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Office of the Revisor of Statutes

HF 2184

as introduced - 91st Legislature (2019 - 2020) Posted on 03/27/2019 01:26pm

KEY: stricken = removed, old language.
underscored = added, new language.
Version List Authors and Status
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Bill Text Versions

Engrossments
Introduction Posted on 03/07/2019

Current Version - as introduced

Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 2.45 2.46 2.47 2.48 2.49 2.50 2.51 2.52 2.53 2.54 2.55 2.56 2.57 2.58 3.1 3.2 3.3 3.4 3.5 3.6
3.7 3.8
3.9 3.10 3.11 3.12 3.13
3.14
3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31
3.32
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 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 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
7.33
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 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 9.32 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 10.32 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 11.33 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 13.34 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 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 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 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
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 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
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
22.29 22.30 22.31 22.32 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
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
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 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 27.29 27.30 27.31 27.32 27.33 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 28.32 28.33 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 29.33 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 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 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 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 36.31 36.32 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 37.31 37.32
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 38.31 38.32 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
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 40.32 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 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 43.33 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 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
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 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 47.32 47.33 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
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 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 50.32 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 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 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 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 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 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 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 59.31 59.32 59.33 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 60.31 60.32 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 61.31 61.32 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 62.32 62.33 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 63.31 63.32 63.33 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 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 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 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 72.32 72.33 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 73.31 73.32 73.33 73.34 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 74.32 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 75.33 75.34 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 76.33 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 77.32 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 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 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
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 81.32 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
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 83.32 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 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30
85.1
85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 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 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 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 87.14 87.15 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
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 88.16 88.17 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 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 89.32 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 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
91.32
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 92.29 92.30
92.31
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 93.28 93.29 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 94.30 94.31 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
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 96.31 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 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 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 99.30 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16
100.17
100.18 100.19 100.20
100.21
100.22 100.23
100.24 100.25 100.26 100.27 100.28 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23
101.24
101.25 101.26 101.27 101.28
102.1 102.2
102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10
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
103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 104.33 104.34 104.35 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18
105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22
107.23
107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 108.33 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16
109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 110.35 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21
111.22
111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 113.35 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 114.34 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 115.34 115.35 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 117.33 117.34 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30
119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18
122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14
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
124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33
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
126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13
127.14
127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 129.35 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 130.34 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21
131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21
133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12
135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31
138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10
138.11
138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20
139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11
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
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
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
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
143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10
144.11 144.12
144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 145.1 145.2
145.3 145.4
145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31
146.32 146.33
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
147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17
150.18 150.19 150.20
150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28
150.29
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
153.24 153.25 153.26 153.27 154.1 154.2 154.3 154.4 154.5 154.6 154.7
154.8
154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32
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
155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10
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
157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31
158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16
159.17 159.18 159.19
159.20 159.21 159.22 159.23 159.24 159.25
159.26 159.27 159.28 159.29 159.30 159.31 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 162.1 162.2
162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17
163.18 163.19 163.20 163.21
163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17
170.18 170.19 170.20 170.21 170.22
170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20
173.21 173.22 173.23
173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24
175.25 175.26 175.27
175.28 175.29 175.30 175.31 175.32 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16
177.17 177.18 177.19 177.20 177.21
177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19
179.20 179.21 179.22
179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17
182.18
182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22
184.23 184.24 184.25
184.26 184.27 184.28 184.29 184.30 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13
185.14
185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 188.1 188.2 188.3
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
188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 189.1 189.2 189.3 189.4 189.5 189.6 189.7
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
190.1 190.2
190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15
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
192.26 192.27 192.28 192.29 192.30 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 195.34 195.35 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22
196.23
196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32
196.33
197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 197.34 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9
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
199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13
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
201.29
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
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
203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 204.1 204.2 204.3 204.4 204.5 204.6 204.7
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
204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 205.34 205.35 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8
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
206.28 206.29 206.30 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14
207.15
207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13
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
208.28 208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12
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
210.28 210.29 210.30 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11
211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 212.1 212.2
212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8
213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12
214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8
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
216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14
217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22
217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 220.1 220.2 220.3
220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 221.1 221.2 221.3 221.4 221.5
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
221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 222.1 222.2 222.3 222.4 222.5 222.6 222.7
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
222.28 222.29 222.30 222.31 222.32 222.33 222.34 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12
223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18
224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9
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
226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14
227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 227.33 227.34
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
228.27 228.28 228.29 228.30 228.31 228.32 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24
229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12
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
230.27 230.28 230.29 230.30 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 231.33 232.1 232.2
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
236.26 236.27 236.28 236.29 236.30 236.31 237.1 237.2 237.3 237.4 237.5 237.6
237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21
239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11
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
242.27 242.28 242.29 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26
248.27 248.28 248.29 248.30 248.31 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29
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
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
253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33
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
256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 258.34 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16
260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21
261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13
262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25
263.26 263.27 263.28 263.29 263.30 263.31 263.32 263.33 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 264.33 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14
265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 267.33 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18
269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 271.33 272.1 272.2 272.3 272.4 272.5 272.6 272.7
272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 273.33 273.34 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11
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
275.29 275.30 275.31 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20
277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 278.32 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28
279.29 279.30 279.31 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 280.33 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31
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
282.25 282.26 282.27 282.28 282.29 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28
283.29 283.30 283.31 283.32 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19
284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18
285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 285.33 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 286.33 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14
287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18
289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10
290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 291.34 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21
292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 293.1 293.2 293.3 293.4 293.5 293.6 293.7
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
293.28 293.29 293.30 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15
294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 295.1 295.2 295.3 295.4 295.5 295.6
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
296.27 296.28 296.29 296.30 296.31 296.32 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 297.33 298.1 298.2
298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9
300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21
300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25
302.26 302.27 302.28 302.29 302.30 302.31
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
305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33 306.1 306.2 306.3
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
307.27 307.28 307.29 307.30 307.31 307.32 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11
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
310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 310.34 311.1 311.2
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
311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10
316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8
317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 317.32 317.33 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 318.33 318.34 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 319.33 319.34 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 320.33 320.34 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10
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
321.26 321.27 321.28 321.29 321.30 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19
322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 323.1 323.2 323.3 323.4
323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 323.33 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14
324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 326.33 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17
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
329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16
330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 331.35 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24
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
335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28
336.29 336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6
337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8
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
339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 340.34 340.35 341.1 341.2 341.3 341.4 341.5 341.6
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
341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9
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
342.28 342.29 342.30 342.31 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16
343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30
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
346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9
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
348.28 348.29 348.30 348.31 348.32 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16
349.17 349.18 349.19 349.20 349.21
349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14
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
353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15
354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24
356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33 358.1 358.2 358.3 358.4 358.5
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
358.25 358.26 358.27 358.28 358.29 358.30 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2
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
361.26 361.27 361.28 361.29 361.30 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26
362.27
362.28 362.29 362.30 362.31 362.32 362.33 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9
363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 363.32 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15
364.16
364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 364.32 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16
365.17
365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26
365.27
365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 366.33 366.34 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29
367.30
367.31 367.32 367.33 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 368.33 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32 369.33 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 370.33 370.34 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13
371.14
371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 371.33 371.34 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17
372.18
372.19 372.20 372.21 372.22 372.23 372.24
372.25 372.26 372.27
372.28 372.29 372.30 372.31 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 373.33 373.34 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18
374.19
374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 375.34 376.1 376.2 376.3 376.4 376.5 376.6 376.7
376.8 376.9 376.10
376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 376.34 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 377.32 377.33 377.34 377.35 377.36 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 378.34 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 379.33 379.34 379.35 380.1 380.2 380.3 380.4 380.5 380.6 380.7
380.8 380.9 380.10 380.11
380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 380.32 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29
381.30
382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 383.33 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15
386.16
386.17 386.18 386.19 386.20 386.21 386.22
386.23
386.24 386.25 386.26 386.27 386.28 386.29 386.30 387.1 387.2 387.3 387.4 387.5
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
387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 388.1 388.2 388.3 388.4 388.5
388.6
388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31 388.32 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 390.33 390.34 390.35 391.1 391.2
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
391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 392.33 392.34 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 393.32 393.33 393.34 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 394.33 394.34 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18
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
396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 397.33 397.34 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 398.34 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 399.32 399.33 399.34 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 400.34 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14
401.15 401.16
401.17 401.18
401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 403.1 403.2
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
403.23 403.24 403.25 403.26 403.27 403.28 403.29 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 404.33 404.34 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11
405.12
405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22
405.23
405.24 405.25 405.26 405.27 405.28 405.29 405.30 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31
407.32 407.33 407.34 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16
409.17 409.18 409.19 409.20 409.21
409.22
409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 410.1 410.2
410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 411.32 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11
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
412.30 412.31 412.32 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8
413.9
413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 416.1 416.2 416.3 416.4 416.5
416.6 416.7
416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12
417.13
417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 418.1 418.2 418.3 418.4 418.5 418.6
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
419.1 419.2 419.3 419.4 419.5
419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16
420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23
421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 421.33 421.34
422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 422.33 422.34 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 423.33 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17
424.18 424.19 424.20 424.21
424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29
428.30 428.31 428.32 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30
429.31 429.32 429.33 429.34 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14
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
431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 432.1 432.2
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
434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12
435.13
435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10
436.11 436.12 436.13
436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14
440.15 440.16 440.17 440.18 440.19
440.20 440.21 440.22 440.23
440.24 440.25
440.26 440.27 440.28 440.29 440.30 440.31 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 442.1 442.2 442.3 442.4
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
442.22 442.23 442.24 442.25 442.26 442.27 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11
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
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
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
445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 446.1 446.2 446.3 446.4 446.5
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
447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30
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
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
451.25 451.26 451.27 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16
452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 453.1 453.2 453.3
453.4 453.5
453.6
453.7 453.8
453.9 453.10 453.11 453.12 453.13 453.14
453.15
453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 454.1 454.2 454.3 454.4
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
455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 455.32 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 457.32 458.1 458.2 458.3 458.4
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
458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21
459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 460.1 460.2 460.3 460.4 460.5 460.6 460.7
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
461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19
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
463.28 463.29 463.30 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13
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
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
466.27 466.28 466.29 466.30 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17
467.18
467.19 467.20
467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18
470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31
480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 482.33 482.34 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 483.32 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 484.31 484.32 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27
485.28
485.29 485.30 485.31 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27 487.28 487.29 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25
488.26 488.27 488.28 488.29 488.30 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 490.34 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27
491.28 491.29 491.30 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25
493.26 493.27 493.28 493.29 493.30 493.31 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15
497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23
499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 500.1 500.2 500.3 500.4 500.5 500.6 500.7
500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16
500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19 501.20 501.21
501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29 502.1 502.2 502.3 502.4
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
502.29 502.30 503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17
504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 506.1 506.2 506.3 506.4 506.5 506.6 506.7
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
506.26 506.27 506.28 506.29 506.30 506.31 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 508.1 508.2 508.3 508.4 508.5 508.6 508.7
508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 509.1 509.2 509.3 509.4 509.5 509.6 509.7
509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29 509.30 509.31 509.32 510.1 510.2 510.3 510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30
511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 511.31 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10
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
512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25
513.26
513.27 513.28
513.29 513.30 513.31 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31
515.1
515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11
515.12
515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21
516.22
516.23 516.24 516.25 516.26
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
517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28 518.29 518.30 518.31 519.1 519.2 519.3 519.4 519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30
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
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
521.28 521.29 521.30 522.1 522.2 522.3 522.4 522.5
522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13
522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 523.31 523.32 524.1 524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22
524.23 524.24
524.25 524.26 524.27 524.28 524.29 524.30 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 525.31 525.32 525.33 525.34 525.35 525.36 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 526.33 526.34 526.35 526.36 527.1 527.2 527.3 527.4 527.5 527.6 527.7
527.8
527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16
527.17 527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 529.1 529.2 529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 529.32 529.33
529.34
530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 530.33
531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8 531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 531.30 531.31 531.32
532.1 532.2 532.3 532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16 532.17 532.18 532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 532.31 532.32 532.33 533.1 533.2
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
533.23 533.24 533.25 533.26 533.27 533.28 533.29 533.30 534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 534.31 535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8 535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21
535.22 535.23
535.24 535.25
535.26 535.27 535.28 535.29 535.30 535.31 535.32 536.1 536.2 536.3 536.4
536.5 536.6 536.7 536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 536.32 536.33 537.1 537.2 537.3 537.4 537.5
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
537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31 538.32 538.33 538.34 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31 539.32 539.33 539.34 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 540.32 540.33 540.34 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 541.31 541.32 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 542.31 542.32 542.33 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 543.32 543.33 543.34 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30 544.31 544.32 544.33 544.34 544.35 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 545.34 545.35 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 546.32 546.33 546.34 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 547.33 547.34 547.35 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 548.33 548.34 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 549.31 549.32 549.33 549.34 549.35 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 550.31 550.32 550.33 550.34 550.35 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 551.30 551.31 551.32 551.33 551.34 551.35 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 552.32 552.33 552.34 552.35 553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 553.32 553.33 553.34 553.35 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 554.32 554.33 554.34 554.35 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24
555.25 555.26 555.27 555.28 555.29 555.30 555.31 555.32 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29 556.30 556.31 556.32 556.33 556.34 556.35 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 557.33 557.34 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 558.31 558.32 558.33 558.34 559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 559.31 559.32 559.33 559.34 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 560.31 560.32 560.33 560.34 560.35 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21 561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31
561.32 561.33 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 562.30 562.31 562.32 563.1 563.2 563.3 563.4 563.5 563.6 563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 563.32 563.33 563.34 563.35 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24 564.25 564.26 564.27 564.28 564.29
564.30 564.31 564.32 564.33 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31
565.32
566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8
566.9
566.10 566.11 566.13 566.12 566.14 566.15 566.17 566.16 566.18 566.19 566.20 566.21 566.22 566.23 566.24 566.25
566.26
566.27 566.28 566.29 566.30 566.32 566.31 566.33 566.34 567.1 567.2 567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27 567.28
567.29
567.30 567.31 567.32 568.1 568.3 568.2 568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27
568.28
568.29 568.30 568.31 568.32 569.1 569.3 569.2 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17 569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27 569.28 569.29 569.30 569.31 569.32 569.33 569.34 569.35 569.36 570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9 570.10 570.11 570.12 570.13
570.14
570.15 570.16 570.17 570.18
570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 570.31 570.32 570.33 571.1 571.2 571.3 571.4
571.5 571.6 571.7
571.8 571.9 571.10
571.11 571.12

A bill for an act
 relating to state government; establishing the health and human services budget;
modifying provisions governing children and family services, operations, direct
care and treatment, continuing care for older adults, disability services, chemical
and mental health, uniform service standards, health care, opioids, health-related
licensing boards, Department of Health programs, adult protection, and medical
cannabis; establishing OneCare Buy-In; establishing consumer protections for
residents of assisted living; requiring licensure of assisted living; establishing
dementia care services; making changes to home care licensing; requiring reports;
making technical changes; establishing controlled substance registration requirement
and registration fee; establishing councils; establishing OneCare Buy-In reserve
account; modifying penalties; providing for rulemaking; modifying and making
fees; making forecast adjustments; appropriating money; amending Minnesota
Statutes 2018, sections 13.69, subdivision 1; 15C.02; 16A.724, subdivision 2;
62A.152, subdivision 3; 62A.3094, subdivision 1; 62J.497, subdivision 1; 119B.011,
subdivisions 19, 20, by adding a subdivision; 119B.02, subdivision 7; 119B.025,
subdivision 1; 119B.03, subdivision 9; 119B.09, subdivisions 1, 7; 119B.095,
subdivision 2, by adding a subdivision; 119B.125, subdivision 6; 119B.13,
subdivisions 1, 6, 7; 119B.16, subdivisions 1, 1a, 1b, by adding subdivisions;
144.0724, subdivisions 4, 5, 8; 144.3831, subdivision 1; 144A.071, subdivisions
1a, 2, 3, 4a, 4c, 5a; 144A.073, subdivision 3c; 144A.43, subdivision 6; 144A.44,
subdivisions 1, 2; 144A.441; 144A.442; 144A.471, subdivisions 1, 5, 9; 144A.472,
subdivision 7; 144A.474, subdivisions 9, 11; 144A.475, subdivisions 3b, 5;
144A.476, subdivision 1; 144A.4791, subdivision 10; 144A.4799; 144D.01,
subdivision 4; 144D.015; 144D.04, subdivision 2; 147D.27, by adding a
subdivision; 147E.40, subdivision 1; 147F.17, subdivision 1; 148.59; 148.6445,
subdivisions 1, 2, 2a, 3, 4, 5, 6, 10; 148.7815, subdivision 1; 148B.5301, subdivision
2; 148E.0555, subdivision 6; 148E.120, subdivision 2; 148E.180; 148F.11,
subdivision 1; 150A.06, by adding subdivisions; 150A.091, by adding subdivisions;
151.01, by adding subdivisions; 151.065, subdivisions 1, 2, 3, 6, by adding a
subdivision; 151.252, subdivision 1; 151.47, by adding a subdivision; 152.01, by
adding a subdivision; 152.10; 152.11, subdivisions 1, 1a, 2, 2a, 2b, 2c; 152.12,
subdivisions 1, 2, 3, 4; 152.125, subdivisions 2, 3, 4; 152.22, subdivision 13;
152.25, subdivision 1c; 152.27, subdivisions 3, 4, 5, 6; 152.28, subdivision 1;
152.29, subdivision 3; 152.32, subdivision 2; 152.33, subdivisions 1, 2; 214.25,
subdivision 2; 237.50, subdivisions 4a, 6a, 10a, 11, by adding subdivisions; 237.51,
subdivisions 1, 5a; 237.52, subdivision 5; 237.53; 245.462, subdivisions 6, 8, 9,
14, 17, 18, 21, 23, by adding a subdivision; 245.4661, subdivision 9; 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, 32, 34; 245.4876, subdivisions 2, 3; 245.4879, subdivisions
1, 2; 245.488, subdivision 1; 245.4889, subdivision 1; 245.696, by adding a
subdivision; 245.735, subdivision 3; 245A.02, subdivisions 5a, 18; 245A.04, by
adding a subdivision; 245A.14, subdivisions 4, 8, by adding subdivisions;
245A.151; 245A.16, subdivision 1; 245A.40; 245A.41; 245A.50; 245A.51,
subdivision 3, by adding subdivisions; 245A.66, subdivisions 2, 3; 245C.02,
subdivision 6a, by adding subdivisions; 245C.03, subdivision 1, by adding a
subdivision; 245C.05, subdivisions 5, 5a; 245C.08, subdivisions 1, 3; 245C.10,
by adding a subdivision; 245C.24, by adding a subdivision; 245C.30, subdivisions
1, 2, 3; 245D.03, subdivision 1; 245D.071, subdivision 1; 245D.081, subdivision
3; 245E.06, subdivision 3; 245H.01, by adding subdivisions; 245H.03, by adding
a subdivision; 245H.07; 245H.10, subdivision 1; 245H.11; 245H.12; 245H.13,
subdivision 5, by adding subdivisions; 245H.14, subdivisions 1, 3, 4, 5, 6; 245H.15,
subdivision 1; 246B.10; 252.275, subdivision 3; 252.41, subdivisions 3, 4, 5, 6,
7, 9; 252.42; 252.43; 252.44; 252.45; 254A.03, subdivision 3; 254B.02, subdivision
1; 254B.03, subdivisions 2, 4; 254B.04, subdivision 1; 254B.05, subdivisions 1a,
5; 254B.06, subdivisions 1, 2; 256.01, subdivision 14b; 256.478; 256.9365; 256.962,
subdivision 5; 256.969, subdivision 9; 256B.04, subdivisions 21, 22; 256B.055,
subdivision 2; 256B.056, subdivision 3; 256B.0615, subdivision 1; 256B.0616,
subdivisions 1, 3; 256B.0622, subdivisions 1, 2, 3a, 4, 5a, 7, 7a, 7b, 7d; 256B.0623,
subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12; 256B.0624, subdivisions 2, 4, 5, 6,
8, 9, 10, 11; 256B.0625, subdivisions 3b, 5, 5l, 13, 13e, 13f, 17, 19c, 23, 24, 42,
45a, 48, 49, 56a, 57, 61, 62, 65, by adding subdivisions; 256B.064, subdivision
1a; 256B.0644; 256B.0659, subdivision 21; 256B.0915, subdivisions 3a, 3b;
256B.092, subdivision 13; 256B.0941, subdivision 1; 256B.0943, subdivisions 1,
2, 3, 4, 5, 6, 7, 8, 9, 11; 256B.0944, subdivisions 1, 3, 4, 5, 6, 7, 8, 9; 256B.0946,
subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947, subdivisions 1, 2, 3, 3a, 5, 6, 7a;
256B.0949, subdivision 2, by adding a subdivision; 256B.49, subdivision 24;
256B.4914, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 10a; 256B.69, subdivision 6d;
256B.76, subdivisions 2, 4; 256B.766; 256B.767; 256B.85, subdivision 3; 256I.04,
subdivisions 1, 2f; 256I.06, subdivision 8; 256L.03, by adding a subdivision;
256L.11, subdivision 7; 256R.02, subdivisions 8, 19; 256R.16, subdivision 1;
256R.21, by adding a subdivision; 256R.23, subdivision 5; 256R.24, subdivision
3; 256R.25; 256R.26; 256R.44; 256R.47; 256R.50, subdivision 6; 260C.007,
subdivision 18, by adding a subdivision; 260C.178, subdivision 1; 260C.201,
subdivisions 1, 2, 6; 260C.212, subdivision 2; 260C.452, subdivision 4; 260C.503,
subdivision 1; 518A.32, subdivision 3; Laws 2003, First Special Session chapter
14, article 13C, section 2, subdivision 6, as amended; Laws 2017, First Special
Session chapter 6, article 3, section 49; article 8, sections 71; 72; article 18, section
2, subdivisions 1, 3, 5, 15; proposing coding for new law in Minnesota Statutes,
chapters 119B; 144; 144A; 145; 148; 151; 245; 245A; 245D; 256; 256B; 256L;
256M; 256R; 260C; proposing coding for new law as Minnesota Statutes, chapters
144I; 245I; 256T; repealing Minnesota Statutes 2018, sections 119B.16, subdivision
2; 144A.071, subdivision 4d; 144A.472, subdivision 4; 144D.01, subdivisions 2a,
3a, 6; 144D.04, subdivision 2a; 144D.045; 144D.06; 144D.09; 144D.10; 144G.01;
144G.02; 144G.03; 144G.04; 144G.05; 144G.06; 214.17; 214.18; 214.19; 214.20;
214.21; 214.22; 214.23; 214.24; 245.462, subdivision 4a; 245E.06, subdivisions
2, 4, 5; 246.18, subdivisions 8, 9; 252.41, subdivision 8; 252.431; 252.451; 254B.03,
subdivision 4a; 256B.0615, subdivisions 2, 4, 5; 256B.0616, subdivisions 2, 4, 5;
256B.0659, subdivision 22; 256B.0705; 256B.0943, subdivision 10; 256B.0944,
subdivision 10; 256B.0946, subdivision 5; 256B.0947, subdivision 9; 256B.431,
subdivisions 3a, 3f, 3g, 3i, 13, 15, 17, 17a, 17c, 17d, 17e, 18, 21, 22, 30, 45;
256B.434, subdivisions 4, 4f, 4i, 4j; 256L.11, subdivision 6a; 256R.36; 256R.40;
256R.41; Laws 2010, First Special Session chapter 1, article 25, section 3,
subdivision 10; Minnesota Rules, parts 2960.3030, subpart 3; 3400.0185, subpart
5; 6400.6970; 7200.6100; 7200.6105; 9502.0425, subparts 4, 16, 17; 9503.0155,
subpart 8; 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; 9549.0057; 9549.0060,
subparts 4, 5, 6, 7, 10, 11, 14.

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

ARTICLE 1

CHILDREN AND FAMILIES SERVICES

Section 1.

Minnesota Statutes 2018, section 119B.011, is amended by adding a subdivision
to read:


new text begin Subd. 13b. new text end

new text begin Homeless. new text end

new text begin "Homeless" means a self-declared housing status as defined in
the McKinney-Vento Homeless Assistance Act and United States Code, title 42, section
11302, paragraph (a).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 119B.011, subdivision 19, is amended to read:


Subd. 19.

Provider.

"Provider" means:

(1) an individual or child care center or facilitydeleted text begin , either licensed or unlicensed, providing
legal child care services as defineddeleted text end new text begin licensed to provide child carenew text end under deleted text begin section 245A.03deleted text end new text begin
chapter 245A when operating within the terms of the licensenew text end ; deleted text begin or
deleted text end

(2)new text begin a license exempt center required to be certified under chapter 245H;
new text end

new text begin (3)new text end an individual or child care center or facility deleted text begin holdingdeleted text end new text begin that: (i) holds new text end a valid child care
license issued by another state or a tribe deleted text begin and providingdeleted text end new text begin ; (ii) providesnew text end child care services in
the licensing state or in the area under the licensing tribe's jurisdictionnew text begin ; and (iii) is in
compliance with federal health and safety requirements as certified by the licensing state
or tribe, or as determined by receipt of child care development block grant funds in the
licensing state; or
new text end

new text begin (4) a legal nonlicensed child care provider as defined under section 119B.011, subdivision
16, providing legal child care servicesnew text end . A deleted text begin legally unlicensed familydeleted text end new text begin legal nonlicensed new text end child
care provider must be at least 18 years of age, and not a member of the MFIP assistance
unit or a member of the family receiving child care assistance to be authorized under this
chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 119B.011, subdivision 20, is amended to read:


Subd. 20.

Transition year families.

"Transition year families" means families who have
received MFIP assistance, or who were eligible to receive MFIP assistance after choosing
to discontinue receipt of the cash portion of MFIP assistance under section 256J.31,
subdivision 12, or families who have received DWP assistance under section 256J.95 for
at least deleted text begin threedeleted text end new text begin onenew text end of the last six months before losing eligibility for MFIP or DWP.
Notwithstanding Minnesota Rules, parts 3400.0040, subpart 10, and 3400.0090, subpart 2,
transition year child care may be used to support employment, approved education or training
programs, or job search that meets the requirements of section 119B.10. Transition year
child care is not available to families who have been disqualified from MFIP or DWP due
to fraud.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 23, 2020.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 119B.02, subdivision 7, is amended to read:


Subd. 7.

Child care market rate survey.

deleted text begin Biennially,deleted text end The commissioner shall new text begin conduct
the next new text end survey new text begin of new text end prices charged by child care providers in Minnesota new text begin in state fiscal year
2021 and every three years thereafter new text end to determine the 75th percentile for like-care
arrangements in county price clusters.

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 2018, section 119B.025, subdivision 1, is amended to read:


Subdivision 1.

Applications.

(a) new text begin Except as provided in paragraph (c), clause (4), new text end the
county shall verify the following at all initial child care applications using the universal
application:

(1) identity of adults;

(2) presence of the minor child in the home, if questionable;

(3) relationship of minor child to the parent, stepparent, legal guardian, eligible relative
caretaker, or the spouses of any of the foregoing;

(4) age;

(5) immigration status, if related to eligibility;

(6) Social Security number, if given;

(7) counted income;

(8) spousal support and child support payments made to persons outside the household;

(9) residence; and

(10) inconsistent information, if related to eligibility.

(b) The county must mail a notice of approval or denial of assistance to the applicant
within 30 calendar days after receiving the application. The county may extend the response
time by 15 calendar days if the applicant is informed of the extension.

new text begin (c) For an applicant who declares that the applicant is homeless and who meets the
definition of homeless in section 119B.011, subdivision 13b, the county must:
 new text end

new text begin (1) if information is needed to determine eligibility, send a request for information to
the applicant within five working days after receiving the application;
 new text end

new text begin (2) if the applicant is eligible, send a notice of approval of assistance within five working
days after receiving the application;
 new text end

new text begin (3) if the applicant is ineligible, send a notice of denial of assistance within 30 days after
receiving the application. The county may extend the response time by 15 calendar days if
the applicant is informed of the extension;
 new text end

new text begin (4) not require verifications required by paragraph (a) before issuing the notice of approval
or denial; and
 new text end

new text begin (5) follow limits set by the commissioner for how frequently expedited application
processing may be used for an applicant under this paragraph.
 new text end

new text begin (d) An applicant who declares that the applicant is homeless must submit proof of
eligibility within three months of the date the application was received. If proof of eligibility
is not submitted within three months, eligibility ends. A 15-day adverse action notice is
required to end eligibility.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 119B.03, subdivision 9, is amended to read:


Subd. 9.

Portability pool.

(a) The commissioner shall establish a pool of up to five
percent of the annual appropriation for the basic sliding fee program to provide continuous
child care assistance for eligible families who move between Minnesota counties. At the
end of each allocation period, any unspent funds in the portability pool must be used for
assistance under the basic sliding fee program. If expenditures from the portability pool
exceed the amount of money available, the reallocation pool must be reduced to cover these
shortages.

(b) deleted text begin To be eligible for portable basic sliding fee assistance,deleted text end A family that has moved from
a county in which it was receiving basic sliding fee assistance to a county with a waiting
list for the basic sliding fee program must:

(1) meet the income and eligibility guidelines for the basic sliding fee program; and

(2) notify deleted text begin the new county of residence within 60 days of moving and submit information
to the new county of residence to verify eligibility for the basic sliding fee programdeleted text end new text begin the
family's previous county of residence of the family's move to a new county of residencenew text end .

(c) The receiving county must:

(1) accept administrative responsibility for applicants for portable basic sliding fee
assistance at the end of the two months of assistance under the Unitary Residency Act;

(2) continue new text begin portability pool new text end basic sliding fee assistance deleted text begin for the lesser of six months ordeleted text end
until the family is able to receive assistance under the county's regular basic sliding program;
and

(3) notify the commissioner through the quarterly reporting process of any family that
meets the criteria of the portable basic sliding fee assistance pool.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective December 2, 2019.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 119B.09, subdivision 1, is amended to read:


Subdivision 1.

General eligibility requirements.

(a) Child care services must be
available to families who need child care to find or keep employment or to obtain the training
or education necessary to find employment and who:

(1) have household income less than or equal to 67 percent of the state median income,
adjusted for family size, at application and redetermination, and meet the requirements of
section 119B.05; receive MFIP assistance; and are participating in employment and training
services under chapter 256J; or

(2) have household income less than or equal to 47 percent of the state median income,
adjusted for family size, at application and less than or equal to 67 percent of the state
median income, adjusted for family size, at redetermination.

(b) Child care services must be made available as in-kind services.

(c) All applicants for child care assistance and families currently receiving child care
assistance must be assisted and required to cooperate in establishment of paternity and
enforcement of child support obligations for all children in the family at application and
redetermination as a condition of program eligibility. For purposes of this section, a family
is considered to meet the requirement for cooperation when the family complies with the
requirements of section 256.741.

(d) All applicants for child care assistance and families currently receiving child care
assistance must pay the co-payment fee under section 119B.12, subdivision 2, as a condition
of eligibility. The co-payment fee may include additional recoupment fees due to a child
care assistance program overpayment.

new text begin (e) If a family has one child with a child care authorization and the child reaches 13
years of age or the child has a disability and reaches 15 years of age, the family remains
eligible until the redetermination.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 29, 2020.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 119B.09, subdivision 7, is amended to read:


Subd. 7.

Date of eligibility for assistance.

(a) The date of eligibility for child care
assistance under this chapter is the later of the date the application was received by the
county; the beginning date of employment, education, or training; the date the infant is born
for applicants to the at-home infant care program; or the date a determination has been made
that the applicant is a participant in employment and training services under Minnesota
Rules, part 3400.0080, or chapter 256J.

(b) Payment ceases for a family under the at-home infant child care program when a
family has used a total of 12 months of assistance as specified under section 119B.035.
Payment of child care assistance for employed persons on MFIP is effective the date of
employment or the date of MFIP eligibility, whichever is later. Payment of child care
assistance for MFIP or DWP participants in employment and training services is effective
the date of commencement of the services or the date of MFIP or DWP eligibility, whichever
is later. Payment of child care assistance for transition year child care must be made
retroactive to the date of eligibility for transition year child care.

(c) Notwithstanding paragraph (b), payment of child care assistance for participants
eligible under section 119B.05 may only be made retroactive for a maximum of deleted text begin sixdeleted text end new text begin threenew text end
months from the date of application for child care assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 119B.095, subdivision 2, is amended to read:


Subd. 2.

Maintain steady child care authorizations.

(a) Notwithstanding Minnesota
Rules, chapter 3400, the amount of child care authorized under section 119B.10 for
employment, education, or an MFIP or DWP employment plan shall continue at the same
number of hours or more hours until redetermination, including:

(1) when the other parent moves in and is employed or has an education plan under
section 119B.10, subdivision 3, or has an MFIP or DWP employment plan; or

(2) when the participant's work hours are reduced or a participant temporarily stops
working or attending an approved education program. Temporary changes include, but are
not limited to, a medical leave, seasonal employment fluctuations, or a school break between
semesters.

(b) The county may increase the amount of child care authorized at any time if the
participant verifies the need for increased hours for authorized activities.

(c) The county may reduce the amount of child care authorized if a parent requests a
reduction or because of a change in:

(1) the child's school schedule;

(2) the custody schedule; or

(3) the provider's availability.

(d) The amount of child care authorized for a family subject to subdivision 1, paragraph
(b), must change when the participant's activity schedule changes. Paragraph (a) does not
apply to a family subject to subdivision 1, paragraph (b).

new text begin (e) When a child reaches 13 years of age or a child with a disability reaches 15 years of
age, the amount of child care authorized shall continue at the same number of hours or more
hours until redetermination.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 29, 2020.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 119B.095, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Assistance for persons who are homeless. new text end

new text begin An applicant who is homeless and
eligible for child care assistance is exempt from the activity participation requirements under
this chapter for three months. The applicant under this subdivision is eligible for 60 hours
of child care assistance per service period for three months from the date the county receives
the application. Additional hours may be authorized as needed based on the applicant's
participation in employment, education, or MFIP or DWP employment plan. To continue
receiving child care assistance after the initial three months, the applicant must verify that
the applicant meets eligibility and activity requirements for child care assistance under this
chapter.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
 new text end

Sec. 11.

Minnesota Statutes 2018, section 119B.125, subdivision 6, is amended to read:


Subd. 6.

Record-keeping requirement.

new text begin (a) As a condition of payment, new text end all providers
receiving child care assistance payments mustnew text begin :
new text end

new text begin (1)new text end keep new text begin accurate and legible new text end daily attendance records at the site where services are
delivered for children receiving child care assistancenew text begin ;new text end and

deleted text begin mustdeleted text end new text begin (2) new text end make those records available immediately to the county or the commissioner
upon request. new text begin Any records not provided to a county or the commissioner at the date and
time of the request are deemed inadmissible if offered as evidence by the provider in any
proceeding to contest an overpayment or disqualification of the provider.
new text end

deleted text begin Thedeleted text end new text begin (b) As a condition of payment,new text end attendance records must be completed daily and
include the date, the first and last name of each child in attendance, and the times when
each child is dropped off and picked up. To the extent possible, the times that the child was
dropped off to and picked up from the child care provider must be entered by the person
dropping off or picking up the child. The daily attendance records must be retained at the
site where services are delivered for six years after the date of service.

new text begin (c)new text end A county or the commissioner may deny new text begin or revoke a provider's new text end authorization deleted text begin as a
child care provider to any applicant, rescind authorization of any provider,deleted text end new text begin to receive child
care assistance payments under section 119B.13, subdivision 6, paragraph (d), pursue a
fraud disqualification under section 256.98, take an action against the provider under chapter
245E,new text end or establish an new text begin attendance record new text end overpayment deleted text begin claim in the systemdeleted text end new text begin under paragraph
(d)new text end against a current or former provider, when the county or the commissioner knows or
has reason to believe that the provider has not complied with the record-keeping requirement
in this subdivision. deleted text begin A provider's failure to produce attendance records as requested on more
than one occasion constitutes grounds for disqualification as a provider.
deleted text end

new text begin (d) To calculate an attendance record overpayment under this subdivision, the
commissioner or county agency shall subtract the maximum daily rate from the total amount
paid to a provider for each day that a child's attendance record is missing, unavailable,
incomplete, illegible, inaccurate, or otherwise inadequate.
 new text end

new text begin (e) The commissioner shall develop criteria for a county to determine an attendance
record overpayment under this subdivision.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 12.

Minnesota Statutes 2018, section 119B.13, subdivision 1, is amended to read:


Subdivision 1.

Subsidy restrictions.

(a) deleted text begin Beginning February 3, 2014,deleted text end 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 2011deleted text end new text begin most recentnew text end child care provider
rate survey new text begin under section 119B.02, subdivision 7, new text end or the deleted text begin maximum rate effective November
28, 2011deleted text end new text begin rates in effect at the time of the updatenew text end . new text begin The first maximum rate update must be
based on the 2018 rate survey and take effect September 20, 2019. Thereafter, maximum
rate updates are effective the first biweekly period following September 1 after the most
recent rate survey. new text end 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 Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum registration
fees in effect on January 1, 2013, shall remain in effect.deleted text end new text begin 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 most recent child care provider rate survey under
section 119B.02, subdivision 7, or the registration fee in effect at the time of the update.
The first maximum registration fee update must be based on the 2018 rate survey and is
effective September 23, 2019. Thereafter, maximum registration fee updates are effective
the first biweekly period following September 1 after the most recent rate survey. Maximum
registration fees must be set for licensed family child care and for child care centers. 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 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 end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective September 20, 2019. Paragraph (i) is
effective September 23, 2019.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 119B.13, subdivision 6, is amended to read:


Subd. 6.

Provider payments.

(a) new text begin A provider shall bill only for services documented
according to section 119B.125, subdivision 6. new text end 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 six months from the date the provider is issued an
authorization of care and billing form.

(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; deleted text begin or
deleted text end

(6) the provider gives false child care price informationdeleted text begin .deleted text end new text begin ; or
new text end

new text begin (7) the provider fails to report decreases in a child's attendance, as required under section
119B.125, subdivision 9.
 new text end

(e) For purposes of paragraph (d), clauses (3), (5), deleted text begin anddeleted text end (6), new text begin and (7), new text end 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 EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 14.

