in
the general fund.
(b) The sales tax imposed by chapter 297A on the sale of pull-tabs and tipboards by the
distributor is imposed on the retail sales price. The retail sale of pull-tabs or tipboards by
the organization is exempt from taxes imposed by chapter 297A and is exempt from all
local taxes and license fees except a fee authorized under section 349.16, subdivision 8.
(c) One-half of one percent of the revenue deposited in the general fund under paragraph
(a), is appropriated to the commissioner of human services for the compulsive gambling
treatment program established under section 245.98. One-half of one percent of the revenue
deposited in the general fund under paragraph (a), is appropriated to the commissioner of
human services for a grant to the state affiliate recognized by the National Council on
Problem Gambling to increase public awareness of problem gambling, education and training
for individuals and organizations providing effective treatment services to problem gamblers
and their families, and research relating to problem gambling. Money appropriated by this
paragraph must supplement and must not replace existing state funding for these programs.
new text begin
(d) The commissioner of human services must provide to the state affiliate recognized
by the National Council on Problem Gambling a monthly statement of the amounts deposited
under paragraph (c). Beginning January 1, 2022, the commissioner of human services must
provide to the chairs and ranking minority members of the legislative committees with
jurisdiction over treatment for problem gambling and to the state affiliate recognized by the
National Council on Problem Gambling an annual reconciliation of the amounts deposited
under paragraph (c). The annual reconciliation under this paragraph must include the amount
allocated to the commissioner of human services for the compulsive gambling treatment
program established under section 245.98, and the amount allocated to the state affiliate
recognized by the National Council on Problem Gambling.
new text end
Sec. 20. new text begin SUBSTANCE USE DISORDER TREATMENT PATHFINDER
COMPANION PILOT PROJECT.
new text end
new text begin
(a) Anoka County and an academic institution acting as a research partner, in consultation
with the North Metro Mental Health Roundtable, shall conduct a one-year pilot project
beginning September 1, 2021, to evaluate the effects on treatment outcomes of the use by
individuals in substance use disorder recovery of the telephone-based Pathfinder Companion
application, which allows individuals in recovery to connect with peers, resources, providers,
and others helping with recovery after an individual is discharged from treatment, and the
use by providers of the computer-based Pathfinder Bridge application, which allows providers
to prioritize care, connect directly with patients, and monitor long-term outcomes and
recovery effectiveness.
new text end
new text begin
(b) Prior to launching the program, Anoka County must secure the participation of an
academic research institution as a research partner and the project must receive approval
from the institution's institutional review board.
new text end
new text begin
(c) The pilot project must monitor and evaluate the effects on treatment outcomes of
using the Pathfinder Companion and Pathfinder Bridge applications in order to determine
whether the addition of digital recovery support services alongside traditional methods of
recovery treatment improves treatment outcomes. The participating research partner shall
design and conduct the program evaluation.
new text end
new text begin
(d) Anoka County and the participating research partner, in consultation with the North
Metro Mental Health Roundtable, shall report to the commissioner of human services and
the chairs and ranking minority members of the legislative committees with jurisdiction
over substance use disorder treatment by January 15, 2023, on the results of the pilot project.
new text end
Sec. 21. new text begin FIRST EPISODE OF PSYCHOSIS GRANT PROGRAM; AUTHORIZED
USES OF GRANT FUNDS.
new text end
new text begin
(a) Grant funds awarded by the commissioner of human services pursuant to Minnesota
Statutes, section 245.4889, subdivision 1, paragraph (b), clause (15), must be used to:
new text end
new text begin
(1) provide intensive treatment and support for adolescents and adults experiencing or
at risk of experiencing a first psychotic episode. Intensive treatment and support includes
medication management, psychoeducation for an individual and an individual's family, case
management, employment support, education support, cognitive behavioral approaches,
social skills training, peer support, crisis planning, and stress management. Projects must
use all available funding streams;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinics, on early psychosis symptoms, screening
tools, and best practices; and
new text end
new text begin
(3) ensure access for individuals to first psychotic episode services under this section,
including ensuring access to first psychotic episode services for individuals who live in
rural areas.
new text end
new text begin
(b) Grant funds may also be used to pay for housing or travel expenses or to address
other barriers preventing individuals and their families from participating in first psychotic
episode services.
new text end
Sec. 22. new text begin EMERGING MOOD DISORDER GRANT PROGRAM; AUTHORIZED
USES OF GRANT FUNDS.
new text end
new text begin
(a) Grant funds awarded by the commissioner of human services pursuant to Minnesota
Statutes, section 245.4889, subdivision 1, paragraph (b), clause (18), must be used to:
new text end
new text begin
(1) provide intensive treatment and support to adolescents and young adults experiencing
or at risk of experiencing an emerging mood disorder. Intensive treatment and support
includes medication management, psychoeducation for the individual and the individual's
family, case management, employment support, education support, cognitive behavioral
approaches, social skills training, peer support, crisis planning, and stress management.
Grant recipients must use all available funding streams;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinics, on early symptoms of mood disorders,
screening tools, and best practices; and
new text end
new text begin
(3) ensure access for individuals to emerging mood disorder services under this section,
including ensuring access to services for individuals who live in rural areas.
new text end
new text begin
(b) Grant funds may also be used by the grant recipient to evaluate the efficacy for
providing intensive services and supports to people with emerging mood disorders.
new text end
Sec. 23. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MENTAL
HEALTH GRANT PROGRAMS STATUTE REVISION.
new text end
new text begin
The commissioner of human services, in coordination with the Office of Senate Counsel,
Research, and Fiscal Analysis, the Office of the House Research Department, and the revisor
of statutes, shall prepare legislation for the 2022 legislative session to enact as statutes the
grant programs authorized and funded under Minnesota Statutes, section 245.4661,
subdivision 9. The draft statutes shall at least include the eligibility criteria, target populations,
authorized uses of grant funds, and outcome measures for each grant. The commissioner
shall provide a courtesy copy of the proposed legislation to the chairs and ranking minority
members of the legislative committees with jurisdiction over mental health grants.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PAPERWORK REDUCTION.
new text end
new text begin
(a) The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment professional associations, and other
relevant stakeholders, shall develop, assess, and recommend systems improvements to
minimize regulatory paperwork and improve systems for substance use disorder programs
licensed under Minnesota Statutes, chapter 245A, and regulated under Minnesota Statutes,
chapters 245F and 245G, and Minnesota Rules, chapters 2960 and 9530. The commissioner
of human services shall make available any resources needed from other divisions within
the department to implement systems improvements.
new text end
new text begin
(b) The commissioner of health shall make available needed information and resources
from the Division of Health Policy.
new text end
new text begin
(c) The Office of MN.IT Services shall provide advance consultation and implementation
of the changes needed in data systems.
new text end
new text begin
(d) The commissioner of human services shall contract with a vendor that has experience
with developing statewide system changes for multiple states at the payer and provider
levels. If the commissioner, after exercising reasonable diligence, is unable to secure a
vendor with the requisite qualifications, the commissioner may select the best qualified
vendor available. When developing recommendations, the commissioner shall consider
input from all stakeholders. The commissioner's recommendations shall maximize benefits
for clients and utility for providers, regulatory agencies, and payers.
new text end
new text begin
(e) The commissioner of human services and the contracted vendor shall follow the
recommendations from the report issued in response to Laws 2019, First Special Session
chapter 9, article 6, section 76.
new text end
new text begin
(f) By December 15, 2022, the commissioner of human services shall take steps to
implement paperwork reductions and systems improvements within the commissioner's
authority and submit to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services a report that includes recommendations
for changes in statutes that would further enhance systems improvements to reduce
paperwork. The report shall include a summary of the approaches developed and assessed
by the commissioner of human services and stakeholders and the results of any assessments
conducted.
new text end
Sec. 25. new text begin DIRECTION TO THE COMMISSIONER; SOBER HOUSING PROGRAM
RECOMMENDATIONS.
new text end
new text begin
(a) The commissioner of human services, in consultation with stakeholders, must develop
recommendations on:
new text end
new text begin
(1) increasing access to sober housing programs;
new text end
new text begin
(2) promoting person-centered practices and cultural responsiveness in sober housing
programs;
new text end
new text begin
(3) potential oversight of sober housing programs; and
new text end
new text begin
(4) providing consumer protections for individuals in sober housing programs with
substance use disorders and individuals with co-occurring mental illnesses.
new text end
new text begin
(b) Stakeholders include but are not limited to the Minnesota Association of Sober
Homes, the Minnesota Association of Resources for Recovery and Chemical Health,
Minnesota Recovery Connection, NAMI Minnesota, and residents and former residents of
sober housing programs based in Minnesota. Stakeholders must equitably represent
geographic areas of the state, and must include individuals in recovery and providers
representing Black, Indigenous, people of color, or immigrant communities.
new text end
new text begin
(c) The commissioner must complete and submit a report on the recommendations in
this section to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance on or before September 1,
2022.
new text end
Sec. 26. new text begin DIRECTION TO COMMISSIONERS OF HEALTH AND HUMAN
SERVICES; COMPULSIVE GAMBLING PROGRAMMING AND FUNDING.
new text end
new text begin
By September 1, 2022, the commissioner of human services shall consult with the
commissioner of health and report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services with a
recommendation on whether the revenue appropriated to the commissioner of human services
for a grant to the state affiliate recognized by the National Council on Problem Gambling
under Minnesota Statutes, section 297E.02, subdivision 3, paragraph (c), is more properly
appropriated to and managed by an agency other than the Department of Human Services.
The commissioners shall also recommend whether the compulsive gambling treatment
program in Minnesota Statutes, section 245.98, should continue to be managed by the
Department of Human Services or be managed by another agency.
new text end
Sec. 27. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; SUD
DEMONSTRATION PROJECT ENROLLMENT REPORT.
new text end
new text begin
Beginning with the November 2021 budget forecast and for each budget forecast
thereafter, the commissioner of human services shall report to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services on the number
of institutions for mental disease providers enrolled in the demonstration project under
Minnesota Statutes, section 256B.0759, and the amount of the federal financial participation
for institutions for mental disease providers enrolled in the demonstration project and the
amount of the federal financial participation that exceeds the commissioner's projected
enrollment as of the November 2021 forecast. This report shall be provided for the duration
of the demonstration project.
new text end
Sec. 28. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT RATE RESTRUCTURE.
new text end
new text begin
(a) By January 1, 2022, the commissioner shall issue a request for proposal for
frameworks and modeling of substance use disorder rates. Rates must be predicated on a
uniform methodology that is transparent, culturally responsive, supports staffing needed to
treat a patient's assessed need, and promotes quality service delivery and patient choice.
The commissioner must consult with substance use disorder treatment programs across the
spectrum of services, substance use disorder treatment programs from across each region
of the state, and culturally responsive providers in the development of the request for proposal
process and for the duration of the contract.
new text end
new text begin
(b) By January 15, 2023, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance on the results of the vendor's work. The report must
include legislative language necessary to implement a new substance use disorder treatment
rate methodology and a detailed fiscal analysis.
new text end
Sec. 29. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TECHNICAL ASSISTANCE CENTERS.
new text end
new text begin
The commissioner shall establish one or more community-based technical assistance
centers for substance use disorder treatment providers that offer both virtual learning
environments and in-person opportunities. The technical assistance centers must provide
guidance to substance use disorder providers concerning the enrollment process for the
substance use disorder reform demonstration project under Minnesota Statutes, section
256B.0759, and provide advice concerning bringing the provider's treatment practices into
compliance with American Society of Addiction Medicine standards during the one-year
transition period. Technical assistance centers may also promote awareness of new and
evidence-based practices and services for the treatment of substance use disorders, and offer
education, training, resources, and information for the behavioral health care workforce.
The commissioner must award funding to technical assistance centers by March 1, 2022,
to initiate operations.
new text end
Sec. 30. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; CHILDREN'S MENTAL HEALTH GRANTS FOR
EMERGING MOOD DISORDERS PROGRAMS.
new text end
new text begin
From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $400,000 in fiscal year 2022,
$400,000 in fiscal year 2023, $400,000 in fiscal year 2024, and $400,000 in fiscal year
2025, for children's mental health grants for emerging mood disorder programs under
Minnesota Statutes, section 245.4889, subdivision 1, paragraph (b), clause (18).
new text end
Sec. 31. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; CHILDREN'S MENTAL HEALTH GRANTS FOR FIRST
EPISODE OF PSYCHOSIS PROGRAMS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $1,600,000 in fiscal year 2022,
$1,500,000 in fiscal year 2023, and $222,000 in fiscal year 2024, for children's mental health
grants for first episode of psychosis programs under Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (15).
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $1,278,000 in fiscal year 2024 and
$1,500,000 in fiscal year 2025, for children's mental health grants for first episode of
psychosis programs under Minnesota Statutes, section 245.4889, subdivision 1, paragraph
(b), clause (15).
new text end
new text begin
(c) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $200,000 in fiscal year 2022 and $200,000
in fiscal year 2023, foradditional funding to four existing first episode of psychosis programs
that receive children's mental health grants funding under Minnesota Statutes, section
245.4889, subdivision 1, paragraph (b), clause (15).
new text end
new text begin
(d) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $200,000 in fiscal year 2024 and
$200,000 in fiscal year 2025, for additional funding to four existing first episode of psychosis
programs that receive children's mental health grants funding under Minnesota Statutes,
section 245.4889, subdivision 1, paragraph (b), clause (15).
new text end
Sec. 32. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; ADULT MENTAL HEALTH INITIATIVE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $2,350,000 in fiscal year 2022
and $2,350,000 in fiscal year 2023, for adult mental health initiative grants under Minnesota
Statutes, section 245.4661, subdivision 1.
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, the commissioner of human services shall allocate
$2,350,000 in fiscal year 2024 and $2,350,000 in fiscal year 2025, for the adult mental
health initiative grants under Minnesota Statutes, section 245.4661, subdivision 1.
new text end
Sec. 33. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; SCHOOL-LINKED MENTAL HEALTH GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $2,500,000 in fiscal year 2022
and $2,500,000 in fiscal year 2023, for school-linked mental health grants under Minnesota
Statutes, section 245.4901.
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $2,500,000 in fiscal year 2024 and
$2,500,000 in fiscal year 2025, for school-linked mental health grants under Minnesota
Statutes, section 245.4901.
new text end
Sec. 34. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; SCHOOL-LINKED SUBSTANCE ABUSE
GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $1,500,000 in
fiscal year 2022, $1,500,000 in fiscal year 2023, and $1,079,000 in fiscal year 2024, for
school-linked substance abuse grants under Minnesota Statutes, section 245.4901.
new text end
new text begin
(b) From the amount that Minnesota received under section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $421,000 in fiscal year 2024 and $1,500,000 in fiscal
year 2025, for school-linked substance abuse grants under Minnesota Statutes, section
245.4901.
new text end
Sec. 35. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; SUBSTANCE USE DISORDER TREATMENT
PATHFINDER COMPANION PILOT PROJECT.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $250,000 in fiscal
year 2022 for a grant to Anoka County to conduct a substance use disorder treatment
pathfinder companion pilot project. This is a onetime allocation and is available until January
15, 2023.
new text end
new text begin
(b) Of this allocation, up to $200,000 is for licensed use of the pathfinder companion
application for individuals participating in the pilot project and up to $50,000 is for licensed
use of the pathfinder bridge application for providers participating in the pilot project.
new text end
new text begin
(c) From the amount that Minnesota received under section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $300,000 in fiscal year 2022 for a grant to Anoka
County to conduct the substance use disorder treatment pathfinder companion pilot project.
This is a onetime allocation and is available until January 15, 2023.
new text end
Sec. 36. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; OPIOID EPIDEMIC RESPONSE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $3,500,000 in
fiscal year 2022 and $3,500,000 in fiscal year 2023, for grants to be awarded according to
recommendations of the Opioid Epidemic Response Advisory Council under Minnesota
Statutes, section 256.042.
new text end
new text begin
(b) From the amount that Minnesota received under Section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $3,500,000 in fiscal year 2024 and $3,500,000 in
fiscal year 2025, for grants to be awarded according to recommendations of the Opioid
Epidemic Response Advisory Council under Minnesota Statutes, section 256.042.
new text end
new text begin
(c) The commissioner shall include information on the grants awarded under this section
in the annual report under Minnesota Statutes, section 256.042, subdivision 5, paragraph
(a).
new text end
Sec. 37. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; RECOVERY COMMUNITY ORGANIZATION
INFRASTRUCTURE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $2,000,000 in
fiscal year 2022 and $2,000,000 in fiscal year 2023, for grants to recovery community
organizations, as defined in Minnesota Statutes, section 254B.01, subdivision 8, to provide
community-based peer recovery support services that are not otherwise eligible for
reimbursement under Minnesota Statutes, section 254B.05.
new text end
new text begin
(b) From the amount that Minnesota received under Section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant for grants, the commissioner of human services shall allocate $2,000,000 in fiscal
year 2024 and $2,000,000 in fiscal year 2025, to recovery community organizations, as
defined in Minnesota Statutes, section 254B.01, subdivision 8, to provide community-based
peer recovery support services that are not otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05.
new text end
Sec. 38. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall replace "EXCELLENCE IN MENTAL HEALTH
DEMONSTRATION PROJECT" with "CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINIC SERVICES" in the section headnote for Minnesota Statutes, section
245.735.
new text end
Sec. 39. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, and 4,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 14
DISABILITY SERVICES AND CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the commissioner of health MDS assessments that conform with the assessment
schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
by the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
The commissioner of health may substitute successor manuals or question and answer
documents published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, to replace or supplement the current version
of the manual or document.