Minnesota Statutes 2018, section 119B.13, subdivision 7, is amended to read:


Subd. 7.

Absent days.

(a) Licensed child care providers and license-exempt centers
must not be reimbursed for more than 25 full-day absent days per child, excluding holidays,
in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year, or for more than ten consecutive full-day absent days. new text begin "Absent
day" means any day that the child is authorized and scheduled to be in care with a licensed
provider or license exempt center, and the child is absent from the care for the entire day.
new text end Legal nonlicensed family child care providers must not be reimbursed for absent days. If a
child attends for part of the time authorized to be in care in a day, but is absent for part of
the time authorized to be in care in that same day, the absent time must be reimbursed but
the time must not count toward the absent days limit. Child care providers must only be
reimbursed for absent days if the provider has a written policy for child absences and charges
all other families in care for similar absences.

(b) Notwithstanding paragraph (a), children with documented medical conditions that
cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
full-day absent days limit. Absences due to a documented medical condition of a parent or
sibling who lives in the same residence as the child receiving child care assistance do not
count against the absent days limit in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year. Documentation of medical
conditions must be on the forms and submitted according to the timelines established by
the commissioner. A public health nurse or school nurse may verify the illness in lieu of a
medical practitioner. If a provider sends a child home early due to a medical reason,
including, but not limited to, fever or contagious illness, the child care center director or
lead teacher may verify the illness in lieu of a medical practitioner.

(c) Notwithstanding paragraph (a), children in families may exceed the absent days limit
if at least one parent: (1) is under the age of 21; (2) does not have a high school diploma or
commissioner of education-selected high school equivalency certification; and (3) is a
student in a school district or another similar program that provides or arranges for child
care, parenting support, social services, career and employment supports, and academic
support to achieve high school graduation, upon request of the program and approval of the
county. If a child attends part of an authorized day, payment to the provider must be for the
full amount of care authorized for that day.

(d) Child care providers must be reimbursed for up to ten federal or state holidays or
designated holidays per year when the provider charges all families for these days and the
holiday or designated holiday falls on a day when the child is authorized to be in attendance.
Parents may substitute other cultural or religious holidays for the ten recognized state and
federal holidays. Holidays do not count toward the absent days limit.

(e) A family or child care provider must not be assessed an overpayment for an absent
day payment unless (1) there was an error in the amount of care authorized for the family,
(2) all of the allowed full-day absent payments for the child have been paid, or (3) the family
or provider did not timely report a change as required under law.

(f) The provider and family shall receive notification of the number of absent days used
upon initial provider authorization for a family and ongoing notification of the number of
absent days used as of the date of the notification.

(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent days
per child, excluding holidays, in a deleted text begin fiscaldeleted text end new text begin calendarnew text end year; and ten consecutive full-day absent
days.

new text begin (h) For purposes of this subdivision, "holidays limit" means ten full-day holidays per
child, excluding absent days, in a calendar year.
 new text end

new text begin (i) If a day meets the criteria of an absent day or a holiday under this subdivision, the
provider must bill that day as an absent day or holiday. A provider's failure to properly bill
an absent day or a holiday results in an overpayment, regardless of whether the child reached,
or is exempt from, the absent days limit or holidays limit for the calendar year.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 15.

Minnesota Statutes 2018, section 119B.16, subdivision 1, is amended to read:


Subdivision 1.

Fair hearing allowednew text begin for applicants and recipientsnew text end .

new text begin (a) new text end An applicant
or recipient adversely affected by new text begin an action of new text end a county agency deleted text begin actiondeleted text end new text begin or the commissioner,
for an action taken directly against the applicant or recipient,new text end may request new text begin and receive new text end a fair
hearing in accordance with new text begin this subdivision and new text end section 256.045.new text begin An applicant or recipient
does not have a right to a fair hearing if a county agency or the commissioner takes action
against a provider.
new text end

new text begin (b) A county agency must offer an informal conference to an applicant or recipient who
is entitled to a fair hearing under this section. A county agency must advise an applicant or
recipient that a request for a conference is optional and does not delay or replace the right
to a fair hearing.
 new text end

new text begin (c) If a provider's authorization is suspended, denied, or revoked, a county agency or
the commissioner must mail notice to each child care assistance program recipient receiving
care from the provider.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 119B.16, subdivision 1a, is amended to read:


Subd. 1a.

Fair hearing allowed for providers.

(a) This subdivision applies to providers
caring for children receiving child care assistance.

deleted text begin (b) A provider to whom a county agency has assigned responsibility for an overpayment
may request a fair hearing in accordance with section 256.045 for the limited purpose of
challenging the assignment of responsibility for the overpayment and the amount of the
overpayment. The scope of the fair hearing does not include the issues of whether the
provider wrongfully obtained public assistance in violation of section 256.98 or was properly
disqualified under section 256.98, subdivision 8, paragraph (c), unless the fair hearing has
been combined with an administrative disqualification hearing brought against the provider
under section 256.046.
 deleted text end

new text begin (b) A provider may request a fair hearing according to sections 256.045 and 256.046
only if a county agency or the commissioner:
 new text end

new text begin (1) denies or revokes a provider's authorization, unless the action entitles the provider
to an administrative review under section 119B.161;
 new text end

new text begin (2) assigns responsibility for an overpayment to a provider under section 119B.11,
subdivision 2a;
 new text end

new text begin (3) establishes an overpayment for failure to comply with section 119B.125, subdivision
6;
 new text end

new text begin (4) seeks monetary recovery or recoupment under section 245E.02, subdivision 4,
paragraph (c), clause (2);
 new text end

new text begin (5) initiates an administrative fraud disqualification hearing; or
 new text end

new text begin (6) issues a payment and the provider disagrees with the amount of the payment.
 new text end

new text begin (c) A provider may request a fair hearing by submitting a written request to the
Department of Human Services, Appeals Division. A provider's request must be received
by the Appeals Division no later than 30 days after the date a county or the commissioner
mails the notice.
 new text end

new text begin (d) The provider's appeal request must contain the following:
 new text end

new text begin (1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
 new text end

new text begin (2) the computation the provider believes to be correct, if applicable;
 new text end

new text begin (3) the statute or rule relied on for each disputed item; and
 new text end

new text begin (4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 17.

Minnesota Statutes 2018, section 119B.16, subdivision 1b, is amended to read:


Subd. 1b.

Joint fair hearings.

deleted text begin When a provider requests a fair hearing under subdivision
1a, the family in whose case the overpayment was created must be made a party to the fair
hearing. All other issues raised by the family must be resolved in the same proceeding.
When a family requests a fair hearing and claims that the county should have assigned
responsibility for an overpayment to a provider, the provider must be made a party to the
fair hearing.deleted text end The human services judge assigned to a fair hearing may join a family or a
provider as a party to the fair hearing whenever joinder of that party is necessary to fully
and fairly resolve deleted text begin overpaymentdeleted text end issues raised in the appeal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 1c. new text end

new text begin Notice to providers. new text end

new text begin (a) Before taking an action appealable under subdivision
1a, paragraph (b), a county agency or the commissioner must mail written notice to the
provider against whom the action is being taken. Unless otherwise specified under chapter
119B or 245E or Minnesota Rules, chapter 3400, a county agency or the commissioner must
mail the written notice at least 15 calendar days before the adverse action's effective date.
 new text end

new text begin (b) The notice shall state (1) the factual basis for the department's determination, (2) the
action the department intends to take, (3) the dollar amount of the monetary recovery or
recoupment, if known, and (4) the provider's right to appeal the department's proposed
action.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Fair hearing stayed. new text end

new text begin (a) If a county agency or the commissioner denies or
revokes a provider's authorization based on a licensing action under section 245A.07, and
the provider appeals, the provider's fair hearing must be stayed until the commissioner issues
an order as required under section 245A.08, subdivision 5.
 new text end

new text begin (b) If the commissioner denies or revokes a provider's authorization based on
decertification under section 245H.07, and the provider appeals, the provider's fair hearing
must be stayed until the commissioner issues a final order as required under section 245H.07.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 20.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Final department action. new text end

new text begin Unless the commissioner receives a timely and
proper request for an appeal, a county agency's or the commissioner's action shall be
considered a final department action.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 21.

new text begin [119B.161] ADMINISTRATIVE REVIEW.
 new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin A provider has the right to an administrative review under
this section if (1) a payment was suspended under chapter 245E, or (2) the provider's
authorization was denied or revoked under section 119B.13, subdivision 6, paragraph (d),
clause (1) or (2).
 new text end

new text begin Subd. 2. new text end

new text begin Notice. new text end

new text begin (a) A county agency or the commissioner must mail written notice to
a provider within five days of suspending payment or denying or revoking the provider's
authorization under subdivision 1.
 new text end

new text begin (b) The notice must:
 new text end

new text begin (1) state the provision under which a county agency or the commissioner is denying,
revoking, or suspending the provider's authorization or suspending payment to the provider;
 new text end

new text begin (2) set forth the general allegations leading to the denial, revocation, or suspension of
the provider's authorization. The notice need not disclose any specific information concerning
an ongoing investigation;
 new text end

new text begin (3) state that the denial, revocation, or suspension of the provider's authorization is for
a temporary period and explain the circumstances under which the action expires; and
 new text end

new text begin (4) inform the provider of the right to submit written evidence and argument for
consideration by the commissioner.
 new text end

new text begin (c) Notwithstanding Minnesota Rules, part 3400.0185, if a county agency or the
commissioner suspends payment to a provider under chapter 245E or denies or revokes a
provider's authorization under section 119B.13, subdivision 6, paragraph (d), clause (1) or
(2), a county agency or the commissioner must send notice of service authorization closure
to each affected family. The notice sent to an affected family is effective on the date the
notice is created.
 new text end

new text begin Subd. 3. new text end

new text begin Duration. new text end

new text begin If a provider's payment is suspended under chapter 245E or a
provider's authorization is denied or revoked under section 119B.13, subdivision 6, paragraph
(d), clause (1) or (2), the provider's denial, revocation, temporary suspension, or payment
suspension remains in effect until:
 new text end

new text begin (1) the commissioner or a law enforcement authority determines that there is insufficient
evidence warranting the action and a county agency or the commissioner does not pursue
an additional administrative remedy under chapter 245E or section 256.98; or
 new text end

new text begin (2) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted.
 new text end

new text begin Subd. 4. new text end

new text begin Good cause exception. new text end

new text begin The commissioner may find that good cause exists not
to deny, revoke, or suspend a provider's authorization, or not to continue a denial, revocation,
or suspension of a provider's authorization if any of the following are applicable:
 new text end

new text begin (1) a law enforcement authority specifically requested that a provider's authorization
not be denied, revoked, or suspended because that action may compromise an ongoing
investigation;
 new text end

new text begin (2) the commissioner determines that the denial, revocation, or suspension should be
removed based on the provider's written submission; or
 new text end

new text begin (3) the commissioner determines that the denial, revocation, or suspension is not in the
best interests of the program.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 22.

Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:


new text begin Subd. 9a. new text end

new text begin Child foster home variances for capacity. new text end

new text begin (a) The commissioner, or the
commissioner of corrections under section 241.021, may grant a variance for a licensed
family foster parent to allow additional foster children if:
 new text end

new text begin (1) the variance is needed to allow: (i) a parenting youth in foster care to remain with
the child of the parenting youth; (ii) siblings to remain together; (iii) a child with an
established meaningful relationship with the family to remain with the family; or (iv) a
family with special training or skills to provide care to a child who has a severe disability;
 new text end

new text begin (2) there is no risk of harm to a child currently in the home;
 new text end

new text begin (3) the structural characteristics of the home, including sleeping space, accommodates
additional foster children;
 new text end

new text begin (4) the home remains in compliance with applicable zoning, health, fire, and building
codes; and
 new text end

new text begin (5) the statement of intended use specifies conditions for an exception to capacity limits
and specifies how the license holder will maintain a ratio of adults to children that ensures
the safety and appropriate supervision of all the children in the home.
 new text end

new text begin (b) A variance granted to a family foster home under Minnesota Rules, part 2960.3030,
subpart 3, prior to October 1, 2019, remains in effect until January 1, 2020.
 new text end

Sec. 23.

Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:


new text begin Subd. 6b. new text end

new text begin Children's residential facility. new text end

new text begin "Children's residential facility" means a
children's residential facility licensed by the commissioner of corrections or the commissioner
of human services under Minnesota Rules, chapter 2960.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
 new text end

Sec. 24.

Minnesota Statutes 2018, 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,new text begin children's residential
facilities,new text end 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 the
commissioner's 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
only retain fingerprints of subjects with a criminal history.

(e) The commissioner's 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. The 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
 new text end

Sec. 25.

Minnesota Statutes 2018, 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, clause (2);

(6) for a background study related to a child foster care application for licensure,new text begin children's
residential facilities,new text end 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; and

(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

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
 new text end

Sec. 26.

Minnesota Statutes 2018, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 14. new text end

new text begin Children's residential facilities. new text end

new text begin The commissioner shall recover the cost of
background studies initiated by a licensed children's residential facility 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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
 new text end

Sec. 27.

Minnesota Statutes 2018, section 245C.24, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Five-year bar to set aside disqualification; children's residential
facilities. new text end

new text begin The commissioner shall not set aside the disqualification of an individual in
connection with a license for a children's residential facility who was convicted of a felony
within the past five years for: (1) physical assault or battery; or (2) a drug-related offense.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for background studies initiated on or
after July 1, 2019.
 new text end

Sec. 28.

Minnesota Statutes 2018, section 245E.06, subdivision 3, is amended to read:


Subd. 3.

Appeal of department deleted text begin sanctiondeleted text end new text begin actionnew text end .

deleted text begin (a) If the department does not pursue
a criminal action against a provider, license holder, controlling individual, or recipient for
financial misconduct, but the department imposes an administrative sanction under section
245E.02, subdivision 4, paragraph (c), any individual or entity against whom the sanction
was imposed may appeal the department's administrative sanction under this section pursuant
to section 119B.16 or 256.045 with the additional requirements in clauses (1) to (4). An
appeal must specify:
 deleted text end

deleted text begin (1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item, if appropriate;
 deleted text end

deleted text begin (2) the computation that is believed to be correct, if appropriate;
 deleted text end

deleted text begin (3) the authority in the statute or rule relied upon for each disputed item; and
 deleted text end

deleted text begin (4) the name, address, and phone number of the person at the provider's place of business
with whom contact may be made regarding the appeal.
 deleted text end

deleted text begin (b) Notwithstanding section 245E.03, subdivision 4, an appeal is considered timely only
if postmarked or received by the department's Appeals Division within 30 days after receiving
a notice of department sanction.
 deleted text end

deleted text begin (c) Before the appeal hearing, the department may deny or terminate authorizations or
payment to the entity or individual if the department determines that the action is necessary
to protect the public welfare or the interests of the child care assistance program.
 deleted text end

new text begin A provider's rights related to the department's action taken under this chapter against a
provider are established in sections 119B.16 and 119B.161.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 29.

Minnesota Statutes 2018, section 245H.07, is amended to read:


245H.07 DECERTIFICATION.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

(a) The commissioner may decertify a center if a certification
holder:

(1) failed to comply with an applicable law or rule; deleted text begin or
deleted text end

(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rulesdeleted text begin .deleted text end new text begin ; or
new text end

new text begin (3) has authorization to receive child care assistance payments revoked pursuant to
chapter 119B.
 new text end

(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.

(c) When a center is decertified, the center is ineligible to receive a child care assistance
paymentnew text begin under chapter 119Bnew text end .

new text begin Subd. 2. new text end

new text begin Reconsideration. new text end

new text begin (a) The certification holder may request reconsideration of
the decertification by notifying the commissioner by certified mail or personal service. The
request must be made in writing. If sent by certified mail, the request must be postmarked
and sent to the commissioner within ten calendar days after the certification holder received
the order. If a request is made by personal service, it must be received by the commissioner
within ten calendar days after the certification holder received the order. The certification
holder may submit with the request for reconsideration written argument or evidence in
support of the request for reconsideration.
 new text end

new text begin (b) If the commissioner decertifies a center pursuant to subdivision 1, paragraph (a),
clause (3), and if the center appeals the revocation of the center's authorization to receive
child care assistance payments, the final decertification determination is stayed until the
appeal of the center's authorization under chapter 119B is resolved. If the center also requests
reconsideration of the decertification, the center must do so according to paragraph (a). The
final decision on reconsideration is stayed until the appeal of the center's authorization under
chapter 119B is resolved.
 new text end

new text begin (c) The commissioner's disposition of a request for reconsideration is final and not subject
to appeal under chapter 14.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
 new text end

Sec. 30.

Minnesota Statutes 2018, 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 deleted text begin testdeleted text end new text begin initiatenew text end 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) new text begin screening, new text end investigatingnew text begin ,new text end 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 sections 256.045 and 626.556 deleted text begin dealingdeleted text end new text begin that
dealnew text end with the rights of individuals who are the subjects of reports or investigations, including
notice and appeal rights and data practices requirements.new text begin The commissioner shall only
authorize alternative methods that comply with the public policy under section 626.556,
subdivision 1.new text end The commissioner may seek any federal approvals 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)new text begin (i)new text end have capacity to respond to reports of abuse and neglect under section 626.556;new text begin
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);
new text end

(5) provide a wide range of services to families in need of child welfare services; and

(6) have a tribal-state title IV-E agreement in effect.

(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 section 626.556 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.

Sec. 31.

Minnesota Statutes 2018, section 260C.007, subdivision 18, is amended to read:


Subd. 18.

Foster care.

new text begin (a) new text end "Foster care" means deleted text begin 24 hourdeleted text end new text begin 24-hournew text end substitute care for
deleted text begin children placed away from their parents or guardian anddeleted text end new text begin a childnew text end for whom a responsible
social services agency has placement and care responsibilitydeleted text begin . "Foster care" includes, but is
not limited to, placementdeleted text end new text begin and:
new text end

new text begin (1) who is placed away from the child's parent or guardiannew text end in foster family homes, foster
homes of relatives, group homes, emergency shelters, residential facilities not excluded in
this subdivision, child care institutions, and preadoptive homesdeleted text begin .deleted text end new text begin ; or
new text end

new text begin (2) who is colocated with the child's parent or guardian in a licensed residential
family-based substance abuse disorder treatment program as defined in subdivision 22a; or
 new text end

new text begin (3) who is returned to the care of the child's parent or guardian from whom the child
was removed under a trial home visit pursuant to section 260C.201, subdivision 1, paragraph
(a), clause (3).
 new text end

new text begin (b)new text end A child is in foster care under this definition regardless of whether the facility is
licensed and payments are made for the cost of care. Nothing in this definition creates any
authority to place a child in a home or facility that is required to be licensed which is not
licensed. "Foster care" does not include placement in any of the following facilities: hospitals,
inpatient chemical dependency treatment facilitiesnew text begin where the child is the recipient of the
treatmentnew text end , facilities that are primarily for delinquent children, any corrections facility or
program within a particular correction's facility not meeting requirements for title IV-E
facilities as determined by the commissioner, facilities to which a child is committed under
the provision of chapter 253B, forestry camps, or jails. Foster care is intended to provide
for a child's safety or to access treatment. Foster care must not be used as a punishment or
consequence for a child's behavior.

Sec. 32.

Minnesota Statutes 2018, section 260C.007, is amended by adding a subdivision
to read:


new text begin Subd. 22a. new text end

new text begin Licensed residential family-based substance use disorder treatment
program. new text end

new text begin "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.
 new text end

Sec. 33.

Minnesota Statutes 2018, section 260C.178, subdivision 1, is amended to read:


Subdivision 1.

Hearing and release requirements.

(a) If a child was taken into custody
under section 260C.175, subdivision 1, clause (1) or (2), item (ii), the court shall hold a
hearing within 72 hours of the time the child was taken into custody, excluding Saturdays,
Sundays, and holidays, to determine whether the child should continue in custody.

(b) Unless there is reason to believe that the child would endanger self or others or not
return for a court hearing, or that the child's health or welfare would be immediately
endangered, the child shall be released to the custody of a parent, guardian, custodian, or
other suitable person, subject to reasonable conditions of release including, but not limited
to, a requirement that the child undergo a chemical use assessment as provided in section
260C.157, subdivision 1.

(c) If the court determines there is reason to believe that the child would endanger self
or others or not return for a court hearing, or that the child's health or welfare would be
immediately endangered if returned to the care of the parent or guardian who has custody
and from whom the child was removed, the court shall order the child into foster carenew text begin as
defined in section 260C.007, subdivision 18,new text end under the legal responsibility of the responsible
social services agency or responsible probation or corrections agency for the purposes of
protective care as that term is used in the juvenile court rules or into the home of a
noncustodial parent and order the noncustodial parent to comply with any conditions the
court determines to be appropriate to the safety and care of the child, including cooperating
with paternity establishment proceedings in the case of a man who has not been adjudicated
the child's father. The court shall not give the responsible social services legal custody and
order a trial home visit at any time prior to adjudication and disposition under section
260C.201, subdivision 1, paragraph (a), clause (3), but may order the child returned to the
care of the parent or guardian who has custody and from whom the child was removed and
order the parent or guardian to comply with any conditions the court determines to be
appropriate to meet the safety, health, and welfare of the child.

(d) In determining whether the child's health or welfare would be immediately
endangered, the court shall consider whether the child would reside with a perpetrator of
domestic child abuse.

(e) The court, before determining whether a child should be placed in or continue in
foster care under the protective care of the responsible agency, shall also make a
determination, consistent with section 260.012 as to whether reasonable efforts were made
to prevent placement or whether reasonable efforts to prevent placement are not required.
In the case of an Indian child, the court shall determine whether active efforts, according
to section 260.762 and the Indian Child Welfare Act of 1978, United States Code, title 25,
section 1912(d), were made to prevent placement. The court shall enter a finding that the
responsible social services agency has made reasonable efforts to prevent placement when
the agency establishes either:

(1) that it has actually provided services or made efforts in an attempt to prevent the
child's removal but that such services or efforts have not proven sufficient to permit the
child to safely remain in the home; or

(2) that there are no services or other efforts that could be made at the time of the hearing
that could safely permit the child to remain home or to return home. When reasonable efforts
to prevent placement are required and there are services or other efforts that could be ordered
which would permit the child to safely return home, the court shall order the child returned
to the care of the parent or guardian and the services or efforts put in place to ensure the
child's safety. When the court makes a prima facie determination that one of the
circumstances under paragraph (g) exists, the court shall determine that reasonable efforts
to prevent placement and to return the child to the care of the parent or guardian are not
required.

If the court finds the social services agency's preventive or reunification efforts have
not been reasonable but further preventive or reunification efforts could not permit the child
to safely remain at home, the court may nevertheless authorize or continue the removal of
the child.

(f) The court may not order or continue the foster care placement of the child unless the
court makes explicit, individualized findings that continued custody of the child by the
parent or guardian would be contrary to the welfare of the child and that placement is in the
best interest of the child.

(g) At the emergency removal hearing, or at any time during the course of the proceeding,
and upon notice and request of the county attorney, the court shall determine whether a
petition has been filed stating a prima facie case that:

(1) the parent has subjected a child to egregious harm as defined in section 260C.007,
subdivision 14;

(2) the parental rights of the parent to another child have been involuntarily terminated;

(3) the child is an abandoned infant under section 260C.301, subdivision 2, paragraph
(a), clause (2);

(4) the parents' custodial rights to another child have been involuntarily transferred to a
relative under Minnesota Statutes 2010, section 260C.201, subdivision 11, paragraph (e),
clause (1); section 260C.515, subdivision 4; or a similar law of another jurisdiction;

(5) the parent has committed sexual abuse as defined in section 626.556, subdivision 2,
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) the provision of services or further services for the purpose of reunification is futile
and therefore unreasonable.

(h) When a petition to terminate parental rights is required under section 260C.301,
subdivision 4, or 260C.503, subdivision 2, but the county attorney has determined not to
proceed with a termination of parental rights petition, and has instead filed a petition to
transfer permanent legal and physical custody to a relative under section 260C.507, the
court shall schedule a permanency hearing within 30 days of the filing of the petition.

(i) If the county attorney has filed a petition under section 260C.307, the court shall
schedule a trial under section 260C.163 within 90 days of the filing of the petition except
when the county attorney determines that the criminal case shall proceed to trial first under
section 260C.503, subdivision 2, paragraph (c).

(j) If the court determines the child should be ordered into foster care and the child's
parent refuses to give information to the responsible social services agency regarding the
child's father or relatives of the child, the court may order the parent to disclose the names,
addresses, telephone numbers, and other identifying information to the responsible social
services agency for the purpose of complying with sections 260C.151, 260C.212, 260C.215,
and 260C.221.

(k) If a child ordered into foster care has siblings, whether full, half, or step, who are
also ordered into foster care, the court shall inquire of the responsible social services agency
of the efforts to place the children together as required by section 260C.212, subdivision 2,
paragraph (d), if placement together is in each child's best interests, unless a child is in
placement for treatment or a child is placed with a previously noncustodial parent who is
not a parent to all siblings. If the children are not placed together at the time of the hearing,
the court shall inquire at each subsequent hearing of the agency's reasonable efforts to place
the siblings together, as required under section 260.012. If any sibling is not placed with
another sibling or siblings, the agency must develop a plan to facilitate visitation or ongoing
contact among the siblings as required under section 260C.212, subdivision 1, unless it is
contrary to the safety or well-being of any of the siblings to do so.

(l) When the court has ordered the child into foster care or into the home of a noncustodial
parent, the court may order a chemical dependency evaluation, mental health evaluation,
medical examination, and parenting assessment for the parent as necessary to support the
development of a plan for reunification required under subdivision 7 and section 260C.212,
subdivision 1, or the child protective services plan under section 626.556, subdivision 10,
and Minnesota Rules, part 9560.0228.

Sec. 34.

new text begin [260C.190] FAMILY-FOCUSED RESIDENTIAL PLACEMENT.
 new text end

new text begin Subdivision 1. new text end

new text begin Placement. new text end

new text begin (a) An agency with legal responsibility for a child under
section 260C.178, subdivision 1, paragraph (c), or legal custody of a child under section
260C.201, subdivision 1, paragraph (a), clause (3), may colocate a child with a parent who
is receiving services in a licensed residential family-based substance use disorder treatment
program for up to 12 months.
 new text end

new text begin (b) During the child's placement under paragraph (a), the agency: (1) may visit the child
as the agency deems necessary and appropriate; (2) shall continue to have access to
information under section 260C.208; and (3) shall continue to provide appropriate services
to both the parent and the child.
 new text end

new text begin (c) The agency may terminate the child's placement under paragraph (a) to protect the
child's health, safety, or welfare and may remove the child to foster care without a prior
court order or authorization.
 new text end

new text begin Subd. 2. new text end

new text begin Case plans. new text end

new text begin (a) Before a child may be colocated with a parent in a licensed
residential family-based substance use disorder treatment program, a recommendation that
the child's placement with a parent is in the child's best interests must be documented in the
child's case plan. Each child must have a written case plan developed with the parent and
the treatment program staff that describes the safety plan for the child and the treatment
program's responsibilities if the parent leaves or is discharged without completing the
program. The treatment program must be provided with a copy of the case plan that includes
the recommendations and safety plan at the time the child is colocated with the parent.
 new text end

new text begin (b) An out-of-home placement plan under section 260C.212, subdivision 1, must be
completed no later than 30 days from when a child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program. The written plan
developed with parent and treatment program staff in paragraph (a) may be updated and
must be incorporated into the out-of-home placement plan. The treatment program must be
provided with a copy of the child's out-of-home placement plan.
 new text end

new text begin Subd. 3. new text end

new text begin Required reviews and permanency proceedings. new text end

new text begin (a) For a child colocated
with a parent under subdivision 1, court reviews must occur according to section 260C.202.
 new text end

new text begin (b) If a child has been in foster care for six months, a court review under section 260C.202
may be conducted in lieu of a permanency progress review hearing under section 260C.204
when the child is colocated with a parent consistent with section 260C.503, subdivision 3,
paragraph (c), in a licensed residential family-based substance use disorder treatment
program.
 new text end

new text begin (c) If the child is colocated with a parent in a licensed residential family-based substance
use disorder treatment program 12 months after the child was placed in foster care, the
agency must file a report with the court regarding the parent's progress in the treatment
program and the agency's reasonable efforts to finalize the child's safe and permanent return
to the care and custody of the parent consistent with section 260C.503, subdivision 3,
paragraph (c), in lieu of filing a petition required under section 260C.505.
 new text end

new text begin (d) The court shall make findings regarding the reasonable efforts of the agency to
finalize the child's return home as the permanency disposition order in the child's best
interests. The court may continue the child's foster care placement colocated with a parent
in a licensed residential family-based substance use disorder treatment program for up to
12 months. When a child has been in foster care placement for 12 months, but the duration
of the colocation with a parent in a licensed residential family-based substance use disorder
treatment program is less than 12 months, the court may continue the colocation with the
total time spent in foster care not exceeding 15 out of the most recent 22 months. If the
court finds that the agency fails to make reasonable efforts to finalize the child's return home
as the permanency disposition order in the child's best interests, the court may order additional
efforts to support the child remaining in the care of the parent.
 new text end

new text begin (e) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program, the child's placement under
this section is terminated and the agency may remove the child to foster care without a prior
court order or authorization. Within three days of any termination of a child's placement,
the agency shall notify the court and each party.
 new text end

new text begin (f) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child has been in
foster care for less than six months, the court must hold a review hearing within ten days
of receiving notice of a termination of a child's placement and must order an alternative
disposition under section 260C.201.
 new text end

new text begin (g) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than six months but less than
12 months, the court must conduct a permanency progress review hearing under section
260C.204 no later than 30 days after the day the parent leaves or is discharged.
 new text end

new text begin (h) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than 12 months, the court shall
begin permanency proceedings under sections 260C.503 to 260C.521.
 new text end

Sec. 35.

Minnesota Statutes 2018, section 260C.201, subdivision 1, is amended to read:


Subdivision 1.

Dispositions.

(a) If the court finds that the child is in need of protection
or services or neglected and in foster care, it shall enter an order making any of the following
dispositions of the case:

(1) place the child under the protective supervision of the responsible social services
agency or child-placing agency in the home of a parent of the child under conditions
prescribed by the court directed to the correction of the child's need for protection or services:

(i) the court may order the child into the home of a parent who does not otherwise have
legal custody of the child, however, an order under this section does not confer legal custody
on that parent;

(ii) if the court orders the child into the home of a father who is not adjudicated, the
father must cooperate with paternity establishment proceedings regarding the child in the
appropriate jurisdiction as one of the conditions prescribed by the court for the child to
continue in the father's home; and

(iii) the court may order the child into the home of a noncustodial parent with conditions
and may also order both the noncustodial and the custodial parent to comply with the
requirements of a case plan under subdivision 2; or

(2) transfer legal custody to one of the following:

(i) a child-placing agency; or

(ii) the responsible social services agency. In making a foster care placement for a child
whose custody has been transferred under this subdivision, the agency shall make an
individualized determination of how the placement is in the child's best interests using the
consideration for relatives deleted text begin anddeleted text end new text begin ,new text end the best interest factors in section 260C.212, subdivision 2,
paragraph (b)new text begin , and may include a child colocated with a parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190new text end ; or

(3) order a trial home visit without modifying the transfer of legal custody to the
responsible social services agency under clause (2). Trial home visit means the child is
returned to the care of the parent or guardian from whom the child was removed for a period
not to exceed six months. During the period of the trial home visit, the responsible social
services agency:

(i) shall continue to have legal custody of the child, which means the agency may see
the child in the parent's home, at school, in a child care facility, or other setting as the agency
deems necessary and appropriate;

(ii) shall continue to have the ability to access information under section 260C.208;

(iii) shall continue to provide appropriate services to both the parent and the child during
the period of the trial home visit;

(iv) without previous court order or authorization, may terminate the trial home visit in
order to protect the child's health, safety, or welfare and may remove the child to foster care;

(v) shall advise the court and parties within three days of the termination of the trial
home visit when a visit is terminated by the responsible social services agency without a
court order; and

(vi) shall prepare a report for the court when the trial home visit is terminated whether
by the agency or court order which describes the child's circumstances during the trial home
visit and recommends appropriate orders, if any, for the court to enter to provide for the
child's safety and stability. In the event a trial home visit is terminated by the agency by
removing the child to foster care without prior court order or authorization, the court shall
conduct a hearing within ten days of receiving notice of the termination of the trial home
visit by the agency and shall order disposition under this subdivision or deleted text begin conduct a permanency
hearing under subdivision 11 or 11adeleted text end new text begin commence permanency proceedings under sections
260C.503 to 260C.515new text end . The time period for the hearing may be extended by the court for
good cause shown and if it is in the best interests of the child as long as the total time the
child spends in foster care without a permanency hearing does not exceed 12 months;

(4) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a physical or mental
disability or emotional disturbance as defined in section 245.4871, subdivision 15, the court
may order the child's parent, guardian, or custodian to provide it. The court may order the
child's health plan company to provide mental health services to the child. Section 62Q.535
applies to an order for mental health services directed to the child's health plan company.
If the health plan, parent, guardian, or custodian fails or is unable to provide this treatment
or care, the court may order it provided. Absent specific written findings by the court that
the child's disability is the result of abuse or neglect by the child's parent or guardian, the
court shall not transfer legal custody of the child for the purpose of obtaining special
treatment or care solely because the parent is unable to provide the treatment or care. If the
court's order for mental health treatment is based on a diagnosis made by a treatment
professional, the court may order that the diagnosing professional not provide the treatment
to the child if it finds that such an order is in the child's best interests; or

(5) if the court believes that the child has sufficient maturity and judgment and that it is
in the best interests of the child, the court may order a child 16 years old or older to be
allowed to live independently, either alone or with others as approved by the court under
supervision the court considers appropriate, if the county board, after consultation with the
court, has specifically authorized this dispositional alternative for a child.

(b) If the child was adjudicated in need of protection or services because the child is a
runaway or habitual truant, the court may order any of the following dispositions in addition
to or as alternatives to the dispositions authorized under paragraph (a):

(1) counsel the child or the child's parents, guardian, or custodian;

(2) place the child under the supervision of a probation officer or other suitable person
in the child's own home under conditions prescribed by the court, including reasonable rules
for the child's conduct and the conduct of the parents, guardian, or custodian, designed for
the physical, mental, and moral well-being and behavior of the child;

(3) subject to the court's supervision, transfer legal custody of the child to one of the
following:

(i) a reputable person of good moral character. No person may receive custody of two
or more unrelated children unless licensed to operate a residential program under sections
245A.01 to 245A.16; or

(ii) a county probation officer for placement in a group foster home established under
the direction of the juvenile court and licensed pursuant to section 241.021;

(4) require the child to pay a fine of up to $100. The court shall order payment of the
fine in a manner that will not impose undue financial hardship upon the child;

(5) require the child to participate in a community service project;

(6) order the child to undergo a chemical dependency evaluation and, if warranted by
the evaluation, order participation by the child in a drug awareness program or an inpatient
or outpatient chemical dependency treatment program;

(7) if the court believes that it is in the best interests of the child or of public safety that
the child's driver's license or instruction permit be canceled, the court may order the
commissioner of public safety to cancel the child's license or permit for any period up to
the child's 18th birthday. If the child does not have a driver's license or permit, the court
may order a denial of driving privileges for any period up to the child's 18th birthday. The
court shall forward an order issued under this clause to the commissioner, who shall cancel
the license or permit or deny driving privileges without a hearing for the period specified
by the court. At any time before the expiration of the period of cancellation or denial, the
court may, for good cause, order the commissioner of public safety to allow the child to
apply for a license or permit, and the commissioner shall so authorize;

(8) order that the child's parent or legal guardian deliver the child to school at the
beginning of each school day for a period of time specified by the court; or

(9) require the child to perform any other activities or participate in any other treatment
programs deemed appropriate by the court.

To the extent practicable, the court shall enter a disposition order the same day it makes
a finding that a child is in need of protection or services or neglected and in foster care, but
in no event more than 15 days after the finding unless the court finds that the best interests
of the child will be served by granting a delay. If the child was under eight years of age at
the time the petition was filed, the disposition order must be entered within ten days of the
finding and the court may not grant a delay unless good cause is shown and the court finds
the best interests of the child will be served by the delay.

(c) If a child who is 14 years of age or older is adjudicated in need of protection or
services because the child is a habitual truant and truancy procedures involving the child
were previously dealt with by a school attendance review board or county attorney mediation
program under section 260A.06 or 260A.07, the court shall order a cancellation or denial
of driving privileges under paragraph (b), clause (7), for any period up to the child's 18th
birthday.

(d) In the case of a child adjudicated in need of protection or services because the child
has committed domestic abuse and been ordered excluded from the child's parent's home,
the court shall dismiss jurisdiction if the court, at any time, finds the parent is able or willing
to provide an alternative safe living arrangement for the child, as defined in Laws 1997,
chapter 239, article 10, section 2.

(e) When a parent has complied with a case plan ordered under subdivision 6 and the
child is in the care of the parent, the court may order the responsible social services agency
to monitor the parent's continued ability to maintain the child safely in the home under such
terms and conditions as the court determines appropriate under the circumstances.

Sec. 36.

Minnesota Statutes 2018, section 260C.201, subdivision 2, is amended to read:


Subd. 2.

Written findings.

(a) Any order for a disposition authorized under this section
shall contain written findings of fact to support the disposition and case plan ordered and
shall also set forth in writing the following information:

(1) why the best interests and safety of the child are served by the disposition and case
plan ordered;

(2) what alternative dispositions or services under the case plan were considered by the
court and why such dispositions or services were not appropriate in the instant case;

(3) when legal custody of the child is transferred, the appropriateness of the particular
placement made or to be made by the placing agency using the factors in section 260C.212,
subdivision 2, paragraph (b)new text begin , or the appropriateness of a child colocated with a parent in a
licensed residential family-based substance use disorder treatment program under section
260C.190new text end ;

(4) whether reasonable efforts to finalize the permanent plan for the child consistent
with section 260.012 were made including reasonable efforts:

(i) to prevent the child's placement and to reunify the child with the parent or guardian
from whom the child was removed at the earliest time consistent with the child's safety.
The court's findings must include a brief description of what preventive and reunification
efforts were made and why further efforts could not have prevented or eliminated the
necessity of removal or that reasonable efforts were not required under section 260.012 or
260C.178, subdivision 1;

(ii) to identify and locate any noncustodial or nonresident parent of the child and to
assess such parent's ability to provide day-to-day care of the child, and, where appropriate,
provide services necessary to enable the noncustodial or nonresident parent to safely provide
day-to-day care of the child as required under section 260C.219, unless such services are
not required under section 260.012 or 260C.178, subdivision 1;

(iii) to make the diligent search for relatives and provide the notices required under
section 260C.221; a finding made pursuant to a hearing under section 260C.202 that the
agency has made diligent efforts to conduct a relative search and has appropriately engaged
relatives who responded to the notice under section 260C.221 and other relatives, who came
to the attention of the agency after notice under section 260C.221 was sent, in placement
and case planning decisions fulfills the requirement of this item;

(iv) to identify and make a foster care placement in the home of an unlicensed relative,
according to the requirements of section 245A.035, a licensed relative, or other licensed
foster care provider who will commit to being the permanent legal parent or custodian for
the child in the event reunification cannot occur, but who will actively support the
reunification plan for the child; and

(v) to place siblings together in the same home or to ensure visitation is occurring when
siblings are separated in foster care placement and visitation is in the siblings' best interests
under section 260C.212, subdivision 2, paragraph (d); and

(5) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a mental disability or
emotional disturbance as defined in section 245.4871, subdivision 15, the written findings
shall also set forth:

(i) whether the child has mental health needs that must be addressed by the case plan;

(ii) what consideration was given to the diagnostic and functional assessments performed
by the child's mental health professional and to health and mental health care professionals'
treatment recommendations;

(iii) what consideration was given to the requests or preferences of the child's parent or
guardian with regard to the child's interventions, services, or treatment; and

(iv) what consideration was given to the cultural appropriateness of the child's treatment
or services.

(b) If the court finds that the social services agency's preventive or reunification efforts
have not been reasonable but that further preventive or reunification efforts could not permit
the child to safely remain at home, the court may nevertheless authorize or continue the
removal of the child.

(c) If the child has been identified by the responsible social services agency as the subject
of concurrent permanency planning, the court shall review the reasonable efforts of the
agency to develop a permanency plan for the child that includes a primary plan which is
for reunification with the child's parent or guardian and a secondary plan which is for an
alternative, legally permanent home for the child in the event reunification cannot be achieved
in a timely manner.

Sec. 37.

Minnesota Statutes 2018, section 260C.201, subdivision 6, is amended to read:


Subd. 6.

Case plan.

(a) For each disposition ordered where the child is placed away
from a parent or guardian, the court shall order the responsible social services agency to
prepare a written out-of-home placement plan according to the requirements of section
260C.212, subdivision 1.new text begin When a foster child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program under section 260C.190,
the case plan must specify the recommendation for the colocation before the child is colocated
with the parent.
new text end

(b) In cases where the child is not placed out of the home or is ordered into the home of
a noncustodial parent, the responsible social services agency shall prepare a plan for delivery
of social services to the child and custodial parent under section 626.556, subdivision 10,
or any other case plan required to meet the needs of the child. The plan shall be designed
to safely maintain the child in the home or to reunite the child with the custodial parent.

(c) The court may approve the case plan as presented or modify it after hearing from
the parties. Once the plan is approved, the court shall order all parties to comply with it. A
copy of the approved case plan shall be attached to the court's order and incorporated into
it by reference.

(d) A party has a right to request a court review of the reasonableness of the case plan
upon a showing of a substantial change of circumstances.

Sec. 38.

Minnesota Statutes 2018, 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 adoption; 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.

new text begin (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. 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.
 new text end

Sec. 39.

new text begin [260C.228] VOLUNTARY FOSTER CARE; CHILD IS COLOCATED
WITH PARENT IN TREATMENT PROGRAM.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin When a parent requests assistance from an agency and both
the parent and agency agree that a child's placement in foster care and colocation with a
parent in a licensed residential family-based substance use treatment facility as defined by
section 260C.007, subdivision 22a, is in the child's best interests, the agency must specify
the recommendation for the placement in the child's case plan. After the child's case plan
includes the recommendation, the agency and the parent may enter into a written voluntary
placement agreement on a form approved by the commissioner.
 new text end

new text begin Subd. 2. new text end

new text begin Judicial review. new text end

new text begin (a) A judicial review of a child's voluntary placement is
required within 165 days of the date the voluntary agreement was signed. The agency
responsible for the child's placement in foster care shall request the judicial review.
 new text end

new text begin (b) The agency must forward a written report to the court at least five business days
prior to the judicial review in paragraph (a). The report must contain:
 new text end

new text begin (i) a statement regarding whether the colocation of the child with a parent in a licensed
residential family-based substance use disorder treatment program meets the child's needs
and continues to be in the child's best interests;
 new text end

new text begin (ii) the child's name, dates of birth, race, gender, and current address;
 new text end

new text begin (iii) the names, race, dates of birth, residences, and post office addresses of the child's
parents or custodian;
 new text end

new text begin (iv) 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;
 new text end

new text begin (v) the name and address of the licensed residential family-based substance use disorder
treatment program where the child and parent or custodian are colocated;
 new text end

new text begin (vi) a copy of the out-of-home placement plan under section 260C.212, subdivisions 1
and 3;
 new text end

new text begin (vii) a written summary of the proceedings of any administrative review required under
section 260C.203; and
 new text end

new text begin (viii) any other information the agency, parent or custodian, child, or licensed residential
family-based substance use disorder treatment program wants the court to consider.
 new text end

new text begin (c) The agency must inform a child, if the child is 12 years of age or older; the child's
parent; and the licensed residential family-based substance use disorder treatment program
of the reporting and court review requirements of this section and of their rights to submit
information to the court as follows:
 new text end

new text begin (1) if the child, the child's parent, or the licensed residential family-based substance use
disorder treatment program 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 to submit to the court with the agency's report; and
 new text end

new text begin (2) the agency must inform the child, the child's parent, and the licensed residential
family-based substance use disorder treatment program that they have the right to be heard
in person by the court. An in-person hearing must be held if requested by the child, parent
or legal guardian, or licensed residential family-based substance use disorder treatment
program.
 new text end

new text begin (d) If, at the time required for the agency's report under this section, a child 12 years of
age or older disagrees about the placement colocating the child with the parent in a licensed
residential family-based substance use disorder treatment program or services provided
under the out-of-home placement plan 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.
 new text end

new text begin (e) Regardless of whether an in-person hearing is requested within ten days of receiving
the agency's report, the court has jurisdiction to and must determine:
 new text end

new text begin (i) whether the voluntary foster care arrangement is in the child's best interests;
 new text end

new text begin (ii) whether the parent and agency are appropriately planning for the child; and
 new text end

new text begin (iii) if a child 12 years of age or older disagrees with the foster care placement colocating
the child with the parent in a licensed residential family-based substance use disorder
treatment program or services provided under the out-of-home placement plan, whether to
appoint counsel and a guardian ad litem for the child according to section 260C.163.
 new text end

new text begin (f) Unless requested by the parent, representative of the licensed residential family-based
substance use disorder treatment program, or child, an in-person hearing is not required for
the court to make findings and issue an order.
 new text end

new text begin (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 the court's determination.
The individual 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 to the court under paragraph (d).
 new text end

new text begin (h) The court shall send a copy of the order to the county attorney, the agency, the parent,
a child 12 years of age or older, and the licensed residential family-based substance use
disorder treatment program.
 new text end

new text begin (i) 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 is not appropriately planning for the child, the
court shall notify the agency, the parent, the licensed residential family-based substance
use disorder treatment program, a child 12 years of age or older, and the county attorney of
the court's determination and the basis for the court's determination. 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 end

new text begin Subd. 3. new text end

new text begin Termination. new text end

new text begin The voluntary placement agreement terminates at the parent's
discharge from the licensed residential family-based substance use disorder treatment
program, or upon receipt of a written and dated request from the parent, unless the request
specifies a later date. If the child's voluntary foster care placement meets the calculated time
to require a permanency proceeding under section 260C.503, subdivision 3, paragraph (a),
and the child is not returned home, the agency must file a petition according to section
260C.141 or 260C.505.
 new text end

Sec. 40.

Minnesota Statutes 2018, section 260C.452, subdivision 4, is amended to read:


Subd. 4.

Administrative or court review of placements.

(a) When the child is 14 years
of age or older, the court, in consultation with the child, shall review the independent living
plan according to section 260C.203, paragraph (d).

(b) The responsible social services agency shall file a copy of the notification required
in subdivision 3 with the court. If the responsible social services agency does not file the
notice by the time the child is 17-1/2 years of age, the court shall require the responsible
social services agency to file the notice.

(c) The court shall ensure that the responsible social services agency assists the child in
obtaining the following documents before the child leaves foster care: a Social Security
card; an official or certified copy of the child's birth certificate; a state identification card
or driver's license, tribal enrollment identification card, green card, or school visa; health
insurance information; the child's school, medical, and dental records; a contact list of the
child's medical, dental, and mental health providers; and contact information for the child's
siblings, if the siblings are in foster care.

(d) For a child who will be discharged from foster care at 18 years of age or older, the
responsible social services agency must develop a personalized transition plan as directed
by the child during the 90-day period immediately prior to the expected date of discharge.
The transition plan must be as detailed as the child 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 services, including the Healthy
Transitions and Homeless Prevention program, if available;

(5) workforce supports and employment services;

(6) a copy of the child's 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 child;

(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
child if the child becomes unable to participate in decisions; deleted text begin and
deleted text end

(8) appropriate contact information through 21 years of age if the child needs information
or help dealing with a crisis situationdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (9) official documentation that the youth was previously in foster care.
 new text end

Sec. 41.

Minnesota Statutes 2018, section 260C.503, subdivision 1, is amended to read:


Subdivision 1.

Required permanency proceedings.

new text begin (a) new text end Except for children in foster
care pursuant to chapter 260D, where the child is in foster care or in the care of a noncustodial
or nonresident parent, the court shall commence proceedings to determine the permanent
status of a child by holding the admit-deny hearing required under section 260C.507 not
later than 12 months after the child is placed in foster care or in the care of a noncustodial
or nonresident parent. Permanency proceedings for children in foster care pursuant to chapter
260D shall be according to section 260D.07.

new text begin (b) Permanency proceedings for a foster child who is colocated with a parent in a licensed
residential family-based substance use disorder treatment program shall be conducted
according to section 260C.190.
 new text end

Sec. 42.

Minnesota Statutes 2018, section 518A.32, subdivision 3, is amended to read:


Subd. 3.

Parent not considered voluntarily unemployed, underemployed, or employed
on a less than full-time basis.

A parent is not considered voluntarily unemployed,
underemployed, or employed on a less than full-time basis upon a showing by the parent
that:

(1) the unemployment, underemployment, or employment on a less than full-time basis
is temporary and will ultimately lead to an increase in income;

(2) the unemployment, underemployment, or employment on a less than full-time basis
represents a bona fide career change that outweighs the adverse effect of that parent's
diminished income on the child; or

(3) the unemployment, underemployment, or employment on a less than full-time basis
is because a parent is physically or mentally incapacitated or due to incarcerationdeleted text begin , except
where the reason for incarceration is the parent's nonpayment of supportdeleted 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. 43. new text begin INSTRUCTION TO COMMISSIONER.
new text end

new text begin All individuals in connection with a licensed children's residential facility required to
complete a background study under Minnesota Statutes, chapter 245C, must complete a
new background study consistent with the obligations and requirements of this article. The
commissioner of human services shall establish a schedule for (1) individuals in connection
with a licensed children's residential facility that serves children eligible to receive federal
Title IV-E funding to complete the new background study by March 1, 2020, and (2)
individuals in connection with a licensed children's residential facility that serves children
not eligible to receive federal Title IV-E funding to complete the new background study by
March 1, 2021.
 new text end

Sec. 44. new text begin CHILD WELFARE TRAINING ACADEMY.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin The commissioner of human services shall
modify the Child Welfare Training System developed pursuant to Minnesota Statutes,
section 626.5591, subdivision 2, according to this section. The new training framework
shall be known as the Child Welfare Training Academy.
 new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin (a) The Child Welfare Training Academy must be administered
through five regional hubs in northwest, northeast, southwest, southeast, and central
Minnesota. Each hub must deliver training targeted to the needs of the hub's particular
region, taking into account varying demographics, resources, and practice outcomes.
 new text end

new text begin (b) The Child Welfare Training Academy must use training methods best suited to the
training content. National best practices in adult learning must be used to the greatest extent
possible, including online learning methodologies, coaching, mentoring, and simulated skill
application.
 new text end

new text begin (c) Each child welfare worker and supervisor must complete a certification, including
a competency-based knowledge test and a skills demonstration, at the completion of the
worker's or supervisor's initial training and biennially thereafter. The commissioner shall
develop ongoing training requirements and a method for tracking certifications.
 new text end

new text begin (d) Each regional hub must have a regional organizational effectiveness specialist trained
in continuous quality improvement strategies. The specialist shall provide organizational
change assistance to counties and tribes, with priority given to efforts intended to impact
child safety.
 new text end

new text begin (e) The Child Welfare Training Academy must include training and resources that address
worker well-being and secondary traumatic stress.
 new text end

new text begin (f) The Child Welfare Training Academy must serve the primary training audiences of
(1) county and tribal child welfare workers, (2) county and tribal child welfare supervisors,
and (3) staff at private agencies providing out-of-home placement services for children
involved in Minnesota's county and tribal child welfare system.
 new text end

new text begin Subd. 3. new text end

new text begin Partnerships. new text end

new text begin (a) The commissioner of human services shall enter into a
partnership with the University of Minnesota to collaborate in the administration of workforce
training.
 new text end

new text begin (b) The commissioner of human services shall enter into a partnership with one or more
agencies to provide consultation, subject matter expertise, and capacity building in
organizational resilience and child welfare workforce well-being.
 new text end

new text begin Subd. 4. new text end

new text begin Rulemaking. new text end

new text begin The commissioner of human services may adopt rules by
December 31, 2020, as necessary to establish the Child Welfare Training Academy. If the
commissioner of human services does not adopt rules by July 1, 2023, rulemaking authority
under this section is repealed. Rulemaking authority under this section is not continuing
authority to amend or repeal rules. Any additional action on rules after adoption must be
under specific statutory authority to take the additional action.
 new text end

Sec. 45. new text begin CHILD WELFARE CASELOAD STUDY.
new text end

new text begin (a) The commissioner of human services shall conduct a child welfare caseload study
to collect data on (1) the number of child welfare workers in Minnesota, and (2) the amount
of time that child welfare workers spend on different components of child welfare work.
The study must be completed by July 1, 2020.
 new text end

new text begin (b) The commissioner shall report the results of the child welfare caseload study to the
governor and to the chairs and ranking minority members of the committees in the house
of representatives and senate with jurisdiction over human services by December 1, 2020.
 new text end

new text begin (c) After the child welfare caseload study is complete, the commissioner shall work with
counties and other stakeholders to develop a process for ongoing monitoring of child welfare
workers' caseloads.
 new text end

Sec. 46. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 119B.16, subdivision 2; and 245E.06, subdivisions
2, 4, and 5, new text end new text begin are repealed effective the day following final enactment.
 new text end

new text begin (b) new text end new text begin Minnesota Rules, part 3400.0185, subpart 5, new text end new text begin is repealed effective February 26, 2021.
 new text end

new text begin (c) new text end new text begin Minnesota Rules, part 2960.3030, subpart 3, new text end new text begin is repealed.
 new text end

ARTICLE 2

OPERATIONS

Section 1.

Minnesota Statutes 2018, section 15C.02, is amended to read:


15C.02 LIABILITY FOR CERTAIN ACTS.

(a) A person who commits any act described in clauses (1) to (7) is liable to the state or
the political subdivision for a civil penalty deleted text begin of not less than $5,500 and not more than $11,000
per false or fraudulent claimdeleted text end new text begin in the amounts set forth in the federal False Claims Act, United
States Code, title 31, section 3729, and as modified by the federal Civil Penalties Inflation
Adjustment Act Improvements Act of 2015new text end , plus three times the amount of damages that
the state or the political subdivision sustains because of the act of that person, except as
otherwise provided in paragraph (b):

(1) knowingly presents, or causes to be presented, a false or fraudulent claim for payment
or approval;

(2) knowingly makes or uses, or causes to be made or used, a false record or statement
material to a false or fraudulent claim;

(3) knowingly conspires to commit a violation of clause (1), (2), (4), (5), (6), or (7);

(4) has possession, custody, or control of property or money used, or to be used, by the
state or a political subdivision and knowingly delivers or causes to be delivered less than
all of that money or property;

(5) is authorized to make or deliver a document certifying receipt for money or property
used, or to be used, by the state or a political subdivision and, intending to defraud the state
or a political subdivision, makes or delivers the receipt without completely knowing that
the information on the receipt is true;

(6) knowingly buys, or receives as a pledge of an obligation or debt, public property
from an officer or employee of the state or a political subdivision who lawfully may not
sell or pledge the property; or

(7) knowingly makes or uses, or causes to be made or used, a false record or statement
material to an obligation to pay or transmit money or property to the state or a political
subdivision, or knowingly conceals or knowingly and improperly avoids or decreases an
obligation to pay or transmit money or property to the state or a political subdivision.

(b) Notwithstanding paragraph (a), the court may assess not less than two times the
amount of damages that the state or the political subdivision sustains because of the act of
the person if:

(1) the person committing a violation under paragraph (a) furnished an officer or
employee of the state or the political subdivision responsible for investigating the false or
fraudulent claim violation with all information known to the person about the violation
within 30 days after the date on which the person first obtained the information;

(2) the person fully cooperated with any investigation by the state or the political
subdivision of the violation; and

(3) at the time the person furnished the state or the political subdivision with information
about the violation, no criminal prosecution, civil action, or administrative action had been
commenced under this chapter with respect to the violation and the person did not have
actual knowledge of the existence of an investigation into the violation.

(c) A person violating this section is also liable to the state or the political subdivision
for the costs of a civil action brought to recover any penalty or damages.

(d) A person is not liable under this section for mere negligence, inadvertence, or mistake
with respect to activities involving a false or fraudulent claim.

Sec. 2.

Minnesota Statutes 2018, section 245A.02, subdivision 18, is amended to read:


Subd. 18.

Supervision.

new text begin (a) new text end For purposes ofnew text begin licensednew text end child care centers, "supervision"
means when a program staff personnew text begin :
new text end

new text begin (1)new text end is deleted text begin within sight and hearing of a child at all times so that the program staffdeleted text end new text begin accountable
for the child's care;
new text end

new text begin (2)new text end can intervene to protect the health and safety of the childdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (3) is within sight and hearing of the child at all times except as described in paragraphs
(b) to (d).
 new text end

new text begin (b)new text end When an infant is placed in a crib room to sleep, supervision occurs when anew text begin programnew text end
staff person is within sight or hearing of the infant. When supervision of a crib room is
provided by sight or hearing, the center must have a plan to address the other supervision
deleted text begin componentdeleted text end new text begin componentsnew text end .

new text begin (c) When a single school-age child uses the restroom within the licensed space,
supervision occurs when a program staff person has knowledge of the child's activity and
location and checks on the child at least every five minutes. When a school-age child uses
the restroom outside the licensed space, including but not limited to field trips, supervision
occurs when staff accompany children to the restroom.
 new text end

new text begin (d) When a school-age child leaves the classroom but remains within the licensed space
to deliver or retrieve items from the child's personal storage space, supervision occurs when
a program staff person has knowledge of the child's activity and location and checks on the
child at least every five minutes.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 245A.14, subdivision 4, is amended to read:


Subd. 4.

Special family day care homes.

Nonresidential child care programs serving
14 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 if:

(a) the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwelling that is located on a residential lot;

(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;

(c) the license holder is a church or religious organization;

(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;

(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:

(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;

(2) the program meets a one to seven staff-to-child ratio during the variance period;

(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;

(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;

(5) the program is in compliance with local zoning regulations;

(6) the program is in compliance with the applicable fire code as follows:

(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 deleted text begin 2003deleted text end new text begin
2015new text end , Section 202; or

(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 deleted text begin 2003deleted text end new text begin
2015new text end , Section 202new text begin , 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 202new text end ; and

(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or

(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:

(1) the program is in compliance with local zoning regulations;

(2) the program is in compliance with the applicable fire code as follows:

(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 deleted text begin 2003deleted text end new text begin
2015new text end , Section 202; or

(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 deleted text begin 2003deleted text end new text begin
2015new text end , Section 202;

(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and

(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."

new 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 own respective licensed program as a distinct program and
within the capacity, age, and ratio distributions of each license.
 new text end

new text begin (h) 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 paragraphs (e) and (f)
if the license holder meets the other requirements of the statute.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 245A.14, subdivision 8, is amended to read:


Subd. 8.

Experienced aides; child care centers.

(a) An individual employed as an aide
at a child care center may work with children without being directly supervised for an
amount of time that does not exceed 25 percent of the child care center's daily hours if:

(1) a teacher is in the facility;

deleted text begin (2) the individual has received within the last three years first aid training that meets the
requirements under section 245A.40, subdivision 3, and CPR training that meets the
requirements under section 245A.40, subdivision 4;
 deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end the individual is at least 20 years old; and

deleted text begin (4)deleted text end new text begin (3)new text end the individual has at least 4,160 hours of child care experience as a staff member
in a licensed child care center or as the license holder of a family day care home, 120 days
of which must be in the employment of the current company.

(b) A child care center that uses experienced aides under this subdivision must notify
parents or guardians by posting the notification in each classroom that uses experienced
aides, identifying which staff member is the experienced aide. Records of experienced aide
usage must be kept on site and given to the commissioner upon request.

(c) A child care center may not use the experienced aide provision for one year following
two determined experienced aide violations within a one-year period.

(d) A child care center may use one experienced aide per every four full-time child care
classroom staff.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision to
read:


new text begin Subd. 16. new text end

new text begin Valid driver's license. new text end

new text begin Notwithstanding any law to the contrary, when a
licensed child care center provides transportation for children or contracts to provide
transportation for children, a person who has a current, valid driver's license appropriate to
the vehicle driven may transport the child.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision to
read:


new text begin Subd. 17. new text end

new text begin Reusable water bottles or cups. new text end

new text begin Notwithstanding any law to the contrary, a
child care center that meets the standards in Minnesota Rules, chapter 9503, may provide
drinking water to a child in a reusable water bottle or reusable cup if the center develops
and ensures implementation of a written policy that at a minimum includes the following
procedures:
 new text end

new text begin (1) each day the water bottle or cup is used, the child care center cleans and sanitizes
the water bottle or cup using procedures that comply with the Food Code under Minnesota
Rules, chapter 4626;
 new text end

new text begin (2) water bottle or cup is assigned to a specific child and labeled with the child's first
and last name;
 new text end

new text begin (3) water bottles and cups are stored in a manner that reduces the risk of a child using
the wrong water bottle or cup; and
 new text end

new text begin (4) a water bottle or cup is used only for water.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 245A.151, is amended to read:


245A.151 FIRE MARSHAL INSPECTION.

When licensure under this chapternew text begin or certification under chapter 245Hnew text end requires an
inspection by a fire marshal to determine compliance with the State Fire Code under section
299F.011, a local fire code inspector approved by the state fire marshal may conduct the
inspection. If a community does not have a local fire code inspector or if the local fire code
inspector does not perform the inspection, the state fire marshal must conduct the inspection.
A local fire code inspector or the state fire marshal may recover the cost of these inspections
through a fee of no more than $50 per inspection charged to the applicant or license holdernew text begin
or license-exempt child care center certification holdernew text end . The fees collected by the state fire
marshal under this section are appropriated to the commissioner of public safety for the
purpose of conducting the inspections.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 8.

Minnesota Statutes 2018, 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; deleted text begin and
deleted text end

(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holderdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (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.
 new text end

Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.

(b) 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.

(c) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.

(d) 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.

(e) A license issued under this section may be issued for up to two years.

(f) 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.

(g) 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.

(h) 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; deleted text begin and
deleted text end

(2) any death, serious injury, or determination of substantiated maltreatmentdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (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 48
hours of the fire.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 245A.40, is amended to read:


245A.40 CHILD CARE CENTER TRAINING REQUIREMENTS.

Subdivision 1.

Orientation.

new text begin (a) new text end The child care center license holder must ensure that
deleted text begin everydeleted text end new text begin the director,new text end staff deleted text begin person and volunteer isdeleted text end new text begin persons, substitutes, and unsupervised
volunteers arenew text end given orientation training and successfully deleted text begin completesdeleted text end new text begin completenew text end the training
before starting assigned duties. deleted text begin The orientation training in this subdivision applies to
volunteers who will have direct contact with or access to children and who are not under
the direct supervision of a staff person. Completion of the orientation must be documented
in the individual's personnel record.deleted text end The orientation training must include information about:

(1) the center's philosophy, child care program, and procedures for maintaining health
and safety according to section 245A.41 and Minnesota Rules, part 9503.0140, and handling
emergencies and accidents according to Minnesota Rules, part 9503.0110;

(2) specific job responsibilities;

(3) the behavior guidance standards in Minnesota Rules, part 9503.0055; deleted text begin and
deleted text end

(4) the reporting responsibilities in section 626.556, and Minnesota Rules, part
9503.0130deleted text begin .deleted text end new text begin ;
new text end

new text begin (5) the center's drug and alcohol policy under section 245A.04, subdivision 1, paragraph
(c);
 new text end

new text begin (6) the center's risk reduction plan as required under section 245A.66, subdivision 2;
 new text end

new text begin (7) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required in subdivision 5, if applicable;
 new text end

new text begin (8) at least one-half hour of training on the risk of abusive head trauma as required for
the director and staff under subdivision 5a, if applicable; and
 new text end

new text begin (9) training required by a child's individual child care program plan as required under
Minnesota Rules, part 9503.0065, subpart 3, if applicable.
 new text end

new text begin (b) In addition to paragraph (a), before having unsupervised direct contact with a child,
the director and staff persons within the first 90 days of employment, and substitutes and
unsupervised volunteers within 90 days after the first date of direct contact with a child,
must complete:
 new text end

new text begin (1) pediatric first aid, in accordance with subdivision 3; and
 new text end

new text begin (2) pediatric cardiopulmonary resuscitation, in accordance with subdivision 4.
 new text end

new text begin (c) In addition to paragraph (b), the director and staff persons within the first 90 days
of employment, and substitutes and unsupervised volunteers within 90 days from the first
date of direct contact with a child, must complete training in child development, in accordance
with subdivision 2.
 new text end

new text begin (d) The license holder must ensure that documentation, as required in subdivision 10,
identifies the number of hours completed for each topic with a minimum training time
identified, if applicable, and that all required content is included.
 new text end

new text begin (e) Training in this subdivision must not be used to meet in-service training requirements
in subdivision 7.
 new text end

new text begin (f) Training completed within the previous 12 months under paragraphs (a), clauses (7)
and (8), and (c) are transferable to another child care center.
 new text end

new text begin Subd. 1a. 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.
 new text end

new text begin (b) "Substitute" means an adult who is temporarily filling a position as a director, teacher,
assistant teacher, or aide in a licensed child care center for less than 240 hours total in a
calendar year due to the absence of a regularly employed staff person.
 new text end

new text begin (c) "Staff person" means an employee of a child care center who provides direct contact
services to children.
 new text end

new text begin (d) "Unsupervised volunteer" means an individual who:
 new text end

new text begin (1) assists in the care of a child in care;
 new text end

new text begin (2) is not under the continuous direct supervision of a staff person; and
 new text end

new text begin (3) is not employed by the child care center.
 new text end

Subd. 2.

Child development and learning training.

(a) deleted text begin For purposes of child care
centers,deleted text end The director and all staff deleted text begin hired after July 1, 2006,deleted text end new text begin persons, substitutes, and
unsupervised volunteersnew text end shall complete deleted text begin and document at least two hours ofdeleted text end child development
and learning training within the first 90 days of employment.new text begin The director and staff persons,
not including substitutes, must complete at least two hours of training on child development
and learning. The training for substitutes and unsupervised volunteers is not required to be
of a minimum length.new text end For purposes of this subdivision, "child development and learning
training" meansnew text begin anynew text end training innew text begin Knowledge and Competency Area I: Child Development
and Learning, which is training innew text end understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community. deleted text begin Training completed under this subdivision may be used to meet the in-service
training requirements under subdivision 7.
deleted text end

(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:

(1) have taken a three-credit college course on early childhood development within the
past five years;

(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;

(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or

(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.

new text begin (c) The director and staff persons, not including substitutes, must complete at least two
hours of child development and learning training every second calendar year.
 new text end

new text begin (d) Substitutes and unsupervised volunteers must complete child development and
learning training every second calendar year. There is no minimum number of training hours
required.
 new text end

new text begin (e) Except for training required under paragraph (a), training completed under this
subdivision may be used to meet the in-service training requirements under subdivision 7.
 new text end

Subd. 3.

First aid.

(a) deleted text begin All teachers and assistant teachers in a child care center governed
by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least one staff person during
field trips and when transporting children in care, must satisfactorily complete pediatric
first aid training within 90 days of the start of work, unless the training has been completed
within the previous two years.deleted text end new text begin Unless training has been completed within the previous two
years, the director, staff persons, substitutes, and unsupervised volunteers must satisfactorily
complete pediatric first aid training prior to having unsupervised direct contact with a child,
but not to exceed the first 90 days of employment.
new text end

(b) deleted text begin Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed pediatric first aid training must be present
at all times in the center, during field trips, and when transporting children in care.deleted text end new text begin Pediatric
first aid training must be repeated at least every second calendar year. First aid training
under this subdivision must be provided by an individual approved as a first aid instructor
and must not be used to meet in-service training requirements under subdivision 7.
new text end

deleted text begin (c) The pediatric first aid training must be repeated at least every two years, documented
in the person's personnel record and indicated on the center's staffing chart, and provided
by an individual approved as a first aid instructor. This training may be less than eight hours.
 deleted text end

Subd. 4.

Cardiopulmonary resuscitation.

deleted text begin (a) All teachers and assistant teachers in a
child care center governed by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least
one staff person during field trips and when transporting children in care, must satisfactorily
complete training in cardiopulmonary resuscitation (CPR) that includes CPR techniques
for infants and children and in the treatment of obstructed airways. The CPR training must
be completed within 90 days of the start of work, unless the training has been completed
within the previous two years. The CPR training must have been provided by an individual
approved to provide CPR instruction, must be repeated at least once every two years, and
must be documented in the staff person's records.
 deleted text end

deleted text begin (b) Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed cardiopulmonary resuscitation training
must be present at all times in the center, during field trips, and when transporting children
in care.
 deleted text end

deleted text begin (c) CPR training may be provided for less than four hours.
 deleted text end

deleted text begin (d) Persons providing CPR training must use CPR training that has been developed:
 deleted text end

deleted text begin (1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
 deleted text end

deleted text begin (2) using nationally recognized, evidence-based guidelines for CPR and incorporates
psychomotor skills to support the instruction.
 deleted text end

new text begin (a) Unless training has been completed within the previous two years, the director, staff
persons, substitutes, and unsupervised volunteers must satisfactorily complete pediatric
cardiopulmonary resuscitation (CPR) training that meets the requirements of this subdivision.
Pediatric CPR training must be completed prior to having unsupervised direct contact with
a child, but not to exceed the first 90 days of employment.
 new text end

new text begin (b) Pediatric CPR training must be provided by an individual approved to provide
pediatric CPR instruction.
 new text end

new text begin (c) The Pediatric CPR training must:
 new text end

new text begin (1) cover CPR techniques for infants and children and the treatment of obstructed airways;
 new text end

new text begin (2) include instruction, hands-on practice, and an in-person, observed skills assessment
under the direct supervision of a CPR instructor; and
 new text end

new text begin (3) be developed by the American Heart Association, the American Red Cross, or another
organization that uses nationally recognized, evidence-based guidelines for CPR.
 new text end

new text begin (d) Pediatric CPR training must be repeated at least once every second calendar year.
 new text end

new text begin (e) Pediatric CPR training in this subdivision must not be used to meet in-service training
requirements under subdivision 7.
 new text end

Subd. 5.

Sudden unexpected infant death deleted text begin and abusive head traumadeleted text end training.

new text begin (a)
Before caring for infants, the director, staff persons, substitutes, and unsupervised volunteers
must receive training on the standards under section 245A.1435 and on reducing the risk
of sudden unexpected infant death during orientation and each calendar year thereafter.
 new text end

new text begin (b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length. At a minimum, the training must address the risk
factors related to sudden unexpected infant death, means of reducing the risk of sudden
unexpected infant death in child care, and license holder communication with parents
regarding reducing the risk of sudden unexpected infant death.
 new text end

new text begin (c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
 new text end

new text begin Subd. 5a. new text end

new text begin Abusive head trauma training. new text end

deleted text begin (a) License holders must document that
before staff persons and volunteers care for infants, they are instructed on the standards in
section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
death. In addition, license holders must document that before staff persons care for infants
or children under school age, they receive training on the risk of abusive head trauma from
shaking infants and young children. The training in this subdivision may be provided as
orientation training under subdivision 1 and in-service training under subdivision 7. deleted text end new text begin (a)
Before caring for children under school age, the director, staff persons, substitutes, and
unsupervised volunteers must receive training on the risk of abusive head trauma during
orientation and each calendar year thereafter.
 new text end

deleted text begin (b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length and must be completed at least once every year. At
a minimum, the training must address the risk factors related to sudden unexpected infant
death, means of reducing the risk of sudden unexpected infant death in child care, and license
holder communication with parents regarding reducing the risk of sudden unexpected infant
death.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end Abusive head trauma training under this subdivision must be at least one-half
hour in length deleted text begin and must be completed at least once every yeardeleted text end . At a minimum, the training
must address the risk factors related to shaking infants and young children, means to reduce
the risk of abusive head trauma in child care, and license holder communication with parents
regarding reducing the risk of abusive head trauma.

new text begin (c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
 new text end

(d) The commissioner shall make available for viewing a video presentation on the
dangers associated with shaking infants and young children, which may be used in
conjunction with the annual training required under paragraph deleted text begin (c)deleted text end new text begin (a)new text end .

Subd. 6.

Child passenger restraint systemsdeleted text begin ; training requirementdeleted text end .

deleted text begin (a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685. (b) Child care centers that serve a child or children under nine years
of age must document training that fulfills the requirements in this subdivision.
 deleted text end

deleted text begin (1)deleted text end new text begin (a)new text end Before a license holder transports a child or children under age deleted text begin ninedeleted text end new text begin eightnew text end in a
motor vehicle, the person placing the child or children in a passenger restraint must
satisfactorily complete training on the proper use and installation of child restraint systems
in motor vehicles. deleted text begin Training completed under this subdivision may be used to meet orientation
training under subdivision 1 and in-service training under subdivision 7.
deleted text end

deleted text begin (2)deleted text end new text begin (b)new text end Training required under this subdivision must be deleted text begin at least one hour in length,
completed at orientation, anddeleted text end repeated at least once every five years. At a minimum, the
training must address the proper use of child restraint systems based on the child's size,
weight, and age, and the proper installation of a car seat or booster seat in the motor vehicle
used by the license holder to transport the child or children.

deleted text begin (3)deleted text end new text begin (c)new text end Training required under this subdivision must be provided by individuals who
are certified and approved by the Department of Public Safety, Office of Traffic Safety.
License holders may obtain a list of certified and approved trainers through the Department
of Public Safety website or by contacting the agency.

deleted text begin (4)deleted text end new text begin (d)new text end Child care providers that only transport school-age children as defined in section
245A.02, subdivision 16, in child care buses as defined in section 169.448, subdivision 1,
paragraph (e), are exempt from this subdivision.

new text begin (e) Training completed under this subdivision may be used to meet in-service training
requirements under subdivision 7. Training completed within the previous five years is
transferable upon a staff person's change in employment to another child care center.
 new text end

Subd. 7.

In-service.

(a) A license holder must ensure that the center director deleted text begin and all staff
who have direct contact with a child complete annual in-service training. In-service training
requirements must be met by a staff person's participation in the following training areas:deleted text end new text begin ,
staff persons, substitutes, and unsupervised volunteers complete in-service training each
calendar year.
new text end

new text begin (b) The center director and staff persons who work more than 20 hours per week must
complete 24 hours of in-service training each calendar year. Staff persons who work 20
hours or less per week must complete 12 hours of in-service training each calendar year.
Substitutes and unsupervised volunteers must complete the requirements of paragraphs (e)
to (h) and do not otherwise have a minimum number of hours of training to complete.
 new text end

new text begin (c) The number of in-service training hours may be prorated for individuals not employed
for an entire year.
 new text end

new text begin (d) Each year, in-service training must include:
 new text end

new text begin (1) the center's procedures for maintaining health and safety according to section 245A.41
and Minnesota Rules, part 9503.0140, and handling emergencies and accidents according
to Minnesota Rules, part 9503.0110;
 new text end

new text begin (2) the reporting responsibilities under section 626.556 and Minnesota Rules, part
9503.0130;
 new text end

new text begin (3) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required under subdivision 5, if
applicable; and
 new text end

new text begin (4) at least one-half hour of training on the risk of abusive head trauma from shaking
infants and young children as required under subdivision 5a, if applicable.
 new text end

new text begin (e) Each year, or when a change is made, whichever is more frequent, in-service training
must be provided on: (1) the center's risk reduction plan under section 245A.66, subdivision
2; and (2) a child's individual child care program plan as required under Minnesota Rules,
part 9503.0065, subpart 3.
 new text end

new text begin (f) At least once every two calendar years, the in-service training must include:
 new text end

new text begin (1) child development and learning training under subdivision 2;
 new text end

new text begin (2) pediatric first aid that meets the requirements of subdivision 3;
 new text end

new text begin (3) pediatric cardiopulmonary resuscitation training that meets the requirements of
subdivision 4;
 new text end

new text begin (4) cultural dynamics training to increase awareness of cultural differences; and
 new text end

new text begin (5) disabilities training to increase awareness of differing abilities of children.
 new text end

new text begin (g) At least once every five years, in-service training must include child passenger
restraint training that meets the requirements of subdivision 6, if applicable.
 new text end

new text begin (h) The remaining hours of the in-service training requirement must be met by completing
training in the following content areas of the Minnesota Knowledge and Competency
Framework:
 new text end

(1)new text begin Content area I:new text end child development and learning;

(2)new text begin Content area II:new text end developmentally appropriate learning experiences;

(3)new text begin Content area III:new text end relationships with families;

(4)new text begin Content area IV:new text end assessment, evaluation, and individualization;

(5)new text begin Content area V:new text end historical and contemporary development of early childhood
education;

(6)new text begin Content area VI:new text end professionalism; deleted text begin and
deleted text end

(7)new text begin Content area VII:new text end health, safety, and nutritionnew text begin ; and
new text end

new text begin (8) Content area VIII: application through clinical experiencesnew text end .

deleted text begin (b)deleted text end new text begin (i)new text end For purposes of this subdivision, the following terms have the meanings given
them.