(b) The assessments used to determine a case mix classification for reimbursement
include the following:
(1) a new admission assessment;
(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;
(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessment;
(4) all quarterly assessments must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; and
(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classification.
(c) new text begin In addition to the assessments listed in paragraph (b), a significant change in status
assessment is required when:
new text end
new text begin
(1) all speech, occupational, and physical therapies have ended. The assessment reference
date of this assessment must be set on day eight after all therapy services have ended; and
new text end
new text begin
(2) isolation for an active infectious disease has ended. The assessment reference date
of this assessment must be set on day 15 after isolation has ended.
new text end
new text begin (d) new text end In addition to the assessments listed in deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (b)new text begin and (c)new text end , the
assessments used to determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for all assessments with an assessment
reference date of July 1, 2021, or later.
new text end
Sec. 2.
Minnesota Statutes 2020, section 144A.073, subdivision 2, is amended to read:
Subd. 2.
Request for proposals.
At the authorization by the legislature of additional
medical assistance expenditures for exceptions to the moratorium on nursing homes, the
commissioner shall publish in the State Register a request for proposals for nursing home
and certified boarding care home projects for conversion, relocation, renovation, replacement,
upgrading, or addition. The public notice of this funding and the request for proposals must
specify how the approval criteria will be prioritized by the commissioner. The notice must
describe the information that must accompany a request and state that proposals must be
submitted to the commissioner within 150 days of the date of publication. The notice must
include the amount of the legislative appropriation available for the additional costs to the
medical assistance program of projects approved under this section. If money is appropriated,
the commissioner shall initiate the application and review process described in this section
at least once each biennium. A second application and review process must occur if remaining
funds are either greater than $300,000 or more than 50 percent of the baseline appropriation
for the biennium. Authorized funds may be awarded in full in the first review process of
the biennium. Appropriated funds not encumbered within a biennium shall carry forwarddeleted text begin
to the following bienniumdeleted text end . To be considered for approval, a proposal must include the
following information:
(1) whether the request is for renovation, replacement, upgrading, conversion, addition,
or relocation;
(2) a description of the problems the project is designed to address;
(3) a description of the proposed project;
(4) an analysis of projected costs of the nursing facility proposed project, including:
(i) initial construction and remodeling costs;
(ii) site preparation costs;
(iii) equipment and technology costs;
(iv) financing costs, the current estimated long-term financing costs of the proposal,
which is to include details of any proposed funding mechanism already arranged or being
considered, including estimates of the amount and sources of money, reserves if required,
annual payments schedule, interest rates, length of term, closing costs and fees, insurance
costs, any completed marketing study or underwriting review; and
(v) estimated operating costs during the first two years after completion of the project;
(5) for proposals involving replacement of all or part of a facility, the proposed location
of the replacement facility and an estimate of the cost of addressing the problem through
renovation;
(6) for proposals involving renovation, an estimate of the cost of addressing the problem
through replacement;
(7) the proposed timetable for commencing construction and completing the project;
(8) a statement of any licensure or certification issues, such as certification survey
deficiencies;
(9) the proposed relocation plan for current residents if beds are to be closed according
to section 144A.161; and
(10) other information required by permanent rule of the commissioner of health in
accordance with subdivisions 4 and 8.
Sec. 3.
Minnesota Statutes 2020, section 144A.073, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Moratorium exception funding. new text end
new text begin
(a) During the biennium beginning July 1,
2021, and during each biennium thereafter, the commissioner of health may approve
moratorium exception projects under this section for which the full biennial state share of
medical assistance costs does not exceed $10,000,000, plus any carryover of previous
appropriations for this purpose.
new text end
new text begin
(b) For the purposes of this subdivision, "biennium" has the meaning given in section
16A.011, subdivision 6.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end
(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agencydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 and residing in the
customized living setting before July 1, 2022, for which a license is required. A customized
living service provider subject to this exception may rebut the presumption that a license
is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
new text end
new text begin
(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
new text end
new text begin
(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
new text end
new text begin
(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
new text end
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.
(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.
(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256.477, is amended to read:
256.477 SELF-ADVOCACY GRANTS.
new text begin Subdivision 1. new text end
new text begin The Rick Cardenas Statewide Self-Advocacy Network. new text end
(a) The
commissioner shall make available a grant for the purposes of establishing and maintaining
deleted text begin adeleted text end new text begin the Rick Cardenasnew text end Statewide Self-Advocacy Network for persons with intellectual and
developmental disabilities. The new text begin Rick Cardenas Statewide new text end Self-Advocacy Network shall:
(1) ensure that persons with intellectual and developmental disabilities are informed of
their rights in employment, housing, transportation, voting, government policy, and other
issues pertinent to the intellectual and developmental disability community;
(2) provide public education and awareness of the civil and human rights issues persons
with intellectual and developmental disabilities face;
(3) provide funds, technical assistance, and other resources for self-advocacy groups
across the state; deleted text begin and
deleted text end
(4) organize systems of communications to facilitate an exchange of information between
self-advocacy groupsnew text begin ;
new text end
new text begin
(5) train and support the activities of a statewide network of peer-to-peer mentors for
persons with developmental disabilities focused on building awareness among people with
developmental disabilities of service options; assisting people with developmental disabilities
choose service options; and developing the advocacy skills of people with developmental
disabilities necessary for them to move toward full inclusion in community life, including
by developing and delivering a curriculum to support the peer-to-peer network;
new text end
new text begin
(6) provide outreach activities, including statewide conferences and disability networking
opportunities, focused on self-advocacy, informed choice, and community engagement
skills; and
new text end
new text begin (7) provide an annual leadership program for persons with intellectual and developmental
disabilitiesnew text end .
(b) An organization receiving a grant under paragraph (a) must be an organization
governed by people with intellectual and developmental disabilities that administers a
statewide network of disability groups in order to maintain and promote self-advocacy
services and supports for persons with intellectual and developmental disabilities throughout
the state.
new text begin
(c) An organization receiving a grant under this subdivision may use a portion of grant
revenue determined by the commissioner for administration and general operating costs.
new text end
new text begin Subd. 2. new text end
new text begin Subgrants for outreach to persons in institutional settings. new text end
new text begin
The commissioner
shall make available to an organization described under subdivision 1 a grant for subgrants
to organizations in Minnesota to conduct outreach to persons working and living in
institutional settings to provide education and information about community options. Subgrant
funds must be used to deliver peer-led skill training sessions in six regions of the state to
help persons with intellectual and developmental disabilities understand community service
options related to:
new text end
new text begin
(1) housing;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) education;
new text end
new text begin
(4) transportation;
new text end
new text begin
(5) emerging service reform initiatives contained in the state's Olmstead plan; the
Workforce Innovation and Opportunity Act, Public Law 113-128; and federal home and
community-based services regulations; and
new text end
new text begin
(6) connecting with individuals who can help persons with intellectual and developmental
disabilities make an informed choice and plan for a transition in services.
new text end
Sec. 6.
new text begin
[256.4772] MINNESOTA INCLUSION INITIATIVE GRANT.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of human services shall
establish the Minnesota inclusion initiative grant program to encourage self-advocacy groups
of persons with intellectual and developmental disabilities to develop and organize projects
that increase the inclusion of persons with intellectual and developmental disabilities in the
community, improve community integration outcomes, educate decision-makers and the
public about persons with intellectual and developmental disabilities, including the systemic
barriers that prevent them from being included in the community, and to advocate for changes
that increase access to formal and informal supports and services necessary for greater
inclusion of persons with intellectual and developmental disabilities in the community.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
The commissioner of human services, as authorized by section
256.01, subdivision 2, paragraph (a), clause (6), shall issue a request for proposals to contract
with a public or private entity to (1) serve as a fiscal host for the money appropriated for
the purposes described in this section, and (2) develop guidelines, criteria, and procedures
for awarding grants. The fiscal host shall establish an advisory committee consisting of
self-advocates, nonprofit advocacy organizations, and Department of Human Services staff
to review applications and award grants under this section.
new text end
new text begin Subd. 3. new text end
new text begin Applications. new text end
new text begin
(a) Entities seeking grants under this section shall apply to the
advisory committee of the fiscal host under contract with the commissioner. The grant
applicant must include a description of the project that the applicant is proposing, the amount
of money that the applicant is seeking, and a proposed budget describing how the applicant
will spend the grant money.
new text end
new text begin
(b) The advisory committee may award grants to applicants only for projects that meet
the requirements of subdivision 4.
new text end
new text begin Subd. 4. new text end
new text begin Use of grant money. new text end
new text begin
Projects funded by grant money must have person-centered
goals, call attention to issues that limit inclusion of persons with intellectual and
developmental disabilities, address barriers to inclusion that persons with intellectual and
developmental disabilities face in their communities, or increase the inclusion of persons
with intellectual and developmental disabilities in their communities. Applicants may
propose strategies to increase inclusion of persons with intellectual and developmental
disabilities in their communities by:
new text end
new text begin
(1) decreasing barriers to workforce participation experienced by persons with intellectual
and developmental disabilities;
new text end
new text begin
(2) overcoming barriers to accessible and reliable transportation options for persons with
intellectual and developmental disabilities;
new text end
new text begin
(3) identifying and addressing barriers to voting experienced by persons with intellectual
and developmental disabilities;
new text end
new text begin
(4) advocating for increased accessible housing for persons with intellectual and
developmental disabilities;
new text end
new text begin
(5) working with governmental agencies or businesses on accessibility issues under the
Americans with Disabilities Act;
new text end
new text begin
(6) increasing collaboration between self-advocacy groups and other organizations to
effectively address systemic issues that impact persons with intellectual and developmental
disabilities;
new text end
new text begin
(7) increasing capacity for inclusion in a community; or
new text end
new text begin
(8) providing public education and awareness of the civil and human rights of persons
with intellectual and developmental disabilities.
new text end
new text begin Subd. 5. new text end
new text begin Reports. new text end
new text begin
(a) Grant recipients shall provide the advisory committee with a report
about the activities funded by the grant program in a format and at a time specified by the
advisory committee. The advisory committee shall require grant recipients to include in the
grant recipient's report at least the information necessary for the advisory committee to meet
the advisory committee's obligation under paragraph (b).
new text end
new text begin
(b) The advisory committee shall provide the commissioner with a report that describes
all of the activities and outcomes of projects funded by the grant program in a format and
at a time determined by the commissioner.
new text end
Sec. 7.
new text begin
[256.4776] PARENT-TO-PARENT PEER SUPPORT.
new text end
new text begin
(a) The commissioner shall make a grant to an alliance member of Parent to Parent USA
to support the alliance member's parent-to-parent peer support program for families of
children with any type of disability or special health care needs. An eligible alliance member
must have an established parent-to-parent peer support program that is statewide and
represents diverse cultures and geographic locations, that conducts outreach and provides
individualized support to any parent or guardian of a child with a disability or special health
care need, including newly identified parents of such a child or parents experiencing
transitions or changes in their child's care, and that implements best practices for peer-to-peer
support, including providing support from trained parent staff and volunteer support parents
who have received Parent to Parent USA's specialized parent-to-parent peer support training.
new text end
new text begin
(b) Grant recipients must use grant money for the purposes specified in paragraph (a).
new text end
new text begin
(c) For purposes of this section, "special health care needs" means disabilities, chronic
illnesses or conditions, health-related educational or behavioral problems, or the risk of
developing disabilities, conditions, illnesses, or problems.
new text end
new text begin
(d) Grant recipients must report to the commissioner of human services annually by
January 15 about the services and programs funded by this grant. The report must include
measurable outcomes from the previous year, including the number of families served by
the organization's parent-to-parent programs and the number of volunteer support parents
trained by the organization's parent-to-parent programs.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0653, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Payment rates for home health agency services. new text end
new text begin
The commissioner shall
annually adjust payments for home health agency services to reflect the change in the federal
Centers for Medicare and Medicaid Services Home Health Agency Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, for services delivered on or after January 1, 2022. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0654, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Payment rates for home care nursing services. new text end
new text begin
The commissioner shall
annually adjust payments for home care nursing services to reflect the change in the federal
Centers for Medicare and Medicaid Services Home Health Agency Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, for services delivered on or after January 1, 2022. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0659, subdivision 11, is amended to read:
Subd. 11.
Personal care assistant; requirements.
(a) A personal care assistant must
meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
(i) not disqualified under section 245C.14; or
(ii) disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;
(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional, physician, or
advanced practice registered nurse;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;
(9) complete training and orientation on the needs of the recipient; and
(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.
(d) Personal care assistance services qualify for the enhanced rate described in subdivision
17a if the personal care assistant providing the services:
(1) provides covered services to a recipient who qualifies for deleted text begin 12deleted text end new text begin tennew text end or more hours per
day of personal care assistance services; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0659, subdivision 17a, is amended to
read:
Subd. 17a.
Enhanced rate.
An enhanced rate of 107.5 percent of the rate paid for
personal care assistance services shall be paid for services provided to persons who qualify
for deleted text begin 12deleted text end new text begin tennew text end or more hours of personal care assistance services per day when provided by a
personal care assistant who meets the requirements of subdivision 11, paragraph (d). The
enhanced rate for personal care assistance services includes, and is not in addition to, any
rate adjustments implemented by the commissioner on July 1, 2019, to comply with the
terms of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54, that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of personal
care assistance services per day.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0911, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For purposes of this section, the following definitions apply:
(a) Until additional requirements apply under paragraph (b), "long-term care consultation
services" means:
(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;
(2) providing recommendations for and referrals to cost-effective community services
that are available to the individual;
(3) development of an individual's person-centered community support plan;
(4) providing information regarding eligibility for Minnesota health care programs;
(5) face-to-face long-term care consultation assessments, which may be completed in a
hospital, nursing facility, intermediate care facility for persons with developmental disabilities
(ICF/DDs), regional treatment centers, or the person's current or planned residence;
(6) determination of home and community-based waiver and other service eligibility as
required under chapter 256S and sections 256B.0913, 256B.092, and 256B.49, including
level of care determination for individuals who need an institutional level of care as
determined under subdivision 4e, based on a long-term care consultation assessment and
community support plan development, appropriate referrals to obtain necessary diagnostic
information, and including an eligibility determination for consumer-directed community
supports;
(7) providing recommendations for institutional placement when there are no
cost-effective community services available;
(8) providing access to assistance to transition people back to community settings after
institutional admission;
(9) providing information about competitive employment, with or without supports, for
school-age youth and working-age adults and referrals to the Disability Hub and Disability
Benefits 101 to ensure that an informed choice about competitive employment can be made.
For the purposes of this subdivision, "competitive employment" means work in the
competitive labor market that is performed on a full-time or part-time basis in an integrated
setting, and for which an individual is compensated at or above the minimum wage, but not
less than the customary wage and level of benefits paid by the employer for the same or
similar work performed by individuals without disabilities;
(10) providing information about independent living to ensure that an informed choice
about independent living can be made; and
(11) providing information about self-directed services and supports, including
self-directed funding options, to ensure that an informed choice about self-directed options
can be made.
(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
and 3a, "long-term care consultation services" also means:
(1) service eligibility determination for the following state plan services:
(i) personal care assistance services under section 256B.0625, subdivisions 19a and 19c;
(ii) consumer support grants under section 256.476; or
(iii) community first services and supports under section 256B.85;
(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
gaining access to:
(i) relocation targeted case management services available under section 256B.0621,
subdivision 2, clause (4);
(ii) case management services targeted to vulnerable adults or developmental disabilities
under section 256B.0924; and
(iii) case management services targeted to people with developmental disabilities under
Minnesota Rules, part 9525.0016;
(3) determination of eligibility for semi-independent living services under section
252.275; and
(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
and (3).
(c) "Long-term care options counseling" means the services provided by sections 256.01,
subdivision 24, and 256.975, subdivision 7, and also includes telephone assistance and
follow up once a long-term care consultation assessment has been completed.
(d) "Minnesota health care programs" means the medical assistance program under this
chapter and the alternative care program under section 256B.0913.
(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation services.
(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives, the settings in which the person
receives the services, and the setting in which the person lives.
(g) "Informed choice" deleted text begin means a voluntary choice of services, settings, living arrangement,
and work by a person from all available service and setting options based on accurate and
complete information concerning all available service and setting options and concerning
the person's own preferences, abilities, goals, and objectives. In order for a person to make
an informed choice, all available options must be developed and presented to the person in
a way the person can understand to empower the person to make fully informed choicesdeleted text end new text begin
has the meaning given in section 256B.4905, subdivision 1a, paragraph (b)new text end .
(h) "Available service and setting options" or "available options," with respect to the
home and community-based waivers under chapter 256S and sections 256B.092 and 256B.49,
means all services and settings defined under the waiver plan for which a waiver applicant
or waiver participant is eligible.
(i) "Independent living" means living in a setting that is not controlled by a provider.
Sec. 13.
Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. Face-to-face
assessments must be conducted according to paragraphs (b) to (i).