(1) "Child development and learning training" deleted text begin has the meaning given it in subdivision
2, paragraph (a).deleted text end new text begin means training in understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community.
new text end

(2) "Developmentally appropriate learning experiences" means creating positive learning
experiences, promoting cognitive development, promoting social and emotional development,
promoting physical development, and promoting creative development.

(3) "Relationships with families" means training on building a positive, respectful
relationship with the child's family.

(4) "Assessment, evaluation, and individualization" means 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" means
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs.

(6) "Professionalism" means training in knowledge, skills, and abilities that promote
ongoing professional development.

(7) "Health, safety, and nutrition" means training in establishing health practices, ensuring
safety, and providing healthy nutrition.

new text begin (8) "Application through clinical experiences" means clinical experiences in which a
person applies effective teaching practices using a range of educational programming models.
 new text end

deleted text begin (c) The director and all program staff persons must annually complete a number of hours
of in-service training equal to at least two percent of the hours for which the director or
program staff person is annually paid, unless one of the following is applicable.
 deleted text end

deleted text begin (1) A teacher at a child care center must complete one percent of working hours of
in-service training annually if the teacher:
 deleted text end

deleted text begin (i) possesses a baccalaureate or master's degree in early childhood education or school-age
care;
 deleted text end

deleted text begin (ii) is licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
 deleted text end

deleted text begin (iii) possesses a baccalaureate degree with a Montessori certificate.
 deleted text end

deleted text begin (2) A teacher or assistant teacher at a child care center must complete one and one-half
percent of working hours of in-service training annually if the individual is:
 deleted text end

deleted text begin (i) a registered nurse or licensed practical nurse with experience working with infants;
 deleted text end

deleted text begin (ii) possesses a Montessori certificate, a technical college certificate in early childhood
development, or a child development associate certificate; or
 deleted text end

deleted text begin (iii) possesses an associate of arts degree in early childhood education, a baccalaureate
degree in child development, or a technical college diploma in early childhood development.
 deleted text end

deleted text begin (d) The number of required training hours may be prorated for individuals not employed
full time or for an entire year.
 deleted text end

deleted text begin (e) The annual in-service training must be completed within the calendar year for which
it was required. In-service training completed by staff persons is transferable upon a staff
person's change in employment to another child care program.
 deleted text end

deleted text begin (f)deleted text end new text begin (j)new text end The license holder must ensure thatdeleted text begin , when a staff person completes in-service
training, the training is documented in the staff person's personnel record. The documentation
must include the date training was completed, the goal of the training and topics covered,
trainer's name and organizational affiliation, trainer's signed statement that training was
successfully completed,deleted text end new text begin documentation, as required in subdivision 10, includes the number
of total training hours required to be completed, name of the training, the Minnesota
Knowledge and Competency Framework content area, number of hours completed,new text end and the
director's approval of the training.

new text begin (k) In-service training completed by a staff person that is not specific to that child care
center is transferable upon a staff person's change in employment to another child care
program.
 new text end

deleted text begin Subd. 8. deleted text end

deleted text begin Cultural dynamics and disabilities training for child care providers. deleted text end

deleted text begin (a)
The training required of licensed child care center staff must include training in the cultural
dynamics of early childhood development and child care. The cultural dynamics and
disabilities training and skills development of child care providers must be designed to
achieve outcomes for providers of child care that include, but are not limited to:
 deleted text end

deleted text begin (1) an understanding and support of the importance of culture and differences in ability
in children's identity development;
 deleted text end

deleted text begin (2) understanding the importance of awareness of cultural differences and similarities
in working with children and their families;
 deleted text end

deleted text begin (3) understanding and support of the needs of families and children with differences in
ability;
 deleted text end

deleted text begin (4) developing skills to help children develop unbiased attitudes about cultural differences
and differences in ability;
 deleted text end

deleted text begin (5) developing skills in culturally appropriate caregiving; and
 deleted text end

deleted text begin (6) developing skills in appropriate caregiving for children of different abilities.
 deleted text end

deleted text begin (b) Curriculum for cultural dynamics and disability training shall be approved by the
commissioner.
 deleted text end

deleted text begin (c) The commissioner shall amend current rules relating to the training of the licensed
child care center staff to require cultural dynamics training. Timelines established in the
rule amendments for complying with the cultural dynamics training requirements must be
based on the commissioner's determination that curriculum materials and trainers are available
statewide.
 deleted text end

deleted text begin (d) For programs caring for children with special needs, the license holder shall ensure
that any additional staff training required by the child's individual child care program plan
required under Minnesota Rules, part 9503.0065, subpart 3, is provided.
 deleted text end

deleted text begin Subd. 9. deleted text end

deleted text begin Ongoing health and safety training. deleted text end

deleted text begin A staff person's orientation training on
maintaining health and safety and handling emergencies and accidents, as required in
subdivision 1, must be repeated at least once each calendar year by each staff person. The
completion of the annual training must be documented in the staff person's personnel record.
 deleted text end

new text begin Subd. 10. new text end

new text begin Documentation. new text end

new text begin All training must be documented and maintained on site in
each personnel record. In addition to any requirements for each training provided in this
section, documentation for each staff person must include the staff person's first date of
direct contact and first date of unsupervised contact with a child in care.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 245A.41, is amended to read:


245A.41 CHILD CARE CENTER HEALTH AND SAFETY REQUIREMENTS.

Subdivision 1.

Allergy prevention and response.

(a) Before admitting a child for care,
the license holder must obtain documentation of any known allergy from the child's parent
or legal guardian or the child's source of medical care. If a child has a known allergy, the
license holder must maintain current information about the allergy in the child's record and
develop an individual child care program plan as specified in Minnesota Rules, part
9503.0065, subpart 3. The individual child care program plan must include but not be limited
to a description of the allergy, specific triggers, avoidance techniques, symptoms of an
allergic reaction, and procedures for responding to an allergic reaction, including medication,
dosages, and a doctor's contact information.

(b) The license holder must ensure that each staff person who is responsible for carrying
out the individual child care program plan review and follow the plan. Documentation of a
staff person's review must be kept on site.

(c) At least deleted text begin annuallydeleted text end new text begin once each calendar yearnew text end or following any changes made to
allergy-related information in the child's record, the license holder must update the child's
individual child care program plan and inform each staff person who is responsible for
carrying out the individual child care program plan of the change. The license holder must
keep on site documentation that a staff person was informed of a change.

(d) A child's allergy information must be available at all times including on site, when
on field trips, or during transportation. A child's food allergy information must be readily
available to a staff person in the area where food is prepared and served to the child.

(e) The license holder must contact the child's parent or legal guardian as soon as possible
in any instance of exposure or allergic reaction that requires medication or medical
intervention. The license holder must call emergency medical services when epinephrine
is administered to a child in the license holder's care.

Subd. 2.

Handling and disposal of bodily fluids.

The licensed child care center must
comply with the following procedures for safely handling and disposing of bodily fluids:

(1) surfaces that come in contact with potentially infectious bodily fluids, including
blood and vomit, must be cleaned and disinfected according to Minnesota Rules, part
9503.0005, subpart 11;

(2) blood-contaminated material must be disposed of in a plastic bag with a secure tie;

(3) sharp items used for a child with special care needs must be disposed of in a "sharps
container." The sharps container must be stored out of reach of a child;

(4) the license holder must have the following bodily fluid disposal supplies in the center:
disposable gloves, disposal bags, and eye protection; and

(5) the license holder must ensure that each staff person deleted text begin is trained ondeleted text end new text begin followsnew text end universal
precautions to reduce the risk of spreading infectious disease. deleted text begin A staff person's completion
of the training must be documented in the staff person's personnel record.
deleted text end

Subd. 3.

Emergency preparedness.

(a) deleted text begin No later than September 30, 2017,deleted text end A licensed
child care center must have a written emergency plan for emergencies that require evacuation,
sheltering, or other protection of a child, such as fire, natural disaster, intruder, or other
threatening situation that may pose a health or safety hazard to a child. The plan must be
written on a form developed by the commissioner and must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the evacuation, relocation,
shelter-in-place, or lockdown, including procedures for reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin ; and
new text end

new text begin (8) accommodations for infants and toddlersnew text end .

deleted text begin (b) The license holder must train staff persons on the emergency plan at orientation,
when changes are made to the plan, and at least once each calendar year. Training must be
documented in each staff person's personnel file.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9503.0110, subpart 3. The date and time of the drills must be documented.

deleted text begin (d)deleted text end new text begin (c)new text end The license holder must review and update the emergency plan deleted text begin annuallydeleted text end new text begin at least
once each calendar year. Staff must be informed of any changes made to the emergency
plannew text end . Documentation of the deleted text begin annualdeleted text end new text begin yearlynew text end emergency plan reviewnew text begin and staff notification of
changesnew text end shall be maintained in the program's administrative records.

deleted text begin (e)deleted text end new text begin (d)new text end The license holder must include the emergency plan in the program's policies
and procedures as specified under section 245A.04, subdivision 14. deleted text begin The license holder must
provide a physical or electronic copy of the emergency plan to the child's parent or legal
guardian upon enrollment.
deleted text end

deleted text begin (f)deleted text end new text begin (e)new text end The relocation site and evacuation route must be posted in a visible place as part
of the written procedures for emergencies and accidents in Minnesota Rules, part 9503.0140,
subpart 21.

new text begin Subd. 4. new text end

new text begin Child passenger restraint requirements. new text end

new text begin A license holder must comply with
all seat belt and child passenger restraint system requirements under section 169.685.
 new text end

new text begin Subd. 5. new text end

new text begin Telephone requirement in licensed child care centers. new text end

new text begin (a) A working telephone
which is capable of making outgoing calls and receiving incoming calls must be located
within the licensed child care center at all times. Staff must have access to a working
telephone while providing care and supervision to children in care, even if the care occurs
outside of the child care facility. A license holder may use a cellular telephone to meet the
requirements of this subdivision.
 new text end

new text begin (b) If a cellular telephone is used to satisfy the requirements of this subdivision, the
cellular telephone must be accessible to staff, be stored in a centrally located area when not
in use, and remain charged at all times.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 11.

Minnesota Statutes 2018, section 245A.50, is amended to read:


245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.

Subdivision 1.

Initial training.

(a) License holders, caregivers, deleted text begin anddeleted text end substitutesnew text begin ,
emergency substitutes, and helpersnew text end must comply with the training requirements in this
section.

deleted text begin (b) Helpers who assist with care on a regular basis must complete six hours of training
within one year after the date of initial employment.
 deleted text end

new text begin (b) The license holder, before initial licensure, and a caregiver, before caring for a child,
must complete:
 new text end

new text begin (1) the six-hour Supervising for Safety for Family Child Care course developed by the
commissioner;
 new text end

new text begin (2) a two-hour course in Knowledge and Competency Area I: Child Development and
Learning, as required by subdivision 2;
 new text end

new text begin (3) a two-hour course in behavior guidance that may be fulfilled by completing any
course in Knowledge and Competency Area II-C: Promoting Social and Emotional
Development, as required by subdivision 2;
 new text end

new text begin (4) pediatric first aid, as required by subdivision 3;
 new text end

new text begin (5) pediatric cardiopulmonary resuscitation, as required by subdivision 4;
 new text end

new text begin (6) if applicable, training in reducing the risk of sudden unexpected infant death and
abusive head trauma as required by subdivision 5; and
 new text end

new text begin (7) if applicable, training in child passenger restraint as required by subdivision 6.
 new text end

new text begin The license holder or caregiver may take one four-hour course that covers both clauses (2)
and (3) to meet the requirements of this subdivision.
 new text end

new text begin (c) Before caring for a child, each substitute and emergency substitute must complete:
 new text end

new text begin (1) the four-hour Basics of Licensed Family Child Care for Substitutes course developed
by the commissioner;
 new text end

new text begin (2) pediatric first aid, as required by subdivision 3;
 new text end

new text begin (3) pediatric cardiopulmonary resuscitation, as required by subdivision 4; and
 new text end

new text begin (4) if applicable, training in reducing the risk of sudden unexpected infant death and
abusive head trauma as required by subdivision 5.
 new text end

new text begin (d) Each helper must complete:
 new text end

new text begin (1) if applicable, before assisting with the care of a child under school age, training in
reducing the risk of sudden unexpected infant death and abusive head trauma, as required
by subdivision 5; and
 new text end

new text begin (2) within 90 days of the start of employment, the one-hour Child Development for
Helpers course developed by the commissioner.
 new text end

new text begin (e) Before caring for a child or assisting in the care of a child, the license holder must
train each caregiver, substitute, and emergency substitute on:
 new text end

new text begin (1) the emergency plan required under section 245A.51, subdivision 3, paragraph (b);
 new text end

new text begin (2) allergy prevention and response required under section 245A.51, subdivision 1,
paragraph (b); and
 new text end

new text begin (3) the drug and alcohol policy required under section 245A.04, subdivision 1, paragraph
(c).
 new text end

deleted text begin (c)deleted text end new text begin (f)new text end Training requirements established under this section that must be completed prior
to initial licensure must be satisfied only by a newly licensed child care provider or by a
child care provider who has not held an active child care license in Minnesota in the previous
12 months. A child care provider who relocates within the state or who voluntarily cancels
a license or allows the license to lapse for a period of less than 12 months and who seeks
reinstatement of the lapsed or canceled license within 12 months of the lapse or cancellation
must satisfy the annual, ongoing training requirements, and is not required to satisfy the
training requirements that must be completed prior to initial licensure.

new text begin Subd. 1a. 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) "Basics of Family Child Care for Substitutes" means a class developed by the
commissioner that includes the following topics: prevention and control of infectious
diseases; administering medication; preventing and responding to allergies; ensuring building
and physical premise safety; handling and storing biological contaminants; preventing and
reporting abuse and child maltreatment; emergency preparedness; and child development.
 new text end

new text begin (c) "Caregiver" means an adult other than the license holder who supervises children
for a cumulative total of 300 or more hours in any calendar year.
 new text end

new text begin (d) "Emergency substitute" means an adult who assumes the responsibility of a provider
for a cumulative total of not more than 50 hours in a calendar year.
 new text end

new text begin (e) "Helper" means a minor, ages 13 through 17, who assists in the care of the children.
 new text end

new text begin (f) "Substitute" means an adult who assumes the responsibility of a provider for a
cumulative total of not more than 300 hours in any calendar year.
 new text end

Subd. 2.

Child development and learning and behavior guidance training.

(a) deleted text begin For
purposes of family and group family child care,deleted text end The license holder and each deleted text begin adultdeleted text end caregiver
deleted text begin who provides care in the licensed setting for more than 30 days in any 12-month perioddeleted text end
shall complete deleted text begin and documentdeleted text end at least four hours of child growth and learning and behavior
guidance training prior to initial licensure, and before caring for children. deleted text begin For purposes of
this subdivision, "child development and learning training" means training in understanding
how children develop physically, cognitively, emotionally, and socially and learn as part
of the children's family, culture, and community. "Behavior guidance training" means
training in the understanding of the functions of child behavior and strategies for managing
challenging situations. At least two hours of child development and learning or behavior
guidance training must be repeated annually. Training curriculum shall be developed or
approved by the commissioner of human services.
deleted text end

(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:

(1) have taken a three-credit course on early childhood development within the past five
years;

(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;

(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to grade 6 teacher with a prekindergarten specialty, an early childhood special
education teacher, or an elementary teacher with a kindergarten endorsement; or

(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.

new text begin (c) The license holder and each caregiver must complete at least two hours of child
development training annually that may be fulfilled by completing any course in Knowledge
and Competency Area I: Child Development and Learning; or behavior guidance training
that may be fulfilled by completing any course in Knowledge and Competency Area II-C:
Promoting Social and Emotional Development. The commissioner shall develop or approve
training curriculum.
 new text end

Subd. 3.

First aid.

(a) deleted text begin When children are present in a family child care home governed
by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person must be present
in the home who has been trained in first aid.deleted text end new text begin The license holder must complete pediatric
first aid training before licensure and each caregiver, substitute, and emergency substitute
must complete pediatric first aid training before caring for children.new text end The first aid training
must have been provided by an individual approved to provide first aid instruction. First
aid training may be less than eight hours and persons qualified to provide first aid training
include individuals approved as first aid instructors. deleted text begin First aid training must be repeated
every two years.
deleted text end

(b) deleted text begin A family child care provider is exempt from the first aid training requirements under
this subdivision related to any substitute caregiver who provides less than 30 hours of care
during any 12-month period.deleted text end new text begin The license holder, each caregiver, substitute, and emergency
substitute must complete additional pediatric first aid training every two years.
new text end

(c) Video training reviewed and approved by the county licensing agency satisfies the
training requirement of this subdivision.

Subd. 4.

Cardiopulmonary resuscitation.

(a) deleted text begin When children are present in a family
child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one
caregiver must be present in the home who has been trained in cardiopulmonary resuscitation
(CPR), including CPR techniques for infants and children, and in the treatment of obstructed
airways. The CPR training must have been provided by an individual approved to provide
CPR instruction, must be repeated at least once every two years, and must be documented
in the caregiver's records.deleted text end new text begin The family child care license holder must complete pediatric
cardiopulmonary resuscitation (CPR) training prior to licensure. Caregivers, substitutes,
and emergency substitutes must complete pediatric CPR training prior to caring for children.
Training that has been completed in the previous two years fulfills this requirement.
new text end

(b) deleted text begin A family child care provider is exempt from the CPR training requirement in this
subdivision related to any substitute caregiver who provides less than 30 hours of care during
any 12-month period.deleted text end new text begin The CPR training must be provided by an individual approved to
provide CPR instruction.
new text end

(c) deleted text begin Persons providing CPR training must use CPR training that has been developed:deleted text end new text begin The
Pediatric CPR training must:
new text end

deleted text begin (1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
 deleted text end

deleted text begin (2) using nationally recognized, evidence-based guidelines for CPR training and
incorporates psychomotor skills to support the instruction.
 deleted text end

new text begin (1) cover CPR techniques for infants and children and the treatment of obstructed airways;
 new text end

new text begin (2) include instruction, hands-on practice, and an in-person observed skills assessment
under the direct supervision of a CPR instructor; and
 new text end

new text begin (3) be developed by the American Heart Association, the American Red Cross, or another
organization that uses nationally recognized, evidence-based guidelines for CPR.
 new text end

new text begin (d) License holders, caregivers, substitutes, and emergency substitutes must complete
pediatric CPR training at least once every two years.
 new text end

Subd. 5.

Sudden unexpected infant death and abusive head trauma training.

(a)new text begin
The license holder must complete training on reducing the risk of sudden unexpected infant
death prior to caring for infants.new text end License holders must deleted text begin documentdeleted text end new text begin ensurenew text end that before deleted text begin staff
persons,deleted text end caregivers,new text begin substitutes, emergency substitutes,new text end and helpers assist in the care of
infants, they are instructed on the standards in section 245A.1435 and receive training on
reducing the risk of sudden unexpected infant death.

new text begin (b) The license holder must complete training on reducing the risk of abusive head
trauma, prior to caring for infants and children under school age.new text end In addition, license holders
must deleted text begin documentdeleted text end new text begin ensurenew text end that before deleted text begin staff persons,deleted text end caregivers,new text begin substitutes, emergency substitutes,new text end
and helpers assist in the care of infants and children under school age, they receive training
on reducing the risk of abusive head trauma deleted text begin from shaking infants and young childrendeleted text end . deleted text begin The
training in this subdivision may be provided as initial training under subdivision 1 or ongoing
annual training under subdivision 7.
deleted text end

deleted text begin (b)deleted text end new text begin (c)new text end Sudden unexpected infant death reduction training required under this subdivision
must, at a minimum, address the risk factors related to sudden unexpected infant death,
means of reducing the risk of sudden unexpected infant death in child care, and license
holder communication with parents regarding reducing the risk of sudden unexpected infant
death.

deleted text begin (c)deleted text end new text begin (d)new text end Abusive head trauma training required under this subdivision must, at a minimum,
address the risk factors related to shaking infants and young children, means of reducing
the risk of abusive head trauma in child care, and license holder communication with parents
regarding reducing the risk of abusive head trauma.

deleted text begin (d)deleted text end new text begin (e)new text end Training for family and group family child care providers must be developed by
the commissioner deleted text begin in conjunction with the Minnesota Sudden Infant Death Centerdeleted text end and
approved by deleted text begin the Minnesota Center for Professional Developmentdeleted text end new text begin Achieve - The MN Center
for Professional Developmentnew text end . Sudden unexpected infant death reduction training and
abusive head trauma training may be provided in a single course of no more than two hours
in length.

deleted text begin (e)deleted text end new text begin (f)new text end Sudden unexpected infant death reduction training and abusive head trauma
training required under this subdivision must be completed in person or as allowed under
subdivision 10, clause (1) or (2), at least once every two years. On the years when the license
holder deleted text begin isdeleted text end new text begin , caregiver, substitute, and helper arenew text end not receiving training in person or as allowed
under subdivision 10, clause (1) or (2), the license holdernew text begin , caregiver, substitute, and helpernew text end
must receive sudden unexpected infant death reduction training and abusive head trauma
training through a video of no more than one hour in length. The video must be developed
or approved by the commissioner.

deleted text begin (f)deleted text end new text begin (g)new text end An individual who is related to the license holder as defined in section 245A.02,
subdivision 13, and who is involved only in the care of the license holder's own infant or
child under school age and who is not designated to be a caregiver, helper, or substitute, as
defined in Minnesota Rules, part 9502.0315, for the licensed program, is exempt from the
sudden unexpected infant death and abusive head trauma training.

Subd. 6.

Child passenger restraint systems; training requirement.

deleted text begin (a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685.
 deleted text end

deleted text begin (b) Family and group family child care programs licensed by the Department of Human
Services that serve a child or children under nine years of age must document training that
fulfills the requirements in this subdivision.
 deleted text end

new text begin (a)new text end (1) Before a license holder, deleted text begin staff person, caregiver, or helperdeleted text end new text begin caregiver, substitute, or
emergency substitutenew text end transports a child or children under age deleted text begin ninedeleted text end new text begin eightnew text end in a motor vehicle,
the person placing the child or children in a passenger restraint must satisfactorily complete
training on the proper use and installation of child restraint systems in motor vehicles.
Training completed under this subdivision may be used to meet initial training under
subdivision 1 or ongoing training under subdivision 7.

(2) Training required under this subdivision must be deleted text begin at least one hour in length, completed
at initial training, anddeleted text end repeated at least once every five years.

new text begin (3)new text end At a minimum, the training must address the proper use of child restraint systems
based on the child's size, weight, and age, and the proper installation of a car seat or booster
seat in the motor vehicle used by the license holder to transport the child or children.

deleted text begin (3)deleted text end new text begin (4)new text end Training under this subdivision must be provided by individuals who are certified
and approved by the Department of Public Safety, Office of Traffic Safety. License holders
may obtain a list of certified and approved trainers through the Department of Public Safety
website or by contacting the agency.

deleted text begin (c)deleted text end new text begin (b)new text end Child care providers that only transport school-age children as defined in section
245A.02, subdivision 19, paragraph (f), in child care buses as defined in section 169.448,
subdivision 1, paragraph (e), are exempt from this subdivision.

Subd. 7.

new text begin Ongoing new text end training requirements for family and group family child carenew text begin
license holders and caregiversnew text end .

deleted text begin For purposes of family and group family child care,deleted text end new text begin (a)new text end
The license holder and each primary caregiver must complete 16 hours of ongoing training
each year. deleted text begin For purposes of this subdivision, a primary caregiver is an adult caregiver who
provides services in the licensed setting for more than 30 days in any 12-month period.
Repeat of topical training requirements in subdivisions 2 to 8 shall count toward the annual
16-hour training requirement.
deleted text end

new text begin (b) The license holder and caregiver must annually complete ongoing training as follows:
 new text end

new text begin (1) as required by subdivision 2, a two-hour course in: child development that may be
fulfilled by any course in Knowledge and Competency Area I: Child Development and
Learning; or behavior guidance that may be fulfilled by any course in Knowledge and
Competency Area II-C: Promoting Social and Emotional Development;
 new text end

new text begin (2) a two-hour course in active supervision that may be fulfilled by any course in:
Knowledge and Competency Area VII-A: Establishing Healthy Practices; or Knowledge
and Competency Area VII-B: Ensuring Safety; and
 new text end

new text begin (3) if applicable, ongoing training in reducing the risk of sudden unexpected infant death
and abusive head trauma, as required under subdivision 5.
 new text end

new text begin (c) At least once every two years, the license holder and caregiver must complete ongoing
training as follows:
 new text end

new text begin (1) training in pediatric first aid as required under subdivision 3;
 new text end

new text begin (2) training in pediatric CPR as required under subdivision 4; and
 new text end

new text begin (3) a two-hour course on accommodating children with disabilities or on cultural
dynamics that may be fulfilled by completing any course in Knowledge and Competency
Area III: Relationships with Families.
 new text end

new text begin (d) At least once every five years, the license holder and caregiver must complete ongoing
training as follows:
 new text end

new text begin (1) the two-hour courses Health and Safety I and Health and Safety II; and
 new text end

new text begin (2) if applicable, ongoing training in child passenger restraint, as required under
subdivision 6.
 new text end

new text begin (e)new text end Additional ongoing training subjects to meet the annual 16-hour training requirement
must be selected from deleted text begin the following areasdeleted text end new text begin training in the following content areas of the
Minnesota Knowledge and Competency Frameworknew text end :

(1)new text begin Content area I:new text end child development and learningnew text begin , includingnew text end training deleted text begin under subdivision
2, paragraph (a)deleted text end new text begin in understanding how children develop physically, cognitively, emotionally,
and socially; and learn as part of the childrens' family, culture, and communitynew text end ;

(2)new text begin Content area II:new text end 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)new text begin Content area III:new text end relationships with families, including training in building a positive,
respectful relationship with the child's family;

(4)new text begin Content area IV:new text end 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)new text begin Content area V:new text end 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)new text begin Content area VI:new text end professionalism, including training in knowledge, skills, and abilities
that promote ongoing professional development; and

(7)new text begin Content area VII:new text end health, safety, and nutrition, including training in establishing
healthy practices; ensuring safety; and providing healthy nutrition.

Subd. 8.

deleted text begin Other required training requirementsdeleted text end new text begin Ongoing training requirements for
substitutes, emergency substitutes, and helpersnew text end .

deleted text begin (a) The training required of family and
group family child care providers and staff must include training in the cultural dynamics
of early childhood development and child care. The cultural dynamics and disabilities
training and skills development of child care providers must be designed to achieve outcomes
for providers of child care that include, but are not limited to:
 deleted text end

deleted text begin (1) an understanding and support of the importance of culture and differences in ability
in children's identity development;
 deleted text end

deleted text begin (2) understanding the importance of awareness of cultural differences and similarities
in working with children and their families;
 deleted text end

deleted text begin (3) understanding and support of the needs of families and children with differences in
ability;
 deleted text end

deleted text begin (4) developing skills to help children develop unbiased attitudes about cultural differences
and differences in ability;
 deleted text end

deleted text begin (5) developing skills in culturally appropriate caregiving; and
 deleted text end

deleted text begin (6) developing skills in appropriate caregiving for children of different abilities.
 deleted text end

deleted text begin The commissioner shall approve the curriculum for cultural dynamics and disability
training.
 deleted text end

deleted text begin (b) The provider must meet the training requirement in section 245A.14, subdivision
11, paragraph (a), clause (4), to be eligible to allow a child cared for at the family child care
or group family child care home to use the swimming pool located at the home.
 deleted text end

new text begin (a) Each substitute and emergency substitute must complete ongoing training on the
following schedule:
 new text end

new text begin (1) annually, if applicable, training in reducing the risk of sudden unexpected infant
death and abusive head trauma as required under subdivision 5;
 new text end

new text begin (2) at least once every two years: (i) training in pediatric first aid as required under
subdivision 3; (ii) training in pediatric CPR as required under subdivision 4; and (iii) the
four-hour Basics of Licensed Family Child Care for Substitutes course; and
 new text end

new text begin (3) at least once every five years, if applicable, training in child passenger restraints, as
required under subdivision 6.
 new text end

new text begin (b) Each helper must complete training on the following schedule:
 new text end

new text begin (1) annually, if applicable, training in reducing the risk of sudden unexpected infant
death and abusive head trauma as required under subdivision 5; and
 new text end

new text begin (2) at least once every two years: (i) the one-hour course Basics of Child Development
for Helpers; or (ii) any course in Knowledge and Competency Area I: Child Development
and Learning.
 new text end

deleted text begin Subd. 9. deleted text end

deleted text begin Supervising for safety; training requirement. deleted text end

deleted text begin (a) Before initial licensure and
before caring for a child, all family child care license holders and each adult caregiver who
provides care in the licensed family child care home for more than 30 days in any 12-month
period shall complete and document the completion of the six-hour Supervising for Safety
for Family Child Care course developed by the commissioner.
 deleted text end

deleted text begin (b) The family child care license holder and each adult caregiver who provides care in
the licensed family child care home for more than 30 days in any 12-month period shall
complete and document:
 deleted text end

deleted text begin (1) the annual completion of a two-hour active supervision course developed by the
commissioner; and
 deleted text end

deleted text begin (2) the completion at least once every five years of the two-hour courses Health and
Safety I and Health and Safety II. A license holder's or adult caregiver's completion of either
training in a given year meets the annual active supervision training requirement in clause
(1).
 deleted text end

Subd. 10.

Approved training.

County licensing staff must accept training approved by
deleted text begin the Minnesota Center for Professional Developmentdeleted text end new text begin Achieve - the MN Center for
Professional Developmentnew text end , including:

(1) face-to-face or classroom training;

(2) online training; and

(3) relationship-based professional development, such as mentoring, coaching, and
consulting.

Subd. 11.

Provider training.

New and increased training requirements under this section
must not be imposed on providers until the commissioner establishes statewide accessibility
to the required provider training.

new text begin Subd. 12. new text end

new text begin Documentation. new text end

new text begin The license holder must document the date of a completed
training required by this section for the license holder, each caregiver, substitute, emergency
substitute, and helper.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 12.

Minnesota Statutes 2018, section 245A.51, subdivision 3, is amended to read:


Subd. 3.

Emergency preparedness plan.

(a) deleted text begin No later than September 30, 2017,deleted text end A
licensed family child care provider must have a written emergency preparedness plan for
emergencies that require evacuation, sheltering, or other protection of children, such as fire,
natural disaster, intruder, or other threatening situation that may pose a health or safety
hazard to children. The plan must be written on a form developed by the commissioner and
updated at least annually. The plan must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the evacuation,
shelter-in-place, or lockdown, including procedures for reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitate easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin ; and
new text end

new text begin (8) accommodations for infants and toddlersnew text end .

(b) The license holder must train caregivers before the caregiver provides care and at
least annually on the emergency preparedness plan and document completion of this training.

(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9502.0435, subpart 8. The date and time of the drills must be documented.

deleted text begin (d) The license holder must have the emergency preparedness plan available for review
and posted in a prominent location. The license holder must provide a physical or electronic
copy of the plan to the child's parent or legal guardian upon enrollment.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Transporting children. new text end

new text begin A license holder must comply with all seat belt and
child passenger restraint system requirements under section 169.685.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 14.

Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Telephone requirement. new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0435,
subpart 8, item B, a license holder is not required to post a list of emergency numbers. A
license holder may use a cellular telephone to meet the requirements of Minnesota Rules,
part 9502.0435, subpart 8, if the cellular telephone remains charged at all times.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 15.

new text begin [245A.52] FAMILY CHILD CARE PHYSICAL SPACE REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Means of escape. new text end

new text begin (a) (1) At least one emergency escape route separate
from the main exit from the space must be available in each room used for sleeping by
anyone receiving licensed care, and (2) a basement used for child care. One means of escape
must be a stairway or door leading to the floor of exit discharge. The other must be a door
or window leading directly outside. A window used as an emergency escape route must be
openable without special knowledge.
 new text end

new text begin (b) In homes with construction that began before May 2, 2016, the interior of the window
leading directly outside must have a net clear opening area of not less than 4.5 square feet
or 648 square inches and have minimum clear opening dimensions of 20 inches wide and
20 inches high. The opening must be no higher than 48 inches from the floor. The height
to the window may be measured from a platform if a platform is located below the window.
 new text end

new text begin (c) In homes with construction that began on or after May 2, 2016, the interior of the
window leading directly outside must have minimum clear opening dimensions of 20 inches
wide and 24 inches high. The net clear opening dimensions shall be the result of normal
operation of the opening. The opening must be no higher than 44 inches from the floor.
 new text end

new text begin (d) The commissioner may establish additional requirements that are dependent on the
distance of the openings from the ground outside the window including: (1) windows or
other openings with a sill height not more than 44 inches above or below the finished ground
level adjacent to the opening (grade-floor emergency escape and rescue openings) must
have a minimum opening of five square feet; and (2) non-grade floor emergency escape
and rescue openings must have a minimum opening of 5.7 square feet.
 new text end

new text begin Subd. 2. new text end

new text begin Door to attached garage. new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0425,
subpart 5, day care residences with an attached garage are not required to have a self-closing
door to the residence. The door to the residence may be a steel insulated door if the door is
at least 1-3/8 inches thick.
 new text end

new text begin Subd. 3. new text end

new text begin Heating and venting systems. new text end

new text begin Notwithstanding Minnesota Rules, part
9502.0425, subpart 7, items that can be ignited and support combustion, including but not
limited to plastic, fabric, and wood products must not be located within 18 inches of a gas
or fuel-oil heater or furnace. If a license holder produces manufacturer instructions listing
a smaller distance, then the manufacturer instructions control the distance combustible items
must be from gas, fuel-oil, or solid-fuel burning heaters or furnaces.
 new text end

new text begin Subd. 4. new text end

new text begin Fire extinguisher. new text end

new text begin A portable, operational, multipurpose, dry chemical fire
extinguisher with a minimum 2 A 10 BC rating must be located in or near the kitchen and
cooking areas of the residence at all times. The fire extinguisher must be serviced annually
by a qualified inspector. All caregivers must know how to properly use the fire extinguisher.
 new text end

new text begin Subd. 5. new text end

new text begin Carbon monoxide and smoke alarms. new text end

new text begin (a) All homes must have an approved
and operational carbon monoxide alarm installed within ten feet of each room used for
sleeping children in care.
 new text end

new text begin (b) Smoke alarms that have been listed by the Underwriter Laboratory must be properly
installed and maintained on all levels including basements, but not including crawl spaces
and uninhabitable attics, and in hallways outside rooms used for sleeping children in care.
 new text end

new text begin (c) In homes with construction that began on or after May 2, 2016, smoke alarms must
be installed and maintained in each room used for sleeping children in care.
 new text end

new text begin Subd. 6. new text end

new text begin Updates. new text end

new text begin After readoption of the Minnesota State Fire Code, the fire marshal
must notify the commissioner of any changes that conflict with this section and Minnesota
Rules, chapter 9502. The state fire marshal must identify necessary statutory changes to
align statutes with the revised code. The commissioner must recommend updates to sections
of chapter 245A that are derived from the Minnesota State Fire Code in the legislative
session following readoption of the code.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 16.

new text begin [245A.53] SUPERVISION AND USE OF SUBSTITUTES.
 new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0365, subpart 5, the use of a substitute
caregiver must be limited to a cumulative total of not more than 300 hours in a calendar
year and a provider may use an additional 50 hours of care provided by an emergency
substitute, as defined in section 245A.50, subdivision 1a, in the same calendar year.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 17.

Minnesota Statutes 2018, section 245A.66, subdivision 2, is amended to read:


Subd. 2.

Child care centers; risk reduction plan.

(a) Child care centers licensed under
this chapter and Minnesota Rules, chapter 9503, must develop a risk reduction plan that
identifies the general risks to children served by the child care center. The license holder
must establish procedures to minimize identified risks, train staff on the procedures, and
annually review the procedures.

(b) The risk reduction plan must include an assessment of risk to children the center
serves or intends to serve and identify specific risks based on the outcome of the assessment.
The assessment of risk must be based on the following:

(1) an assessment of the risks presented by the physical plant where the licensed services
are provided, including an evaluation of the following factors: the condition and design of
the facility and its outdoor space, bathrooms, storage areas, and accessibility of medications
and cleaning products that are harmful to children when children are not supervised and the
existence of areas that are difficult to supervise; and

(2) an assessment of the risks presented by the environment for each facility and for
each site, including an evaluation of the following factors: the type of grounds and terrain
surrounding the building and the proximity to hazards, busy roads, and publicly accessed
businesses.

(c) The risk reduction plan must include a statement of measures that will be taken to
minimize the risk of harm presented to children for each risk identified in the assessment
required under paragraph (b) related to the physical plant and environment. At a minimum,
the stated measures must include the development and implementation of specific policies
and procedures or reference to existing policies and procedures that minimize the risks
identified.

(d) In addition to any program-specific risks identified in paragraph (b), the plan must
include development and implementation of specific policies and procedures or refer to
existing policies and procedures that minimize the risk of harm or injury to children,
including:

(1) closing children's fingers in doors, including cabinet doors;

(2) leaving children in the community without supervision;

(3) children leaving the facility without supervision;

(4) caregiver dislocation of children's elbows;

(5) burns from hot food or beverages, whether served to children or being consumed by
caregivers, and the devices used to warm food and beverages;

(6) injuries from equipment, such as scissors and glue guns;

(7) sunburn;

(8) feeding children foods to which they are allergic;

(9) children falling from changing tables; and

(10) children accessing dangerous items or chemicals or coming into contact with residue
from harmful cleaning products.

(e) The plan shall prohibit the accessibility of hazardous items to children.

(f) The plan must include specific policies and procedures to ensure adequate supervision
of children at all times as defined under section 245A.02, subdivision 18, with particular
emphasis on:

(1) times when children are transitioned from one area within the facility to another;

(2) nap-time supervision, including infant crib rooms as specified under section 245A.02,
subdivision 18, which requires that when an infant is placed in a crib to sleep, supervision
occurs when a staff person is within sight or hearing of the infant. When supervision of a
crib room is provided by sight or hearing, the center must have a plan to address the other
supervision components;

(3) child drop-off and pick-up times;

(4) supervision during outdoor play and on community activities, including but not
limited to field trips and neighborhood walks; deleted text begin and
deleted text end

(5) supervision of children in hallwaysdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) supervision of school-age children when using the restroom and visiting the child's
personal storage space.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 245A.66, subdivision 3, is amended to read:


Subd. 3.

deleted text begin Orientation todeleted text end new text begin Yearly review ofnew text end risk reduction plan deleted text begin and annual review of
plandeleted text end .

deleted text begin (a) The license holder shall ensure that all mandated reporters, as defined in section
626.556, subdivision 3, who are under the control of the license holder, receive an orientation
to the risk reduction plan prior to first providing unsupervised direct contact services, as
defined in section 245C.02, subdivision 11, to children, not to exceed 14 days from the first
supervised direct contact, and annually thereafter. The license holder must document the
orientation to the risk reduction plan in the mandated reporter's personnel records.
 deleted text end

deleted text begin (b)deleted text end The license holder must review the risk reduction plan deleted text begin annuallydeleted text end new text begin each calendar yearnew text end
and document the deleted text begin annualdeleted text end review. When conducting the review, the license holder must
consider incidents that have occurred in the center since the last review, including:

(1) the assessment factors in the plan;

(2) the internal reviews conducted under this section, if any;

(3) substantiated maltreatment findings, if any; and

(4) incidents that caused injury or harm to a child, if any, that occurred since the last
review.

Following any change to the risk reduction plan, the license holder must inform deleted text begin mandated
reportersdeleted text end new text begin staff personsnew text end , under the control of the license holder, of the changes in the risk
reduction plan, and document that the deleted text begin mandated reportersdeleted text end new text begin staffnew text end were informed of the changes.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:


new text begin Subd. 5a. new text end

new text begin License-exempt child care center certification holder. new text end

new text begin "License-exempt
child care center certification holder" has the meaning given for "certification holder" in
section 245H.01, subdivision 4.
 new text end

Sec. 20.

Minnesota Statutes 2018, section 245C.02, subdivision 6a, is amended to read:


Subd. 6a.

Child care background study subject.

new text begin (a) new text end "Child care background study
subject" means an individual who is affiliated with a licensed child care center, certified
license exempt child care center, licensed family child care program, or legal nonlicensed
child care provider authorized under chapter 119B, andnew text begin who isnew text end :

(1) deleted text begin who isdeleted text end employed by a child care provider for compensation;

(2) deleted text begin whose activities involvedeleted text end new text begin assisting innew text end the deleted text begin supervisiondeleted text end new text begin carenew text end of a child for a child care
provider; deleted text begin or
deleted text end

deleted text begin (3) who is required to have a background study under section 245C.03, subdivision 1.
 deleted text end

new text begin (3) a person applying for licensure, certification, or enrollment;
 new text end

new text begin (4) a controlling individual as defined in section 245A.02, subdivision 5a;
 new text end

new text begin (5) an individual 13 years of age or older who lives in the household where the licensed
program will be provided and who is not receiving licensed services from the program;
 new text end

new text begin (6) an individual ten to 12 years of age who lives in the household where the licensed
services will be provided when the commissioner has reasonable cause as defined in section
245C.02, subdivision 15;
 new text end

new text begin (7) an individual who, without providing direct contact services at a licensed program,
certified program, or program authorized under chapter 119B, may have unsupervised access
to a child receiving services from a program when the commissioner has reasonable cause
as defined in section 245C.02, subdivision 15; or
 new text end

new text begin (8) a volunteer, contractor, prospective employee, or other individual who has
unsupervised physical access to a child served by a program and who is not under direct,
continuous supervision by an individual listed in clause (1) or (5), regardless of whether
the individual provides program services.
 new text end

new text begin (b) Notwithstanding paragraph (a), an individual who is providing services that are not
part of the child care program is not required to have a background study if:
 new text end

new text begin (1) the child receiving services is signed out of the child care program for the duration
that the services are provided;
 new text end

new text begin (2) the licensed program, certified program, or program authorized under chapter 119B
has obtained advanced written permission from the parent authorizing the child to receive
the services, which is maintained in the child's record;
 new text end

new text begin (3) the license holder maintains documentation on-site that identifies the individual
service provider and the services being provided; and
 new text end

new text begin (4) the license holder ensures that the service provider does not have unsupervised access
to a child not receiving the provider's services.
 new text end

Sec. 21.

Minnesota Statutes 2018, section 245C.03, subdivision 1, is amended to read:


Subdivision 1.

Licensed programs.

(a) The commissioner shall conduct a background
study on:

(1) the person or persons applying for a license;

(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;

(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;

(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);

(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(7) all controlling individuals as defined in section 245A.02, subdivision 5a; and

(8) new text begin notwithstanding the other requirements in this subdivision, new text end child care background
study subjects as defined in section 245C.02, subdivision 6a.

deleted text begin (b) Paragraph (a), clauses (2), (5), and (6), apply to legal nonlicensed child care and
certified license-exempt child care programs.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end For child foster care when the license holder resides in the home where foster
care services are provided, a short-term substitute caregiver providing direct contact services
for a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.

Sec. 22.

Minnesota Statutes 2018, section 245C.05, subdivision 5a, is amended to read:


Subd. 5a.

Background study requirements for minors.

(a) A background study
completed under this chapter on a subject who is required to be studied under section
245C.03, subdivision 1, and is 17 years of age or younger shall be completed by the
commissioner for:

(1) a legal nonlicensed child care provider authorized under chapter 119B;

(2) a licensed family child care program; or

(3) a licensed foster care home.

(b) The subject shall submit to the commissioner only the information under subdivision
1, paragraph (a).

(c) A subject who is 17 years of age or younger is required to submit fingerprints and a
photograph, and the commissioner shall conduct a national criminal history record check,
if:

(1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or

(2) under paragraph (a), clauses (1) and (2), the subject is employed by the provider or
supervises children served by the program.

new text begin (d) A subject who is 17 years of age or younger is required to submit
non-fingerprint-based data according to section 245C.08, subdivision 1, paragraph (a),
clause (6), item (iii), and the commissioner shall conduct the check if:
 new text end

new text begin (1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or
 new text end

new text begin (2) the subject is employed by the provider or supervises children served by the program
under paragraph (a), clauses (1) and (2).
 new text end

Sec. 23.

Minnesota Statutes 2018, 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, clause (2);

(6) for a background study related to a child foster care application for licensure, 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; deleted text begin and
deleted text end

(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

new text begin (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
 new text end

(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. 24.

Minnesota Statutes 2018, 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 deleted text begin commissionerdeleted text end new text begin commissionersnew text end of healthnew text begin and human servicesnew text end ;

(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) new text begin Except as required by law, new text end 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 deleted text begin license holder whodeleted text end new text begin entity thatnew text end initiated the background study.

new text begin (c) If the commissioner conducts a national criminal history record check when required
by law and uses the relevant information under paragraph (a), clauses (9) and (10), to make
a disqualification determination: (1) the data is private and cannot be shared with county
agencies, private agencies, or prospective employers of the study subject; and (2) the license
holder or other entity that submitted the study is not required to obtain a copy of the study
subject's notice of disqualification under section 245C.17, subdivision 3.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 25.

Minnesota Statutes 2018, section 245C.30, subdivision 1, is amended to read:


Subdivision 1.

License holder new text begin and license-exempt child care center certification
holder new text end variance.

(a) Except for any disqualification under section 245C.15, subdivision 1,
when the commissioner has not set aside a background study subject's disqualification, and
there are conditions under which the disqualified individual may provide direct contact
services or have access to people receiving services that minimize the risk of harm to people
receiving services, the commissioner may grant a time-limited variance to a license holdernew text begin
or license-exempt child care center certification holdernew text end .

(b) The variance shall state the reason for the disqualification, the services that may be
provided by the disqualified individual, and the conditions with which the license holdernew text begin ,
license-exempt child care center certification holder,new text end or applicant must comply for the
variance to remain in effect.

(c) Except for programs licensed to provide family child care, foster care for children
in the provider's own home, or foster care or day care services for adults in the provider's
own home, the variance must be requested by the license holdernew text begin or license-exempt child
care center certification holdernew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 26.

Minnesota Statutes 2018, section 245C.30, subdivision 2, is amended to read:


Subd. 2.

Disclosure of reason for disqualification.

(a) The commissioner may not grant
a variance for a disqualified individual unless the applicantnew text begin , license-exempt child care center
certification holder,new text end or license holder requests the variance and the disqualified individual
provides written consent for the commissioner to disclose to the applicantnew text begin , license-exempt
child care center certification holder,new text end or license holder the reason for the disqualification.

(b) This subdivision does not apply to programs licensed to provide family child care
for children, foster care for children in the provider's own home, or foster care or day care
services for adults in the provider's own home. When the commissioner grants a variance
for a disqualified individual in connection with a license to provide the services specified
in this paragraph, the disqualified individual's consent is not required to disclose the reason
for the disqualification to the license holder in the variance issued under subdivision 1,
provided that the commissioner may not disclose the reason for the disqualification if the
disqualification is based on a felony-level conviction for a drug-related offense within the
past five years.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 27.

Minnesota Statutes 2018, section 245C.30, subdivision 3, is amended to read:


Subd. 3.

Consequences for failing to comply with conditions of variance.

When a
license holdernew text begin or license-exempt child care center certification holdernew text end permits a disqualified
individual to provide any services for which the subject is disqualified without complying
with the conditions of the variance, the commissioner may terminate the variance effective
immediately and subject the license holder to a licensing action under sections 245A.06
and 245A.07new text begin or a license-exempt child care center certification holder to an action under
sections 245H.06 and 245H.07new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 28.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Substitute. new text end

new text begin "Substitute" means an adult who is temporarily filling a position
as a staff person for less than 240 hours total in a calendar year due to the absence of a
regularly employed staff person who provides direct contact services to a child.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 29.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Staff person. new text end

new text begin "Staff person" means an employee of a certified center who
provides direct contact services to children.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 30.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Unsupervised volunteer. new text end

new text begin "Unsupervised volunteer" means an individual who:
(1) assists in the care of a child in care; (2) is not under the continuous direct supervision
of a staff person; and (3) is not employed by the certified center.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 31.

Minnesota Statutes 2018, section 245H.03, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Reconsideration of certification denial. new text end

new text begin (a) The applicant may request
reconsideration of the denial by notifying the commissioner by certified mail or personal
service. The request must be made in writing. If sent by certified mail, the request must be
postmarked and sent to the commissioner within ten calendar days after the applicant received
the order. If a request is made by personal service, it must be received by the commissioner
within ten calendar days after the applicant received the order. The applicant may submit
with the request for reconsideration a written argument or evidence in support of the request
for reconsideration.
 new text end

new text begin (b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 32.

Minnesota Statutes 2018, section 245H.07, is amended to read:


245H.07 DECERTIFICATION.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

(a) The commissioner may decertify a center if a certification
holder:

(1) failed to comply with an applicable law or rule; or

(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rules.

(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.

(c) When a center is decertified, the center is ineligible to receive a child care assistance
payment.

new text begin Subd. 2. new text end

new text begin Reconsideration of decertification. new text end

new text begin (a) The certification holder may request
reconsideration of the decertification by notifying the commissioner by certified mail or
personal service. The request must be made in writing. If sent by certified mail, the request
must be postmarked and sent to the commissioner within ten calendar days after the
certification holder received the order. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the certification holder received
the order. With the request for reconsideration, the certification holder may submit a written
argument or evidence in support of the request for reconsideration.
 new text end

new text begin (b) If the commissioner decertifies a center pursuant to subdivision 1, paragraph (a),
clause (1), based on a determination that the center was responsible for maltreatment, and
if the center requests reconsideration of the decertification according to this subdivision
and appeals the maltreatment determination under section 626.556, subdivision 10i, the
final decertification determination is stayed until the commissioner issues a final decision
regarding the maltreatment appeal.
 new text end

new text begin (c) The commissioner's disposition of a request for reconsideration is final and not subject
to appeal under chapter 14.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 33.

Minnesota Statutes 2018, section 245H.10, subdivision 1, is amended to read:


Subdivision 1.

Documentation.

(a) The applicant or certification holder must submit
and maintain documentation of a completed background study for:

(1) each person applying for the certification;

(2) each person identified as a center operator or program operator as defined in section
245H.01, subdivision 3;

(3) each current or prospective staff person or contractor of the certified center who will
have direct contact with a child served by the center;

(4) each volunteer who has direct contact with a child served by the center if the contact
is not under the continuous, direct supervision by an individual listed in clause (1), (2), or
(3); and

(5) each managerial staff person of the certification holder with oversight and supervision
of the certified center.

(b) To be accepted for certification, a background study on every individual in paragraph
(a), clause (1), must be completed under chapter 245C and result in a not disqualified
determination under section 245C.14 or a disqualification that was set aside under section
245C.22new text begin or was issued a variance under section 245C.30new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 34.

Minnesota Statutes 2018, section 245H.11, is amended to read:


245H.11 REPORTING.

(a) The certification holder must complynew text begin and must have written policies for staff to
complynew text end with the reporting requirements for abuse and neglect specified in section 626.556.
A person mandated to report physical or sexual child abuse or neglect occurring within a
certified center shall report the information to the commissioner.

(b) The certification holder must inform the commissioner within 24 hours of:

(1) the death of a child in the program; and

(2) any injury to a child in the program that required treatment by a physician.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 35.

Minnesota Statutes 2018, section 245H.12, is amended to read:


245H.12 FEES.

deleted text begin The commissioner shall consult with stakeholders to develop an administrative fee to
implement this chapter. By February 15, 2019, the commissioner shall provide
recommendations on the amount of an administrative fee to the legislative committees with
jurisdiction over health and human services policy and finance. deleted text end new text begin A certified center must pay
an initial application fee of $200 and an annual nonrefundable renewal fee of $100.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for any center that applies for certification
or certified center that renews the center's certification to provide services on January 1,
2020, and thereafter.
 new text end

Sec. 36.

Minnesota Statutes 2018, section 245H.13, subdivision 5, is amended to read:


Subd. 5.

Building and physical premises; free of hazards.

(a) deleted text begin The certified center
must document compliance with the State Fire Code by providingdeleted text end new text begin To be accepted for
certification, the applicant must demonstrate compliance with the State Fire Code, section
299F.011, by either:
new text end

new text begin (1) providing new text end documentation of a fire marshal inspection completed within the previous
three years by a state fire marshal or a local fire code inspector trained by the state fire
marshaldeleted text begin .deleted text end new text begin ; or
new text end

new text begin (2) complying with the fire marshal inspection requirements according to section
245A.151.
 new text end

(b) The certified center must designate a primary indoor and outdoor space used for
child care on a facility site floor plan.

(c) The certified center must ensure the areas used by a child are clean and in good repair,
with structurally sound and functional furniture and equipment that is appropriate to the
age and size of a child who uses the area.

(d) The certified center must ensure hazardous items including but not limited to sharp
objects, medicines, cleaning supplies, poisonous plants, and chemicals are out of reach of
a child.

(e) The certified center must safely handle and dispose of bodily fluids and other
potentially infectious fluids by using gloves, disinfecting surfaces that come in contact with
potentially infectious bodily fluids, and disposing of bodily fluid in a securely sealed plastic
bag.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 37.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Risk reduction plan. new text end

new text begin (a) The certified center must develop a risk reduction
plan that identifies risks to children served by the child care center. The assessment of risk
must include risks presented by (1) the physical plant where the certified services are
provided, including electrical hazards; and (2) the environment, including the proximity to
busy roads and bodies of water.
 new text end

new text begin (b) The certification holder must establish policies and procedures to minimize identified
risks. After any change to the risk reduction plan, the certification holder must inform staff
of the change in the risk reduction plan and document that staff were informed of the change.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 38.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Required policies. new text end

new text begin A certified center must have written policies for health and
safety items in subdivisions 1 to 6.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 39.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Behavior guidance. new text end

new text begin The certified center must ensure that staff and volunteers
use positive behavior guidance and do not subject children to:
 new text end

new text begin (1) corporal punishment, including but not limited to rough handling, shoving, hair
pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking;
 new text end

new text begin (2) humiliation;
 new text end

new text begin (3) abusive language;
 new text end

new text begin (4) the use of mechanical restraints, including tying;
 new text end

new text begin (5) the use of physical restraints other than to physically hold a child when containment
is necessary to protect a child or others from harm; or
 new text end

new text begin (6) the withholding or forcing of food and other basic needs.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 40.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Supervision. new text end

new text begin Staff must supervise each child at all times. Staff are responsible
for the ongoing activity of each child, appropriate visual or auditory awareness, physical
proximity, and knowledge of activity requirements and each child's needs. Staff must
intervene when necessary to ensure a child's safety. In determining the appropriate level of
supervision of a child, staff must consider: (1) the age of a child; (2) individual differences
and abilities; (3) indoor and outdoor layout of the child care program; and (4) environmental
circumstances, hazards, and risks.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 41.

Minnesota Statutes 2018, section 245H.14, subdivision 1, is amended to read:


Subdivision 1.

First aid and cardiopulmonary resuscitation.

deleted text begin At least one designated
staff person who completed pediatric first aid training and pediatric cardiopulmonary
resuscitation (CPR) training must be present at all times at the program, during field trips,
and when transporting a child. The designated staff person must repeat pediatric first aid
training and pediatric CPR training at least once every two years.
 deleted text end

new text begin (a) Before having unsupervised direct contact with a child, but within the first 90 days
of employment, the director and all staff persons, including substitutes and unsupervised
volunteers who have direct contact with a child, must successfully complete pediatric first
aid and pediatric cardiopulmonary resuscitation (CPR) training, unless the training has been
completed within the previous two calendar years. Staff must complete the pediatric first
aid and pediatric CPR training at least every other calendar year and the center must
document the training in the staff person's personnel record.
 new text end

new text begin (b) Training completed under this subdivision may be used to meet the in-service training
requirements under subdivision 6.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 42.

Minnesota Statutes 2018, section 245H.14, subdivision 3, is amended to read:


Subd. 3.

Abusive head trauma.

A certified center that cares for a child deleted text begin through four
years of agedeleted text end new text begin under school agenew text end must ensure thatnew text begin the director and allnew text end staff persons deleted text begin and
volunteersdeleted text end new text begin , including substitutes and unsupervised volunteers,new text end receive training on abusive
head trauma deleted text begin from shaking infants and young childrendeleted text end before assisting in the care of a child
deleted text begin through four years of agedeleted text end new text begin under school agenew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 43.

Minnesota Statutes 2018, section 245H.14, subdivision 4, is amended to read:


Subd. 4.

Child development.

The certified center must ensure deleted text begin each staff person completes
at least two hours ofdeleted text end new text begin that the director and all staff persons, including substitutes and
unsupervised volunteers, completenew text end child development and learning training within deleted text begin 14deleted text end new text begin 90new text end
days of employment and deleted text begin annuallydeleted text end new text begin every second calendar yearnew text end thereafter.new text begin The director and
staff persons not including substitutes must complete at least two hours of training on child
development. The training for substitutes and unsupervised volunteers is not required to be
of a minimum length.new text end For purposes of this subdivision, "child development and learning
training" means how a child develops physically, cognitively, emotionally, and socially and
learns as part of the child's family, culture, and community.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 44.

Minnesota Statutes 2018, section 245H.14, subdivision 5, is amended to read:


Subd. 5.

Orientation.

The certified center must ensure deleted text begin each staff person isdeleted text end new text begin the director
and all staff persons, substitutes, and unsupervised volunteers arenew text end trained at orientation on
health and safety requirements in sections 245H.11, 245H.13, 245H.14, and 245H.15. The
certified center must provide deleted text begin staff with andeleted text end new text begin thenew text end orientation within 14 days of employmentnew text begin or
first date of direct contact with a child, whichever is earliernew text end . Before the completion of
orientation, deleted text begin a staff persondeleted text end new text begin these individualsnew text end must be supervised while providing direct care
to a child.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 45.

Minnesota Statutes 2018, section 245H.14, subdivision 6, is amended to read:


Subd. 6.

In service.

(a) The certified center must ensure deleted text begin eachdeleted text end new text begin that the director and allnew text end
staff deleted text begin person isdeleted text end new text begin persons, including substitutes and unsupervised volunteers, arenew text end trained at
least deleted text begin annuallydeleted text end new text begin once each calendar yearnew text end on health and safety requirements in sections 245H.11,
245H.13, 245H.14, and 245H.15.

(b) new text begin The director and new text end each staff personnew text begin , not including substitutes,new text end must deleted text begin annuallydeleted text end complete
at least six hours of trainingnew text begin each calendar yearnew text end . Training required under paragraph (a) may
be used toward the hourly training requirements of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 46.

Minnesota Statutes 2018, section 245H.15, subdivision 1, is amended to read:


Subdivision 1.

Written emergency plan.

(a) A certified center must have a written
emergency plan for emergencies that require evacuation, sheltering, or other protection of
children, such as fire, natural disaster, intruder, or other threatening situation that may pose
a health or safety hazard to children. The plan must be written on a form developed by the
commissioner and reviewed and updated at least once each calendar year. The annual review
of the emergency plan must be documented.

(b) The plan must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the relocation and
reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text begin and
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin ; and
new text end

new text begin (8) accommodations for infants and toddlersnew text end .

deleted text begin (c) The certification holder must have an emergency plan available for review upon
request by the child's parent or legal guardian.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
 new text end

Sec. 47. new text begin REPEALER.
new text end

new text begin Minnesota Rules, parts 9502.0425, subparts 4, 16, and 17; and 9503.0155, subpart 8, 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 September 30, 2019.
 new text end

ARTICLE 3

DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2018, section 246B.10, is amended to read:


246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.

new text begin (a) new text end The civilly committed sex offender's county shall pay to the state a portion of the
cost of care provided in the Minnesota sex offender program to a civilly committed sex
offender who has legally settled in that county.

new text begin (b)new text end A county's payment must be made from the county's own sources of revenue and
payments mustnew text begin :
new text end

new text begin (1) equal ten percent of the cost of care, as determined by the commissioner, for each
day or portion of a day that the civilly committed sex offender spends at the facility for
individuals admitted to the Minnesota sex offender program before August 1, 2011; or
 new text end

new text begin (2)new text end equal 25 percent of the cost of care, as determined by the commissioner, for each
day or portion of a daydeleted text begin ,deleted text end that the civilly committed sex offendernew text begin :
new text end

new text begin (i) new text end spends at the facilitydeleted text begin .deleted text end new text begin for individuals admitted to the Minnesota sex offender program
on or after August 1, 2011; or
new text end

new text begin (ii) receives services within a program operated by the Minnesota sex offender program
while on provisional discharge.
 new text end

new text begin (c) The county is responsible for paying the state the remaining amountnew text end if payments
received by the state under this chapter exceednew text begin :
new text end

new text begin (1) 90 percent of the cost of care for individuals admitted to the Minnesota sex offender
program before August 1, 2011; or
 new text end

new text begin (2)new text end 75 percent of the cost of caredeleted text begin , the county is responsible for paying the state the
remaining amountdeleted text end new text begin for individuals:
new text end

new text begin (i) admitted to the Minnesota sex offender program on or after August 1, 2011; or
 new text end

new text begin (ii) receiving services within a program operated by the Minnesota sex offender program
while on provisional dischargenew text end .

new text begin (d)new text end The county is not entitled to reimbursement from the civilly committed sex offender,
the civilly committed sex offender's estate, or from the civilly committed sex offender's
relatives, except as provided in section 246B.07.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 2. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, section 246.18, subdivisions 8 and 9, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 10, new text end new text begin is
repealed.
 new text end

ARTICLE 4

CONTINUING CARE FOR OLDER ADULTS

Section 1.

Minnesota Statutes 2018, 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 assessmentdeleted text begin ;deleted text end new text begin . Effective for
rehabilitation therapy completed on or after January 1, 2020, a facility must complete a
significant change in status assessment if for any reason all speech, occupational, and
physical therapies have ended. The ARD of the significant change in status assessment must
be the eighth day after all speech, occupational, and physical therapies have ended. The last
day on which rehabilitation therapy was furnished is considered day zero when determining
the ARD for the significant change in status assessment;
new text end

(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; deleted text begin and
deleted text end

(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classificationdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (7) modifications to the most recent assessment in clauses (1) to (6).
 new text end

(c) In addition to the assessments listed in paragraph (b), 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.

Sec. 2.

Minnesota Statutes 2018, section 144.0724, subdivision 5, is amended to read:


Subd. 5.

Short stays.

(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or less.

(b) Notwithstanding the admission assessment requirements of paragraph (a), a facility
may elect to accept a short stay rate with a case mix index of 1.0 for all facility residents
who stay 14 days or less in lieu of submitting an admission assessment. Facilities shall make
this election annually.

(c) Nursing facilities must elect one of the options described in paragraphs (a) and (b)
by reporting to the commissioner of health, as prescribed by the commissioner. The election
is effective on July 1 each year.

new text begin (d) An admission assessment is not required regardless of the facility's election status
when a resident is admitted to and discharged from the facility on the same day.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for admissions on or after July 1, 2019.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 144.0724, subdivision 8, is amended to read:


Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident, or
resident's representative, or the nursing facility or boarding care home may request that the
commissioner of health reconsider the assigned reimbursement classificationnew text begin including any
items changed during the audit processnew text end . The request for reconsideration must be submitted
in writing to the commissioner within 30 days of the day the resident or the resident's
representative receives the resident classification notice. The request for reconsideration
must include the name of the resident, the name and address of the facility in which the
resident resides, the reasons for the reconsideration, and documentation supporting the
request. The documentation accompanying the reconsideration request is limited to deleted text begin a copy
of the MDS that determined the classification and otherdeleted text end documents that would support or
change the MDS findings.

(b) Upon request, the nursing facility must give the resident or the resident's representative
a copy of the assessment form and the other documentation that was given to the
commissioner of health to support the assessment findings. The nursing facility shall also
provide access to and a copy of other information from the resident's record that has been
requested by or on behalf of the resident to support a resident's reconsideration request. A
copy of any requested material must be provided within three working days of receipt of a
written request for the information. Notwithstanding any law to the contrary, the facility
may not charge a fee for providing copies of the requested documentation. If a facility fails
to provide the material within this time, it is subject to the issuance of a correction order
and penalty assessment under sections 144.653 and 144A.10. Notwithstanding those sections,
any correction order issued under this subdivision must require that the nursing facility
immediately comply with the request for information and that as of the date of the issuance
of the correction order, the facility shall forfeit to the state a $100 fine for the first day of
noncompliance, and an increase in the $100 fine by $50 increments for each day the
noncompliance continues.

(c) In addition to the information required under paragraphs (a) and (b), a reconsideration
request from a nursing facility must contain the following information: (i) the date the
reimbursement classification notices were received by the facility; (ii) the date the
classification notices were distributed to the resident or the resident's representative; and
(iii) a copy of a notice sent to the resident or to the resident's representative. This notice
must inform the resident or the resident's representative that a reconsideration of the resident's
classification is being requested, the reason for the request, that the resident's rate will change
if the request is approved by the commissioner, the extent of the change, that copies of the
facility's request and supporting documentation are available for review, and that the resident
also has the right to request a reconsideration. If the facility fails to provide the required
information listed in item (iii) with the reconsideration request, the commissioner may
request that the facility provide the information within 14 calendar days. The reconsideration
request must be denied if the information is then not provided, and the facility may not
make further reconsideration requests on that specific reimbursement classification.

(d) Reconsideration by the commissioner must be made by individuals not involved in
reviewing the assessment, audit, or reconsideration that established the disputed classification.
The reconsideration must be based upon the assessment that determined the classification
and upon the information provided to the commissioner under paragraphs (a) and (b). If
necessary for evaluating the reconsideration request, the commissioner may conduct on-site
reviews. Within 15 working days of receiving the request for reconsideration, the
commissioner shall affirm or modify the original resident classification. The original
classification must be modified if the commissioner determines that the assessment resulting
in the classification did not accurately reflect characteristics of the resident at the time of
the assessment. The resident and the nursing facility or boarding care home shall be notified
within five working days after the decision is made. A decision by the commissioner under
this subdivision is the final administrative decision of the agency for the party requesting
reconsideration.

(e) The resident classification established by the commissioner shall be the classification
that applies to the resident while the request for reconsideration is pending. If a request for
reconsideration applies to an assessment used to determine nursing facility level of care
under subdivision 4, paragraph (c), the resident shall continue to be eligible for nursing
facility level of care while the request for reconsideration is pending.

(f) The commissioner may request additional documentation regarding a reconsideration
necessary to make an accurate reconsideration determination.

Sec. 4.

Minnesota Statutes 2018, section 144A.071, subdivision 1a, is amended to read:


Subd. 1a.

Definitions.

For purposes of sections 144A.071 to 144A.073, the following
terms have the meanings given them:

(a) "Attached fixtures" has the meaning given in Minnesota Rules, part 9549.0020,
subpart 6.

(b) deleted text begin "Buildings"deleted text end new text begin "Building"new text end has the meaning given in deleted text begin Minnesota Rules, part 9549.0020,
subpart 7deleted text end new text begin section 256R.261, subdivision 4new text end .

(c) "Capital assets" has the meaning given in section deleted text begin 256B.421, subdivision 16deleted text end new text begin 256R.02,
subdivision 8new text end .

(d) "Commenced construction" means that all of the following conditions were met: the
final working drawings and specifications were approved by the commissioner of health;
the construction contracts were let; a timely construction schedule was developed, stipulating
dates for beginning, achieving various stages, and completing construction; and all zoning
and building permits were applied for.

(e) "Completion date" means the date on which clearance for the construction project
is issued, or if a clearance for the construction project is not required, the date on which the
construction project assets are available for facility use.

(f) "Construction" means any erection, building, alteration, reconstruction, modernization,
or improvement necessary to comply with the nursing home licensure rules.

(g) "Construction project" means:

(1) a capital asset addition to, or replacement of a nursing home or certified boarding
care home that results in new space or the remodeling of or renovations to existing facility
space; and

(2) the remodeling or renovation of existing facility space the use of which is modified
as a result of the project described in clause (1). This existing space and the project described
in clause (1) must be used for the functions as designated on the construction plans on
completion of the project described in clause (1) for a period of not less than 24 months.

(h) "Depreciation guidelines" deleted text begin means the most recent publication of "The Estimated
Useful Lives of Depreciable Hospital Assets," issued by the American Hospital Association,
840 North Lake Shore Drive, Chicago, Illinois, 60611deleted text end new text begin has the meaning given in section
256R.261, subdivision 9new text end .

(i) "New licensed" or "new certified beds" means:

(1) newly constructed beds in a facility or the construction of a new facility that would
increase the total number of licensed nursing home beds or certified boarding care or nursing
home beds in the state; or

(2) newly licensed nursing home beds or newly certified boarding care or nursing home
beds that result from remodeling of the facility that involves relocation of beds but does not
result in an increase in the total number of beds, except when the project involves the upgrade
of boarding care beds to nursing home beds, as defined in section 144A.073, subdivision
1. "Remodeling" includes any of the type of conversion, renovation, replacement, or
upgrading projects as defined in section 144A.073, subdivision 1.

deleted text begin (j) "Project construction costs" means the cost of the following items that have a
completion date within 12 months before or after the completion date of the project described
in item (g), clause (1):
 deleted text end

deleted text begin (1) facility capital asset additions;
 deleted text end

deleted text begin (2) replacements;
 deleted text end

deleted text begin (3) renovations;
 deleted text end

deleted text begin (4) remodeling projects;
 deleted text end

deleted text begin (5) construction site preparation costs;
 deleted text end

deleted text begin (6) related soft costs; and
 deleted text end

deleted text begin (7) the cost of new technology implemented as part of the construction project and
depreciable equipment directly identified to the project, if the construction costs for clauses
(1) to (6) exceed the threshold for additions and replacements stated in section 256B.431,
subdivision 16. Technology and depreciable equipment shall be included in the project
construction costs unless a written election is made by the facility, to not include it in the
facility's appraised value for purposes of Minnesota Rules, part 9549.0020, subpart 5. Debt
incurred for purchase of technology and depreciable equipment shall be included as allowable
debt for purposes of Minnesota Rules, part 9549.0060, subpart 5, items A and C, unless the
written election is to not include it. Any new technology and depreciable equipment included
in the project construction costs that the facility elects not to include in its appraised value
and allowable debt shall be treated as provided in section 256B.431, subdivision 17,
deleted text end deleted text begin paragraph (b). Written election under this paragraph must be included in the facility's request
for the rate change related to the project, and this election may not be changed.
 deleted text end

deleted text begin (k) "Technology" means information systems or devices that make documentation,
charting, and staff time more efficient or encourage and allow for care through alternative
settings including, but not limited to, touch screens, monitors, hand-helds, swipe cards,
motion detectors, pagers, telemedicine, medication dispensers, and equipment to monitor
vital signs and self-injections, and to observe skin and other conditions.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 144A.071, subdivision 2, is amended to read:


Subd. 2.

Moratorium.

The commissioner of health, in coordination with the
commissioner of human services, shall deny each request for new licensed or certified
nursing home or certified boarding care beds except as provided in subdivision 3 or 4a, or
section 144A.073. "Certified bed" means a nursing home bed or a boarding care bed certified
by the commissioner of health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq. Certified beds in facilities which do not
allow medical assistance intake shall be deemed to be decertified for purposes of this section
only.

The commissioner of human services, in coordination with the commissioner of health,
shall deny any request to issue a license under section 252.28 and chapter 245A to a nursing
home or boarding care home, if that license would result in an increase in the medical
assistance reimbursement amount.

In addition, the commissioner of health must not approve any construction project whose
cost exceeds deleted text begin $1,000,000deleted text end new text begin $1,500,000new text end , unless:

(a) any construction costs exceeding deleted text begin $1,000,000deleted text end new text begin $1,500,000new text end are not added to the facility's
appraised value and are not included in the facility's payment rate for reimbursement under
the medical assistance program; or

(b) the project:

(1) has been approved through the process described in section 144A.073;

(2) meets an exception in subdivision 3 or 4a;

(3) is necessary to correct violations of state or federal law issued by the commissioner
of health;

(4) is necessary to repair or replace a portion of the facility that was damaged by fire,
lightning, ground shifts, or other such hazards, including environmental hazards, provided
that the provisions of subdivision 4a, clause (a), are met;

(5) as of May 1, 1992, the facility has submitted to the commissioner of health written
documentation evidencing that the facility meets the "commenced construction" definition
as specified in subdivision 1a, paragraph (d), or that substantial steps have been taken prior
to April 1, 1992, relating to the construction project. "Substantial steps" require that the
facility has made arrangements with outside parties relating to the construction project and
include the hiring of an architect or construction firm, submission of preliminary plans to
the Department of Health or documentation from a financial institution that financing
arrangements for the construction project have been made; or

(6) is being proposed by a licensed nursing facility that is not certified to participate in
the medical assistance program and will not result in new licensed or certified beds.

Prior to the final plan approval of any construction project, the deleted text begin commissionerdeleted text end new text begin
commissionersnew text end of health new text begin and human services new text end shall be provided with an itemized cost estimate
for the project construction costs. If a construction project is anticipated to be completed in
phases, the total estimated cost of all phases of the project shall be submitted to the
deleted text begin commissionerdeleted text end new text begin commissionersnew text end and shall be considered as one construction project. Once the
construction project is completed and prior to the final clearance by the deleted text begin commissionerdeleted text end new text begin
commissionersnew text end , the total project construction costs for the construction project shall be
submitted to the deleted text begin commissionerdeleted text end new text begin commissionersnew text end . If the final project construction cost exceeds
the dollar threshold in this subdivision, the commissioner of human services shall not
recognize any of the project construction costs or the related financing costs in excess of
this threshold in establishing the facility's property-related payment rate.

The dollar thresholds for construction projects are as follows: for construction projects
other than those authorized in clauses (1) to (6), the dollar threshold is $1,000,000. For
projects authorized after July 1, 1993, under clause (1), the dollar threshold is the cost
estimate submitted with a proposal for an exception under section 144A.073, plus inflation
as calculated according to section 256B.431, subdivision 3f, paragraph (a). For projects
authorized under clauses (2) to (4), the dollar threshold is the itemized estimate project
construction costs submitted to the commissioner of health at the time of final plan approval,
plus inflation as calculated according to section 256B.431, subdivision 3f, paragraph (a).

The commissioner of health shall adopt rules to implement this section or to amend the
emergency rules for granting exceptions to the moratorium on nursing homes under section
144A.073.

Sec. 6.

Minnesota Statutes 2018, section 144A.071, subdivision 3, is amended to read:


Subd. 3.

Exceptions authorizing increase in beds; hardship areas.

(a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the addition of new licensed and Medicare and Medicaid certified nursing home
beds, using the criteria and process set forth in this subdivision.