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) The assessment must be conducted by a certified assessor in a face-to-face
conversational interview with the person being assessed. The person's legal representative
must provide input during the assessment process and may do so remotely if requested. At
the request of the person, other individuals may participate in the assessment to provide
information on the needs, strengths, and preferences of the person necessary to develop a
community support plan that ensures the person's health and safety. Except for legal
representatives or family members invited by the person, persons participating in the
assessment may not be a provider of service or have any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living or adult
day services under chapter 256S, with the permission of the person being assessed or the
person's designated or legal representative, the client's current or proposed provider of
services may submit a copy of the provider's nursing assessment or written report outlining
its recommendations regarding the client's care needs. The person conducting the assessment
must notify the provider of the date by which this information is to be submitted. This
information shall be provided to the person conducting the assessment prior to the assessment.
For a person who is to be assessed for waiver services under section 256B.092 or 256B.49,
with the permission of the person being assessed or the person's designated legal
representative, the person's current provider of services may submit a written report outlining
recommendations regarding the person's care needs the person completed in consultation
with someone who is known to the person and has interaction with the person on a regular
basis. The provider must submit the report at least 60 days before the end of the person's
current service agreement. The certified assessor must consider the content of the submitted
report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) Face-to-face assessment completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.
new text begin
(n) If a person who receives home and community-based waiver services under section
256B.0913, 256B.092, or 256B.49 or chapter 256S temporarily enters for 121 days or fewer
a hospital, institution of mental disease, nursing facility, intensive residential treatment
services program, transitional care unit, or inpatient substance use disorder treatment setting,
the person may return to the community with home and community-based waiver services
under the same waiver, without requiring an assessment or reassessment under this section,
unless the person's annual reassessment is otherwise due. Nothing in this paragraph shall
change annual long-term care consultation reassessment requirements, payment for
institutional or treatment services, medical assistance financial eligibility, or any other law.
new text end
deleted text begin (n)deleted text end new text begin (o)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver residential supports and services currently residing in a community
residential setting, licensed adult foster care home that is either not the primary residence
of the license holder or in which the license holder is not the primary caregiver, family adult
foster care residence, customized living setting, or supervised living facility to determine
if that person would prefer to be served in a community-living setting as defined in section
256B.49, subdivision 23, in a setting not controlled by a provider, or to receive integrated
community supports as described in section 245D.03, subdivision 1, paragraph (c), clause
(8). The certified assessor shall offer the person, through a person-centered planning process,
the option to receive alternative housing and service options.
deleted text begin (o)deleted text end new text begin (p)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver day services to determine if that person would prefer to receive employment
services as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7).
The certified assessor shall describe to the person through a person-centered planning process
the option to receive employment services.
deleted text begin (p)deleted text end new text begin (q)new text end At the time of reassessment, the certified assessor shall assess each person
receiving non-self-directed waiver services to determine if that person would prefer an
available service and setting option that would permit self-directed services and supports.
The certified assessor shall describe to the person through a person-centered planning process
the option to receive self-directed services and supports.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0911, subdivision 6, is amended to read:
Subd. 6.
Payment for long-term care consultation services.
deleted text begin
(a) Until September 30,
2013, payment for long-term care consultation face-to-face assessment shall be made as
described in this subdivision.
deleted text end
deleted text begin
(b) The total payment for each county must be paid monthly by Certified nursing facilities
in the county. The monthly amount to be paid by each nursing facility for each fiscal year
must be determined by dividing the county's annual allocation for long-term care consultation
services by 12 to determine the monthly payment and allocating the monthly payment to
each nursing facility based on the number of licensed beds in the nursing facility. Payments
to counties in which there is no certified nursing facility must be made by increasing the
payment rate of the two facilities located nearest to the county seat.
deleted text end
deleted text begin
(c) The commissioner shall include the total annual payment determined under paragraph
(b) for each nursing facility reimbursed under section 256B.431 or 256B.434 or chapter
256R.
deleted text end
deleted text begin
(d) In the event of the layaway, delicensure and decertification, or removal from layaway
of 25 percent or more of the beds in a facility, the commissioner may adjust the per diem
payment amount in paragraph (c) and may adjust the monthly payment amount in paragraph
(b). The effective date of an adjustment made under this paragraph shall be on or after the
first day of the month following the effective date of the layaway, delicensure and
decertification, or removal from layaway.
deleted text end
deleted text begin (e)deleted text end new text begin (a)new text end Payments for long-term care consultation services are available to deleted text begin the county ordeleted text end
counties new text begin and Tribal nations that are lead agencies new text end to cover staff salaries and expenses to
provide the services described in subdivision 1a. The county new text begin or Tribal nation new text end shall employ,
or contract with other agencies to employ, deleted text begin within the limits of available funding,deleted text end sufficient
personnel to provide long-term care consultation services while meeting the state's long-term
care outcomes and objectives as defined in subdivision 1. The county new text begin or Tribal nation new text end shall
be accountable for meeting local objectives as approved by the commissioner in the biennial
home and community-based services quality assurance plan on a form provided by the
commissioner.
deleted text begin
(f) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
deleted text end
deleted text begin
(g) The commissioner of human services shall amend the Minnesota medical assistance
plan to include reimbursement for the local consultation teams.
deleted text end
deleted text begin (h) Until the alternative payment methodology in paragraph (i) is implemented, the
county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs.
deleted text end
new text begin (b) new text end No individual or family member shall be charged for an initial assessment or initial
support plan development provided under subdivision 3a or 3b.
deleted text begin (i)deleted text end new text begin (c)new text end The commissioner shall develop an alternative payment methodology, effective
on October 1, 2013, for long-term care consultation services that includes the funding
available under this subdivision, and for assessments authorized under sections 256B.092
and 256B.0659. In developing the new payment methodology, the commissioner shall
consider the maximization of other funding sources, including federal administrative
reimbursement through federal financial participation funding, for all long-term care
consultation activity. The alternative payment methodology shall include the use of the
appropriate time studies and the state financing of nonfederal share as part of the state's
medical assistance program. Between July 1, 2017, and June 30, 2019, the state shall pay
84.3 percent of the nonfederal share as reimbursement to the counties. Beginning July 1,
2019, the state shall pay 81.9 percent of the nonfederal share as reimbursement to the
counties.
Sec. 15.
Minnesota Statutes 2020, section 256B.0911, is amended by adding a subdivision
to read:
new text begin Subd. 6b. new text end
new text begin
Payment for long-term care consultation services; transition to tiered
rates.
new text end
new text begin
(a) Notwithstanding subdivision 6, paragraph (c), beginning July 1, 2021, for each
fiscal year through fiscal year 2025, the state shall pay to each county and Tribal nation as
reimbursement for services provided under this section a percentage of the nonfederal share
equal to the value of the county's or the Tribal nation's prorated share of the nonfederal
share paid to counties and Tribal nations as reimbursement for services provided under
subdivision 6, paragraph (c), during fiscal year 2019.
new text end
new text begin
(b) Beginning October 1, 2022, each county or Tribal nation reimbursed under paragraph
(a) must submit to the commissioner by October 1 an annual report documenting the total
number of assessments performed under this section, the number of assessments by type of
assessment, amount of time spent on each assessment, amount of time spent preparing for
each assessment, amount of time spent finalizing a community support plan following each
assessment, and amount of time an assessor spent on other assessment-related activities for
each assessment. In its annual report, each county and Tribal nation must distinguish between
services provided to people who were eligible for medical assistance at the time the services
were provided and services provided to those who were not.
new text end
new text begin
(c) This subdivision expires July 1, 2025.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.092, subdivision 1b, is amended to read:
Subd. 1b.
Coordinated service and support plan.
(a) Each recipient of home and
community-based waivered services shall be provided a copy of the written person-centered
coordinated service and support plan that:
(1) is developed with and signed by the recipient within the timelines established by the
commissioner and section 256B.0911, subdivision 3a, paragraph (e);
(2) includes the person's need for service, including identification of service needs that
will be or that are met by the person's relatives, friends, and others, as well as community
services used by the general public;
(3) reasonably ensures the health and welfare of the recipient;
(4) identifies the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor, including the person's
choices made on self-directed options, services and supports to achieve employment goals,
and living arrangements;
(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for case
management services and providers;
(6) identifies long-range and short-range goals for the person;
(7) identifies specific services and the amount and frequency of the services to be provided
to the person based on assessed needs, preferences, and available resources. The
person-centered coordinated service and support plan shall also specify other services the
person needs that are not availablenew text begin and indicate in a clear and accessible manner the total
monetary resources available to meet the assessed needs and preferences of the individualnew text end ;
(8) identifies the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;
(9) identifies provider responsibilities to implement and make recommendations for
modification to the coordinated service and support plan;
(10) includes notice of the right to request a conciliation conference or a hearing under
section 256.045;
(11) is agreed upon and signed by the person, the person's legal guardian or conservator,
or the parent if the person is a minor, and the authorized county representative;
(12) is reviewed by a health professional if the person has overriding medical needs that
impact the delivery of services; and
(13) includes the authorized annual and monthly amounts for the services.
(b) In developing the person-centered coordinated service and support plan, the case
manager is encouraged to include the use of volunteers, religious organizations, social clubs,
and civic and service organizations to support the individual in the community. The lead
agency must be held harmless for damages or injuries sustained through the use of volunteers
and agencies under this paragraph, including workers' compensation liability.
(c) Approved, written, and signed changes to a consumer's services that meet the criteria
in this subdivision shall be an addendum to that consumer's individual service plan.
Sec. 17.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Regional quality councils and systems improvement. new text end
new text begin
The commissioner of
human services shall maintain the regional quality councils initially established under
Minnesota Statutes 2020, section 256B.097, subdivision 4. The regional quality councils
shall:
new text end
new text begin
(1) support efforts and initiatives that drive overall systems and social change to promote
inclusion of people who have disabilities in the state of Minnesota;
new text end
new text begin
(2) improve person-centered outcomes in disability services; and
new text end
new text begin
(3) identify or enhance quality of life indicators for people who have disabilities.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Membership and staff. new text end
new text begin
(a) Regional quality councils shall be comprised of
key stakeholders including, but not limited to:
new text end
new text begin
(1) individuals who have disabilities;
new text end
new text begin
(2) family members of people who have disabilities;
new text end
new text begin
(3) disability service providers;
new text end
new text begin
(4) disability advocacy groups;
new text end
new text begin
(5) lead agency staff; and
new text end
new text begin
(6) staff of state agencies with jurisdiction over special education and disability services.
new text end
new text begin
(b) Membership in a regional quality council must be representative of the communities
in which the council operates, with an emphasis on individuals with lived experience from
diverse racial and cultural backgrounds.
new text end
new text begin
(c) Each regional quality council may hire staff to perform the duties assigned in
subdivision 9.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Duties. new text end
new text begin
(a) Each regional quality council shall:
new text end
new text begin
(1) identify issues and barriers that impede Minnesotans who have disabilities from
optimizing choice of home and community-based services;
new text end
new text begin
(2) promote informed-decision making, autonomy, and self-direction;
new text end
new text begin
(3) analyze and review quality outcomes and critical incident data, and immediately
report incidents of life safety concerns to the Department of Human Services Licensing
Division;
new text end
new text begin
(4) inform a comprehensive system for effective incident reporting, investigation, analysis,
and follow-up;
new text end
new text begin
(5) collaborate on projects and initiatives to advance priorities shared with state agencies,
lead agencies, educational institutions, advocacy organizations, community partners, and
other entities engaged in disability service improvements;
new text end
new text begin
(6) establish partnerships and working relationships with individuals and groups in the
regions;
new text end
new text begin
(7) identify and implement regional and statewide quality improvement projects;
new text end
new text begin
(8) transform systems and drive social change in alignment with the disability rights and
disability justice movements identified by leaders who have disabilities;
new text end
new text begin
(9) provide information and training programs for persons who have disabilities and
their families and legal representatives on formal and informal support options and quality
expectations;
new text end
new text begin
(10) make recommendations to state agencies and other key decision-makers regarding
disability services and supports;
new text end
new text begin
(11) submit every two years a report to legislative committees with jurisdiction over
disability services on the status, outcomes, improvement priorities, and activities in the
region;
new text end
new text begin
(12) support people by advocating to resolve complaints between the counties, providers,
persons receiving services, and their families and legal representatives; and
new text end
new text begin
(13) recruit, train, and assign duties to regional quality council teams, including council
members, interns, and volunteers, taking into account the skills necessary for the team
members to be successful in this work.
new text end
new text begin
(b) Each regional quality council may engage in quality improvement initiatives related
to, but not limited to:
new text end
new text begin
(1) the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
including brain injuries and services for those persons who qualify for nursing facility level
of care or hospital facility level of care and any other services licensed under chapter 245D;
new text end
new text begin
(2) home care services under section 256B.0651;
new text end
new text begin
(3) family support grants under section 252.32;
new text end
new text begin
(4) consumer support grants under section 256.476;
new text end
new text begin
(5) semi-independent living services under section 252.275; and
new text end
new text begin
(6) services provided through an intermediate care facility for persons with developmental
disabilities.
new text end
new text begin
(c) Each regional quality council's work must be informed and directed by the needs
and desires of persons who have disabilities in the region in which the council operates.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Compensation. new text end
new text begin
(a) A member of a regional quality council who does not
receive a salary or wages from an employer may be paid a per diem and reimbursed for
expenses related to the member's participation in efforts and initiatives described in
subdivision 9 in the same manner and in an amount not to exceed the amount authorized
by the commissioner's plan adopted under section 43A.18, subdivision 2.
new text end
new text begin
(b) Regional quality councils may charge fees for their services.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.19, subdivision 1, is amended to read:
Subdivision 1.
Division of cost.
The state and county share of medical assistance costs
not paid by federal funds shall be as follows:
(1) beginning January 1, 1992, 50 percent state funds and 50 percent county funds for
the cost of placement of severely emotionally disturbed children in regional treatment
centers;
(2) beginning January 1, 2003, 80 percent state funds and 20 percent county funds for
the costs of nursing facility placements of persons with disabilities under the age of 65 that
have exceeded 90 days. This clause shall be subject to chapter 256G and shall not apply to
placements in facilities not certified to participate in medical assistance;
(3) beginning July 1, 2004, 90 percent state funds and ten percent county funds for the
costs of placements that have exceeded 90 days in intermediate care facilities for persons
with developmental disabilities that have seven or more beds. This provision includes
pass-through payments made under section 256B.5015; deleted text begin and
deleted text end
(4) beginning July 1, 2004, when state funds are used to pay for a nursing facility
placement due to the facility's status as an institution for mental diseases (IMD), the county
shall pay 20 percent of the nonfederal share of costs that have exceeded 90 days. This clause
is subject to chapter 256Gnew text begin ;
new text end
new text begin
(5) for any individual who has not been continuously receiving services in an intermediate
care facility for persons with developmental disabilities since December 31, 2021, 90 percent
state funds and ten percent county funds for the costs of any placement of an individual 18
years of age or older and under 27 years of age exceeding 90 days in any intermediate care
facility for persons with developmental disabilities. This provision includes pass-through
payments made under section 256B.5015. This provision is not in addition to the division
of costs under clause (3). This provision continues to apply to an individual after the
individual reaches the age of 27 and until the individual transitions to a community setting;
and
new text end
new text begin (6) for any individual who has not been continuously receiving residential support
services since December 31, 2021, 90 percent state funds and ten percent county funds for
the costs of residential support services when authorized for an individual 18 years of age
or older and under 27 years of age. This provision continues to apply to an individual after
the individual reaches the age of 27 and until the individual no longer receives residential
support services. For the purposes of this clause, "residential support services" means the
following residential support services reimbursed under section 256B.4914: community
residential services, customized living services, and 24-hour customized living servicesnew text end .
For counties that participate in a Medicaid demonstration project under sections 256B.69
and 256B.71, the division of the nonfederal share of medical assistance expenses for
payments made to prepaid health plans or for payments made to health maintenance
organizations in the form of prepaid capitation payments, this division of medical assistance
expenses shall be 95 percent by the state and five percent by the county of financial
responsibility.
In counties where prepaid health plans are under contract to the commissioner to provide
services to medical assistance recipients, the cost of court ordered treatment ordered without
consulting the prepaid health plan that does not include diagnostic evaluation,
recommendation, and referral for treatment by the prepaid health plan is the responsibility
of the county of financial responsibility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.49, subdivision 23, is amended to read:
Subd. 23.
Community-living settings.
(a) For the purposes of this chapter,
"community-living settings" means a single-family home or multifamily dwelling unit where
a service recipient or a service recipient's family owns or rents, and maintains control over
the individual unit as demonstrated by a lease agreement. Community-living settings does
not include a home or dwelling unit that the service provider owns, operates, or leases or
in which the service provider has a direct or indirect financial interest.
(b) To ensure a service recipient or the service recipient's family maintains control over
the home or dwelling unit, community-living settings are subject to the following
requirements:
(1) service recipients must not be required to receive services or share services;
(2) service recipients must not be required to have a disability or specific diagnosis to
live in the community-living setting;
(3) service recipients may hire service providers of their choice;
(4) service recipients may choose whether to share their household and with whom;
(5) the home or multifamily dwelling unit must include living, sleeping, bathing, and
cooking areas;
(6) service recipients must have lockable access and egress;
(7) service recipients must be free to receive visitors and leave the settings at times and
for durations of their own choosing;
(8) leases must comply with chapter 504B;
(9) landlords must not charge different rents to tenants who are receiving home and
community-based services; and
(10) access to the greater community must be easily facilitated based on the service
recipient's needs and preferences.
(c) Nothing in this section prohibits a service recipient from having another person or
entity not affiliated with the service provider cosign a lease. Nothing in this section prohibits
a service recipient, during any period in which a service provider has cosigned the service
recipient's lease, from modifying services with an existing cosigning service provider and,
subject to the approval of the landlord, maintaining a lease cosigned by the service provider.
Nothing in this section prohibits a service recipient, during any period in which a service
provider has cosigned the service recipient's lease, from terminating services with the
cosigning service provider, receiving services from a new service provider, and, subject to
the approval of the landlord, maintaining a lease cosigned by the new service provider.
(d) A lease cosigned by a service provider meets the requirements of paragraph (a) if
the service recipient and service provider develop and implement a transition plan which
must provide that, within two years of cosigning the initial lease, the service provider shall
transfer the lease to the service recipient and other cosigners, if any.
(e) In the event the landlord has not approved the transfer of the lease within two years
of the service provider cosigning the initial lease, the service provider must submit a
time-limited extension request to the commissioner of human services to continue the
cosigned lease arrangement. The extension request must include:
(1) the reason the landlord denied the transfer;
(2) the plan to overcome the denial to transfer the lease;
(3) the length of time needed to successfully transfer the lease, not to exceed an additional
two years;
(4) a description of how the transition plan was followed, what occurred that led to the
landlord denying the transfer, and what changes in circumstances or condition, if any, the
service recipient experienced; and
(5) a revised transition plan to transfer the cosigned lease between the service provider
and the service recipient to the service recipient.
The commissioner must approve an extension within sufficient time to ensure the continued
occupancy by the service recipient.
new text begin
(f) In the event that a landlord has not approved a transfer of the lease within the timelines
of any approved time-limited extension request, a service provider must submit another
time-limited extension request to the commissioner of human services to continue a cosigned
lease arrangement. A time-limited extension request submitted under this paragraph must
include the same information required for an initial time-limited extension request under
paragraph (e). The commissioner must approve of an extension within sufficient time to
ensure continued occupancy by the service recipient.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin
Customized living moratorium for brain injury and community access
for disability inclusion waivers.
new text end
new text begin
(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), to prevent new development of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14,
the commissioner shall not enroll new customized living settings serving four or fewer
people in a single-family home to deliver customized living services as defined under the
brain injury or community access for disability inclusion waiver plans under section 256B.49.
new text end
new text begin
(b) The commissioner may approve an exception to paragraph (a) when an existing
customized living setting changes ownership at the same address.
new text end
new text begin
(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.
new text end
new text begin
(d) For any new customized living settings serving four or fewer people in a single-family
home to deliver customized living services as defined in paragraph (a) and that was not
operational on or before June 30, 2021, the authorizing lead agency is financially responsible
for all home and community-based service payments in the setting.
new text end
new text begin
(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person in the customized living setting.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021. This section applies only
to customized living services as defined under the brain injury or community access for
disability inclusion waiver plans under Minnesota Statutes, section 256B.49.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Informed choice" means a choice that adults who have disabilities and, with support
from their families or legal representatives, that children who have disabilities make regarding
services and supports that best meets the adult's or child's needs and preferences. Before
making an informed choice, an individual who has disabilities must be provided, in an
accessible format and manner that meets the individual's needs, the tools, information, and
opportunities the individual requests or requires to understand all of the individual's options.
new text end
new text begin
(c) "HCBS" means home and community-based services covered under this chapter by
the medical assistance state plan, and the home and community-based waiver services
covered under sections 256B.092 and 256B.49.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Informed choice policy. new text end
new text begin
It is the policy of this state that all adults who have
disabilities and, with support from their families or legal representatives, all children who
have disabilities:
new text end
new text begin
(1) can make informed choices to select and utilize disability services and supports; and
new text end
new text begin
(2) will be offered an informed decision-making process sufficient to make informed
choices.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Informed decision making. new text end
new text begin
(a) The commissioner of human services and
lead agencies shall ensure that:
new text end
new text begin
(1) disability services support the presumption that adults who have disabilities and,
with support from their families or legal representatives, children who have disabilities can
make informed choices;
new text end
new text begin
(2) all adults who have disabilities and are accessing HCBS and all families of children
who have disabilities and are accessing HCBS are provided an informed decision-making
process satisfying the requirements of paragraph (b);
new text end
new text begin
(3) all adults who have disabilities and are accessing HCBS and all families of children
who have disabilities and are accessing HCBS are provided the opportunity to revisit or
change any decision or choice at any time of the adult's or family's choosing; and
new text end
new text begin
(4) services or supports necessary to accomplish each step of an informed
decision-making process or to make an informed choice to utilize disability services are
authorized and implemented within a reasonable time frame for individuals accessing HCBS.
new text end
new text begin
(b) The commissioner of human services must develop and ensure compliance with an
informed decision-making standard that provides accessible, correct, and complete
information to help an individual accessing HCBS make an informed choice. This information
must be accessible and understandable to the person so that the person can demonstrate
understanding of the options. Any written information provided in the process must be
accessible and the process must be experiential whenever possible. The process must also
consider and offer to the person, in a person-centered manner, the following:
new text end
new text begin
(1) reasonable accommodations as needed or requested by the person to fully participate
in the informed decision-making process and acquire the information necessary to make an
informed choice;
new text end
new text begin
(2) discussion of the person's own preferences, abilities, goals, and objectives;
new text end
new text begin
(3) identification of the person's cultural needs and access to culturally responsive services
and providers;
new text end
new text begin
(4) information about the benefits of inclusive and individualized services and supports;
new text end
new text begin
(5) presentation and discussion of all options with the person;
new text end
new text begin
(6) documentation, in a manner prescribed by the commissioner, of each option discussed;
new text end
new text begin
(7) exploration and development of new or other options;
new text end
new text begin
(8) facilitation of opportunities to visit alternative locations or to engage in experiences
to understand how any service option might work for the person;
new text end
new text begin
(9) opportunities to meet with other individuals with disabilities who live, work, and
receive services different from the person's own services;
new text end
new text begin
(10) development of a transition plan, when needed or requested by the person, to
facilitate the choice to move from one service type or setting to another, and authorization
of the services and supports necessary to effectuate the plan;
new text end
new text begin
(11) identification of any barriers to assisting or implementing the person's informed
choice and authorization of the services and supports necessary to overcome those barriers;
and
new text end
new text begin
(12) ample time and timely opportunity to consider available options before the individual
makes a final choice or changes a choice.
new text end
new text begin
(c) The commissioner shall ensure that individuals accessing HCBS have access to an
informed decision-making process at least annually by:
new text end
new text begin
(1) updating informed choice protocols for HCBS to reflect the informed choice definition
in subdivision 1a, paragraph (b), and the informed decision-making process outlined in
paragraph (b);
new text end
new text begin
(2) developing a survey designed for individuals accessing HCBS to assess their
experience with informed choice and the informed decision-making process, including how
frequently it is offered and how well it meets the standard in paragraph (b). The survey shall
be administered and results used to determine the quality and frequency of informed choice
and informed decision making consistent with this section. The commissioner shall utilize
survey results to increase the frequency and quality of informed decision making and
informed choice as experienced by individuals accessing HCBS;
new text end
new text begin
(3) creating option for interested persons to file incident reports regarding an access to
and the quality of informed choice and informed decision making experienced by an
individual accessing HCBS, and implementing appropriate processes upon receipt of the
reports;
new text end
new text begin
(4) developing and implementing a curriculum and training plan to ensure all lead agency
assessors and case managers have the knowledge and skills to comply with this section.
Training and competency evaluations must be completed annually by all staff responsible
for case management as described in section 256B.092, subdivision 1a, paragraph (f), and
section 256B.49, subdivision 13, paragraph (e); and
new text end
new text begin
(5) mandating informed choice training for lead agency staff who support individuals
accessing HCBS.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Informed choice in employment policy. new text end
new text begin
It is the policy of this state that
working-age individuals who have disabilities:
new text end
new text begin
(1) can work and achieve competitive integrated employment with appropriate services
and supports, as needed;
new text end
new text begin
(2) make informed choices about their postsecondary education, work, and career goals;
and
new text end
new text begin
(3) will be offered the opportunity to make an informed choice, at least annually, to
pursue postsecondary education or to work and earn a competitive wage.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 5a. new text end
new text begin Informed choice in employment implementation. new text end
new text begin
(a) The commissioner of
human services and lead agencies shall ensure that disability services align with the
employment first policy adopted by the Olmstead subcabinet on September 29, 2014, or
successor policies.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take other appropriate actions to ensure that all working-age individuals
who have disabilities and are accessing HCBS are offered an informed decision-making
process that will help them make an informed choice about postsecondary education offering
meaningful credentials; and about working and earning, with appropriate services and
supports, a competitive wage in work or a career that the individual chooses before being
offered exclusively day services as defined in section 245D.03, subdivision 1, paragraph
(c), clause (4), or successor provisions.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Informed choice in community living policy. new text end
new text begin
It is the policy of this state that
all adults who have disabilities:
new text end
new text begin
(1) can live in the communities of the individual's choosing with appropriate services
and supports as needed; and
new text end
new text begin
(2) have the right, at least annually, to make an informed decision-making process that
can help them make an informed choice to live outside of a provider-controlled setting.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Informed choice in community living implementation. new text end
new text begin
(a) The commissioner
of human services and lead agencies shall ensure that disability services support the
presumption that all adults who have disabilities can and want to live in the communities
of the individual's choosing with services and supports as needed.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any appropriate action to ensure that all adults who have
disabilities and are accessing HCBS are offered, after an informed decision-making process
and during a person-centered planning process, the services and supports the individual
needs to live as the individual chooses, including in a non-provider-controlled setting.
Provider-controlled settings include customized living services provided in a single-family
home or residential supports and services as defined in section 245D.03, subdivision 1,
paragraph (c), clause (3), or successor provisions, unless the residential services and supports
are provided in a family adult foster care residence under a shared living option as described
in Laws 2013, chapter 108, article 7, section 62.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Informed choice in self-direction policy. new text end
new text begin
It is the policy of this state that adults
who have disabilities and families of children who have disabilities:
new text end
new text begin
(1) can direct the adult's or child's needed services and supports; and
new text end
new text begin
(2) have the right to make an informed choice to self-direct the adult's or child's services
and supports before being offered options that do not allow the adult or family to self-direct
the adult's or child's services and supports.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Informed choice in self-direction implementation. new text end
new text begin
(a) The commissioner
of human services and lead agencies shall ensure that disability services support the
presumption that adults who have disabilities and families of children who have disabilities
can direct all of the adult's or child's services and supports, including control over the funding
of the adult's or child's services and supports.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any other appropriate actions to ensure that at intervals described
in paragraph (c), adults who have disabilities and are accessing HCBS and families of
children who have disabilities and are accessing HCBS are offered, after an informed
decision-making process and during a person-centered planning process, the option to direct
the adult's or child's services and supports, including the option to have control over the
funding of the adult's or child's services and supports.
new text end
new text begin
(c) The commissioner or lead agency shall offer adults who have disabilities and families
of children who have disabilities the options described in paragraph (b) at least annually
during regularly scheduled planning meetings or more frequently when:
new text end
new text begin
(1) the adults who have disabilities or families of children who have disabilities requests
or suggests the options described in paragraph (b) or when the adult or family expresses
dissatisfaction with services and supports that do not allow for self-direction;
new text end
new text begin
(2) the family or a legal representative of the individual with disabilities requests or
suggests the options described in paragraph (b);
new text end
new text begin
(3) any member of the individual's service planning team or expanded service planning
team requests or suggests the options described in paragraph (b); or
new text end
new text begin
(4) self-directed services and supports could enhance the individual's independence or
quality of life.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Informed choice in technology policy. new text end
new text begin
It is the policy of this state that all
adults who have disabilities and children who have disabilities:
new text end
new text begin
(1) can use assistive technology, remote supports, or a combination of both to enhance
the adult's or child's independence and quality of life; and
new text end
new text begin
(2) have the right, at least annually, to make an informed choice about the adult's or
child's use of assistive technology and remote supports.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Informed choice in technology implementation. new text end
new text begin
(a) The commissioner of
human services and lead agencies shall ensure that disability services support the presumption
that adults who have disabilities and children who have disabilities can use or benefit from
assistive technology, remote supports, or both.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any other appropriate actions to ensure that at intervals described
in paragraph (c), adults who have disabilities and are accessing HCBS and families of
children who have disabilities and are accessing HCBS are offered, after an informed
decision-making process and during a person-centered planning process, the opportunity
to choose assistive technology, remote support, or both, to ensure equitable access.
new text end
new text begin
(c) The commissioner or lead agency shall offer adults who have disabilities and families
of children who have disabilities the options described in paragraph (b) at least annually
during a regularly scheduled planning meeting or more frequently when:
new text end
new text begin
(1) the adult who has disabilities or the family of a child who has disabilities requests
or suggests the options described in paragraph (b) or when the adult or family expresses
dissatisfaction with in-person services and supports;
new text end
new text begin
(2) the family or a legal representative of the individual with disabilities requests or
suggests the options described in paragraph (b);
new text end
new text begin
(3) any member of the individual's service planning team or expanded service planning
team requests or suggests the options described in paragraph (b); or
new text end
new text begin
(4) assistive technology, remote supports, or both could enhance the individual's
independence or quality of life.
new text end
new text begin
(d) The availability of assistive technology, remote supports, or both, shall not preclude
an individual with disabilities from accessing in-person supports and services, nor shall it
result in a denial of in-person supports and services.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256B.4914, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
(b) "Commissioner" means the commissioner of human services.
(c) "Comparable occupations" means the occupations, excluding direct care staff, as
represented by the Bureau of Labor Statistics standard occupational classification codes
that have the same classification for:
(1) typical education needed for entry;
(2) work experience in a related occupation; and
(3) typical on-the-job training competency as the most predominant classification for
direct care staff.
(d) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
(e) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.
(f) "Direct care staff" means employees providing direct service to people receiving
services under this section. Direct care staff excludes executive, managerial, and
administrative staff.
(g) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.
(h) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.
(i) "Lead agency" means a county, partnership of counties, or tribal agency charged with
administering waivered services under sections 256B.092 and 256B.49.
(j) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.
(k) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.
(l) "Rates management system" means a web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.
(m) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.
(n) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.
(o) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.
(p) "Unit of service" means the following:
(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
(2) for day services under subdivision 7:
(i) for day training and habilitation services, a unit of service is either:
(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and
(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;
(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
(iii) for day support services, a unit of service is 15 minutes; and
(iv) for prevocational services, a unit of service is a day or 15 minutes. A day unit of
service is six or more hours of time spent providing direct service;
(3) for unit-based services with programming under subdivision 8:
(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; deleted text begin and
deleted text end
(ii) new text begin for individualized home supports with training, a unit of service is a day or 15 minutes.
A day unit of service is six or more hours of time spent providing direct service; and
new text end
new text begin (iii) new text end for all other services, a unit of service is 15 minutes; and
(4) for unit-based services without programming under subdivision 9, a unit of service
is 15 minutes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);
(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);
(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;
(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(14) for employment exploration services staff, 50 percent of the median wage for
deleted text begin rehabilitation counselor (SOC code 21-1015)deleted text end new text begin education, guidance, school, and vocational
counselors (SOC code 21-1012)new text end ; and 50 percent of the median wage for community and
social services specialist (SOC code 21-1099);
(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);
(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).
(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
(c) Component values for family foster care are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 3.3 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence factor: 1.7 percent.
(d) Component values for day training and habilitation, day support services, and
prevocational services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: ten percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
(e) new text begin Component values for day support services and prevocational services delivered
remotely are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 5.6 percent;
new text end
new text begin
(6) client programming and support ratio: 10.37 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 1.8 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 9.4 percent.
new text end
new text begin (f) new text end Component values for adult day services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: 7.4 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
deleted text begin (f)deleted text end new text begin (g)new text end Component values for unit-based services with programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan supports ratio: 15.5 percent;
(6) client programming and supports ratio: 4.7 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 6.1 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
deleted text begin (g)deleted text end new text begin (h) Component values for unit-based services with programming delivered remotely
are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan supports ratio: 15.5 percent;
new text end
new text begin
(6) client programming and supports ratio: 4.7 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 6.1 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
new text begin (i) new text end Component values for unit-based services without programming except respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 7.0 percent;
(6) client programming and support ratio: 2.3 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 2.9 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(j) Component values for unit-based services without programming delivered remotely,
except respite, are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 7.0 percent;
new text end
new text begin
(6) client programming and support ratio: 2.3 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 2.9 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (h)deleted text end new text begin (k) new text end Component values for unit-based services without programming for respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 2.9 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin (i)deleted text end new text begin (l)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.
deleted text begin (j)deleted text end new text begin (m)new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:
(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
(3) workforce data as required under subdivision 10a, paragraph (g).