(b) The commissioner, in cooperation with the commissioner of human services, shall
consider the following criteria when determining that an area of the state is a hardship area
with regard to access to nursing facility services:

(1) a low number of beds per thousand in a specified area using as a standard the beds
per thousand people age 65 and older, in five year age groups, using data from the most
recent census and population projections, weighted by each group's most recent nursing
home utilization, of the county at the 20th percentile, as determined by the commissioner
of human services;

(2) a high level of out-migration for nursing facility services associated with a described
area from the county or counties of residence to other Minnesota counties, as determined
by the commissioner of human services, using as a standard an amount greater than the
out-migration of the county ranked at the 50th percentile;

(3) an adequate level of availability of noninstitutional long-term care services measured
as public spending for home and community-based long-term care services per individual
age 65 and older, in five year age groups, using data from the most recent census and
population projections, weighted by each group's most recent nursing home utilization, as
determined by the commissioner of human services using as a standard an amount greater
than the 50th percentile of counties;

(4) there must be a declaration of hardship resulting from insufficient access to nursing
home beds by local county agencies and area agencies on aging; and

(5) other factors that may demonstrate the need to add new nursing facility beds.

(c) On August 15 of odd-numbered years, the commissioner, in cooperation with the
commissioner of human services, may publish in the State Register a request for information
in which interested parties, using the data provided under section 144A.351, along with any
other relevant data, demonstrate that a specified area is a hardship area with regard to access
to nursing facility services. For a response to be considered, the commissioner must receive
it by November 15. The commissioner shall make responses to the request for information
available to the public and shall allow 30 days for comment. The commissioner shall review
responses and comments and determine if any areas of the state are to be declared hardship
areas.

(d) For each designated hardship area determined in paragraph (c), the commissioner
shall publish a request for proposals in accordance with section 144A.073 and Minnesota
Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
State Register by March 15 following receipt of responses to the request for information.
The request for proposals must specify the number of new beds which may be added in the
designated hardship area, which must not exceed the number which, if added to the existing
number of beds in the area, including beds in layaway status, would have prevented it from
being determined to be a hardship area under paragraph (b), clause (1). Beginning July 1,
2011, the number of new beds approved must not exceed 200 beds statewide per biennium.
After June 30, 2019, the number of new beds that may be approved in a biennium must not
exceed 300 statewide. For a proposal to be considered, the commissioner must receive it
within six months of the publication of the request for proposals. The commissioner shall
review responses to the request for proposals and shall approve or disapprove each proposal
by the following July 15, in accordance with section 144A.073 and Minnesota Rules, parts
4655.1070 to 4655.1098. The commissioner shall base approvals or disapprovals on a
comparison and ranking of proposals using only the criteria in subdivision 4a. Approval of
a proposal expires after 18 months unless the facility has added the new beds using existing
space, subject to approval by the commissioner, or has commenced construction as defined
in subdivision 1a, paragraph (d). If, after the approved beds have been added, fewer than
50 percent of the beds in a facility are newly licensed, the operating payment rates previously
in effect shall remain. If, after the approved beds have been added, 50 percent or more of
the beds in a facility are newly licensed, operatingnew text begin and external fixednew text end payment rates shall
be determined according to deleted text begin Minnesota Rules, part 9549.0057, using the limits under sections
256R.23, subdivision 5, and 256R.24, subdivision 3. External fixed costs payment rates
must be determined according to section 256R.25deleted text end new text begin section 256R.21, subdivision 5new text end . Property
payment rates for facilities with beds added under this subdivision must be determined deleted text begin in
the same manner as rate determinations resulting from projects approved and completed
under section 144A.073deleted text end new text begin under section 256R.26new text end .

(e) The commissioner may:

(1) certify or license new beds in a new facility that is to be operated by the commissioner
of veterans affairs or when the costs of constructing and operating the new beds are to be
reimbursed by the commissioner of veterans affairs or the United States Veterans
Administration; and

(2) license or certify beds in a facility that has been involuntarily delicensed or decertified
for participation in the medical assistance program, provided that an application for
relicensure or recertification is submitted to the commissioner by an organization that is
not a related organization as defined in section 256R.02, subdivision 43, to the prior licensee
within 120 days after delicensure or decertification.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 144A.071, subdivision 4a, is amended to read:


Subd. 4a.

Exceptions for replacement beds.

It is in the best interest of the state to
ensure that nursing homes and boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain construction projects. Facilities
should be maintained in condition to satisfy the physical and emotional needs of residents
while allowing the state to maintain control over nursing home expenditure growth.

The commissioner of health in coordination with the commissioner of human services,
may approve the renovation, replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:

(a) to license or certify beds in a new facility constructed to replace a facility or to make
repairs in an existing facility that was destroyed or damaged after June 30, 1987, by fire,
lightning, or other hazard provided:

(i) destruction was not caused by the intentional act of or at the direction of a controlling
person of the facility;

(ii) at the time the facility was destroyed or damaged the controlling persons of the
facility maintained insurance coverage for the type of hazard that occurred in an amount
that a reasonable person would conclude was adequate;

(iii) the net proceeds from an insurance settlement for the damages caused by the hazard
are applied to the cost of the new facility or repairs;

(iv) the number of licensed and certified beds in the new facility does not exceed the
number of licensed and certified beds in the destroyed facility; and

(v) the commissioner determines that the replacement beds are needed to prevent an
inadequate supply of beds.

Project construction costs incurred for repairs authorized under this clause shall not be
considered in the dollar threshold amount defined in subdivision 2;

(b) to license or certify beds that are moved from one location to another within a nursing
home facility, provided the total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $1,000,000;

(c) to license or certify beds in a project recommended for approval under section
144A.073;

(d) to license or certify beds that are moved from an existing state nursing home to a
different state facility, provided there is no net increase in the number of state nursing home
beds;

(e) to certify and license as nursing home beds boarding care beds in a certified boarding
care facility if the beds meet the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section 144A.073, and if the cost of any
remodeling of the facility does not exceed $1,000,000. If boarding care beds are licensed
as nursing home beds, the number of boarding care beds in the facility must not increase
beyond the number remaining at the time of the upgrade in licensure. The provisions
contained in section 144A.073 regarding the upgrading of the facilities do not apply to
facilities that satisfy these requirements;

(f) to license and certify up to 40 beds transferred from an existing facility owned and
operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
same location as the existing facility that will serve persons with Alzheimer's disease and
other related disorders. The transfer of beds may occur gradually or in stages, provided the
total number of beds transferred does not exceed 40. At the time of licensure and certification
of a bed or beds in the new unit, the commissioner of health shall delicense and decertify
the same number of beds in the existing facility. As a condition of receiving a license or
certification under this clause, the facility must make a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate as a result of the transfers allowed under this paragraph;

(g) to license and certify nursing home beds to replace currently licensed and certified
boarding care beds which may be located either in a remodeled or renovated boarding care
or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
nursing home facility within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the number of
boarding care beds in the facility or complex are decreased by the number to be licensed as
nursing home beds and further provided that, if the total costs of new construction,
replacement, remodeling, or renovation exceed ten percent of the appraised value of the
facility or $200,000, whichever is less, the facility makes a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate by reason of the new construction, replacement, remodeling,
or renovation. The provisions contained in section 144A.073 regarding the upgrading of
facilities do not apply to facilities that satisfy these requirements;

(h) to license as a nursing home and certify as a nursing facility a facility that is licensed
as a boarding care facility but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the commissioner of health that licensing
the facility as a nursing home and certifying the facility as a nursing facility will result in
a net annual savings to the state general fund of $200,000 or more;

(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing home
beds in a facility that was licensed and in operation prior to January 1, 1992;

(j) to license and certify new nursing home beds to replace beds in a facility acquired
by the Minneapolis Community Development Agency as part of redevelopment activities
in a city of the first class, provided the new facility is located within three miles of the site
of the old facility. Operating and property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434 or chapter 256R;

(k) to license and certify up to 20 new nursing home beds in a community-operated
hospital and attached convalescent and nursing care facility with 40 beds on April 21, 1991,
that suspended operation of the hospital in April 1986. The commissioner of human services
shall provide the facility with the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its existing 40 beds;

(l) to license or certify beds in renovation, replacement, or upgrading projects as defined
in section 144A.073, subdivision 1, so long as the cumulative total costs of the facility's
remodeling projects do not exceed $1,000,000;

(m) to license and certify beds that are moved from one location to another for the
purposes of converting up to five four-bed wards to single or double occupancy rooms in
a nursing home that, as of January 1, 1993, was county-owned and had a licensed capacity
of 115 beds;

(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified nursing
facility located in Minneapolis to layaway all of its licensed and certified nursing home
beds. These beds may be relicensed and recertified in a newly constructed teaching nursing
home facility affiliated with a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency committee on long-term
care planning. The beds on layaway status shall have the same status as voluntarily delicensed
and decertified beds, except that beds on layaway status remain subject to the surcharge in
section 256.9657. This layaway provision expires July 1, 1998;

(o) to allow a project which will be completed in conjunction with an approved
moratorium exception project for a nursing home in southern Cass County and which is
directly related to that portion of the facility that must be repaired, renovated, or replaced,
to correct an emergency plumbing problem for which a state correction order has been
issued and which must be corrected by August 31, 1993;

(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified nursing
facility located in Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified beds by converting three-bed
wards to single or double occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on layaway status remain subject
to the surcharge in section 256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per bed reactivation fee. In
addition, at any time within three years of the effective date of the layaway, the beds on
layaway status may be:

(1) relicensed and recertified upon relocation and reactivation of some or all of the beds
to an existing licensed and certified facility or facilities located in Pine River, Brainerd, or
International Falls; provided that the total project construction costs related to the relocation
of beds from layaway status for any facility receiving relocated beds may not exceed the
dollar threshold provided in subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073;

(2) relicensed and recertified, upon reactivation of some or all of the beds within the
facility which placed the beds in layaway status, if the commissioner has determined a need
for the reactivation of the beds on layaway status.

The property-related payment rate of a facility placing beds on layaway status must be
adjusted by the incremental change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for a facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than three years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(q) to license and certify beds in a renovation and remodeling project to convert 12
four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
home that, as of January 1, 1994, met the following conditions: the nursing home was located
in Ramsey County; had a licensed capacity of 154 beds; and had been ranked among the
top 15 applicants by the 1993 moratorium exceptions advisory review panel. The total
project construction cost estimate for this project must not exceed the cost estimate submitted
in connection with the 1993 moratorium exception process;

(r) to license and certify up to 117 beds that are relocated from a licensed and certified
138-bed nursing facility located in St. Paul to a hospital with 130 licensed hospital beds
located in South St. Paul, provided that the nursing facility and hospital are owned by the
same or a related organization and that prior to the date the relocation is completed the
hospital ceases operation of its inpatient hospital services at that hospital. After relocation,
the nursing facility's status shall be the same as it was prior to relocation. The nursing
facility's property-related payment rate resulting from the project authorized in this paragraph
shall become effective no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting from this project, the allowable
appraised value of the nursing facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed $2,490,000;

(s) to license and certify two beds in a facility to replace beds that were voluntarily
delicensed and decertified on June 28, 1991;

(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed nursing
home and 21-bed boarding care home facility in Minneapolis, notwithstanding the licensure
and certification after July 1, 1995, of the Minneapolis facility as a 147-bed nursing home
facility after completion of a construction project approved in 1993 under section 144A.073,
to be laid away upon 30 days' prior written notice to the commissioner. Beds on layaway
status shall have the same status as voluntarily delicensed or decertified beds except that
they shall remain subject to the surcharge in section 256.9657. The 16 beds on layaway
status may be relicensed as nursing home beds and recertified at any time within five years
of the effective date of the layaway upon relocation of some or all of the beds to a licensed
and certified facility located in Watertown, provided that the total project construction costs
related to the relocation of beds from layaway status for the Watertown facility may not
exceed the dollar threshold provided in subdivision 2 unless the construction project has
been approved through the moratorium exception process under section 144A.073.

The property-related payment rate of the facility placing beds on layaway status must
be adjusted by the incremental change in its rental per diem after recalculating the rental
per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for the facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than five years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(u) to license and certify beds that are moved within an existing area of a facility or to
a newly constructed addition which is built for the purpose of eliminating three- and four-bed
rooms and adding space for dining, lounge areas, bathing rooms, and ancillary service areas
in a nursing home that, as of January 1, 1995, was located in Fridley and had a licensed
capacity of 129 beds;

(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County to
a 160-bed facility in Crow Wing County, provided all the affected beds are under common
ownership;

(w) to license and certify a total replacement project of up to 49 beds located in Norman
County that are relocated from a nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment rates for the new nursing
facility shall be determined based on the interim and settle-up payment provisions of
deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section 256R.27new text end and the reimbursement provisions of
chapter 256R. Property-related reimbursement rates shall be determined under section
256R.26, taking into account any federal or state flood-related loans or grants provided to
the facility;

(x) to license and certify to the licensee of a nursing home in Polk County that was
destroyed by flood in 1997 replacement projects with a total of up to 129 beds, with at least
25 beds to be located in Polk County and up to 104 beds distributed among up to three other
counties. These beds may only be distributed to counties with fewer than the median number
of age intensity adjusted beds per thousand, as most recently published by the commissioner
of human services. If the licensee chooses to distribute beds outside of Polk County under
this paragraph, prior to distributing the beds, the commissioner of health must approve the
location in which the licensee plans to distribute the beds. The commissioner of health shall
consult with the commissioner of human services prior to approving the location of the
proposed beds. The licensee may combine these beds with beds relocated from other nursing
facilities as provided in section 144A.073, subdivision 3c. The operating payment rates for
the new nursing facilities shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, parts 9549.0010 to 9549.0080. Property-related
reimbursement rates shall be determined under section 256R.26. If the replacement beds
permitted under this paragraph are combined with beds from other nursing facilities, the
rates shall be calculated as the weighted average of rates determined as provided in this
paragraph and section 256R.50;

(y) to license and certify beds in a renovation and remodeling project to convert 13
three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met the following conditions:
the nursing home was located in Ramsey County, was not owned by a hospital corporation,
had a licensed capacity of 64 beds, and had been ranked among the top 15 applicants by
the 1993 moratorium exceptions advisory review panel. The total project construction cost
estimate for this project must not exceed the cost estimate submitted in connection with the
1993 moratorium exception process;

(z) to license and certify up to 150 nursing home beds to replace an existing 285 bed
nursing facility located in St. Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at the existing site. The reduction
in the licensed capacity of the existing facility shall occur during the construction project
as beds are taken out of service due to the construction process. Prior to the start of the
construction process, the facility shall provide written information to the commissioner of
health describing the process for bed reduction, plans for the relocation of residents, and
the estimated construction schedule. The relocation of residents shall be in accordance with
the provisions of law and rule;

(aa) to allow the commissioner of human services to license an additional 36 beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
the total number of licensed and certified beds at the facility does not increase;

(bb) to license and certify a new facility in St. Louis County with 44 beds constructed
to replace an existing facility in St. Louis County with 31 beds, which has resident rooms
on two separate floors and an antiquated elevator that creates safety concerns for residents
and prevents nonambulatory residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;

(cc) to license and certify four beds in a 16-bed certified boarding care home in
Minneapolis to replace beds that were voluntarily delicensed and decertified on or before
March 31, 1992. The licensure and certification is conditional upon the facility periodically
assessing and adjusting its resident mix and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of human services shall retain
the authority to audit the facility at any time and shall require the facility to comply with
any requirements necessary to prevent an institution for mental disease declaration, including
delicensure and decertification of beds, if necessary;

(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 80
beds as part of a renovation project. The renovation must include construction of an addition
to accommodate ten residents with beginning and midstage dementia in a self-contained
living unit; creation of three resident households where dining, activities, and support spaces
are located near resident living quarters; designation of four beds for rehabilitation in a
self-contained area; designation of 30 private rooms; and other improvements;

(ee) to license and certify beds in a facility that has undergone replacement or remodeling
as part of a planned closure under section 256R.40;

(ff) to license and certify a total replacement project of up to 124 beds located in Wilkin
County that are in need of relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section
256R.27new text end and the reimbursement provisions of chapter 256R. Property-related reimbursement
rates shall be determined under section 256R.26, taking into account any federal or state
flood-related loans or grants provided to the facility;

(gg) to allow the commissioner of human services to license an additional nine beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
total number of licensed and certified beds at the facility does not increase;

(hh) to license and certify up to 120 new nursing facility beds to replace beds in a facility
in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility and is in Anoka County. Operating
and property rates shall be determined and allowed under chapter 256R and Minnesota
Rules, parts 9549.0010 to 9549.0080; or

(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County that,
as of March 25, 2001, is in the active process of closing, to a 122-licensed bed nonprofit
nursing facility located in the city of Columbia Heights or its affiliate. The transfer is effective
when the receiving facility notifies the commissioner in writing of the number of beds
accepted. The commissioner shall place all transferred beds on layaway status held in the
name of the receiving facility. The layaway adjustment provisions of section 256B.431,
subdivision 30, do not apply to this layaway. The receiving facility may only remove the
beds from layaway for recertification and relicensure at the receiving facility's current site,
or at a newly constructed facility located in Anoka County. The receiving facility must
receive statutory authorization before removing these beds from layaway status, or may
remove these beds from layaway status if removal from layaway status is part of a
moratorium exception project approved by the commissioner under section 144A.073.

Sec. 8.

Minnesota Statutes 2018, section 144A.071, subdivision 4c, is amended to read:


Subd. 4c.

Exceptions for replacement beds after June 30, 2003.

(a) The commissioner
of health, in coordination with the commissioner of human services, may approve the
renovation, replacement, upgrading, or relocation of a nursing home or boarding care home,
under the following conditions:

(1) to license and certify an 80-bed city-owned facility in Nicollet County to be
constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
attached to a hospital that is also being replaced. The threshold allowed for this project
under section 144A.073 shall be the maximum amount available to pay the additional
medical assistance costs of the new facility;

(2) to license and certify 29 beds to be added to an existing 69-bed facility in St. Louis
County, provided that the 29 beds must be transferred from active or layaway status at an
existing facility in St. Louis County that had 235 beds on April 1, 2003.

The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
rate at that facility shall not be adjusted as a result of this transfer. The operating payment
rate of the facility adding beds after completion of this project shall be the same as it was
on the day prior to the day the beds are licensed and certified. This project shall not proceed
unless it is approved and financed under the provisions of section 144A.073;

(3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of the new
beds are transferred from a 45-bed facility in Austin under common ownership that is closed
and 15 of the new beds are transferred from a 182-bed facility in Albert Lea under common
ownership; (ii) the commissioner of human services is authorized by the 2004 legislature
to negotiate budget-neutral planned nursing facility closures; and (iii) money is available
from planned closures of facilities under common ownership to make implementation of
this clause budget-neutral to the state. The bed capacity of the Albert Lea facility shall be
reduced to 167 beds following the transfer. Of the 60 beds at the new facility, 20 beds shall
be used for a special care unit for persons with Alzheimer's disease or related dementias;

(4) to license and certify up to 80 beds transferred from an existing state-owned nursing
facility in Cass County to a new facility located on the grounds of the Ah-Gwah-Ching
campus. The operating cost payment rates for the new facility shall be determined based
on the interim and settle-up payment provisions of deleted text begin Minnesota Rules, part 9549.0057,deleted text end new text begin section
256R.27new text end and the reimbursement provisions of chapter 256R. The property payment rate for
the first three years of operation shall be $35 per day. For subsequent years, the property
payment rate of $35 per day shall be adjusted for inflation as provided in section 256B.434,
subdivision 4, paragraph (c), as long as the facility has a contract under section 256B.434;

(5) to initiate a pilot program to license and certify up to 80 beds transferred from an
existing county-owned nursing facility in Steele County relocated to the site of a new acute
care facility as part of the county's Communities for a Lifetime comprehensive plan to create
innovative responses to the aging of its population. Upon relocation to the new site, the
nursing facility shall delicense 28 beds. The payment rate for external fixed costs for the
new facility shall be increased by an amount as calculated according to items (i) to (v):

(i) compute the estimated decrease in medical assistance residents served by the nursing
facility by multiplying the decrease in licensed beds by the historical percentage of medical
assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
of 28 beds by multiplying the anticipated decrease in medical assistance residents, determined
in item (i), by the existing facility's weighted average payment rate multiplied by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the nursing facility,
determined in item (i), by the average monthly elderly waiver service costs for individuals
in Steele County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) divide the amount in item (iv) by an amount equal to the relocated nursing facility's
occupancy factor under section 256B.431, subdivision 3f, paragraph (c), multiplied by the
historical percentage of medical assistance resident days; and

(6) to consolidate and relocate nursing facility beds to a new site in Goodhue County
and to integrate these services with other community-based programs and services under a
communities for a lifetime pilot program and comprehensive plan to create innovative
responses to the aging of its population. Two nursing facilities, one for 84 beds and one for
65 beds, in the city of Red Wing licensed on July 1, 2015, shall be consolidated into a newly
renovated 64-bed nursing facility resulting in the delicensure of 85 beds. Notwithstanding
the carryforward of the approval authority in section 144A.073, subdivision 11, the funding
approved in April 2009 by the commissioner of health for a project in Goodhue County
shall not carry forward. The closure of the 85 beds shall not be eligible for a planned closure
rate adjustment under section 256R.40. The construction project permitted in this clause
shall not be eligible for a threshold project rate adjustment under section 256B.434,
subdivision 4f. The payment rate for external fixed costs for the new facility shall be
increased by an amount as calculated according to items (i) to (vi):

(i) compute the estimated decrease in medical assistance residents served by both nursing
facilities by multiplying the difference between the occupied beds of the two nursing facilities
for the reporting year ending September 30, 2009, and the projected occupancy of the facility
at 95 percent occupancy by the historical percentage of medical assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
by multiplying the anticipated decrease in the medical assistance residents, determined in
item (i), by the hospital-owned nursing facility weighted average payment rate multiplied
by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the facilities, determined
in item (i), by the average monthly elderly waiver service costs for individuals in Goodhue
County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) multiply the amount in item (iv) by 57.2 percent; and

(vi) divide the difference of the amount in item (iv) and the amount in item (v) by an
amount equal to the relocated nursing facility's occupancy factor under section 256B.431,
subdivision 3f, paragraph (c), multiplied by the historical percentage of medical assistance
resident days.

(b) Projects approved under this subdivision shall be treated in a manner equivalent to
projects approved under subdivision 4a.

Sec. 9.

Minnesota Statutes 2018, section 144A.071, subdivision 5a, is amended to read:


Subd. 5a.

Cost estimate of a moratorium exception project.

deleted text begin (a)deleted text end For the purposes of
this section and section 144A.073, the cost estimate of a moratorium exception project shall
include the effects of the proposed project on the costs of the state subsidy for
community-based services, nursing services, and housing in institutional and noninstitutional
settings. The commissioner of health, in cooperation with the commissioner of human
services, shall define the method for estimating these costs in the permanent rule
implementing section 144A.073. The commissioner of human services shall prepare an
estimate of thenew text begin property-related payment rate to be established upon completion of the
project andnew text end total state annual long-term costs of each moratorium exception proposal.new text begin The
property-related payment rate estimate shall be made using the actual cost of the project
but the final property rate must be based on the appraisal and subject to the limitations in
section 256R.26, subdivision 6.
new text end

deleted text begin (b) The interest rate to be used for estimating the cost of each moratorium exception
project proposal shall be the lesser of either the prime rate plus two percentage points, or
the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan
Mortgage Corporation plus two percentage points as published in the Wall Street Journal
and in effect 56 days prior to the application deadline. If the applicant's proposal uses this
interest rate, the commissioner of human services, in determining the facility's actual
property-related payment rate to be established upon completion of the project must use the
actual interest rate obtained by the facility for the project's permanent financing up to the
maximum permitted under Minnesota Rules, part 9549.0060, subpart 6.
 deleted text end

deleted text begin The applicant may choose an alternate interest rate for estimating the project's cost. If
the applicant makes this election, the commissioner of human services, in determining the
facility's actual property-related payment rate to be established upon completion of the
project, must use the lesser of the actual interest rate obtained for the project's permanent
financing or the interest rate which was used to estimate the proposal's project cost. For
succeeding rate years, the applicant is at risk for financing costs in excess of the interest
rate selected.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 144A.073, subdivision 3c, is amended to read:


Subd. 3c.

deleted text begin Cost neutraldeleted text end Relocation projects.

deleted text begin (a)deleted text end Notwithstanding subdivision 3, the
commissioner may at any time accept proposals, or amendments to proposals previously
approved under this section, for relocations deleted text begin that are cost neutral with respect to state costs
as defined in section 144A.071, subdivision 5adeleted text end . The commissioner, in consultation with the
commissioner of human services, shall evaluate proposals according to subdivision 4a,
clauses (1), (4), (5), (6), and (8), and other criteria established in rule or law. deleted text begin The
commissioner of human services shall determine the allowable payment rates of the facility
receiving the beds in accordance with section 256R.50.deleted text end The commissioner shall approve or
disapprove a project within 90 days.

deleted text begin (b) For the purposes of paragraph (a), cost neutrality shall be measured over the first
three 12-month periods of operation after completion of the project.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 11.

Minnesota Statutes 2018, section 256R.02, subdivision 8, is amended to read:


Subd. 8.

Capital assets.

"Capital assets" means a nursing facility's buildings, deleted text begin attached
fixturesdeleted text end new text begin fixed equipmentnew text end , land improvements, leasehold improvements, and all additions to
or replacements of those assets used directly for resident care.

Sec. 12.

Minnesota Statutes 2018, section 256R.02, subdivision 19, is amended to read:


Subd. 19.

External fixed costs.

"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
deleted text begin planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41;deleted text end property taxes, new text begin special new text end assessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018; and Public Employees Retirement Association employer costs.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 256R.16, subdivision 1, is amended to read:


Subdivision 1.

Calculation of a quality score.

(a) The commissioner shall determine
a quality score for each nursing facility using quality measures established in section
256B.439, according to methods determined by the commissioner in consultation with
stakeholders and experts, and using the most recently available data as provided in the
Minnesota Nursing Home Report Card. These methods shall be exempt from the rulemaking
requirements under chapter 14.

(b) For each quality measure, a score shall be determined with the number of points
assigned as determined by the commissioner using the methodology established according
to this subdivision. The determination of the quality measures to be used and the methods
of calculating scores may be revised annually by the commissioner.

(c) The quality score shall include up to 50 points related to the Minnesota quality
indicators score derived from the minimum data set, up to 40 points related to the resident
quality of life score derived from the consumer survey conducted under section 256B.439,
subdivision 3, and up to ten points related to the state inspection results score.

(d) The commissioner, in cooperation with the commissioner of health, may adjust the
formula in paragraph (c), or the methodology for computing the total quality score, deleted text begin effective
July 1 of any year,deleted text end with five months advance public notice. In changing the formula, the
commissioner shall consider quality measure priorities registered by report card users, advice
of stakeholders, and available research.

Sec. 14.

Minnesota Statutes 2018, section 256R.21, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Total payment rate for new facilities. new text end

new text begin For a new nursing facility created under
section 144A.073, subdivision 3c, the total payment rate must be determined according to
this section, except:
 new text end

new text begin (1) the direct care payment rate used in subdivision 2, clause (1), must be determined
according to section 256R.27;
 new text end

new text begin (2) the other care-related payment rate used in subdivision 2, clause (2), must be
determined according to section 256R.27;
 new text end

new text begin (3) the external fixed costs payment rate used in subdivision 4, clause (2), must be
determined according to section 256R.27; and
 new text end

new text begin (4) the property payment rate used in subdivision 4, clause (3), must be determined
according to section 256R.26.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 15.

Minnesota Statutes 2018, section 256R.23, subdivision 5, is amended to read:


Subd. 5.

Determination of total care-related payment rate limits.

The commissioner
must determine each facility's total care-related payment rate limit by:

(1) multiplying the facility's quality score, as determined under section 256R.16,
subdivision 1new text begin , paragraph (d)new text end , by deleted text begin 0.5625deleted text end new text begin 2.0new text end ;

(2) deleted text begin adding 89.375 todeleted text end new text begin subtracting 40.0 fromnew text end the amount determined in clause (1), and
dividing the total by 100; deleted text begin and
deleted text end

(3) multiplying the amount determined in clause (2) by the median total care-related
cost per daydeleted text begin .deleted text end new text begin ; and
new text end

new text begin (4) multiplying the amount determined in clause (3) by the most-recent available
Core-Based Statistical Area wage indices established by the Centers for Medicare and
Medicaid Services for the Skilled Nursing Facility Prospective Payment System.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 256R.24, subdivision 3, is amended to read:


Subd. 3.

Determination of the other operating payment rate.

A facility's other
operating payment rate equals new text begin the lesser of (1) new text end 105 percent of the median other operating
cost per daynew text begin as determined by subdivisions 1 and 2, or (2) the prior year operating payment
rate adjusted by a forecasting market basket and forecasting index. The adjustment factor
shall come from the Information Handling Services Healthcare Cost Review, the Skilled
Nursing Facility Total Market Basket Index, and the four-quarter moving average percentage
change line or a comparable index if this index ceases to be published. The commissioner
shall use the fourth quarter index of the upcoming calendar year from the forecast published
for the third quarter of the calendar year immediately prior to the rate year for which the
rate is being determinednew text end .

Sec. 17.

Minnesota Statutes 2018, section 256R.25, is amended to read:


256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.

(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
(b) to deleted text begin (n)deleted text end new text begin (k)new text end .

(b) For a facility licensed as a nursing home, the portion related to the provider surcharge
under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
nursing home and a boarding care home, the portion related to the provider surcharge under
section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
of nursing home beds divided by its total number of licensed beds.

(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
amount of the fee divided by the sum of the facility's resident days.

(d) The portion related to development and education of resident and family advisory
councils under section 144A.33 is $5 per resident day divided by 365.

(e) The portion related to scholarships is determined under section 256R.37.

deleted text begin (f) The portion related to planned closure rate adjustments is as determined under section
256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.
 deleted text end

deleted text begin (g) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.
 deleted text end

deleted text begin (h) The portion related to single-bed room incentives is as determined under section
256R.41.
 deleted text end

deleted text begin (i)deleted text end new text begin (f)new text end The portions related to real estate taxes, special assessments, and payments made
in lieu of real estate taxes directly identified or allocated to the nursing facility are the deleted text begin actualdeleted text end new text begin
allowablenew text end amounts divided by the sum of the facility's resident days. Allowable costs under
this paragraph for payments made by a nonprofit nursing facility that are in lieu of real
estate taxes shall not exceed the amount which the nursing facility would have paid to a
city or township and county for fire, police, sanitation services, and road maintenance costs
had real estate taxes been levied on that property for those purposes.

deleted text begin (j)deleted text end new text begin (g)new text end The portion related to employer health insurance costs is the allowable costs
divided by the sum of the facility's resident days.

deleted text begin (k)deleted text end new text begin (h)new text end The portion related to the Public Employees Retirement Association is deleted text begin actualdeleted text end new text begin
allowablenew text end costs divided by the sum of the facility's resident days.

deleted text begin (l)deleted text end new text begin (i)new text end The portion related to quality improvement incentive payment rate adjustments
is the amount determined under section 256R.39.

deleted text begin (m)deleted text end new text begin (j)new text end The portion related to performance-based incentive payments is the amount
determined under section 256R.38.

deleted text begin (n)deleted text end new text begin (k)new text end The portion related to special dietary needs is the amount determined under
section 256R.51.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January, 1, 2020.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 256R.26, is amended to read:


256R.26 PROPERTY PAYMENT RATE.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

deleted text begin The property payment rate for a nursing facility is the property
rate established for the facility under sections 256B.431 and 256B.434. deleted text end new text begin (a) For rate years
beginning on or after January 1, 2020, the commissioner shall reimburse nursing facilities
participating in the medical assistance program for the rental use of real estate and depreciable
assets according to this section and sections 256R.261 to 256R.27. The property payment
rate made under this methodology is the only payment for costs related to capital assets,
including depreciation, interest and lease expenses for all depreciable assets, also including
movable equipment, land improvements, and land.
 new text end

new text begin (b) The commercial valuation system selected by the commissioner must be utilized in
all appraisals. The appraisal is not intended to exactly reflect market value, and no
adjustments or substitutions are permitted for any alternative analysis of properties than the
selected commercial valuation system.
 new text end

new text begin (c) Based on the valuation of a building and fixed equipment, the property appraisal
firm selected by the commissioner must produce a report detailing both the depreciated
replacement cost (DRC) and undepreciated replacement cost (URC) of the nursing facility.
The valuation excludes movable equipment, land, or land improvements. The valuation
must be adjusted for any shared area included in the DRC and URC not used for nursing
facility purposes. Physical plant for central office operations is not included in the appraisal.
 new text end

new text begin (d) The appraisal initially may include the full value of all shared areas. The DRC, URC,
and square footage are established by an appraisal and must be adjusted to reflect only the
nursing facility usage of shared areas in the final nursing facility values. The adjustment
must be based on a Medicare-approved allocation basis for the type of service provided by
each area. Shared areas outside the appraised space must be added to the DRC, URC, and
related square footage using the average of each value from the space in the appraisal.
 new text end

new text begin Subd. 2. new text end

new text begin Appraised value. new text end

new text begin For rate years beginning on or after January 1, 2020, the
DRC and URC are based on the appraisals of a building and attached fixtures as determined
by the contracted property appraisal firm using a commercial valuation system selected by
the commissioner.
 new text end

new text begin Subd. 3. new text end

new text begin Initial rate year. new text end

new text begin The property payment rate calculated under section 256R.265
for the initial rate year effective January 1, 2020, must be a per diem amount based on the
DRC and URC of a nursing facility's building and attached fixtures, as estimated by a
commercial property appraisal firm in 2016. The initial values for both the DRC and URC,
adjusted for nonnursing facility space, must be increased by six percent.
 new text end

new text begin Subd. 4. new text end

new text begin Subsequent rate years. new text end

new text begin (a) Beginning in calendar year 2020, the commissioner
shall contract with a property appraisal firm to appraise the building and attached fixtures
for nursing facilities using the commercial valuation system. Approximately one-third of
the nursing facilities must be appraised each year.
 new text end

new text begin (b) If a nursing facility wishes to appeal findings of fact in the appraisal report, the
nursing facility must request a revision within 20 calendar days after receipt of the appraisal
report.
 new text end

new text begin (c) The property payment rate for rate year beginning January 1, 2021, for the one-third
of nursing facilities that are newly appraised in 2020 must be based upon new DRCs and
URCs for buildings and attached fixtures as determined by the contracted property appraisal
firm.
 new text end

new text begin (d) The property payment rate for rate years beginning January 1, 2021, and January 1,
2022, for the remainder of the nursing facilities that were not previously appraised, must
use the net DRC and URC used in the January 1, 2020, property payment rates adjusted for
inflation before any formula limitations are applied. The index for the inflation adjustment
must be based on the change in the United States All-Items Consumer Price Index (CPI-U)
forecasted by the Reports and Forecasts Division of the Department of Human Services in
the third quarter of the calendar year preceding the rate year. The inflation adjustment must
be based on the 12-month period from the midpoint of the previous rate year to the midpoint
of the rate year for which the rate is being determined. Nursing facilities under this paragraph
must have the property payment rates beginning January 1, 2022, and January 1, 2023,
based on new replacement costs and depreciated values as determined in appraisals based
on the three-year cycle.
 new text end

new text begin (e) For the nursing facility's new physical appraisal after the nursing facility's 2016
appraisal, the most recent DRC and URC must be updated through the commercial valuation
system. These valuations are updates only and not subject to revisions of any of the original
valuations or appeal by the nursing facility.
 new text end

new text begin Subd. 5. new text end

new text begin Special reappraisals. new text end

new text begin (a) A nursing facility that completes an addition to or
replacement of a building or attached fixtures as approved in section 144A.073 after January
1, 2020, may request a property rate adjustment effective the first of January, April, July,
or October after project completion. The nursing facility must submit all cost data related
to the project to the commissioner within 90 days of project completion. The commissioner
must add the nursing facility to the next group of scheduled appraisals. The nursing facility's
updated appraisal must be used to calculate a revised property rate effective the first of
January, April, July, or October after project completion. If an updated appraisal cannot be
scheduled within 90 days of the effective date of the revised property, the commissioner
must establish an interim valuation which must be adjusted retroactively when the updated
appraisal is available. For a nursing facility with projects approved under section 144A.073
prior to January 1, 2020, moratorium project construction adjustments must be calculated
under Minnesota Statutes 2018, section 256B.434, subdivision 4f, and the adjustment added
to the nursing facility's hold harmless rate effective the first of January, April, July, or
October after project completion. This adjustment is in addition to the updated appraisal
described in this paragraph.
 new text end

new text begin (b) A nursing facility that completes a threshold construction project after January 1,
2020, may submit a project rate adjustment request to the commissioner if the building
improvement or addition costs exceed $300,000 and the threshold construction project is
not reflected in an appraisal used for rate setting. The cost must be incurred by the nursing
facility, or if the nursing facility is leased and the cost is incurred by the lease holder, the
provider's lease has been increased for the project. Threshold project costs exceeding a total
of $1,500,000 within a three-year period, or a prorated amount if the appraisals are less than
three years apart, must not be recognized. The property payment rate must be updated to
reflect the new DRC and URC values effective the first of January or July after project
completion. In subsequent property payment rate calculations, an addition to the DRC and
URC must be eliminated once a full appraisal is complete for the nursing facility after project
completion. At the option of the commissioner the appraisal schedule may be adjusted for
nursing facilities completing threshold projects. Threshold project costs are not considered
if the costs were incurred prior to the date of the last appraisal.
 new text end

new text begin (c) Effective January 1, 2020, a nursing facility new to the medical assistance program
must have the building and fixed equipment appraised by the property appraisal firm upon
completion of construction of the nursing facility, or, if not newly constructed, upon entering
the medical assistance program. If an appraisal cannot be scheduled within 90 days of the
certification date, the commissioner must establish an interim valuation to be adjusted
retroactively when the appraisal is available.
 new text end

new text begin Subd. 6. new text end

new text begin Limitation on appraisal valuations. new text end

new text begin Effective for appraisals conducted on or
after January 1, 2020, the increase in the URC is limited to $500,000 per year since the last
completed appraisal plus any completed project costs approved under section 144A.073.
Any limitation to the URC must be applied in the same proportion to the DRC.
 new text end

new text begin Subd. 7. new text end

new text begin Total hold harmless rate. new text end

new text begin (a) Total hold harmless rate includes closure
adjustments under Minnesota Statutes 2018, section 256R.40, subdivision 5; consolidation
adjustments under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6),
and 4d; equity incentives under sections 256B.431, subdivision 16, and Minnesota Statutes
2018, 256B.434, subdivision 4f; single-bed incentives under Minnesota Statutes 2018,
section 256R.41; project construction costs under Minnesota Statutes 2018, section 144A.071,
subdivision 1a, paragraph (j); and all components of the property payment rate under section
256R.26 in effect on December 31, 2019.
 new text end

new text begin (b) For moratorium projects as defined under sections 144A.071 and 144A.073 that are
eligible for rate adjustments approved prior to January 1, 2020, but not reflected in the rate
on December 31, 2019, the moratorium rate adjustments determined under Minnesota
Statutes 2018, sections 256B.431, subdivisions 3f, 17, 17a, 17c, 17d, 17e, 21, 30, and 45,
and 256B.434, subdivisions 4f and 4j, must be added to the total hold harmless rate in effect
on the first of January, April, July, or October after project completion.
 new text end

new text begin (c) Effective January 1, 2020, rate adjustments under Minnesota Statutes 2018, section
256R.25, paragraphs (f) to (h) from previous rate years shall be included in the total hold
harmless rate.
 new text end

new text begin Subd. 8. new text end

new text begin Phase out of hold harmless rate. new text end

new text begin (a) For a nursing facility that has a higher
total hold harmless rate than the rate calculated in section 256R.265, the nursing facility
must receive 100 percent of the total hold harmless rate for the rate year beginning January
1, 2020.
 new text end

new text begin (b) For rate years beginning January 1, 2021, to January 1, 2024, the property payment
rate is a blending of the total hold harmless rate and the property rate determined in section
256R.265, plus any adjustments issued for construction projects between appraisals, if a
higher rate results. If not, the property payment rate is determined according to section
256R.265.
 new text end

new text begin (c) For the rate year beginning January 1, 2021, for eligible nursing facilities, the property
payment rate is 80 percent of the total hold harmless rate and 20 percent of the property
payment rate calculated in section 256R.265.
 new text end

new text begin (d) For the rate year beginning January 1, 2022, for eligible nursing facilities, the property
payment rate is 60 percent of the total hold harmless rate and 40 percent of the property
payment rate calculated in section 256R.265.
 new text end

new text begin (e) For the rate year beginning January 1, 2023, for eligible nursing facilities, the property
payment rate is 40 percent of the total hold harmless rate and 60 percent of the property
payment rate calculated in section 256R.265.
 new text end

new text begin (f) For the rate year beginning January 1, 2024, for eligible nursing facilities, the property
payment rate is 20 percent of the total hold harmless rate and 80 percent of the property
payment rate calculated in section 256R.265.
 new text end

new text begin (g) For rate years beginning January 1, 2025, and thereafter, the property payment rate
is as calculated under section 256R.265.
 new text end