The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
deleted text begin (k)deleted text end new text begin (n)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); and paragraph (g), clause (6); new text begin paragraph (h), clause (6); paragraph (i), clause
(6); paragraph (j), clause (6); new text end subdivision 6, paragraphs (b), clauses (9) and (10), and (e),
clause (10); and subdivision 7, clauses (11), (17), and (18), for changes in the Consumer
Price Index. The commissioner shall adjust these values higher or lower by the percentage
change in the CPI-U from the date of the previous update to the data available 30 months
and one day prior to the scheduled update. The commissioner shall publish these updated
values and load them into the rate management system.
deleted text begin (l)deleted text end new text begin (o)new text end Upon the implementation of the updates under paragraphs deleted text begin (i) and (k)deleted text end new text begin (l) and (n)new text end ,
rate adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter
108, article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be
removed from service rates calculated under this section.
deleted text begin (m)deleted text end new text begin (p)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)
and (k)deleted text end new text begin (l) and (n)new text end .
deleted text begin (n)deleted text end new text begin (q)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, family residential services, foster care
services, integrated community supports, and supportive living services daily.
(b) Payments for community residential services, corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;
(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;
(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);
(9) for client programming and supports, the commissioner shall add $2,179; and
(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(c) The total rate must be calculated using the following steps:
(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(d) The payment methodology for customized living new text begin andnew text end , 24-hour customized living,
deleted text begin anddeleted text end deleted text begin residential caredeleted text end services must be the customized living tool. deleted text begin Revisions todeleted text end new text begin The
commissioner shall revisenew text end the customized living tool deleted text begin must be madedeleted text end to reflect the services
and activities unique to disability-related recipient needsnew text begin , adjust for regional differences in
the cost of providing services, and the rate adjustments described in section 256S.205.
Customized living and 24-hour customized living rates determined under this section shall
not include more than 24 hours of support in a daily unit. The commissioner shall establish
acuity-based input limits, based on case mix, for customized living and 24-hour customized
living rates determined under this sectionnew text end .
(e) Payments for integrated community support services must be calculated as follows:
(1) the base shared staffing deleted text begin shalldeleted text end new text begin mustnew text end be eight hours divided by the number of people
receiving support in the integrated community support setting;
(2) the individual staffing hours deleted text begin shalldeleted text end new text begin mustnew text end be the average number of direct support hours
provided directly to the service recipient;
(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;
(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);
(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;
(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);
(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;
(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
(f) The total rate must be calculated as follows:
(1) add the results of paragraph (e), clauses (9) and (10);
(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
deleted text begin
(g) The payment methodology for customized living and 24-hour customized living
deleted text end
deleted text begin
services must be the customized living tool. The commissioner shall revise the customized
deleted text end
deleted text begin
living tool to reflect the services and activities unique to disability-related recipient needs
deleted text end
deleted text begin
and adjust for regional differences in the cost of providing services.
deleted text end
deleted text begin (h)deleted text end new text begin (g)new text end The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, except the fourth sentence of paragraph (d) is effective January 1, 2022.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:
Subd. 7.
Payments for day programs.
Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day services new text begin provided in person or remotely new text end must be
calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;
(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (2), new text begin for in-person services or
subdivision 5, paragraph (e), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(3)new text begin , for in-person services or subdivision 5, paragraph (e), clause (3), for remote servicesnew text end .
This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (5)new text begin , for in-person services or
subdivision 5, paragraph (e), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (4)new text begin , for in-person services
or subdivision 5, paragraph (e), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (6)new text begin , for
in-person services or subdivision 5, paragraph (e), clause (6), for remote servicesnew text end ;
(11) for program facility costs, add deleted text begin $19.30deleted text end new text begin $20.02new text end per week with consideration of staffing
ratios to meet individual needs;
(12) for adult day bath services, add $7.01 per 15 minute unit;
(13) this is the subtotal rate;
(14) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;
(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;
(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including employment exploration services, employment
development services, housing access coordination, individualized home supports with
family training, individualized home supports with training, in-home family support,
independent living skills training, and hourly supported living services provided to an
individual outside of any day or residential service plannew text begin provided in person or remotelynew text end
must be calculated as follows, unless the services are authorized separately under subdivision
6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (2), new text begin for in-person services or
subdivision 5, paragraph (h), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (h), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (h), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (h), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (6)new text begin ,
for in-person services or subdivision 5, paragraph (h), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills trainingdeleted text begin , individualized home supports with training,deleted text end and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed twonew text begin . For individualized home supports
with training, provided in a shared manner, including for a day unit of individualized home
supports with training provided in a shared manner, divide the total payment amount in
clause (13) by the number of service recipients, not to exceed threenew text end ; and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
(a) Except for the amendment to clause (14), this section is
effective January 1, 2022, six months after the end of the federal public health emergency,
or upon federal approval, whichever is later. The commissioner of human services shall
notify the revisor of statutes when the federal public health emergency ends and when
federal approval is obtained.
new text end
new text begin
(b) The amendment to clause (14) is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256B.4914, subdivision 9, is amended to read:
Subd. 9.
Payments for unit-based services without programming.
Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plannew text begin provided in person or remotelynew text end must be calculated as
follows unless the services are authorized separately under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (2), new text begin for in-person services or
subdivision 5, paragraph (j), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (j), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (j), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (j), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (j), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for respite services, determine the number of day units of service to meet an
individual's needs;
(15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (1);
(17) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (16);
(18) multiply the number of direct staff hours by the appropriate staff wage;
(19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin
(k)new text end , clause (3). This is defined as the direct staffing rate;
(21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (4);
(22) this is the subtotal rate;
(23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;
(25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
(26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
(27) adjust the result of clauses (13), (25), and (26) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256B.5012, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin ICF/DD rate increases effective July 1, 2021. new text end
new text begin
(a) For the rate period beginning
July 1, 2021, the commissioner must increase operating payments for each facility reimbursed
under this section equal to five percent of the operating payment rates in effect on June 30,
2021.
new text end
new text begin
(b) For each facility, the commissioner must apply the rate increase based on occupied
beds, using the percentage specified in this subdivision multiplied by the total payment rate,
including the variable rate but excluding the property-related payment rate in effect on June
30, 2021. The total rate increase must include the adjustment provided in section 256B.501,
subdivision 12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256B.5013, subdivision 1, is amended to read:
Subdivision 1.
Variable rate adjustments.
(a) deleted text begin For rate years beginning on or after
October 1, 2000,deleted text end When there is a documented increase in the needs of a current ICF/DD
recipient, the county of financial responsibility may recommend a variable rate to enable
the facility to meet the individual's increased needs. Variable rate adjustments made under
this subdivision replace payments for persons with special needs for crisis intervention
services under section 256B.501, subdivision 8a. deleted text begin Effective July 1, 2003, facilities with a
base rate above the 50th percentile of the statewide average reimbursement rate for a Class
A facility or Class B facility, whichever matches the facility licensure, are not eligible for
a variable rate adjustment. Variable rate adjustments may not exceed a 12-month period,
except when approved for purposes established in paragraph (b), clause (1).deleted text end new text begin Once approved,
variable rate adjustments must continue to remain in place unless there is an identified
change in need. A review of needed resources must be done at the time of the individual's
annual support plan meeting. Any change in need identified must result in submission of a
request to adjust the resources for the individual.new text end Variable rate adjustments approved solely
on the basis of changes on a developmental disabilities screening document will end June
30, 2002.
new text begin
(b) The county of financial responsibility must act on a variable rate request within 30
days and notify the initiator of the request of the county's recommendation in writing.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end A variable rate may be recommended by the county of financial responsibility
for increased needs in the following situations:
(1) a need for resources due to an individual's full or partial retirement from participation
in a day training and habilitation service when the individual: (i) has reached the age of 65
or has a change in health condition that makes it difficult for the person to participate in
day training and habilitation services over an extended period of time because it is medically
contraindicated; and (ii) has expressed a desire for change through the developmental
disability screening process under section 256B.092;
(2) a need for additional resources for intensive short-term programming deleted text begin whichdeleted text end new text begin thatnew text end is
necessary prior to an individual's discharge to a less restrictive, more integrated setting;
(3) a demonstrated medical need that significantly impacts the type or amount of services
needed by the individual; deleted text begin or
deleted text end
(4) a demonstrated behavioralnew text begin or cognitivenew text end need that significantly impacts the type or
amount of services needed by the individualdeleted text begin .deleted text end new text begin ; or
new text end
deleted text begin
(c) The county of financial responsibility must justify the purpose, the projected length
of time, and the additional funding needed for the facility to meet the needs of the individual.
deleted text end
deleted text begin
(d) The facility shall provide an annual report to the county case manager on the use of
the variable rate funds and the status of the individual on whose behalf the funds were
approved. The county case manager will forward the facility's report with a recommendation
to the commissioner to approve or disapprove a continuation of the variable rate.
deleted text end
deleted text begin
(e) Funds made available through the variable rate process that are not used by the facility
to meet the needs of the individual for whom they were approved shall be returned to the
state.
deleted text end
new text begin
(5) a demonstrated increased need for staff assistance, changes in the type of staff
credentials needed, or a need for expert consultation based on assessments conducted prior
to the annual support plan meeting.
new text end
new text begin
(d) Variable rate requests must include the following information:
new text end
new text begin
(1) the service needs change;
new text end
new text begin
(2) the variable rate requested and the difference from the current rate;
new text end
new text begin
(3) a basis for the underlying costs used for the variable rate and any accompanying
documentation; and
new text end
new text begin
(4) documentation of the expected outcomes to be achieved and the frequency of progress
monitoring associated with the rate increase.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 43.
Minnesota Statutes 2020, section 256B.5013, subdivision 6, is amended to read:
Subd. 6.
Commissioner's responsibilities.
The commissioner shall:
(1) make a determination to approve, deny, or modify a request for a variable rate
adjustment within 30 days of the receipt of the completed application;
(2) notify the ICF/DD facility and county case manager of the deleted text begin duration and conditions
of variable rate adjustment approvalsdeleted text end new text begin determinationnew text end ; and
(3) modify MMIS II service agreements to reimburse ICF/DD facilities for approved
variable rates.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256B.5015, subdivision 2, is amended to read:
Subd. 2.
Services during the day.
new text begin (a) new text end Services during the day, as defined in section
256B.501, but excluding day training and habilitation services, shall be paid as a pass-through
payment deleted text begin no later than January 1, 2004deleted text end . The commissioner shall establish rates for these
services, other than day training and habilitation services, at deleted text begin levels that do not exceed 75deleted text end new text begin
100new text end percent of a recipient's day training and habilitation service costs prior to the service
change.
new text begin
(b) An individual qualifies for services during the day under paragraph (a) if, through
consultation with the individual and the individual's support team or interdisciplinary team:
new text end
new text begin
(1) it has been determined that the individual's needs can best be met through partial or
full retirement from:
new text end
new text begin
(i) participation in a day training and habilitation service; or
new text end
new text begin
(ii) the use of services during the day in the individual's home environment; and
new text end
new text begin
(2) an individualized plan has been developed with designated outcomes that:
new text end
new text begin
(i) address the support needs and desires contained in the person-centered plan or
individual support plan; and
new text end
new text begin
(ii) include goals that focus on community integration as appropriate for the individual.
new text end
new text begin (c) new text end When establishing a rate for these services, the commissioner shall also consider an
individual recipient's needs as identified in the deleted text begin individualized servicedeleted text end new text begin individual supportnew text end
plan and the person's need for active treatment as defined under federal regulations. The
pass-through payments for services during the day shall be paid separately by the
commissioner and shall not be included in the computation of the ICF/DD facility total
payment rate.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 45.
Minnesota Statutes 2020, section 256B.85, subdivision 7a, is amended to read:
Subd. 7a.
Enhanced rate.
An enhanced rate of 107.5 percent of the rate paid for CFSS
must be paid for services provided to persons who qualify for deleted text begin 12deleted text end new text begin tennew text end or more hours of CFSS
per day when provided by a support worker who meets the requirements of subdivision 16,
paragraph (e). The enhanced rate for CFSS includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54 that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of CFSS
per day.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256B.85, subdivision 16, is amended to read:
Subd. 16.
Support workers requirements.
(a) Support workers shall:
(1) enroll with the department as a support worker after a background study under chapter
245C has been completed and the support worker has received a notice from the
commissioner that the support worker:
(i) is not disqualified under section 245C.14; or
(ii) is disqualified, but has received a set-aside of the disqualification under section
245C.22;
(2) have the ability to effectively communicate with the participant or the participant's
representative;
(3) have the skills and ability to provide the services and supports according to the
participant's CFSS service delivery plan and respond appropriately to the participant's needs;
(4) complete the basic standardized CFSS training as determined by the commissioner
before completing enrollment. The training must be available in languages other than English
and to those who need accommodations due to disabilities. CFSS support worker training
must include successful completion of the following training components: basic first aid,
vulnerable adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance to
participants;
(5) complete employer-directed training and orientation on the participant's individual
needs;
(6) maintain the privacy and confidentiality of the participant; and
(7) not independently determine the medication dose or time for medications for the
participant.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) does not meet the requirements in paragraph (a);
(2) fails to provide the authorized services required by the employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to the
participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or by the
United States Department of Health and Human Services, Office of Inspector General, from
participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the decision
to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than 310 hours of CFSS per
month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.
(e) CFSS qualify for an enhanced rate if the support worker providing the services:
(1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for deleted text begin 12deleted text end new text begin tennew text end or more hours per day of CFSS; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 47.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin
Personal care assistance and community first services and supports
provider agency; required reporting and analysis of cost data.
new text end
new text begin
(a) The commissioner
must evaluate on an ongoing basis whether the rates paid for personal care assistance and
community first services and supports appropriately address the costs to provide these
services. The commissioner must make recommendations to adjust the rates paid as indicated
by the evaluation. As determined by the commissioner, in consultation with stakeholders,
agencies enrolled to provide personal care assistance and community first services and
supports with rates determined under this section must submit requested cost data to the
commissioner. Requested cost data may include but is not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) vacancy rates; and
new text end
new text begin
(11) other data relating to costs necessary to provide services requested by the
commissioner.
new text end
new text begin
(b) At least once in any three-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall give each provider notice 90 days prior to the submission due date. If a provider fails
to submit the required reporting data, the commissioner shall provide notice to the provider
30 days after the required submission date, and a second notice to a provider who fails to
submit the required data 60 days after the required submission date. The commissioner shall
temporarily suspend payments to a provider if the provider fails to submit cost data within
90 days after the required submission date. The commissioner shall make withheld payments
to the provider once the commissioner receives cost data from the provider.
new text end
new text begin
(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy.
new text end
new text begin
(d) The commissioner, in consultation with stakeholders, shall develop and implement
a process for providing training and technical assistance necessary to support provider
submission of cost documentation required under paragraph (a). The commissioner shall
provide dedicated support for providers who meet one of the following criteria:
new text end
new text begin
(1) the provider employs fewer than ten staff to provide the services under this section;
new text end
new text begin
(2) the provider's first language is not English; or
new text end
new text begin
(3) the provider serves a population that includes greater than or equal to 50 percent
black people, Indigenous people, or people of color.
new text end
Sec. 48.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin Payment rates evaluation. new text end
new text begin
(a) The commissioner shall assess data collected
under subdivision 27 and shall publish evaluation findings in a report to the legislature on
August 1, 2024, and once every two years thereafter. Evaluation findings shall include:
new text end
new text begin
(1) the costs that providers incur while providing services under this section;
new text end
new text begin
(2) comparisons between those costs and the costs incurred by providers of comparable
services and employers in industries competing in the same labor market;
new text end
new text begin
(3) changes in wages, benefits provided, hours worked, and retention over time; and
new text end
new text begin
(4) recommendations for the rate methodologies paid based on the evaluation findings.
new text end
new text begin
(b) The commissioner shall only release cost data in an aggregate form and shall not
release cost data from individual providers except as permitted by current law.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 49.
Minnesota Statutes 2020, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to 226 supportive housing
units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a mental
illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
who is living on the street or in a shelter or discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, have
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
a federal or state housing subsidy, the housing support rate for that person is limited to the
supplementary rate under section 256I.05, subdivision 1a, and is determined by subtracting
the amount of the person's countable income that exceeds the MSA equivalent rate from
the housing support supplementary service rate. A resident in a demonstration project site
who no longer participates in the demonstration program shall retain eligibility for a housing
support payment in an amount determined under section 256I.06, subdivision 8, using the
MSA equivalent rate. Service funding under section 256I.05, subdivision 1a, will end June
30, 1997, if federal matching funds are available and the services can be provided through
a managed care entity. If federal matching funds are not available, then service funding will
continue under section 256I.05, subdivision 1a;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a housing support contract with the county and has been licensed as a board and lodge
facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a housing support provider that currently operates a 304-bed facility
in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; deleted text begin and
deleted text end
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed chemical dependency treatment
programdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(9) for an additional 42 beds, resulting in a total of 54 beds, for a recovery community
organization and housing support provider that currently operates a 38-bed facility in Olmsted
County serving individuals diagnosed with substance use disorder, originally licensed and
registered by the Department of Health under section 157.17 in 2019, and will operate a
new 14-bed facility in Olmsted County serving individuals diagnosed with substance use
disorder; and
new text end
new text begin
(10) for 46 beds for a recovery community organization and housing support provider
that as of March 1, 2021, operates three facilities in Blue Earth County licensed and registered
by the Department of Health under section 157.17, serving individuals diagnosed with
substance use disorder.
new text end
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 50.