Sec. 19.

new text begin [256R.261] NURSING FACILITY PROPERTY RATE DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of sections 256R.26 to 256R.27, the following
terms have the meanings given them.
 new text end

new text begin Subd. 2. new text end

new text begin Addition. new text end

new text begin "Addition" means an extension, enlargement, or expansion of the
nursing facility for the purpose of increasing the number of licensed beds or improving
resident care.
 new text end

new text begin Subd. 3. new text end

new text begin Appraisal. new text end

new text begin "Appraisal" means an evaluation of the nursing facility's physical
real estate conducted by a property appraisal firm selected by the commissioner to establish
the valuation of a building and fixed equipment.
 new text end

new text begin Subd. 4. new text end

new text begin Building. new text end

new text begin "Building" means the physical plant and fixed equipment used directly
for resident care and licensed under chapter 144A or sections 144.50 to 144.56. Building
excludes buildings or portions of buildings used by central, affiliated, or corporate offices.
 new text end

new text begin Subd. 5. new text end

new text begin Commercial valuation system. new text end

new text begin "Commercial valuation system" means a
commercially available building valuation system selected by the commissioner that may
include the Marshall and Swift Valuation System.
 new text end

new text begin Subd. 6. new text end

new text begin Depreciable movable equipment. new text end

new text begin "Depreciable movable equipment" means
the standard movable care equipment and support service equipment generally used in
nursing facilities. Depreciable movable equipment includes equipment specified in the major
movable equipment table of the depreciation guidelines. The general characteristics of this
equipment are: (1) a relatively fixed location in the building; (2) capable of being moved
as distinguished from building equipment; (3) a unit cost sufficient to justify ledger control;
and (4) sufficient size and identity to make control feasible by means of identification tags.
 new text end

new text begin Subd. 7. new text end

new text begin Depreciated replacement cost or DRC. new text end

new text begin "Depreciated replacement cost" or
"DRC" means the depreciated replacement cost determined by an appraisal using the
commercial valuation system. DRC excludes costs related to parking structures.
 new text end

new text begin Subd. 8. new text end

new text begin Depreciation expense. new text end

new text begin "Depreciation expense" means the portion of a capital
asset deemed to be consumed or expired over the life of the asset.
 new text end

new text begin Subd. 9. new text end

new text begin Depreciation guidelines. new text end

new text begin "Depreciation guidelines" means the most recent
publication of "Estimated Useful Lives of Depreciable Hospital Assets" issued by the
American Hospital Association.
 new text end

new text begin Subd. 10. new text end

new text begin Equipment allowance. new text end

new text begin "Equipment allowance" means the component of the
property-related payment rate which is a payment for the use of depreciable movable
equipment.
 new text end

new text begin Subd. 11. new text end

new text begin Fair rental value system. new text end

new text begin "Fair rental value system" means a system that
establishes a price for the use of a space based on an appraised value of the property. The
price is established without consideration of the actual accounting cost to construct or
remodel the property. The price is the nursing facility value, subject to limits, multiplied
by an established rental rate.
 new text end

new text begin Subd. 12. new text end

new text begin Fixed equipment. new text end

new text begin "Fixed equipment" means equipment affixed to the building
and not subject to transfer, including but not limited to wiring, electrical fixtures, plumbing,
elevators, and heating and air conditioning systems.
 new text end

new text begin Subd. 13. new text end

new text begin Land improvement. new text end

new text begin "Land improvement" means improvement to the land
surrounding the nursing facility directly used for nursing facility operations as specified in
the land improvements table of the depreciation guidelines. Land improvement includes
construction of auxiliary buildings including sheds, garages, storage buildings, and parking
structures.
 new text end

new text begin Subd. 14. new text end

new text begin Rental rate. new text end

new text begin "Rental rate" means the percentage applied to the allowable value
of the building and attached fixtures per year in the property payment calculation as
determined by the commissioner.
 new text end

new text begin Subd. 15. new text end

new text begin Shared area. new text end

new text begin "Shared area" means square footage that a nursing facility shares
with a non-nursing facility operation to provide a support service.
 new text end

new text begin Subd. 16. new text end

new text begin Threshold project. new text end

new text begin "Threshold project" means additions to a building or fixed
equipment that exceed the costs specified in section 256R.26, subdivision 5, paragraph (b).
Threshold projects exclude land, land improvements, and movable equipment purchases.
 new text end

new text begin Subd. 17. new text end

new text begin Undepreciated replacement cost or URC. new text end

new text begin "Undepreciated replacement cost"
or "URC" means the undepreciated replacement cost determined by the appraisal for building
and attached fixtures using a commercial valuation system. URC excludes costs related to
parking structures.
 new text end

new text begin Subd. 18. new text end

new text begin Undepreciated replacement cost (URC) per bed limit. new text end

new text begin "Undepreciated
replacement cost (URC) per bed limit" means the maximum allowed URC per nursing
facility bed as established by the commissioner based on values across the industry and
compared to an industry standard for reasonableness.
 new text end

Sec. 20.

new text begin [256R.265] PROPERTY RATE CALCULATION UNDER FAIR RENTAL
VALUE SYSTEM.
 new text end

new text begin Subdivision 1. new text end

new text begin Square feet per bed limit. new text end

new text begin The square feet per bed limit is calculated as
follows:
 new text end

new text begin (1) the URC of the nursing facility from the appraisal is divided by the allowable nursing
facility square feet;
 new text end

new text begin (2) the allowable total square feet is calculated by dividing the actual square feet from
the appraisal, after adjustment for non-nursing facility area, by the number of licensed beds
three months prior to the beginning of the rate year limited to the following maximum. The
allowable square feet maximum is 800 square feet per bed plus 25 percent of the square
feet over 800 up to 1,200 square feet per bed. Square feet over 1,200 square feet per bed is
not recognized; and
 new text end

new text begin (3) the allowable total square feet in clause (2) is multiplied by the amount in clause (1)
and by the number of licensed beds three months prior to the beginning of the rate year to
determine the square feet per bed limit.
 new text end

new text begin Subd. 2. new text end

new text begin Total URC limit. new text end

new text begin The total URC limit is calculated as follows:
 new text end

new text begin (1) the allowable square feet per bed limit as determined in subdivision 1 is divided by
the number of licensed beds three months prior to the beginning of the rate year to determine
allowable URC per bed limit for each nursing facility, adjusted for square feet limitation;
 new text end

new text begin (2) the allowable URC per bed limit, adjusted for square feet limitation, for all nursing
facilities is placed in an array annually to determine the value at the 75th percentile. This
is the limit for URC per bed limit for non-single beds;
 new text end

new text begin (3) the value determined in clause (2) is multiplied by 115 percent to determine the limit
for URC per bed limit for single beds;
 new text end

new text begin (4) the number of non-single-licensed beds three months prior to the beginning of the
rate year is multiplied by the amount in clause (2);
 new text end

new text begin (5) the number of single-licensed beds three months prior to the beginning of the rate
year is multiplied by the amount in clause (3); and
 new text end

new text begin (6) the amounts in clauses (4) and (5) are summed to determine the total URC limit;
 new text end

new text begin Subd. 3. new text end

new text begin Calculation of total property rate. new text end

new text begin The total property rate is calculated as
follows:
 new text end

new text begin (1) the lower of the allowable URC based on square feet per bed limit as determined
under subdivision 1 or the total URC limit in subdivision 2 is the final allowed URC;
 new text end

new text begin (2) the final allowed URC determined in clause (1) is divided by the URC from the
appraisal to determine the allowed percentage. The allowed percentage is multiplied by the
depreciated replacement value from the appraisal, adjusted for non-nursing facility area, to
determine the final allowed depreciated replacement value;
 new text end

new text begin (3) the number of licensed beds three months prior to the beginning of the rate year is
multiplied by $5,305 to determine reimbursement for land and land improvements. There
is no separate addition to the property rate for parking structures;
 new text end

new text begin (4) the values in clauses (2) and (3) are summed and then multiplied by the rental rate
of 5.5 percent to determine allowable property reimbursement;
 new text end

new text begin (5) the allowable property reimbursement determined in clause (4) is divided by 90
percent of capacity days to determine the building property rate. Capacity days are determined
by multiplying the number of licensed beds three months prior to the beginning of the report
year by 365;
 new text end

new text begin (6) for the rate year beginning January 1, 2020, the equipment allowance is $2.77 per
resident day. For the rate year beginning January 1, 2021, the equipment allowance must
be adjusted annually for inflation. The index for the inflation adjustment must be based on
the change in the United States All Items Consumer Price Index (CPI-U) forecasted by the
Reports and Forecasts Division of the Department of Human Services in the third quarter
of the calendar year preceding the rate year. The inflation adjustment must be based on the
12-month period from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined; and
 new text end

new text begin (7) the sum of the building property rate and the equipment allowance is the total property
rate.
 new text end

Sec. 21.

new text begin [256R.27] INTERIM AND SETTLE UP TOTAL OPERATING AND
EXTERNAL FIXED COST PAYMENT RATES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) A newly constructed nursing facility, or a nursing facility
with a capacity increase of 50 percent or more, must receive an interim total operating rate
payment and settle up total operating cost payment according to this section.
 new text end

new text begin (b) The nursing facility shall submit a written application to the commissioner to receive
an interim total operating payment rate. In its application, the nursing facility shall state
any reasons for noncompliance with this chapter.
 new text end

new text begin (c) The effective date of the interim total operating payment rate is the earlier of either
the first day a resident is admitted to the newly constructed nursing facility or the date the
nursing facility bed is certified for the medical assistance program. The interim total operating
payment rate must not be in effect more than 17 months.
 new text end

new text begin (d) The nursing facility must continue to receive the interim total operating payment
rate until the settle up total operating cost payment is determined under subdivision 3.
 new text end

new text begin (e) The settle up total operating cost payment rate is effective retroactively to the
beginning of the interim cost report period, and is effective until the end of the interim rate
period.
 new text end

new text begin (f) For the 15-month period following the settle up reporting period, the total operating
rate payment and external fixed cost payment rate must be determined according to
subdivision 3, paragraph (b).
 new text end

new text begin (g) The total operating rate payment and external fixed cost payment rate for the rate
year beginning January 1 following the 15-month period in paragraph (f) must be determined
under this chapter.
 new text end

new text begin (h) The commissioner shall determine interim total operating cost payment rates and
settle up total operating cost payment rates for a newly constructed nursing facility, or a
nursing facility with an increase in licensed capacity of 50 percent or more, according to
subdivisions 2 and 3.
 new text end

new text begin Subd. 2. new text end

new text begin Determination of interim operating and external fixed cost payment rate. new text end

new text begin (a)
The nursing facility shall submit an interim cost report in a format similar to the Minnesota
Statistical and Cost Report and other supporting information as required by this chapter for
the reporting year in which the nursing facility plans to begin operation at least 60 days
before the first day a resident is admitted to the newly constructed nursing facility bed. The
interim cost report must include the nursing facility's anticipated interim costs and anticipated
interim resident days for each resident class in the interim cost report. The anticipated interim
resident days for each resident class is multiplied by the weight for that resident class to
determine the anticipated interim standardized days as defined in section 256R.02,
subdivision 50, and resident days as defined in section 256R.02, subdivision 45, for the
reporting period.
 new text end

new text begin (b) The interim total operating cost payment rate is determined according to this section,
except that:
 new text end

new text begin (1) the anticipated interim costs and anticipated interim resident days reported on the
interim cost report and the anticipated interim standardized days as defined by section
256R.02, subdivision 50, must be used for the interim;
 new text end

new text begin (2) the commissioner shall use anticipated interim costs and anticipated interim
standardized days in determining the allowable historical direct care cost per standardized
day as determined under section 256R.23, subdivision 2;
 new text end

new text begin (3) the commissioner shall use anticipated interim costs and anticipated interim resident
days in determining the allowable historical other care-related cost per resident day as
determined under section 256R.23, subdivision 3;
 new text end

new text begin (4) the commissioner shall use anticipated interim costs and anticipated interim resident
days to determine the allowable historical external fixed cost per day under section 256R.25,
paragraphs (b) to (k);
 new text end

new text begin (5) the total care-related payment rate limits established in section 256R.23, subdivision
5, and in effect at the beginning of the interim period, must be increased by ten percent; and
 new text end

new text begin (6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
 new text end

new text begin Subd. 3. new text end

new text begin Determination of settle up operating and external fixed cost payment
rate. new text end

new text begin (a) When the interim payment rate begins between May 1 and September 30, the
nursing facility shall file settle up cost reports for the period from the beginning of the
interim payment rate through September 30 of the following year.
 new text end

new text begin (b) When the interim payment rate begins between October 1 and April 30, the nursing
facility shall file settle up cost reports for the period from the beginning of the interim
payment rate to the first September 30 following the beginning of the interim payment rate.
 new text end

new text begin (c) The settle up total operating cost payment rate is determined according to this section,
except that:
 new text end

new text begin (1) the allowable costs and resident days reported on the settle up cost report and the
standardized days as defined by section 256R.02, subdivision 50, must be used for the
interim and settle-up period;
 new text end

new text begin (2) the commissioner shall use the allowable costs and standardized days in clause (1)
to determine the allowable historical direct care cost per standardized day as determined
under section 256R.23, subdivision 2;
 new text end

new text begin (3) the commissioner shall use the allowable costs and the allowable resident days to
determine both the allowable historical other care-related cost per resident day as determined
under section 256R.23, subdivision 3;
 new text end

new text begin (4) the commissioner shall use the allowable costs and the allowable resident days to
determine the allowable historical external fixed cost per day under section 256R.25,
paragraphs (b) to (k);
 new text end

new text begin (5) the total care-related payment limits established in section 256R.23, subdivision 5,
are the limits for the settle up reporting periods. If the interim period includes more than
one July 1 date, the commissioner shall use the total care-related payment limit established
in section 256R.23, subdivision 5, increased by ten percent for the second July 1 date; and
 new text end

new text begin (6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
 new text end

Sec. 22.

Minnesota Statutes 2018, section 256R.44, is amended to read:


256R.44 RATE ADJUSTMENT FOR PRIVATE ROOMS FOR MEDICAL
NECESSITY.

The amount paid for a private room is deleted text begin 111.5deleted text end new text begin 110new text end percent of the established total payment
rate for a resident if the resident is a medical assistance recipient and the private room is
considered a medical necessity for the resident or others who are affected by the resident's
conditiondeleted text begin , except as provided in Minnesota Rules, part 9549.0060, subpart 11, item Cdeleted text end .
Conditions requiring a private room must be determined by the resident's attending physician
and submitted to the commissioner for approval or denial by the commissioner on the basis
of medical necessity.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 23.

Minnesota Statutes 2018, section 256R.47, is amended to read:


256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.

(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.

(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.

(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
designated as critical access nursing facilities:

(1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;

(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;

(3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;

(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and

(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.

(d) Designation of a critical access nursing facility is for a period of two years, after
which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
apply for continued designation.

(e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, deleted text begin to December 31, 2019.deleted text end new text begin
through December 31, 2023.
new text end

Sec. 24.

Minnesota Statutes 2018, section 256R.50, subdivision 6, is amended to read:


Subd. 6.

Determination of rate adjustment.

(a) If the amount determined in subdivision
5 is less than or equal to the amount determined in subdivision 4, the commissioner shall
allow a total payment rate equal to the amount used in subdivision 5, clause (3).

(b) If the amount determined in subdivision 5 is greater than the amount determined in
subdivision 4, the commissioner shall allow a rate with a case mix index of 1.0 that when
used in subdivision 5, clause (3), results in the amount determined in subdivision 5 being
equal to the amount determined in subdivision 4.

(c) If the commissioner relies upon provider estimates in subdivision 5, clause (1) or
(2), then annually, for three years after the rates determined in this section take effect, the
commissioner shall determine the accuracy of the alternative factors of medical assistance
case load and the facility average case mix index used in this section and shall reduce the
total payment rate if the factors used result in medical assistance costs exceeding the amount
in subdivision 4. If the actual medical assistance costs exceed the estimates by more than
five percent, the commissioner shall also recover the difference between the estimated costs
in subdivision 5 and the actual costs according to section 256B.0641. The commissioner
may require submission of data from the receiving facility needed to implement this
paragraph.

(d) When beds approved for relocation are put into active service at the destination
facility, rates determined in this section must be adjusted by any adjustment amounts that
were implemented after the date of the letter of approval.

new text begin (e) Rate adjustments determined under this subdivision expire after three full rate years
following the effective date of the rate adjustment. This subdivision expires when the final
rate adjustment determined under this subdivision expires.
 new text end

Sec. 25. new text begin DIRECTION TO COMMISSIONER; MORATORIUM EXCEPTION
FUNDING.
new text end

new text begin In fiscal year 2019, the commissioner of human services may approve moratorium
exception projects under Minnesota Statutes, section 144A.073, for which the full annualized
state share of medical assistance costs does not exceed $1,500,000 plus any carryover of
previous appropriations 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. 26. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 144A.071, subdivision 4d; 256R.40; and 256R.41, new text end new text begin
are repealed effective July 1, 2019.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 256B.431, subdivisions 3a, 3f, 3g, 3i, 13, 15, 17,
17a, 17c, 17d, 17e, 18, 21, 22, 30, and 45; 256B.434, subdivisions 4, 4f, 4i, and 4j; and
256R.36, new text end new text begin and new text end new text begin Minnesota Rules, parts 9549.0057; and 9549.0060, subparts 4, 5, 6, 7, 10, 11,
and 14, new text end new text begin are repealed effective January 1, 2020.
 new text end

ARTICLE 5

DISABILITY SERVICES

Section 1.

Minnesota Statutes 2018, section 237.50, subdivision 4a, is amended to read:


Subd. 4a.

Deaf.

"Deaf" means a hearing loss of such severity that the deleted text begin individualdeleted text end new text begin personnew text end
must depend primarily upon visual communication such as writing, lip reading, sign language,
and gestures.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:


new text begin Subd. 4c. new text end

new text begin Discounted telecommunications services. new text end

new text begin "Discounted telecommunications
services" means private, nonprofit, and public programs intended to subsidize or reduce the
monthly costs of telecommunications services for a person who meets a program's eligibility
requirements.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 237.50, subdivision 6a, is amended to read:


Subd. 6a.

Hard-of-hearing.

"Hard-of-hearing" means a hearing loss resulting in a
functional limitation, but not to the extent that the deleted text begin individualdeleted text end new text begin personnew text end must depend primarily
upon visual communicationnew text begin in all interactionsnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:


new text begin Subd. 6b. new text end

new text begin Interconnectivity product. new text end

new text begin "Interconnectivity product" means any product
including an accessory, application, or device that a person with a communication disability
needs to use in conjunction with a telecommunications device to have functionally equivalent
access to telecommunications services as a person without a communication disability.
Interconnectivity product may include a hearing aid streamer, Bluetooth-enabled device,
advanced communications application for a smartphone, or any other product the
commissioner of human services deems appropriate.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:


new text begin Subd. 6c. new text end

new text begin Multifunctional safety device. new text end

new text begin "Multifunctional safety device" means an
alerting device that has two or more functions. Multifunctional safety device may include
a telephone ring signaler that also alerts a person with a communication disability to the
doorbell, smoke alarm, carbon monoxide alarm, noises in another room, or other
environmental sounds.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 237.50, subdivision 10a, is amended to read:


Subd. 10a.

Telecommunications device.

"Telecommunications device" means a device
that (1) allows a person with a communication disability to have access to
telecommunications services as defined in subdivision 13, and (2) is specifically selected
by the Department of Human Services for its capacity to allow persons with communication
disabilities to use telecommunications services in a manner that is functionally equivalent
to the ability of deleted text begin an individualdeleted text end new text begin a personnew text end who does not have a communication disability. A
telecommunications device may include a ring signaler, an amplified telephone, a hands-free
telephone, a text telephone, a captioned telephone, a wireless device, a device that produces
Braille output for use with a telephone, and any other device the Department of Human
Services deems appropriate.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 237.50, subdivision 11, is amended to read:


Subd. 11.

Telecommunications Relay Services.

"Telecommunications Relay Services"
or "TRS" means the telecommunications transmission services required under Federal
Communications Commission regulations at Code of Federal Regulations, title 47, sections
64.604 to 64.606. TRS allows deleted text begin an individualdeleted text end new text begin a personnew text end who has a communication disability
to use telecommunications services in a manner that is functionally equivalent to the ability
of deleted text begin an individualdeleted text end new text begin a personnew text end who does not have a communication disability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 237.51, subdivision 1, is amended to read:


Subdivision 1.

Creation.

new text begin (a) new text end The commissioner of commerce shall:

(1) administer through interagency agreement with the commissioner of human services
a program to distribute telecommunications devicesnew text begin , interconnectivity products, and
multifunctional safety devicesnew text end to eligible persons who have communication disabilities;
and

(2) contract with one or more qualified vendors that serve persons who have
communication disabilities to provide telecommunications relay services.

new text begin (b) new text end For purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section 237.54, subdivision
2, are not telephone companies or telecommunications carriers as defined in section 237.01.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 237.51, subdivision 5a, is amended to read:


Subd. 5a.

Commissioner of human services duties.

(a) In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of human services shall:

(1) define economic hardship, special needs, and household criteria so as to determine
the priority of eligible applicants for initial distribution of devices new text begin and products new text end and to
determine circumstances necessitating provision of more than one telecommunications
device per household;

(2) establish a method to verify eligibility requirements;

(3) establish specifications for telecommunications devicesnew text begin , interconnectivity products,
and multifunctional safety devicesnew text end to be provided under section 237.53, subdivision 3;

(4) inform the public and specifically persons who have communication disabilities of
the program; deleted text begin and
deleted text end

(5) provide devices new text begin and products new text end based on the assessed need of eligible applicantsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) assist a person with completing an application for discounted telecommunications
services.
 new text end

(b) The commissioner may establish an advisory board to advise the department in
carrying out the duties specified in this section and to advise the commissioner of commerce
in carrying out duties under section 237.54. If so established, the advisory board must
include, at a minimum, the following persons:

(1) at least one member who is deaf;

(2) at least one member who has a speech disability;

(3) at least one member who has a physical disability that makes it difficult or impossible
for the person to access telecommunications services; and

(4) at least one member who is hard-of-hearing.

new text begin (c) new text end The membership terms, compensation, and removal of members and the filling of
membership vacancies are governed by section 15.059. Advisory board meetings shall be
held at the discretion of the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 237.52, subdivision 5, is amended to read:


Subd. 5.

Expenditures.

(a) Money in the fund may only be used for:

(1) expenses of the Department of Commerce, including personnel cost, public relations,
advisory board members' expenses, preparation of reports, and other reasonable expenses
not to exceed ten percent of total program expenditures;

(2) reimbursing the commissioner of human services for purchases made or services
provided pursuant to section 237.53; and

(3) contracting for the provision of TRS required by section 237.54.

(b) All costs directly associated with the establishment of the program, the purchase and
distribution of telecommunications devices, new text begin interconnectivity products, and multifunctional
safety devices new text end and the provision of TRS are either reimbursable or directly payable from
the fund after authorization by the commissioner of commerce. The commissioner of
commerce shall contract with one or more TRS providers to indemnify the
telecommunications service providers for any fines imposed by the Federal Communications
Commission related to the failure of the relay service to comply with federal service
standards. Notwithstanding section 16A.41, the commissioner may advance money to the
TRS providers if the providers establish to the commissioner's satisfaction that the advance
payment is necessary for the provision of the service. The advance payment may be used
only for working capital reserve for the operation of the service. The advance payment must
be offset or repaid by the end of the contract fiscal year together with interest accrued from
the date of payment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 11.

Minnesota Statutes 2018, section 237.53, is amended to read:


237.53 TELECOMMUNICATIONS DEVICEnew text begin , INTERCONNECTIVITY
PRODUCTS, AND MULTIFUNCTIONAL SAFETY DEVICESnew text end .

Subdivision 1.

Application.

A person applying for a telecommunications devicenew text begin ,
interconnectivity product, or multifunctional safety devicenew text end under this section must apply to
the program administrator on a form prescribed by the Department of Human Services.

Subd. 2.

Eligibility.

To be eligible to obtain a telecommunications devicenew text begin ,
interconnectivity product, or multifunctional safety devicenew text end under this section, a person must:

(1) be able to benefit from and use the equipment for its intended purpose;

(2) have a communication disability;

(3) be a resident of the state;

(4) be a resident in a household that has a median income at or below the applicable
median household income in the state, except a person who is deafblind applying for a
Braille device may reside in a household that has a median income no more than 150 percent
of the applicable median household income in the state; and

(5) be a resident in a household that has telecommunications service or that has made
application for service and has been assigned a telephone number; or a resident in a residential
care facility, such as a nursing home or group home where telecommunications service is
not included as part of overall service provision.

new text begin Subd. 2a. new text end

new text begin Assessment of needs. new text end

new text begin After a person is determined to be eligible for the
program, the commissioner of human services shall assess the person's telecommunications
needs to determine: (1) the type of telecommunications devices that provide the person with
functionally equivalent access to telecommunications services; (2) appropriate
interconnectivity products for the person; and (3) multifunctional safety devices to alert the
person to noises in the person's home.
 new text end

Subd. 3.

Distribution.

The commissioner of human services shall new text begin (1) new text end purchase deleted text begin and
distributedeleted text end a sufficient number of telecommunications devicesnew text begin , interconnectivity products,
and multifunctional safety devicesnew text end so that each eligible household receives appropriate
devicesnew text begin and productsnew text end as determined under section 237.51, subdivision 5adeleted text begin . The commissioner
of human services shalldeleted text end new text begin , and (2)new text end distribute the devices new text begin and products new text end to eligible households
free of charge.

Subd. 4.

Training; new text begin information; new text end maintenance.

The commissioner of human services
shall maintain the telecommunications devicesnew text begin , interconnectivity products, and
multifunctional safety devicesnew text end until the warranty period expires, and provide training, without
charge, to first-time users of the devicesdeleted text begin .deleted text end new text begin and products. The commissioner shall provide
information about assistive communications devices and products that may benefit a program
participant and about where a person may obtain or purchase assistive communications
devices and products. Assistive communications devices and products include a pocket
talker for a person who is hard-of-hearing, a communication board for a person with a speech
disability, a one-to-one video communication application for a person who is deaf, and other
devices and products designed to facilitate effective communication for a person with a
communication disability.
new text end

Subd. 6.

Ownership.

Telecommunications devicesnew text begin , interconnectivity products, and
multifunctional safety devicesnew text end purchased pursuant to subdivision 3new text begin , clause (1),new text end are the
property of the state of Minnesota. Policies and procedures for the return of new text begin distributed
new text end devices deleted text begin from individuals who withdraw from the program or whose eligibility status changesdeleted text end new text begin
and productsnew text end shall be determined by the commissioner of human services.

Subd. 7.

Standards.

The telecommunications devices distributed under this section must
comply with the electronic industries alliance standards and be approved by the Federal
Communications Commission. The commissioner of human services must provide each
eligible person a choice of several models of devices, the retail value of which may not
exceed $600 for a text telephone, and a retail value of $7,000 for a Braille device, or an
amount authorized by the Department of Human Services for all other telecommunications
devices deleted text begin anddeleted text end new text begin ,new text end auxiliary equipmentnew text begin , interconnectivity products, and multifunctional safety
devicesnew text end it deems cost-effective and appropriate to distribute according to sections 237.51
to 237.56.

new text begin Subd. 9. new text end

new text begin Discounted telecommunications services assistance. new text end

new text begin The commissioner of
human services shall assist a person who is applying for telecommunication devices and
products in applying for discounted telecommunications services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
 new text end

Sec. 12.

Minnesota Statutes 2018, section 245C.03, is amended by adding a subdivision
to read:


new text begin Subd. 13. 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

Sec. 13.

Minnesota Statutes 2018, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 14. 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 13, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $32 per study charged to the enrolled
agency. Fees collected under this subdivision are appropriated to the commissioner for the
purpose of conducting background studies.
 new text end

Sec. 14.

Minnesota Statutes 2018, section 245D.03, subdivision 1, is amended to read:


Subdivision 1.

Applicability.

(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.

(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:

(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;

(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;

(3) personal support as defined under the developmental disability waiver plan;

(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;

(5) night supervision services as defined under the brain injury waiver plan;

(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services only; deleted text begin and
deleted text end

(7) individual community living support under section 256B.0915, subdivision 3jdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (8) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion, and developmental disability
waiver plans.
 new text end

(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:

(1) intervention services, including:

(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;

(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and

(iii) specialist services as defined under the current developmental disability waiver
plan;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;

(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans;

(iii) semi-independent living services; deleted text begin and
deleted text end

deleted text begin (iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;
 deleted text end

new text begin (iv) individualized home support with training services as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans; and
 new text end

new text begin (v) individualized home support with family training services as defined under the brain
injury, community alternative care, community access for disability inclusion, and
developmental disability waiver plans;
 new text end

(3) residential supports and services, including:

(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;

(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; deleted text begin and
deleted text end

(iii)new text begin community residential services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans provided in a corporate child foster care residence, a community residential
setting, or a supervised living facility;
new text end

new text begin (iv) family residential services as defined in the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plans
provided in a family child foster care residence or a family adult foster care residence; and
 new text end

new text begin (v)new text end residential services provided to more than four persons with developmental disabilities
in a supervised living facility, including ICFs/DD;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii)new text begin day services under sections 252.41 to 252.46, and as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans;
new text end

new text begin (iii)new text end day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and

deleted text begin (iii)deleted text end new text begin (iv)new text end prevocational services as defined under the brain injury deleted text begin anddeleted text end new text begin , community
alternative care,new text end community access for disability inclusionnew text begin , and developmental disabilitynew text end
waiver plans; and

(5) employment exploration services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans;

(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; deleted text begin and
deleted text end

(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plansdeleted text begin .deleted text end new text begin ;
and
new text end

new text begin (8) integrated community support as defined under the brain injury and community
access for disability inclusion waiver plans beginning January 1, 2021, and community
alternative care and developmental disability waiver plans beginning January 1, 2023.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 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. 15.

Minnesota Statutes 2018, section 245D.071, subdivision 1, is amended to read:


Subdivision 1.

Requirements for intensive support services.

Except for services
identified in section 245D.03, subdivision 1, paragraph (c), clauses (1) and (2),new text begin item (ii),new text end a
license holder providing intensive support services identified in section 245D.03, subdivision
1, paragraph (c), must comply with the requirements in this section and section 245D.07,
subdivisions 1new text begin , 1a,new text end and 3. Services identified in section 245D.03, subdivision 1, paragraph
(c), clauses (1) and (2),new text begin item (ii),new text end must comply with the requirements in section 245D.07,
subdivision 2.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
 new text end

Sec. 16.

new text begin [245D.12] INTEGRATED COMMUNITY SUPPORTS; SETTING
CAPACITY REPORT.
 new text end

new text begin (a) The license holder providing integrated community support, as defined in section
245D.03, subdivision 1, paragraph (c), clause (8), must submit a setting capacity report to
the commissioner to ensure the identified location of service delivery meets the criteria of
the home and community-based service requirements as specified in section 256B.492.
 new text end

new text begin (b) The license holder shall provide the setting capacity report on the forms and in the
manner prescribed by the commissioner. The report must include:
 new text end

new text begin (1) the address of the multifamily housing building where the license holder delivers
integrated community supports and owns, leases, or has a direct or indirect financial
relationship with the property owner;
 new text end

new text begin (2) the total number of living units in the multifamily housing building described in
clause (1) where integrated community supports are delivered;
 new text end

new text begin (3) the total number of living units in the multifamily housing building described in
clause (1), including the living units identified in clause (2); and
 new text end

new text begin (4) the percentage of living units that are controlled by the license holder in the
multifamily housing building by dividing clause (2) by clause (3).
 new text end

new text begin (c) Only one license holder may deliver integrated community supports at the address
of the multifamily housing building.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon the date of federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
 new text end

Sec. 17.

Minnesota Statutes 2018, section 252.275, subdivision 3, is amended to read:


Subd. 3.

Reimbursement.

Counties shall be reimbursed for all expenditures made
pursuant to subdivision 1 at a rate of deleted text begin 70deleted text end new text begin 85 new text end percent, up to the allocation determined pursuant
to subdivisions 4 and 4b. However, the commissioner shall not reimburse costs of services
for any person if the costs exceed the state share of the average medical assistance costs for
services provided by intermediate care facilities for a person with a developmental disability
for the same fiscal year, and shall not reimburse costs of a onetime living allowance for any
person if the costs exceed $1,500 in a state fiscal year. The commissioner may make
payments to each county in quarterly installments. The commissioner may certify an advance
of up to 25 percent of the allocation. Subsequent payments shall be made on a reimbursement
basis for reported expenditures and may be adjusted for anticipated spending patterns.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 252.41, subdivision 3, is amended to read:


Subd. 3.

Day deleted text begin training and habilitationdeleted text end services for adults with deleted text begin developmentaldeleted text end
disabilities.

(a) "Day deleted text begin training and habilitationdeleted text end services for adults with deleted text begin developmentaldeleted text end
disabilities" means services that:

(1) include supervision, training, assistancenew text begin , supportnew text end , deleted text begin center-baseddeleted text end new text begin facility-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the deleted text begin individual service and individual habilitation plansdeleted text end new text begin coordinated
service and support plan and coordinated service and support plan addendumnew text end required undernew text begin
sections 245D.02, subdivision 4, paragraphs (a) and (b), and 256B.092, subdivision 1b, andnew text end
Minnesota Rules, deleted text begin partsdeleted text end new text begin partnew text end 9525.0004, deleted text begin to 9525.0036deleted text end new text begin subpart 12new text end , to help an adult reach and
maintain the highest possible level of independence, productivity, and integration into the
community; deleted text begin and
deleted text end

(2)new text begin include day support services, prevocational services, day training and habilitation
services, structured day services, and adult day services as defined in Minnesota's federally
approved disability waiver plans; and
new text end

new text begin (3)new text end are provided by a vendor licensed under sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin , 245D.27
to 245D.31,new text end 252.28, subdivision 2,new text begin and 252.41 to 252.46, and Minnesota Rules, parts
9525.1200 to 9525.1330,new text end to provide day deleted text begin training and habilitationdeleted text end services.

(b) Day deleted text begin training and habilitationdeleted text end services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.

(c) Day deleted text begin training and habilitationdeleted text end services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 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. 19.

Minnesota Statutes 2018, section 252.41, subdivision 4, is amended to read:


Subd. 4.

Independence.

"Independence" means the extent to which persons with
deleted text begin developmentaldeleted text end disabilities exert control and choice over their own lives.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 20.

Minnesota Statutes 2018, section 252.41, subdivision 5, is amended to read:


Subd. 5.

Integration.

"Integration" means that persons with deleted text begin developmentaldeleted text end disabilities:

(1) use the same community resources that are used by and available to individuals who
are not disabled;

(2) participate in the same community activities in which nondisabled individuals
participate; and

(3) regularly interact and have contact with nondisabled individuals.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 21.