Minnesota Statutes 2020, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the deleted text begin countydeleted text end agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient under a home and community-based waiver
under title XIX of the new text begin federal new text end Social Security Act; or funding from the medical assistance
program under section 256B.0659, for personal care services for residents in the setting; or
residing in a setting which receives funding under section 245.73. If funding is available
for other necessary services through a home and community-based waiver, or personal care
services under section 256B.0659, then the housing support rate is limited to the rate set in
subdivision 1. Unless otherwise provided in law, in no case may the supplementary service
rate exceed $426.37. The registration and licensure requirement does not apply to
establishments which are exempt from state licensure because they are located on Indian
reservations and for which the tribe has prescribed health and safety requirements. Service
payments under this section may be prohibited under rules to prevent the supplanting of
federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
the approval of the Secretary of Health and Human Services to provide home and
community-based waiver services under title XIX of the new text begin federal new text end Social Security Act for
residents who are not eligible for an existing home and community-based waiver due to a
primary diagnosis of mental illness or chemical dependency and shall apply for a waiver if
it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the deleted text begin county or countiesdeleted text end new text begin agencynew text end in which the affected beds
are located. The commissioner may also make cost-neutral transfers from the housing support
fund to deleted text begin county human servicedeleted text end agencies for beds permanently removed from the housing
support census under a plan submitted by the deleted text begin countydeleted text end agency and approved by the
commissioner. The commissioner shall report the amount of any transfers under this provision
annually to the legislature.
(c) deleted text begin Countiesdeleted text end new text begin Agenciesnew text end must not negotiate supplementary service rates with providers of
housing support that are licensed as board and lodging with special services and that do not
encourage a policy of sobriety on their premises and make referrals to available community
services for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51.
Minnesota Statutes 2020, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).
(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.
(c) new text begin An agency must increase new text end the room and board rates deleted text begin will be increaseddeleted text end each year when
the MSA equivalent rate is adjusted for SSI cost-of-living increases by the amount of the
annual SSI increase, less the amount of the increase in the medical assistance personal needs
allowance under section 256B.35.
(d) deleted text begin When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences are reported in advance
to the county agency's social service staff. Advance reporting is not required for emergency
absences due to crisis, illness, or injury.
deleted text end
deleted text begin (e) Fordeleted text end new text begin An agency may increase the rates for residents innew text end facilities meeting substantial
change criteria within the prior year. Substantial change criteria deleted text begin existsdeleted text end new text begin existnew text end if the
establishment experiences a 25 percent increase or decrease in the total number of its beds,
if the net cost of capital additions or improvements is in excess of 15 percent of the current
market value of the residence, or if the residence physically moves, or changes its licensure,
and incurs a resulting increase in operation and property costs.
deleted text begin (f)deleted text end new text begin (e)new text end Until June 30, 1994, an agency may increase by up to five percent the total rate
paid for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54
who reside in residences that are licensed by the commissioner of health as a boarding care
home, but are not certified for the purposes of the medical assistance program. However,
an increase under this clause must not exceed an amount equivalent to 65 percent of the
1991 medical assistance reimbursement rate for nursing home resident class A, in the
geographic grouping in which the facility is located, as established under Minnesota Rules,
parts 9549.0051 to 9549.0058.
new text begin
(f) Notwithstanding the provisions of subdivision 1, an agency may increase the monthly
room and board rates by $100 per month for residents in settings under section 256I.04,
subdivision 2a, paragraph (b), clause (2). Participants in the Minnesota supportive housing
demonstration program under section 256I.04, subdivision 3, paragraph (a), clause (3), may
not receive the increase under this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, except the striking of
paragraph (d) is effective July 1, 2021.
new text end
Sec. 52.
Minnesota Statutes 2020, section 256I.05, subdivision 1q, is amended to read:
Subd. 1q.
Supplemental rate; Olmsted County.
new text begin (a) new text end Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider located in Olmsted County that operates long-term residential facilities with a total
of 104 beds that serve chemically dependent men and women and provide 24-hour-a-day
supervision and other support services.
new text begin
(b) Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2021,
a county agency shall negotiate a supplemental service rate for 54 total beds in addition to
the rate specified in subdivision 1, not to exceed the maximum rate allowed under subdivision
1a, including any legislatively authorized inflationary adjustments, for a recovery community
organization and housing support provider located in Olmsted County serving individuals
diagnosed with substance use disorder, originally licensed and registered by the Department
of Health under section 157.17 in 2019.
new text end
Sec. 53.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1s. new text end
new text begin Supplemental rate; Douglas County. new text end
new text begin
Notwithstanding subdivisions 1a and
1c, beginning July 1, 2021, a county agency shall negotiate a supplemental rate for up to
20 beds in addition to the rate specified in subdivision 1, not to exceed the maximum rate
allowed under subdivision 1a, including any legislatively authorized inflationary adjustments,
for a housing support provider located in Douglas County that operates two facilities and
provides room and board and supplementary services to adult males recovering from
substance use disorder, mental illness, or housing instability.
new text end
Sec. 54.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1t. new text end
new text begin Supplementary services rate; Winona County. new text end
new text begin
Notwithstanding the
provisions of subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate
a supplementary services rate in addition to the monthly room and board rate specified in
subdivision 1, not to exceed $750 per month, including any legislatively authorized
inflationary adjustments, for a housing support provider located in Winona County that
operates a permanent supportive housing facility with 20 one-bedroom apartments for adults
with long-term homeless and long-term mental health needs.
new text end
Sec. 55.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1u. new text end
new text begin Supplemental rate; Blue Earth County. new text end
new text begin
Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate a
supplemental service rate for 46 beds in addition to the rate specified in subdivision 1, not
to exceed the maximum rate allowed under subdivision 1a, including any legislatively
authorized inflationary adjustments, for a recovery community organization and housing
support provider that as of March 1, 2021, operates three facilities in Blue Earth County
licensed and registered by the Department of Health under section 157.17, serving individuals
diagnosed with substance use disorder.
new text end
Sec. 56.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1v. new text end
new text begin Supplementary services rate; Steele County. new text end
new text begin
Notwithstanding the provisions
of subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate a
supplementary services rate in addition to the monthly room and board rate specified in
subdivision 1, not to exceed $750 per month, including any legislatively authorized
inflationary adjustments, for a housing support provider located in Steele County that
operates a permanent supportive housing facility with 16 units for adults with long-term
homeless and long-term mental health needs.
new text end
Sec. 57.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Absent days. new text end
new text begin
(a) When a person receiving housing support is temporarily
absent and the absence is reported in advance to the agency's social service staff, the agency
must continue to pay on behalf of the person the applicable rate for housing support. Advance
reporting is not required for absences due to crisis, illness, or injury. The limit on payments
for absence days under this paragraph is 18 calendar days per incident, not to exceed 60
days in a calendar year.
new text end
new text begin
(b) An agency must continue to pay an additional 74 days per incident, not to exceed a
total of 92 days in a calendar year, for a person who is temporarily absent due to admission
at a residential behavioral health facility, inpatient hospital, or nursing facility.
new text end
new text begin
(c) If a person is temporarily absent due to admission at a residential behavioral health
facility, inpatient hospital, or nursing facility for a period of time exceeding the limits
described in paragraph (b), the agency may request in a format prescribed by the
commissioner an absence day limit exception to continue housing support payments until
the person is discharged.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 58.
Minnesota Statutes 2020, section 256I.05, subdivision 11, is amended to read:
Subd. 11.
Transfer of emergency shelter funds.
(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to deleted text begin county human service
agenciesdeleted text end new text begin the agencynew text end for emergency shelter beds removed from the housing support census
under a biennial plan submitted by the deleted text begin countydeleted text end new text begin agencynew text end and approved by the commissioner.
The plan must describe: (1) anticipated and actual outcomes for persons experiencing
homelessness in emergency shelters; (2) improved efficiencies in administration; (3)
requirements for individual eligibility; and (4) plans for quality assurance monitoring and
quality assurance outcomes. The commissioner shall review the deleted text begin countydeleted text end new text begin agencynew text end plan to
monitor implementation and outcomes at least biennially, and more frequently if the
commissioner deems necessary.
(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
deleted text begin countydeleted text end new text begin agencynew text end may return beds to the housing support fund with 180 days' notice, including
financial reconciliation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 59.
Minnesota Statutes 2020, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision deleted text begin 1cdeleted text end deleted text begin , paragraph (d)deleted text end new text begin
2anew text end .
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
(c) For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 60.
Minnesota Statutes 2020, section 256S.203, is amended to read:
256S.203 CUSTOMIZED LIVING SERVICES; MANAGED CARE RATES.
Subdivision 1.
Capitation payments.
The commissioner deleted text begin shalldeleted text end new text begin mustnew text end adjust the elderly
waiver capitation payment rates for managed care organizations paid to reflect the monthly
service rate limits for customized living services and 24-hour customized living services
established under section 256S.202new text begin and the rate adjustments for disproportionate share
facilities under section 256S.205new text end .
Subd. 2.
Reimbursement rates.
Medical assistance rates paid to customized living
providers by managed care organizations under this chapter deleted text begin shalldeleted text end new text begin mustnew text end not exceed the
monthly service rate limits and component rates as determined by the commissioner under
sections 256S.15 and 256S.20 to 256S.202new text begin , plus any rate adjustment under section 256S.205new text end .
Sec. 61.
new text begin
[256S.205] CUSTOMIZED LIVING SERVICES; DISPROPORTIONATE
SHARE RATE ADJUSTMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms in this
subdivision have the meanings given.
new text end
new text begin
(b) "Application year" means a year in which a facility submits an application for
designation as a disproportionate share facility.
new text end
new text begin
(c) "Assisted living facility" or "facility" means an assisted living facility licensed under
chapter 144G.
new text end
new text begin
(d) "Disproportionate share facility" means an assisted living facility designated by the
commissioner under subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Rate adjustment application. new text end
new text begin
An assisted living facility may apply to the
commissioner for designation as a disproportionate share facility. Applications must be
submitted annually between October 1 and October 31. The applying facility must apply
in a manner determined by the commissioner. The applying facility must document as a
percentage the census of elderly waiver participants residing in the facility on October 1 of
the application year.
new text end
new text begin Subd. 3. new text end
new text begin Rate adjustment eligibility criteria. new text end
new text begin
Only facilities with a census of at least
80 percent elderly waiver participants on October 1 of the application year are eligible for
designation as a disproportionate share facility.
new text end
new text begin Subd. 4. new text end
new text begin Designation as a disproportionate share facility. new text end
new text begin
By November 15 of each
application year, the commissioner must designate as a disproportionate share facility a
facility that complies with the application requirements of subdivision 2 and meets the
eligibility criteria of subdivision 3.
new text end
new text begin Subd. 5. new text end
new text begin Rate adjustment; rate floor. new text end
new text begin
(a) Notwithstanding the 24-hour customized
living monthly service rate limits under section 256S.202, subdivision 2, and the component
service rates established under section 256S.201, subdivision 4, the commissioner must
establish a rate floor equal to $119 per resident per day for 24-hour customized living
services provided in a designated disproportionate share facility for the purpose of ensuring
the minimal level of staffing required to meet the health and safety need of elderly waiver
participants.
new text end
new text begin
(b) The commissioner must adjust the rate floor at least annually in the manner described
under section 256S.18, subdivisions 5 and 6.
new text end
new text begin
(c) The commissioner shall not implement the rate floor under this section if the
customized living rates established under sections 256S.21 to 256S.215 will be implemented
at 100 percent on January 1 of the year following an application year.
new text end
new text begin Subd. 6. new text end
new text begin Budget cap disregard. new text end
new text begin
The value of the rate adjustment under this section
must not be included in an elderly waiver client's monthly case mix budget cap.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2021, or upon federal approval,
whichever is later, and applies to services provided on or after January 1, 2022, or on or
after the date upon which federal approval is obtained, whichever is later. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 62.
Laws 2019, First Special Session chapter 9, article 5, section 86, subdivision 1,
as amended by Laws 2020, First Special Session chapter 2, article 3, section 2, subdivision
1, is amended to read:
Subdivision 1.
Intent.
It is the intent of the legislature to reform the medical assistance
waiver programs for people with disabilities to simplify administration of the programs.
Disability waiver reconfiguration must incentivize inclusive, person-centered, individualized
supports and services; enhance each person's self-determination and personal authority over
the person's service choice; align benefits across waivers; ensure equity across programs
and populations; new text begin assess and address racial and geographical disparities and institutional bias
in services and programs; new text end promote long-term sustainability of waiver services; and maintain
service stability and continuity of care while prioritizing, promoting, and creating incentives
for independent, integrated, and individualized supports and services chosen by each person
through an informed decision-making process and person-centered planning.
Sec. 63. new text begin PARENTING WITH A DISABILITY; PILOT PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
The commissioner of human services shall establish a pilot
project to provide grants to personal care assistance provider agencies to provide assistance
with child rearing tasks to a parent who is eligible for personal care assistance services
under Minnesota Statutes, section 256B.0659, or for services and supports provided through
community first services and supports under Minnesota Statutes, section 256B.85. The
purpose of this pilot project is to study the benefits of supportive parenting while assisting
parents with a disability in child rearing tasks and preventing removal of a child from a
parent because the parent has a disability.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, in addition to the definitions
in Minnesota Statutes, section 256B.0659, subdivision 1, applying to the personal care
assistance program and the definitions in Minnesota Statutes, section 256B.85, subdivision
2, applying to community first services and supports, the following terms have the meanings
given them in this subdivision.
new text end
new text begin
(b) "Adaptive parenting equipment" means a piece of equipment that increases, extends,
or improves the parenting capabilities of a parent with a disability.
new text end
new text begin
(c) "Child" means a person under 12 years of age.
new text end
new text begin
(d) "Child rearing task" means a task that assists a parent with a disability to care for a
child. Child rearing task includes, but is not limited to: lifting and carrying a child, organizing
supplies for a child, preparing meals for a child, washing clothing and bedding for a child,
bathing a child, childproofing the home that the parent and child live in, and assisting with
transporting a child.
new text end
new text begin
(e) "Commissioner" means the commissioner of human services.
new text end
new text begin
(f) "Parent" means a child's biological, foster, or adoptive parent or legal guardian who
is legally obligated to care for and support the child.
new text end
new text begin
(g) "Person with a disability" means an individual who has a physical, mental, or
psychological impairment or dysfunction that limits independent functioning in a family,
community, or employment.
new text end
new text begin
(h) "Personal care assistant" or "PCA" also means support worker.
new text end
new text begin
(i) "Personal care assistance services" also means the services and supports provided by
community first services and supports.
new text end
new text begin
(j) "Supportive parenting assistant" or "SPA" means an individual providing supportive
parenting services who is also a personal care assistant.
new text end
new text begin
(k) "Supportive parenting service" means a state-funded service that (1) helps a parent
with a disability compensate for aspects of the parent's disability that affect the parent's
ability to care for the child, and (2) enables the parent to complete parental responsibilities,
including child rearing tasks. Supportive parenting service does not include disciplining the
parent's child.
new text end
new text begin Subd. 3. new text end
new text begin Grants. new text end
new text begin
(a) The commissioner shall develop a competitive application process
for up to three two-year state-funded grants to personal care assistance provider agencies
to provide supportive parenting services described in subdivision 4 and to purchase adaptive
parenting equipment described in subdivision 5. A grant applicant must be a personal care
assistance provider agency.
new text end
new text begin
(b) Grant applications must describe how the applicant would recruit families to
participate in the pilot project and how the applicant would select families to receive
supportive parenting services while giving preference to families in which both parents are
receiving personal care assistance services.
new text end
new text begin
(c) Grantees must agree to provide supportive parenting to each selected family for at
least one year.
new text end
new text begin Subd. 4. new text end
new text begin Supportive parenting services. new text end
new text begin
(a) If a parent is eligible for and receiving
personal care assistance services, the parent is eligible to receive supportive parenting
services funded by a grant under this section. A parent must use one supportive parenting
assistant at a time, regardless of the parent's number of children. Supportive parenting
services provided under this section are services for the parent and not the child.
new text end
new text begin
(b) An SPA providing supportive parenting services under this section must not perform
personal care assistance services while scheduled to provide supportive parenting services.
A PCA providing personal care assistance services must not perform supportive parenting
services while scheduled to provide personal care assistance services. A PCA providing
personal care assistance services and an SPA providing supportive parenting services may
be scheduled to support the parent at the same time. The same individual may provide
personal care assistance services and supportive parenting assistance to a parent as long as
the requirements of this paragraph are met. Supportive parenting services under this section
do not count toward a PCA's 310 hours per-month limit on providing personal care assistance
services under Minnesota Statutes, section 256B.0659, subdivision 11, paragraph (a), clause
(10).
new text end
new text begin
(c) Supportive parenting services under this section must not replace personal care
assistance services.
new text end
new text begin
(d) A parent's supportive parenting services shall be limited to 40 hours per month.
new text end
new text begin Subd. 5. new text end
new text begin Adaptive parenting equipment. new text end
new text begin
A grantee may purchase adaptive parenting
equipment at the request of a parent receiving supportive parenting services under subdivision
4. A grantee must not purchase adaptive parenting equipment covered by medical assistance.
A grantee must purchase the least costly item to meet the parent's need.
new text end
Sec. 64. new text begin DIRECTION TO THE COMMISSIONER; STUDY OF SUPPORTIVE
PARENTING SERVICES.
new text end
new text begin
The commissioner shall study the feasibility of providing supportive parenting services
to parents with disabilities and disabling conditions as a covered medical assistance service
and submit a report to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services by February 15, 2023. The report must
contain at a minimum:
new text end
new text begin
(1) the total number of parents that were provided services through the pilot project;
new text end
new text begin
(2) the total cost of developing and providing the services provided under the pilot
project;
new text end
new text begin
(3) recommendations on expansion or continuation of the pilot project;
new text end
new text begin
(4) recommendations on seeking federal approval of supportive parenting services as a
covered service under medical assistance; and
new text end
new text begin
(5) draft legislative language.
new text end
Sec. 65. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; PLAN
FOR ADDRESSING EFFECTS ON COMMUNITY OF CERTAIN
STATE-OPERATED SERVICES.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders, shall develop
and submit to the chairs and ranking minority members of the house of representatives and
senate committees with jurisdiction over health and human services by January 31, 2022,
a plan to ameliorate the effects of repeated incidents, as defined in Minnesota Statutes,
section 245D.02, subdivision 11, occurring at Minnesota state-operated community services
programs that affect the community in which the program is located and the neighbors of
the service site of the program.
new text end
Sec. 66. new text begin DIRECTION TO THE COMMISSIONER; INITIAL PACE
IMPLEMENTATION FUNDING.
new text end
new text begin
The commissioner of human services must work with stakeholders to develop
recommendations for financing mechanisms to complete the actuarial work and cover the
administrative costs of a program of all-inclusive care for the elderly (PACE). The
commissioner must recommend a financing mechanism that could begin July 1, 2023. The
commissioner shall inform the chairs and ranking minority members of the legislative
committees with jurisdiction over health care funding by December 15, 2022, on the
commissioner's progress toward developing a recommended financing mechanism.
new text end
Sec. 67. new text begin DIRECTION TO COMMISSIONERS; CUSTOMIZED LIVING REPORT.
new text end
new text begin
(a) By January 15, 2022, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance. The report must include the commissioner's:
new text end
new text begin
(1) assessment of the prevalence of customized living services provided under Minnesota
Statutes, section 256B.49, supplanting the provision of residential services and supports
licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under
Minnesota Statutes, chapter 245A;
new text end
new text begin
(2) recommendations regarding the continuation of the moratorium on home and
community-based services customized living settings under Minnesota Statutes, section
256B.49, subdivision 28;
new text end
new text begin
(3) other policy recommendations to ensure that customized living services are being
provided in a manner consistent with the policy objectives of the foster care licensing
moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and
new text end
new text begin
(4) recommendations for needed statutory changes to implement the transition from
existing four-person or fewer customized living settings to corporate adult foster care or
community residential settings.
new text end
new text begin
(b) The commissioner of health shall provide the commissioner of human services with
the required data to complete the report in paragraph (a) and implement the moratorium on
home and community-based services customized living settings under Minnesota Statutes,
section 256B.49, subdivision 28. The data must include, at a minimum, each registered
housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as
a customized living setting to deliver customized living services as defined under the brain
injury or community access for disability inclusion waiver plans under Minnesota Statutes,
section 256B.49.
new text end
Sec. 68. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
DIRECT CARE SERVICES DURING SHORT-TERM ACUTE HOSPITAL VISITS.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders, shall develop
a new covered service under Minnesota Statutes, chapter 256B, or develop modifications
to existing covered services, that permits receipt of direct care services in an acute care
hospital in a manner consistent with the requirements of United States Code, title 42, section
1396a(h). By August 31, 2022, the commissioner must provide to the chairs and ranking
minority members of the house of representatives and senate committees and divisions with
jurisdiction over direct care services any draft legislation as may be necessary to implement
the new or modified covered service.
new text end
Sec. 69. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
DRIVING AS COVERED SERVICE UNDER COMMUNITY FIRST SERVICES
AND SUPPORTS.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders and within
existing appropriations, shall develop a new covered service under Minnesota Statutes,
section 256B.85, that permits a support worker to bill as community first services and
supports, not merely assisting a participant with traveling around and participating in the
community, or merely accompanying a participant while traveling around or participating
in the community, but driving the participant to activities in the community, including to
medical appointments. In developing the new covered services, the commissioner must
account for any substitution effect that will result from the new covered service supplanting
nonemergency medical transportation. By December 31, 2021, the commissioner must
provide to the chairs and ranking minority members of the house of representatives and
senate committees and divisions with jurisdiction over community first services and supports
any draft legislation as may be necessary to implement the new covered service.
new text end
Sec. 70. new text begin DIRECTION TO THE COMMISSIONER; LONG-TERM CARE
CONSULTATION SERVICE RATES.
new text end
new text begin
By January 15, 2025, the commissioner of human services shall develop a proposal with
legislative language for capitated rates for each type of assessment or activity provided
under Minnesota Statutes, section 256B.0911, as determined by the commissioner. The
commissioner shall provide the proposal and legislative language to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over human
services policy and finance by January 15, 2025.
new text end
Sec. 71. new text begin HOUSING SUPPORT SUPPLEMENTAL SERVICE RATE REDUCTION
DELAY.
new text end
new text begin
The rate reduction described in Minnesota Statutes, section 256B.051, subdivision 7,
does not apply until October 1, 2021, for individuals who receive supplemental services
from providers that made a good faith effort to become a Medicaid provider by submitting
an application by June 1, 2021.
new text end
Sec. 72. new text begin PERSONAL CARE ASSISTANCE COMPENSATION FOR SERVICES
PROVIDED BY A PARENT OR SPOUSE.
new text end
new text begin
(a) Notwithstanding Minnesota Statutes, section 256B.0659, subdivisions 3, paragraph
(a), clause (1); 11, paragraph (c); and 19, paragraph (b), clause (3), a parent, stepparent, or
legal guardian of a minor who is a personal care assistance recipient or a spouse of a personal
care assistance recipient may provide and be paid for providing personal care assistance
services.
new text end
new text begin
(b) This section expires upon full implementation and phase-in of the community first
services and supports program under Minnesota Statutes, section 256B.85.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, or
upon federal approval, whichever is later. The commissioner of human services shall notify
the revisor of statutes when federal approval is obtained.
new text end
Sec. 73. new text begin DIRECTIONS TO THE COMMISSIONER OF HUMAN SERVICES;
WAIVER GROWTH LIMITS.
new text end
new text begin Subdivision 1. new text end
new text begin
Community access for disability inclusion waiver growth
limit.
new text end
new text begin
Between July 1, 2021, and June 30, 2025, the commissioner shall allocate to county
and Tribal agencies money for home and community-based waiver programs under Minnesota
Statutes, section 256B.49, to ensure a reduction in forecasted state spending that is equivalent
to limiting the caseload growth of the community access for disability inclusion waiver to
zero allocations per year. Limits do not apply to conversions from nursing facilities. Counties
and Tribal agencies shall manage the annual allocations made by the commissioner to ensure
that persons for whom services are temporarily discontinued for no more than 90 days are
reenrolled. If a county or Tribal agency fails to meet the authorization and spending
requirements under Minnesota Statutes, section 256B.49, subdivision 27, the commissioner
may determine a corrective action plan is unnecessary if the failure to meet the requirements
is due to managing the annual allocation for the purposes of allowing people to reenroll
after their services are temporarily discontinued.
new text end
new text begin Subd. 2. new text end
new text begin Developmental disabilities waiver growth limit. new text end
new text begin
Between July 1, 2021, and
June 30, 2025, the commissioner shall allocate to county and Tribal agencies money for
home and community-based waiver programs under Minnesota Statutes, section 256B.092,
to ensure a reduction in forecasted state spending that is equivalent to limiting the caseload
growth of the developmental disabilities waiver to zero allocations per year. Limits do not
apply to conversions from intermediate care facilities for persons with developmental
disabilities. Counties and Tribal agencies shall manage the annual allocations made by the
commissioner to ensure that persons for whom services are temporarily discontinued for
no more than 90 days are reenrolled.
new text end
Sec. 74. new text begin RETAINER PAYMENTS FOR HOME AND COMMUNITY-BASED
SERVICE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Retainer payments. new text end
new text begin
(a) The commissioner of human services shall make
quarterly retainer payments to eligible recipients by July 1, 2021; September 30, 2021;
December 31, 2021; March 31, 2022; and June 30, 2022. The value of the first quarterly
payment to each eligible recipient shall be equal to a percentage to be determined by the
commissioner under subdivision 9 applied to the eligible recipient's total home and
community-based service revenue from medical assistance as of May 31, 2021. The value
of each subsequent quarterly payment shall be equal to a percentage to be determined by
the commissioner under subdivision 9 applied to the eligible recipient's total home and
community-based service revenue from medical assistance based on new data for service
claims paid as of the first day of the month in which the retainer payment will be made.
new text end
new text begin
(b) The commissioner shall implement retainer payments and the process of making
retainer payments under this subdivision without compliance with time-consuming procedures
and formalities prescribed in law, such as the following statutes and related policies:
Minnesota Statutes, sections 16A.15, subdivision 3; 16B.97; 16B.98, subdivisions 5 and 7;
and 16B.98, subdivision 8, the express audit clause requirement.
new text end
new text begin
(c) The commissioner's determination of the retainer amount determined under this
subdivision is final and is not subject to appeal. This paragraph does not apply to recoupment
by the commissioner under subdivision 8.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
For purposes of this section, the following terms have the meanings
given:
new text end
new text begin
(1) "direct care professional" means any individual who while providing an eligible
service has direct contact with the person receiving the eligible service. Direct care
professional excludes executive, managerial, and administrative staff;
new text end
new text begin
(2) "eligible recipient" means an enrolled provider of eligible services, including the
Direct Care and Treatment Division at the Department of Human Services, that meets the
attestation and agreement requirements in subdivisions 5 and 6;
new text end
new text begin
(3) "eligible service" means a home and community-based service as defined in section
9817(a)(2)(B) of the federal American Rescue Plan Act, Public Law 117-2, except:
new text end
new text begin
(i) community first services and supports;
new text end
new text begin
(ii) extended community first services and supports;
new text end
new text begin
(iii) personal care assistance services;
new text end
new text begin
(iv) extended personal care assistance service;
new text end
new text begin
(v) consumer-directed community supports;
new text end
new text begin
(vi) consumer support grants;
new text end
new text begin
(vii) home health agency services; and
new text end
new text begin
(viii) home care nursing services;
new text end
new text begin
(4) "recipient" means an enrolled provider of an eligible service that receives a retainer
payment under this section; and
new text end
new text begin
(5) "total home and community-based service revenue from medical assistance" includes
both fee-for-service revenue and revenue from managed care organizations attributable to
the provision of eligible services from April 1, 2021, to March 31, 2022. The commissioner
shall determine each eligible provider's total home and community-based service revenue
from medical assistance based on data for service claims paid as of the date specified in
subdivision 9.
new text end
new text begin Subd. 3. new text end
new text begin Allowable uses of funds. new text end
new text begin
(a) Recipients must use retainer payments to
implement one or more of the following activities to enhance, expand, or strengthen home
and community-based services:
new text end
new text begin
(1) temporarily increase wages, salaries, and benefits for direct care professionals and
any corresponding increase in the employer's share of FICA taxes, Medicare taxes, state
and federal unemployment taxes, and workers' compensation premiums;
new text end
new text begin
(2) provide hazard pay, overtime pay, and shift differential pay for direct care
professionals;
new text end
new text begin
(3) pay for paid sick leave, paid family leave, and paid medical leave due to COVID-19
for direct care professionals;
new text end
new text begin
(4) pay for training for direct care professionals that is specific to the COVID-19 public
health emergency;
new text end
new text begin
(5) recruit new direct care professionals;
new text end
new text begin
(6) pay for American sign language and other languages interpreters to assist in providing
eligible services or to inform the general public about COVID-19;
new text end
new text begin
(7) purchase emergency supplies and equipment to enhance access to eligible services
and to protect the health and well-being of direct care professionals;
new text end
new text begin
(8) support family care providers of eligible individuals with needed supplies and
equipment, which may include items not typically covered under the Medicaid program,
such as personal protective equipment and pay; and
new text end
new text begin
(9) pay for assistive technologies, staffing, and other costs incurred during the COVID-19
public health emergency period to mitigate isolation and ensure an individual's
person-centered service plan continues to be fully implemented.
new text end
new text begin
(b) Recipients must:
new text end
new text begin
(1) use at least 50 percent of the additional revenue received in the form of retainer
payments for the purposes described in paragraph (a), clauses (1) to (3); and
new text end
new text begin
(2) use any remainder of the additional revenue received in the form of retainer payments
for the purposes described in paragraph (a), clauses (4) to (9).
new text end
new text begin Subd. 4. new text end
new text begin Retainer payment requests. new text end
new text begin
Eligible recipients must request retainer payments
under this section no later than June 1, 2022. The commissioner shall develop an expedited
request process that includes a form allowing providers to meet the requirements of
subdivisions 5 and 6 in as timely a manner as possible. The commissioner shall allow the
use of electronic submission of request forms and accept electronic signatures.
new text end
new text begin Subd. 5. new text end
new text begin Attestation. new text end
new text begin
(a) As a condition of obtaining funds under this section, an eligible
recipient must attest to the following on the retainer payment request form:
new text end
new text begin
(1) the intent to provide eligible services through March 31, 2022; and
new text end
new text begin
(2) that the recipient will use the retainer payments only for purposes permitted under
this section.
new text end
new text begin
(b) By accepting a retainer payment under this section, the recipient attests to the
conditions specified in this subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Agreement. new text end
new text begin
(a) As a condition of receiving retainer payments under this section,
an eligible recipient must agree to the following on the retainer payment request form:
new text end
new text begin
(1) to cooperate with the commissioner of human services to deliver services according
to the program and service waivers and modifications issued under the commissioner's
authority;
new text end
new text begin
(2) to acknowledge that retention grants may be subject to a special recoupment under
this section if a state audit performed under this section determines that the provider used
retainer payments for purposes not authorized under this section; and
new text end
new text begin
(3) to acknowledge that a recipient must comply with the distribution requirements
described in subdivision 7.
new text end
new text begin
(b) By accepting a retainer payment under this section, the recipient agrees to the
conditions specified in this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Distribution plans. new text end
new text begin
(a) A recipient must prepare and, upon request, submit to
the commissioner, a distribution plan that specifies the anticipated amount and proposed
uses of the additional revenue the recipient will receive under this section.
new text end
new text begin
(b) Within 60 days of receipt of the recipient's first retainer payment, the recipient must
post the distribution plan and leave it posted for a period of at least six weeks in an area of
the recipient's operation to which all direct care professionals have access. The provider
must post with the distribution plan instructions on how to contact the commissioner of
human services if direct care professionals do not believe they have received the wage
increase or benefits required under subdivision 3 specified in the distribution plan. The
instructions must include a mailing address, e-mail address, and telephone number that the
direct care professional may use to contact the commissioner or the commissioner's
representative.
new text end
new text begin Subd. 8. new text end
new text begin Recoupment. new text end
new text begin
(a) The commissioner may perform an audit under this section
up to six years after any retainer payment is made to ensure the funds are utilized solely for
the purposes authorized under this section.
new text end
new text begin
(b) If the commissioner determines that a provider used retainer payments for purposes
not authorized under this section, the commissioner shall treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner shall recover any
overpayment.
new text end
new text begin Subd. 9. new text end
new text begin Calculation of retainer payments. new text end
new text begin
(a) The commissioner shall determine a
percentage to apply to each recipient's total home and community-based service revenue
from medical assistance to calculate the value of each quarterly retainer payment.
new text end
new text begin
(b) The commissioner shall make an estimate of the total projected expenditures for
eligible services between April 1, 2021, and March 31, 2022, determine a percentage to be
applied to the total projected home and community-based service revenue from medical
assistance for all providers of eligible services sufficient to expend the total appropriation
for retainer payments, and apply this percentage to each recipient's total home and
community-based service revenue from medical assistance on the following schedule:
new text end
new text begin
(1) no earlier than July 1, 2021, make a retainer payment by applying the percentage to
each recipient's total home and community-based service revenue from medical assistance
based on service claims paid as of May 31, 2021;
new text end
new text begin
(2) no later than September 30, 2021, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of September 1, 2021, that were not included in the
calculation of a prior retainer payment;
new text end
new text begin
(3) no later than December 31, 2021, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of December 1, 2021, that were not included in the
calculation of a prior retainer payment; and
new text end
new text begin
(4) no later than March 31, 2022, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of March 1, 2022, that were not included in the
calculation of a prior retainer payment.
new text end
new text begin
(c) The commissioner may redetermine the percentage to be applied to each recipient's
total home and community-based services revenue from medical assistance.
new text end
new text begin
(d) By June 30, 2022, the commissioner shall redetermine a percentage to be applied to
the total home and community-based service revenue from medical assistance based on
new service claims paid as of June 1, 2021, that were not included in the calculation of a
prior retainer payment. The redetermined percentage must be sufficient to expend the total
appropriation for retainer payments. No later than June 30, 2022, the commissioner shall
make a final retainer payment by applying the redetermined percentage to each recipient's
total home and community-based service revenue from medical assistance based on new
service claims paid as of June 1, 2021, that were not included in the calculation of a prior
retainer payment.
new text end
Sec. 75. new text begin DIRECTION TO THE COMMISSIONER; PERSONAL CARE
ASSISTANCE SERVICE RATE INCREASES.
new text end
new text begin
Effective July 1, 2021, The commissioner of human services shall increase the
reimbursement rates, individual budgets, grants, and allocations for community first services
and supports under Minnesota Statutes, section 256B.85; personal care assistance services
under Minnesota Statutes, section 256B.0659; extended personal care assistance service as
defined in Minnesota Statutes, section 256B.0605, subdivision 1, paragraph (g); and extended
community first services and supports as defined in Minnesota Statutes, section 256B.85,
subdivision 2, paragraph (l); and for budgets of individuals utilizing consumer-directed
community supports or participating in the consumer support grant program. The
commissioner shall determine the amount of the rate increase to ensure that the state share
of the increase does not exceed the amount appropriated in each fiscal year for this purpose
in this act.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 76. new text begin DIRECTION TO THE COMMISSIONER; HOME CARE SERVICE RATE
INCREASE.
new text end
new text begin
Effective July 1, 2021, The commissioner of human services shall increase service rates
for home health agency services under Minnesota Statutes, section 256B.0653, and for home
care nursing services under Minnesota Statutes, section 256B.0654. The commissioner shall
determine the amount of the rate increase to ensure that the state share of the increase does
not exceed the amount appropriated in this act in each fiscal year for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 77. new text begin DIRECTION TO THE COMMISSIONER; ELDERLY WAIVER RATE
INCREASE.
new text end
new text begin
The commissioner of human services shall modify the ratio of the blended rate described
under Minnesota Statutes, section 256S.2101, to increase statewide service rates and
component service rates. The commissioner shall also adjust service rate limits, monthly
service rate limits, and monthly case mix budget caps to accommodate the increased service
rates and component service rates established under this section. The commissioner shall
modify the blended rates to ensure that the state share of the service rate increase does not
exceed the amount appropriated in each fiscal year for this purpose in this act.
new text end
Sec. 78. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes, in consultation with the Office of Senate Counsel, Research
and Fiscal Analysis, the Office of the House Research Department, and the commissioner
of human services, shall prepare legislation for the 2022 legislative session to recodify
Minnesota Statutes, sections 256.975, subdivisions 7 to 7d, and 256B.0911.
new text end
new text begin
(b) The revisor of statutes, in consultation with the Office of Senate Counsel, Research
and Fiscal Analysis, the Office of the House Research Department, and the commissioner
of human services, shall to the greatest extent practicable renumber as subdivisions the
paragraphs of Minnesota Statutes, section 256B.4914, prior to the publication of the 2021
Supplement of Minnesota Statutes, and shall without changing the meaning or effect of
these provisions minimize the use of internal cross-references, including by drafting new
technical definitions as substitutes for necessary cross-references or by other means
acceptable to the commissioner of human services.
new text end
new text begin
(c) The revisor of statutes shall change the headnote for Minnesota Statutes, section
256B.097, to read "REGIONAL AND SYSTEMS IMPROVEMENT FOR MINNESOTANS
WHO HAVE DISABILITIES."
new text end
Sec. 79. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.4905, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, section 256B.097, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed.
new text end
new text begin
(c)
new text end
new text begin
Laws 2019, First Special Session chapter 9, article 5, section 90,
new text end
new text begin
is repealed.
new text end
ARTICLE 15
COMMUNITY SUPPORTS POLICY
Section 1.
Minnesota Statutes 2020, section 245.4874, subdivision 1, is amended to read:
Subdivision 1.
Duties of county board.
(a) The county board must:
(1) develop a system of affordable and locally available children's mental health services
according to sections 245.487 to 245.4889;
(2) consider the assessment of unmet needs in the county as reported by the local
children's mental health advisory council under section 245.4875, subdivision 5, paragraph
(b), clause (3). The county shall provide, upon request of the local children's mental health
advisory council, readily available data to assist in the determination of unmet needs;
(3) assure that parents and providers in the county receive information about how to
gain access to services provided according to sections 245.487 to 245.4889;
(4) coordinate the delivery of children's mental health services with services provided
by social services, education, corrections, health, and vocational agencies to improve the
availability of mental health services to children and the cost-effectiveness of their delivery;
(5) assure that mental health services delivered according to sections 245.487 to 245.4889
are delivered expeditiously and are appropriate to the child's diagnostic assessment and
individual treatment plan;
(6) provide for case management services to each child with severe emotional disturbance
according to sections 245.486; 245.4871, subdivisions 3 and 4; and 245.4881, subdivisions
1, 3, and 5;
(7) provide for screening of each child under section 245.4885 upon admission to a
residential treatment facility, acute care hospital inpatient treatment, or informal admission
to a regional treatment center;
(8) prudently administer grants and purchase-of-service contracts that the county board
determines are necessary to fulfill its responsibilities under sections 245.487 to 245.4889;
(9) assure that mental health professionals, mental health practitioners, and case managers
employed by or under contract to the county to provide mental health services are qualified
under section 245.4871;
(10) assure that children's mental health services are coordinated with adult mental health
services specified in sections 245.461 to 245.486 so that a continuum of mental health
services is available to serve persons with mental illness, regardless of the person's age;
(11) assure that culturally competent mental health consultants are used as necessary to
assist the county board in assessing and providing appropriate treatment for children of
cultural or racial minority heritage; and
(12) consistent with section 245.486, arrange for or provide a children's mental health
screening for:
(i) a child receiving child protective services;
(ii) a child in out-of-home placement;
(iii) a child for whom parental rights have been terminated;
(iv) a child found to be delinquent; or
(v) a child found to have committed a juvenile petty offense for the third or subsequent
time.
A children's mental health screening is not required when a screening or diagnostic
assessment has been performed within the previous 180 days, or the child is currently under
the care of a mental health professional.
(b) When a child is receiving protective services or is in out-of-home placement, the
court or county agency must notify a parent or guardian whose parental rights have not been
terminated of the potential mental health screening and the option to prevent the screening
by notifying the court or county agency in writing.
(c) When a child is found to be delinquent or a child is found to have committed a
juvenile petty offense for the third or subsequent time, the court or county agency must
obtain written informed consent from the parent or legal guardian before a screening is
conducted unless the court, notwithstanding the parent's failure to consent, determines that
the screening is in the child's best interest.
(d) The screening shall be conducted with a screening instrument approved by the
commissioner of human services according to criteria that are updated and issued annually
to ensure that approved screening instruments are valid and useful for child welfare and
juvenile justice populations. Screenings shall be conducted by a mental health practitioner
as defined in section 245.4871, subdivision 26, or a probation officer or local social services
agency staff person who is trained in the use of the screening instrument. Training in the
use of the instrument shall include:
(1) training in the administration of the instrument;
(2) the interpretation of its validity given the child's current circumstances;
(3) the state and federal data practices laws and confidentiality standards;
(4) the parental consent requirement; and
(5) providing respect for families and cultural values.
If the screen indicates a need for assessment, the child's family, or if the family lacks
mental health insurance, the local social services agency, in consultation with the child's
family, shall have conducted a diagnostic assessment, including a functional assessment.
The administration of the screening shall safeguard the privacy of children receiving the
screening and their families and shall comply with the Minnesota Government Data Practices
Act, chapter 13, and the federal Health Insurance Portability and Accountability Act of
1996, Public Law 104-191. Screening results deleted text begin shall be considered private datadeleted text end deleted text begin and the
commissioner shall not collect individual screening resultsdeleted text end new text begin are classified as private data on
individuals, as defined by section 13.02, subdivision 12. The county board or Tribal nation
may provide the commissioner with access to the screening results for the purposes of
program evaluation and improvementnew text end .
(e) When the county board refers clients to providers of children's therapeutic services
and supports under section 256B.0943, the county board must clearly identify the desired
services components not covered under section 256B.0943 and identify the reimbursement
source for those requested services, the method of payment, and the payment rate to the
provider.
Sec. 2.
Minnesota Statutes 2020, section 245.697, subdivision 1, is amended to read:
Subdivision 1.
Creation.
(a) A State Advisory Council on Mental Health is created. The
council must have members appointed by the governor in accordance with federal
requirements. In making the appointments, the governor shall consider appropriate
representation of communities of color. The council must be composed of:
(1) the assistant commissioner of deleted text begin mental health fordeleted text end the Department of Human Services
new text begin who oversees behavioral health policynew text end ;
(2) a representative of the Department of Human Services responsible for the medical
assistance program;
new text begin
(3) a representative of the Department of Health;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end one member of each of the following professions:
(i) psychiatry;
(ii) psychology;
(iii) social work;
(iv) nursing;
(v) marriage and family therapy; and
(vi) professional clinical counseling;
deleted text begin (4)deleted text end new text begin (5)new text end one representative from each of the following advocacy groups: Mental Health
Association of Minnesota, NAMI-MN, deleted text begin Mental Health Consumer/Survivor Network of
Minnesota, anddeleted text end Minnesota Disability Law Centernew text begin , American Indian Mental Health Advisory
Council, and a consumer-run mental health advocacy groupnew text end ;
deleted text begin (5)deleted text end new text begin (6)new text end providers of mental health services;
deleted text begin (6)deleted text end new text begin (7)new text end consumers of mental health services;
deleted text begin (7)deleted text end new text begin (8)new text end family members of persons with mental illnesses;
deleted text begin (8)deleted text end new text begin (9)new text end legislators;
deleted text begin (9)deleted text end new text begin (10)new text end social service agency directors;
deleted text begin (10)deleted text end new text begin (11)new text end county commissioners; and
deleted text begin (11)deleted text end new text begin (12)new text end other members reflecting a broad range of community interests, including
family physicians, or members as the United States Secretary of Health and Human Services
may prescribe by regulation or as may be selected by the governor.
(b) The council shall select a chair. Terms, compensation, and removal of members and
filling of vacancies are governed by section 15.059. Notwithstanding provisions of section
15.059, the council and its subcommittee on children's mental health do not expire. The
commissioner of human services shall provide staff support and supplies to the council.
Sec. 3.
Minnesota Statutes 2020, section 252.43, is amended to read:
252.43 COMMISSIONER'S DUTIES.
new text begin (a) new text end The commissioner shall supervise lead agencies' provision of day services to adults
with disabilities. The commissioner shall:
(1) determine the need for day deleted text begin servicesdeleted text end new text begin programsnew text end under deleted text begin sectiondeleted text end new text begin sectionsnew text end 256B.4914new text begin and
252.41 to 252.46new text end ;
(2) establish payment rates as provided under section 256B.4914;
(3) adopt rules for the administration and provision of day services under sections
245A.01 to 245A.16deleted text begin ,deleted text end new text begin ;new text end 252.28, subdivision 2deleted text begin ,deleted text end new text begin ;new text end or 252.41 to 252.46deleted text begin ,deleted text end new text begin ;new text end or Minnesota Rules,
parts 9525.1200 to 9525.1330;
(4) enter into interagency agreements necessary to ensure effective coordination and
provision of day services;
(5) monitor and evaluate the costs and effectiveness of day services; and
(6) provide information and technical help to lead agencies and vendors in their
administration and provision of day services.
new text begin
(b) A determination of need in paragraph (a), clause (1), shall not be required for a
change in day service provider name or ownership.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 252A.01, subdivision 1, is amended to read:
Subdivision 1.
Policy.
(a) It is the policy of the state of Minnesota to provide a
coordinated approach to the supervision, protection, and habilitation of its adult citizens
with a developmental disability. In furtherance of this policy, sections 252A.01 to 252A.21
are enacted to authorize the commissioner of human services to:
(1) supervise those adult citizens with a developmental disability who are unable to fully
provide for their own needs and for whom no qualified person is willing and able to seek
guardianship deleted text begin or conservatorshipdeleted text end under sections 524.5-101 to 524.5-502; and
(2) protect adults with a developmental disability from violation of their human and civil
rights by deleted text begin assuringdeleted text end new text begin ensuringnew text end that they receive the full range of needed social, financial,
residential, and habilitative services to which they are lawfully entitled.
(b) Public guardianship deleted text begin or conservatorshipdeleted text end is the most restrictive form of guardianship
deleted text begin or conservatorshipdeleted text end and should be imposed only when deleted text begin no other acceptable alternative is
availabledeleted text end new text begin less restrictive alternatives have been attempted and determined to be insufficient
to meet the person's needs. Less restrictive alternatives include but are not limited to
supported decision making, community or residential services, or appointment of a health
care agentnew text end .
Sec. 5.
Minnesota Statutes 2020, section 252A.02, subdivision 2, is amended to read:
Subd. 2.
Person with a developmental disability.
"Person with a developmental
disability" refers to any person age 18 or older whonew text begin :
new text end
new text begin (1)new text end has been diagnosed as having deleted text begin significantly subaverage intellectual functioning existing
concurrently with demonstrated deficits in adaptive behavior such as to require supervision
and protection for the person's welfare or the public welfare.deleted text end new text begin a developmental disability;
new text end
new text begin
(2) is impaired to the extent of lacking sufficient understanding or capacity to make
personal decisions; and
new text end
new text begin
(3) is unable to meet personal needs for medical care, nutrition, clothing, shelter, or
safety, even with appropriate technological and supported decision-making assistance.
new text end
Sec. 6.
Minnesota Statutes 2020, section 252A.02, subdivision 9, is amended to read:
Subd. 9.
deleted text begin Warddeleted text end new text begin Person subject to public guardianshipnew text end .
deleted text begin "Ward"deleted text end new text begin "Person subject to
public guardianship"new text end means a person with a developmental disability for whom the court
has appointed a public guardian.
Sec. 7.
Minnesota Statutes 2020, section 252A.02, subdivision 11, is amended to read:
Subd. 11.
Interested person.
"Interested person" means an interested responsible adult,
deleted text begin including, but not limited to, a public official, guardian, spouse, parent, adult sibling, legal
counsel, adult child, or next of kin of a person alleged to have a developmental disability.deleted text end new text begin
including but not limited to:
new text end
new text begin
(1) the person subject to guardianship, protected person, or respondent;
new text end
new text begin
(2) a nominated guardian or conservator;
new text end
new text begin
(3) a legal representative;
new text end
new text begin
(4) the spouse; parent, including stepparent; adult children, including adult stepchildren
of a living spouse; and siblings. If no such persons are living or can be located, the next of
kin of the person subject to public guardianship or the respondent is an interested person;
new text end
new text begin
(5) a representative of a state ombudsman's office or a federal protection and advocacy
program that has notified the commissioner or lead agency that it has a matter regarding
the protected person subject to guardianship, person subject to conservatorship, or respondent;
and
new text end
new text begin
(6) a health care agent or proxy appointed pursuant to a health care directive as defined
in section 145C.01, subdivision 5a; a living will under chapter 145B; or other similar
documentation executed in another state and enforceable under the laws of this state.
new text end
Sec. 8.
Minnesota Statutes 2020, section 252A.02, subdivision 12, is amended to read:
Subd. 12.
Comprehensive evaluation.
new text begin (a) new text end "Comprehensive evaluation" deleted text begin shall consistdeleted text end new text begin
consistsnew text end of:
(1) a medical report on the health status and physical condition of the proposed deleted text begin ward,deleted text end new text begin
person subject to public guardianshipnew text end prepared under the direction of a licensed physician
or advanced practice registered nurse;
(2) a report on the deleted text begin proposed ward'sdeleted text end intellectual capacity and functional abilitiesdeleted text begin , specifyingdeleted text end new text begin
of the proposed person subject to public guardianship that specifiesnew text end the tests and other data
used in reaching its conclusionsdeleted text begin ,deleted text end new text begin and isnew text end prepared by a psychologist who is qualified in the
diagnosis of developmental disability; and
(3) a report from the case manager that includes:
(i) the most current assessment of deleted text begin individual servicedeleted text end new text begin coordinated service and supportnew text end
needs as described in rules of the commissioner;
(ii) the most current individual service plan under section 256B.092, subdivision 1b;
and
(iii) a description of contacts with and responses of near relatives of the proposed deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end notifying deleted text begin themdeleted text end new text begin the near relativesnew text end that a nomination
for public guardianship has been made and advising deleted text begin themdeleted text end new text begin the near relativesnew text end that they may
seek private guardianship.
new text begin (b) new text end Each report new text begin under paragraph (a), clause (3), new text end shall contain recommendations as to the
amount of assistance and supervision required by the proposed deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end to function as independently as possible in society. To be considered part of
the comprehensive evaluation, new text begin the new text end reports must be completed no more than one year before
filing the petition under section 252A.05.
Sec. 9.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Protected person. new text end
new text begin
"Protected person" means a person for whom a guardian
or conservator has been appointed or other protective order has been sought. A protected
person may be a minor.
new text end
Sec. 10.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Respondent. new text end
new text begin
"Respondent" means an individual for whom the appointment
of a guardian or conservator or other protective order is sought.
new text end
Sec. 11.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Supported decision making. new text end
new text begin
"Supported decision making" means assistance
to understand the nature and consequences of personal and financial decisions from one or
more persons of the individual's choosing to enable the individual to make the personal and
financial decisions an