Minnesota Statutes 2018, section 252.41, subdivision 6, is amended to read:


Subd. 6.

Productivity.

"Productivity" means that persons with deleted text begin developmentaldeleted text end disabilities:

(1) engage in income-producing work designed to improve their income level,
employment status, or job advancement; or

(2) engage in activities that contribute to a business, household, or community.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 22.

Minnesota Statutes 2018, section 252.41, subdivision 7, is amended to read:


Subd. 7.

Regional center.

"Regional center" means any state-operated facility under
the direct administrative authority of the commissioner that serves persons with
deleted text begin developmentaldeleted text end disabilities.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 23.

Minnesota Statutes 2018, section 252.41, subdivision 9, is amended to read:


Subd. 9.

Vendor.

"Vendor" means a deleted text begin nonprofitdeleted text end legal entity that:

(1) is licensed under sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin , 245D.27 to 245D.31,new text end 252.28,
subdivision 2,new text begin and 252.41 to 252.46, and Minnesota Rules, parts 9525.1200 to 9525.1330,new text end
to provide day deleted text begin training and habilitationdeleted text end services to adults with deleted text begin developmentaldeleted text end disabilities;
and

(2) does not have a financial interest in the legal entity that provides residential services
to the same person or persons to whom it provides day deleted text begin training and habilitationdeleted text end services.
This clause does not apply to regional treatment centers, state-operated, community-based
programs operating according to section 252.50 until July 1, 2000, or vendors licensed prior
to April 15, 1983.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 24.

Minnesota Statutes 2018, section 252.42, is amended to read:


252.42 SERVICE PRINCIPLES.

The design and delivery of services eligible for reimbursement should reflect the
following principles:

(1) services must suit a person's chronological age and be provided in the least restrictive
environment possible, consistent with the needs identified in the person's deleted text begin individual service
and individual habilitation plans underdeleted text end new text begin coordinated service and support plan and coordinated
service and support plan addendum required under sections 256B.092, subdivision 1b, and
245D.02, subdivision 4, paragraphs (a) and (b), andnew text end Minnesota Rules, parts 9525.0004 deleted text begin to
9525.0036deleted text end new text begin , subpart 12new text end ;

(2) a person with a deleted text begin developmentaldeleted text end disability whose individual deleted text begin service and individual
habilitation plansdeleted text end new text begin coordinated service and support plans and coordinated service and support
plan addendumsnew text end authorize employment or employment-related activities shall be given the
opportunity to participate in employment and employment-related activities in which
nondisabled persons participate;

(3) a person with a deleted text begin developmentaldeleted text end disability participating in work shall be paid wages
commensurate with the rate for comparable work and productivity except as regional centers
are governed by section 246.151;

(4) a person with a deleted text begin developmentaldeleted text end disability shall receive services which include services
offered in settings used by the general public and designed to increase the person's active
participation in ordinary community activities;

(5) a person with a deleted text begin developmentaldeleted text end disability shall participate in the patterns, conditions,
and rhythms of everyday living and working that are consistent with the norms of the
mainstream of society.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 25.

Minnesota Statutes 2018, section 252.43, is amended to read:


252.43 COMMISSIONER'S DUTIES.

The commissioner shall supervise deleted text begin county boards'deleted text end new text begin lead agencies'new text end provision of day deleted text begin training
and habilitationdeleted text end services to adults with deleted text begin developmentaldeleted text end disabilities. The commissioner shall:

(1) determine the need for day deleted text begin training and habilitationdeleted text end services under section deleted text begin 252.28deleted text end new text begin
256B.4914new text end ;

(2) establish payment rates as provided under section 256B.4914;

(3)new text begin add transportation costs to the day services payment rate;
new text end

new text begin (4)new text end adopt rules for the administration and provision of day deleted text begin training and habilitationdeleted text end
services under deleted text begin sections 252.41 to 252.46 anddeleted text end sections 245A.01 to 245A.16 deleted text begin anddeleted text end new text begin ,new text end 252.28,
subdivision 2new text begin , and 252.41 to 252.46, and Minnesota Rules, parts 9525.1200 to 9525.1330new text end ;

deleted text begin (4)deleted text end new text begin (5)new text end enter into interagency agreements necessary to ensure effective coordination and
provision of day deleted text begin training and habilitationdeleted text end services;

deleted text begin (5)deleted text end new text begin (6)new text end monitor and evaluate the costs and effectiveness of day deleted text begin training and habilitationdeleted text end
services; and

deleted text begin (6)deleted text end new text begin (7)new text end provide information and technical help to deleted text begin county boardsdeleted text end new text begin lead agenciesnew text end and vendors
in their administration and provision of day deleted text begin training and habilitationdeleted text end services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 26.

Minnesota Statutes 2018, section 252.44, is amended to read:


252.44 deleted text begin COUNTYdeleted text end new text begin LEAD AGENCYnew text end BOARD RESPONSIBILITIES.

When the need for day deleted text begin training and habilitationdeleted text end services in a countynew text begin or tribenew text end has been
determined under section 252.28, the board of commissioners for that deleted text begin countydeleted text end new text begin lead agencynew text end
shall:

(1) authorize the delivery of services according to the deleted text begin individual service and habilitation
plansdeleted text end new text begin coordinated service and support plans and coordinated service and support plan
addendumsnew text end required as part of the deleted text begin county'sdeleted text end new text begin lead agency'snew text end provision of case management
services undernew text begin sections 256B.0913, subdivision 8; 256B.0915, subdivision 6; 256B.092,
subdivision 1b; and 256B.49, subdivision 15, andnew text end Minnesota Rules, parts 9525.0004 to
9525.0036deleted text begin . For calendar years for which section 252.46, subdivisions 2 to 10, apply, the
county board shall not authorize a change in service days from the number of days authorized
for the previous calendar year unless there is documentation for the change in the individual
service plan. An increase in service days must also be supported by documentation that the
goals and objectives assigned to the vendor cannot be met more economically and effectively
by other available community services and that without the additional days of service the
individual service plan could not be implemented in a manner consistent with the service
principles in section 252.42deleted text end ;

(2) ensure that transportation is provided or arranged by the vendor in the most efficient
and reasonable way possible; and

(3) monitor and evaluate the cost and effectiveness of the services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 27.

Minnesota Statutes 2018, section 252.45, is amended to read:


252.45 VENDOR'S DUTIES.

Anew text begin day servicenew text end vendor enrolled with the commissioner is responsible for items under
clauses (1), (2), and (3), and extends only to the provision of services that are reimbursable
under state and federal law. A vendor providing day deleted text begin training and habilitationdeleted text end services shall:

(1) provide the amount and type of services authorized in the individual service plan
undernew text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (a) and (b), and
256B.092, subdivision 1b, andnew text end Minnesota Rules, deleted text begin partsdeleted text end new text begin partnew text end 9525.0004 deleted text begin to 9525.0036deleted text end new text begin , subpart
12new text end ;

(2) design the services to achieve the outcomes assigned to the vendor in the deleted text begin individual
service plandeleted text end new text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (a) and (b), and
256B.092, subdivision 1b, and Minnesota Rules, part 9525.0004, subpart 12new text end ;

(3) provide or arrange for transportation of persons receiving services to and from service
sites;

(4) enter into agreements with community-based intermediate care facilities for persons
with developmental disabilities to ensure compliance with applicable federal regulations;
and

(5) comply with state and federal law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
 new text end

Sec. 28.

Minnesota Statutes 2018, section 256.9365, is amended to read:


256.9365 PURCHASE OF deleted text begin CONTINUATIONdeleted text end new text begin HEALTH CAREnew text end COVERAGE FOR
deleted text begin AIDS PATIENTSdeleted text end new text begin PEOPLE LIVING WITH HIVnew text end .

Subdivision 1.

Program established.

The commissioner of human services shall establish
a program to pay deleted text begin privatedeleted text end new text begin the cost ofnew text end health plan premiumsnew text begin and cost sharing for prescriptions,
including co-payments, deductibles, and coinsurancenew text end for persons who have contracted human
immunodeficiency virus (HIV) to enable them to continue coverage under new text begin or enroll in new text end a
group or individual health plan. If a person is determined to be eligible under subdivision
2, the commissioner shall pay the deleted text begin portion of the group plan premium for which the individual
is responsible, if the individual is responsible for at least 50 percent of the cost of the
premium, or pay the individual plan premiumdeleted text end new text begin health insurance premiums and prescription
cost sharing, including co-payments and deductibles required under section 256B.0631new text end .
The commissioner shall not pay for that portion of a premium that is attributable to other
family members or dependentsnew text begin or is paid by the individual's employernew text end .

Subd. 2.

Eligibility requirements.

To be eligible for the program, an applicant must
deleted text begin satisfy the following requirements:deleted text end new text begin meet all eligibility requirements for and enroll in Part
B of the Ryan White HIV/AIDS Treatment Extension Act of 2009, Public Law 111-87.
new text end

deleted text begin (1) the applicant must provide a physician's, advanced practice registered nurse's, or
physician assistant's statement verifying that the applicant is infected with HIV and is, or
within three months is likely to become, too ill to work in the applicant's current employment
because of HIV-related disease;
 deleted text end

deleted text begin (2) the applicant's monthly gross family income must not exceed 300 percent of the
federal poverty guidelines, after deducting medical expenses and insurance premiums;
 deleted text end

deleted text begin (3) the applicant must not own assets with a combined value of more than $25,000; and
 deleted text end

deleted text begin (4) if applying for payment of group plan premiums, the applicant must be covered by
an employer's or former employer's group insurance plan.
 deleted text end

Subd. 3.

Cost-effective coverage.

Requirements for the payment of individual plan
premiums under subdivision 2deleted text begin , clause (5),deleted text end must be designed to ensure that the state cost of
paying an individual plan premium does not exceed the estimated state cost that would
otherwise be incurred in the medical assistance program. The commissioner shall purchase
the most cost-effective coverage available for eligible individuals.

Sec. 29.

Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:


Subd. 3a.

Elderly waiver cost limits.

(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256R.17 for nursing
home rate determination is implemented and the first day of each subsequent state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.

(b) The monthly limit for the cost of waivered services under paragraph (a) to an
individual elderly waiver client assigned to a case mix classification A with:

(1) no dependencies in activities of daily living; or

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).

(c) If extended medical supplies and equipment or environmental modifications are or
will be purchased for an elderly waiver client, the costs may be prorated for up to 12
consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a), (b), (d), or (e).

(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any
necessary home care services described in section 256B.0651, subdivision 2, for individuals
who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
paragraph (g), shall be the average of the monthly medical assistance amount established
for home care services as described in section 256B.0652, subdivision 7, and the annual
average contracted amount established by the commissioner for nursing facility services
for ventilator-dependent individuals. This monthly limit shall be increased annually as
described in paragraphs (a) and (e).

(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for
elderly waiver services in effect on the previous December 31 shall be increased by the
difference between any legislatively adopted home and community-based provider rate
increases effective on January 1 or since the previous January 1 and the average statewide
percentage increase in nursing facility operating payment rates under chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on January 1, or occurring
since the previous January 1.

new text begin (f) The commissioner shall approve an exception to the monthly case mix budget cap
in paragraph (a) to pay for an enhanced rate for personal care services as described in section
256B.0659. The exception shall not exceed 107.5 percent of the budget otherwise available
to the individual. The exception must be reapproved on an annual basis at the time of a
participant's annual reassessment.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, 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. 30.

Minnesota Statutes 2018, 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 The requirements for background studies under this
section shall be met by an early intensive developmental and behavioral intervention services
agency through the commissioner's NETStudy system as provided under sections 245C.03,
subdivision 13, and 245C.10, subdivision 14.
 new text end

Sec. 31.

Minnesota Statutes 2018, 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) "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.

(d) "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.

new text begin (e) "Direct care staff" means employees providing direct services to an individual
receiving services under this section. Direct care staff excludes executive, managerial, or
administrative staff.
 new text end

deleted text begin (e)deleted text end new text begin (f)new text end "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.

deleted text begin (f)deleted text end new text begin (g)new text end "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.

deleted text begin (g)deleted text end new text begin (h)new text end "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.

deleted text begin (h)deleted text end new text begin (i)new text end "Median" means the amount that divides distribution into two equal groups,
one-half above the median and one-half below the median.

deleted text begin (i)deleted text end new text begin (j)new text end "Payment or rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.

deleted text begin (j)deleted text end new text begin (k)new text end "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.

deleted text begin (k)deleted text end new text begin (l)new text end "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.

deleted text begin (l)deleted text end new text begin (m)new text end "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.

deleted text begin (m)deleted text end new text begin (n)new text end "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.

deleted text begin (n)deleted text end new text begin (o)new text end "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)new text begin for day support services, a unit of service is 15 minutes; and
new text end

new text begin (iv)new text end for prevocational services, a unit of service is a day or an hour. 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; and

(ii) 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.

Sec. 32.

Minnesota Statutes 2018, section 256B.4914, subdivision 3, is amended to read:


Subd. 3.

Applicable services.

Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:

(1) 24-hour customized living;

(2) adult day deleted text begin caredeleted text end new text begin servicesnew text end ;

(3) adult day deleted text begin caredeleted text end new text begin servicesnew text end bath;

deleted text begin (4) behavioral programming;
 deleted text end

deleted text begin (5)deleted text end new text begin (4)new text end companion services;

new text begin (5) community residential services;
 new text end

(6) customized living;

(7)new text begin day support services;
new text end

new text begin (8)new text end day training and habilitation;

new text begin (9) employment exploration services;
 new text end

new text begin (10) employment development services;
 new text end

new text begin (11) employment support services;
 new text end

new text begin (12) family residential services;
 new text end

deleted text begin (8)deleted text end new text begin (13)new text end housing access coordination;

deleted text begin (9)deleted text end new text begin (14)new text end independent living skills;

new text begin (15) individualized home supports;
 new text end

new text begin (16) individualized home supports with training;
 new text end

new text begin (17) individualized home supports with family training;
 new text end

deleted text begin (10)deleted text end new text begin (18)new text end in-home family support;

new text begin (19) integrated community supports;
 new text end

deleted text begin (11)deleted text end new text begin (20)new text end night supervision;

deleted text begin (12)deleted text end new text begin (21)new text end personal support;

new text begin (22) positive support services;
 new text end

deleted text begin (13)deleted text end new text begin (23)new text end prevocational services;

deleted text begin (14) residential care services;
 deleted text end

deleted text begin (15)deleted text end new text begin (24)new text end residential support services;

deleted text begin (16)deleted text end new text begin (25)new text end respite services;

deleted text begin (17)deleted text end new text begin (26)new text end structured day services;

deleted text begin (18) supported employment services;
 deleted text end

deleted text begin (19)deleted text end new text begin (27)new text end supported living services;

deleted text begin (20)deleted text end new text begin (28)new text end transportation services;new text begin and
new text end

deleted text begin (21) individualized home supports;
 deleted text end

deleted text begin (22) independent living skills specialist services;
 deleted text end

deleted text begin (23) employment exploration services;
 deleted text end

deleted text begin (24) employment development services;
 deleted text end

deleted text begin (25) employment support services; and
 deleted text end

deleted text begin (26)deleted text end new text begin (29)new text end other services as approved by the federal government in the state home and
community-based services plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later, except the amendment striking clause (18) related to supported
employment services is effective September 1, 2019. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained.
 new text end

Sec. 33.

Minnesota Statutes 2018, 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)new text begin 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);
new text end

new text begin (3)new text end for day new text begin services, day support services, and prevocational new text end 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);

deleted text begin (3)deleted text end new text begin (4)new text end 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;

deleted text begin (4)deleted text end new text begin (5)new text end for deleted text begin behavior programdeleted text end new text begin positive supportsnew text end analyst staff, 100 percent of the median
wage for mental health counselors (SOC code 21-1014);

deleted text begin (5)deleted text end new text begin (6)new text end for deleted text begin behavior programdeleted text end new text begin positive supportsnew text end professional staff, 100 percent of the
median wage for clinical counseling and school psychologist (SOC code 19-3031);

deleted text begin (6)deleted text end new text begin (7)new text end for deleted text begin behavior programdeleted text end new text begin positive supportsnew text end specialist staff, 100 percent of the median
wage for psychiatric technicians (SOC code 29-2053);

deleted text begin (7)deleted text end new text begin (8)new text end 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);

deleted text begin (8)deleted text end new text begin (9)new text end for housing access coordination staff, 100 percent of the median wage for
community and social services specialist (SOC code 21-1099);

deleted text begin (9)deleted text end new text begin (10)new text end for in-home family support new text begin and individualized home supports with family
training new text end 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);

deleted text begin (10)deleted text end new text begin (11)new text end for individualized home supportsnew text begin with trainingnew text end 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);

deleted text begin (11)deleted text end new text begin (12)new text end 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);

deleted text begin (12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);
 deleted text end

deleted text begin (13) for supported employment 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);
 deleted text end

deleted text begin (14)deleted text end new text begin (13)new text end 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);

deleted text begin (15)deleted text end new text begin (14)new text end for employment exploration 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);

deleted text begin (16)deleted text end new text begin (15)new text end 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);

deleted text begin (17)deleted text end new text begin (16)new text end 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);

new text begin (17) for individualized home supports 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);
 new text end

(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 deleted text begin behaviordeleted text end new text begin
positive supportsnew text end professional, deleted text begin behaviordeleted text end new text begin positive supportsnew text end analyst, and deleted text begin behaviordeleted text end new text begin positive
supportsnew text end 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).

new text begin (b) The commissioner shall adjust the base wage index in paragraph (k) with a competitive
workforce factor of 4.7 percent to provide increased compensation to direct care staff. A
provider shall use the additional revenue from the competitive workforce factor to increase
wages for direct care staff or to improve benefits provided to direct care staff as defined in
subdivision 2, paragraph (e).
 new text end

new text begin (c) 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 shall include recommendations to improve the
competitive workforce factor using (1) the most recently available wage data by SOC code
of 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) labor market 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.
 new text end

deleted text begin (b)deleted text end new text begin (d)new text end Component values for deleted text begin residentialdeleted text end new text begin corporate foster care services, corporate
supportive living services daily, community residential services, and integrated communitynew text end
support services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

deleted text begin (c)deleted text end new text begin (e)new text end Component values for family foster care are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 3.3 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence factor: 1.7 percent.

deleted text begin (d)deleted text end new text begin (f)new text end Component values for day new text begin training and habilitation, day support services, and
prevocational new text end services deleted text begin for all servicesdeleted text end are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 5.6 percent;

(5) client programming and support ratio: ten percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 1.8 percent; and

(8) absence and utilization factor ratio: deleted text begin 9.4deleted text end new text begin 4.5new text end percent.

new text begin (g) Component values for adult day services:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) program plan support ratio: 5.6 percent;
 new text end

new text begin (5) client programming and support ratio: 7.4 percent;
 new text end

new text begin (6) general administrative support ratio: 13.25 percent;
 new text end

new text begin (7) program-related expense ratio: 1.8 percent; and
 new text end

new text begin (8) absence and utilization factor ratio: 4.5 percent.
 new text end

deleted text begin (e)deleted text end new text begin (h)new text end Component values for unit-based services with programming are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan supports ratio: 15.5 percent;

(5) client programming and supports ratio: 4.7 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

deleted text begin (f)deleted text end new text begin (i)new text end Component values for unit-based services without programming except respite
are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 7.0 percent;

(5) client programming and support ratio: 2.3 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 2.9 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

deleted text begin (g)deleted text end new text begin (j)new text end Component values for unit-based services without programming for respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 2.9 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

deleted text begin (h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system.deleted text end new text begin (k)new text end On July 1, 2022, and every deleted text begin fivedeleted text end new text begin
twonew text end years thereafter, the commissioner shall update the base wage index in paragraph (a)
based on deleted text begin the most recently availabledeleted text end wage data by SOC from the Bureau of Labor Statisticsnew text begin
available 18 months and one day priornew text end . The commissioner shall publish these updated values
and load them into the rate management system.

deleted text begin (i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5); subdivision
6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), for changes in the
Consumer Price Index. The commissioner will adjust these values higher or lower by the
percentage change in the Consumer Price Index-All Items, United States city average
(CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall publish these
updated values and load them into the rate management system.deleted text end new text begin (l)new text end On July 1, 2022, and
every deleted text begin fivedeleted text end new text begin twonew text end years thereafter, the commissioner shall update the framework components
in paragraph deleted text begin (d)deleted text end new text begin (f)new text end , clause (5); paragraph deleted text begin (e)deleted text end new text begin (h)new text end , clause (5); deleted text begin anddeleted text end paragraph deleted text begin (f)deleted text end new text begin (i)new text end , clause
(5);new text begin paragraph (g), clause (5);new text end subdivision 6, new text begin paragraphs (b), new text end clauses (8) and (9)deleted text begin ;deleted text end new text begin , and (d),
clause (9);new text end and subdivision 7, clauses (10), (16), and (17), 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 deleted text begin date of thedeleted text end data deleted text begin most recentlydeleted text end
available new text begin on December 31 two years new text end prior to the scheduled update. The commissioner shall
publish these updated values and load them into the rate management system.

new text begin (m) Upon the implementation of automatic inflation adjustments under paragraphs (k)
and (l), 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.
 new text end

new text begin (n) 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 automatic inflation adjustments under
paragraphs (k) and (l).
 new text end

deleted text begin (j)deleted text end new text begin (o)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 (p) In this subdivision, if the Bureau of Labor Statistics occupational codes used to
calculate the base wage index in paragraph (a) are revised, the commissioner shall use the
most recently available data prior to the scheduled update.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later, except the new paragraph (b) is effective January 1, 2020, or upon federal
approval, whichever is later; and the amendment striking paragraph (a), clause (13), related
to supported employment staff, is effective September 1, 2019. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
 new text end

Sec. 34.

Minnesota Statutes 2018, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a)new text begin For purposes of this subdivision,
residential support services include 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.
new text end

new text begin (b)new text end Payments for residential support servicesdeleted text begin , as defined in sections 256B.092, subdivision
11, and 256B.49, subdivision 22,deleted text end new text begin in which the person providing services does not live in
the setting where the service is provided, including community residential services, corporate
foster care services, and corporate supportive living services daily new text end 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. This is defined as the direct-care rate;

(3) 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 (2). This is defined as the customized direct-care rate;

(4) 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 in
subdivision 5, paragraph (a), or the customized direct-care rate;

(5) 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 (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(6) combine the results of clauses (4) and (5), 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 (2). This is defined as the direct staffing cost;

(7) 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 (3);

(8) for client programming and supports, the commissioner shall add $2,179; and

(9) 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.

deleted text begin (b)deleted text end new text begin (c)new text end The total rate must be calculated using the following steps:

(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (7);

(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.

deleted text begin (c) deleted text end new text begin (d) Payments for integrated community support services must be calculated as follows:
 new text end

new text begin (1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;
 new text end

new text begin (2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;
 new text end

new text begin (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. This is defined as the direct-care rate;
 new text end

new text begin (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 (2). This is defined as the customized direct-care rate;
 new text end

new text begin (5) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages in subdivision 5, paragraph (a), or the customized
direct-care rate;
 new text end

new text begin (6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervision span of control ratio in subdivision 5, paragraph (b),
clause (1), and the appropriate supervision wage in subdivision 5, paragraph (a), clause
(21);
 new text end

new text begin (7) combine the results of clauses (4) and (5) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(2). This is defined as the direct staffing cost;
 new text end

new text begin (8) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3); and
 new text end

new text begin (9) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
 new text end

new text begin (e) The total rate must be calculated using the following steps:
 new text end

new text begin (1) subtotal of paragraph (d), clauses (6) to (8);
 new text end

new text begin (2) sum of the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio;
 new text end

new text begin (3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
 new text end

new text begin (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.
 new text end

new text begin (f)new text end The payment methodology for customized livingdeleted text begin ,deleted text end new text begin andnew text end 24-hour customized livingdeleted text begin ,
and residential caredeleted text end services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needsnew text begin and adjusted by a factor to be determined by the commissioner to adjust for
regional differences in the cost of providing servicesnew text end .

deleted text begin (d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
 deleted text end

deleted text begin (e)deleted text end new text begin (g)new text end The number of days authorized for all individuals enrolling after January 1, 2014,
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, 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. 35.

Minnesota Statutes 2018, section 256B.4914, subdivision 7, is amended to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day deleted text begin caredeleted text end new text begin servicesnew text end , day treatment and habilitation,new text begin day support services,new text end
prevocational services, and structured day services 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) 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 (2). This is defined as the customized direct-care rate;

(4) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);

(10) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs;

(11) for adult day bath services, add $7.01 per 15 minute unit;

(12) this is the subtotal rate;

(13) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(14) divide the result of clause (12) by one minus the result of clause (13). This is the
total payment amount;

(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;

(16) 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;

(17) 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, 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 2018, 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 deleted text begin behavior programmingdeleted text end new text begin employment exploration
services, employment development servicesnew text end , housing access coordination,new text begin individualized
home supports with family training, individualized home supports with training,new text end in-home
family support, independent living skills training, deleted text begin independent living skills specialist services,
individualized home supports,deleted text end new text begin andnew text end hourly supported living servicesdeleted text begin , employment exploration
services, employment development services, supported employment, and employment
support servicesdeleted text end provided to an individual outside of any day or residential service plan
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) 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 (2). This is defined as the customized direct-care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan supports ratio in subdivision 5, paragraph (e), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

deleted text begin (13) for supported employment provided in a shared manner, divide the total payment
amount in clause (12) by the number of service recipients, not to exceed three. For
employment support services provided in a shared manner, divide the total payment amount
in clause (12) by the number of service recipients, not to exceed six. For deleted text end deleted text begin independent living
skills training and individualized home supports provided in a shared manner, divide the
total payment amount in clause (12) by the number of service recipients, not to exceed two;
and
 deleted text end

new text begin (13) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (12) 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 (12) by the number of service recipients, not to exceed six. For independent living
skills training, individualized home supports with training, and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(12) by the number of service recipients, not to exceed two; and
 new text end

(14) adjust the result of clause (13) 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, 2021, or upon federal approval,
whichever is later, except the amendments striking "supported employment," in paragraph
(a) and striking clause (13) related to supported employment are effective September 1,
2019. The commissioner of human services shall notify the revisor of statutes when federal
approval is obtained.
 new text end

Sec. 37.

Minnesota Statutes 2018, 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 new text begin individualized home supports, new text end night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plan 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) 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 (2). This is defined as the customized direct care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5 or the customized direct care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (f), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

(13) for respite services, determine the number of day units of service to meet an
individual's needs;

(14) 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;

(15) 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 (14). This
is defined as the customized direct care rate;

(16) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a);

(17) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

(18) combine the results of clauses (16) and (17), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;

(19) for employee-related expenses, multiply the result of clause (18) by one plus the
employee-related cost ratio in subdivision 5, paragraph (g), clause (3);

(20) this is the subtotal rate;

(21) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(22) divide the result of clause (20) by one minus the result of clause (21). This is the
total payment amount; deleted text begin and
deleted text end

(23)new text begin for individualized home supports provided in a shared manner, divide the total
payment amount in clause (12) by the number of service recipients, not to exceed two. For
respite care services provided in a shared manner, divide the total payment amount in clause
(22) by the number of service recipients, not to exceed three; and
new text end

new text begin (24)new text end adjust the result of deleted text begin clauses (12) and (22)deleted text end new text begin clause (23)new text end 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, 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. 38.

Minnesota Statutes 2018, section 256B.4914, subdivision 10, is amended to read:


Subd. 10.

Updating payment values and additional information.

deleted text begin (a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.
 deleted text end

deleted text begin (b)deleted text end new text begin (a)new text end No later than July 1, 2014, the commissioner shall, within available resources,
begin to conduct research and gather data and information from existing state systems or
other outside sources on the following items:

(1) differences in the underlying cost to provide services and care across the state; and

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

deleted text begin (c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end No later than July 1, 2014, the commissioner, in consultation with stakeholders,
shall begin the review and evaluation of the following values already in subdivisions 6 to
9, or issues that impact all services, including, but not limited to:

(1) values for transportation rates;

(2) values for services where monitoring technology replaces staff time;

(3) values for indirect services;

(4) values for nursing;

(5) values for the facility use rate in day services, and the weightings used in the day
service ratios and adjustments to those weightings;

(6) values for workers' compensation as part of employee-related expenses;

(7) values for unemployment insurance as part of employee-related expenses;

(8)new text begin direct care workforce labor market measures;
new text end

new text begin (9)new text end any changes in state or federal law with a direct impact on the underlying cost of
providing home and community-based services; deleted text begin and
deleted text end

deleted text begin (9)deleted text end new text begin (10)new text end outcome measures, determined by the commissioner, for home and
community-based services rates determined under this sectiondeleted text begin .deleted text end new text begin ; and
new text end

new text begin (11) different competitive workforce factors by service, as determined under subdivision
5, paragraph (k).
 new text end

deleted text begin (e)deleted text end new text begin (c)new text end The commissioner shall report to the chairs and the ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs deleted text begin (b) to (d)deleted text end new text begin (a)
and (b)new text end on deleted text begin the following dates:
deleted text end

deleted text begin (1) January 15, 2015, with preliminary results and data;
 deleted text end

deleted text begin (2) January 15, 2016, with a status implementation update, and additional data and
summary information;
 deleted text end

deleted text begin (3) January 15, 2017, with the full report; and
 deleted text end

deleted text begin (4)deleted text end January 15, deleted text begin 2020deleted text end new text begin 2021new text end , with another full report, and a full report once every four
years thereafter.

deleted text begin (f) The commissioner shall implement a regional adjustment factor to all rate calculations
in subdivisions 6 to 9, effective no later than January 1, 2015.deleted text end new text begin (d)new text end Beginning deleted text begin July 1, 2017deleted text end new text begin
January 1, 2022new text end , the commissioner shall renew analysis and implement changes to the
regional adjustment factors deleted text begin when adjustments required under subdivision 5, paragraph (h),
occurdeleted text end new text begin once every six yearsnew text end . Prior to implementation, the commissioner shall consult with
stakeholders on the methodology to calculate the adjustment.

deleted text begin (g)deleted text end new text begin (e)new text end The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively approved
changes in:

(1) calculation values including derived wage rates and related employee and
administrative factors;

(2) service utilization;

(3) county and tribal allocation changes; and

(4) information on adjustments made to calculation values and the timing of those
adjustments.

The information in this notice must be effective January 1 of the following year.

deleted text begin (h)deleted text end new text begin (f)new text end When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.

deleted text begin (i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.
 deleted text end

deleted text begin (j)deleted text end new text begin (g)new text end Beginning July 1, 2017, the commissioner shall collect transportation and trip
information for all day services through the rates management system.

new text begin (h) The commissioner shall develop a new rate methodology for residential services in
which the service provider lives in the setting where the service is provided based on levels
of support needs. The commissioner shall submit recommendations to the legislative
committees with jurisdiction over human services of the new rate methodology to replace
subdivision 6, paragraph (d), by January 1, 2020.
 new text end

new text begin (i) The commissioner shall study value-based payment strategies for fee-for-service
home and community-based services and submit a report to the legislative committees with
jurisdiction over human services by October 1, 2020, with recommended strategies to
improve the quality, efficiency, and effectiveness of services.
 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. 39.

Minnesota Statutes 2018, section 256B.4914, subdivision 10a, is amended to
read:


Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9 reflect the cost to provide the
service. As determined by the commissioner, in consultation with stakeholders identified
in section 256B.4913, subdivision 5, a provider enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner to support
research on the cost of providing services that have rates determined by the disability waiver
rates system. Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(b) At least once in any five-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 provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.

(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.

(d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, deleted text begin 2020deleted text end new text begin 2021new text end . The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph deleted text begin (e)deleted text end new text begin (c)new text end . The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.

(e) The commissioner, in consultation with stakeholders identified in section 256B.4913,
subdivision 5, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (a).

new text begin (f) By December 31, 2020, providers paid with rates calculated under subdivision 5,
paragraph (b), shall identify additional revenues from the competitive workforce factor and
prepare a written distribution plan for the revenues. A provider shall make the provider's
distribution plan available and accessible to all direct care staff for a minimum of one
calendar year. Upon request, a provider shall submit the written distribution plan to the
commissioner.
 new text end

new text begin (g) Providers enrolled to provide services with rates determined under section 256B.4914,
subdivision 3, shall submit labor market data to the commissioner annually on or before
November 1, including but not limited to:
 new text end

new text begin (1) number of direct care staff;
 new text end

new text begin (2) wages of direct care staff;
 new text end

new text begin (3) overtime wages of direct care staff;
 new text end

new text begin (4) hours worked by direct care staff;
 new text end

new text begin (5) overtime hours worked by direct care staff;
 new text end

new text begin (6) benefits provided to direct care staff;
 new text end

new text begin (7) direct care staff job vacancies; and
 new text end

new text begin (8) direct care staff retention rates.
 new text end

new text begin (h) The commissioner shall publish annual reports on provider and state-level labor
market data, including but not limited to the data obtained under paragraph (g).
 new text end

new text begin (i) The commissioner shall temporarily suspend payments to the provider if data requested
under paragraph (g) is not received 90 days after the required submission date. Withheld
payments shall be made once data is received by the commissioner.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment except
paragraph (g) is effective November 1, 2019, and paragraph (h) is effective February 1,
2020.
 new text end

Sec. 40.

Minnesota Statutes 2018, section 256B.85, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

(a) CFSS is available to a person who meets one of the following:

(1) is an enrollee of medical assistance as determined under section 256B.055, 256B.056,
or 256B.057, subdivisions 5 and 9;

(2) is a participant in the alternative care program under section 256B.0913;

(3) is a waiver participant as defined under section 256B.0915, 256B.092, 256B.093, or
256B.49; or

(4) has medical services identified in a person's individualized education program and
is eligible for services as determined in section 256B.0625, subdivision 26.

(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:

(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and

(2) is not a participant under a family support grant under section 252.32.

new text begin (c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
 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. 41.

Laws 2017, First Special Session chapter 6, article 3, section 49, is amended to
read:


Sec. 49. ELECTRONIC deleted text begin SERVICE DELIVERY DOCUMENTATION SYSTEMdeleted text end new text begin
VISIT VERIFICATIONnew text end .

Subdivision 1.

Documentation; establishment.

The commissioner of human services
shall establish implementation requirements and standards for deleted text begin andeleted text end electronic deleted text begin service delivery
documentation systemdeleted text end new text begin visit verificationnew text end to comply with the 21st Century Cures Act, Public
Law 114-255. Within available appropriations, the commissioner shall take steps to comply
with the electronic visit verification requirements in the 21st Century Cures Act, Public
Law 114-255.

Subd. 2.

Definitions.

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

(b) "Electronic deleted text begin service delivery documentationdeleted text end new text begin visit verificationnew text end " means the electronic
documentation of the:

(1) type of service performed;

(2) individual receiving the service;

(3) date of the service;

(4) location of the service delivery;

(5) individual providing the service; and

(6) time the service begins and ends.

(c) "Electronic deleted text begin service delivery documentationdeleted text end new text begin visit verificationnew text end system" means a system
that provides electronic deleted text begin service delivery documentationdeleted text end new text begin verification of servicesnew text end that complies
with the 21st Century Cures Act, Public Law 114-255, and the requirements of subdivision
3.

(d) "Service" means one of the following:

(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
subdivision 19a, and provided according to Minnesota Statutes, section 256B.0659; deleted text begin or
deleted text end

(2) community first services and supports under Minnesota Statutes, section 256B.85new text begin ;
new text end

new text begin (3) home health services under Minnesota Statutes, section 256B.0625, subdivision 6a;
or
 new text end

new text begin (4) other medical supplies and equipment or home and community-based services that
are required to be electronically verified by the 21st Century Cures Act, Public Law 114-255new text end .

Subd. 3.

Requirements.

(a) In developing implementation requirements for deleted text begin andeleted text end electronic
deleted text begin service delivery documentation systemdeleted text end new text begin visit verificationnew text end , the commissioner shall deleted text begin consider
electronic visit verification systems and other electronic service delivery documentation
methods. The commissioner shall convene stakeholders that will be impacted by an electronic
service delivery system, including service providers and their representatives, service
recipients and their representatives, and, as appropriate, those with expertise in the
development and operation of an electronic service delivery documentation system, todeleted text end ensure
that the requirements:

(1) are minimally administratively and financially burdensome to a provider;

(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;

(3) consider existing best practices and use of electronic deleted text begin service delivery documentationdeleted text end new text begin
visit verificationnew text end ;

(4) are conducted according to all state and federal laws;

(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and

(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.

(b) The commissioner shall make training available to providers on the electronic deleted text begin service
delivery documentationdeleted text end new text begin visit verificationnew text end system requirements.

(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic deleted text begin service delivery documentationdeleted text end new text begin
visit verificationnew text end requirements on program integrity.

new text begin (d) The commissioner shall make a state-selected electronic visit verification system
available to providers of services.
 new text end

new text begin Subd. 3a. new text end

new text begin Provider requirements. new text end

new text begin (a) A provider of services may select any electronic
visit verification system that meets the requirements established by the commissioner.
 new text end

new text begin (b) All electronic visit verification systems used by providers to comply with the
requirements established by the commissioner must provide data to the commissioner in a
format and at a frequency to be established by the commissioner.
 new text end

new text begin (c) Providers must implement the electronic visit verification systems required under
this section by a date established by the commissioner to be set after the state-selected
electronic visit verification systems for personal care services and home health services are
in production. For purposes of this paragraph, "personal care services" and "home health
services" have the meanings given in United States Code, title 42, section 1396b(l)(5).
 new text end

deleted text begin Subd. 4. deleted text end

deleted text begin Legislative report. deleted text end

deleted text begin (a) The commissioner shall submit a report by January 15,
2018, to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services with recommendations, based on the requirements of
subdivision 3, to establish electronic service delivery documentation system requirements
and standards. The report shall identify:
 deleted text end

deleted text begin (1) the essential elements necessary to operationalize a base-level electronic service
delivery documentation system to be implemented by January 1, 2019; and
 deleted text end

deleted text begin (2) enhancements to the base-level electronic service delivery documentation system to
be implemented by January 1, 2019, or after, with projected operational costs and the costs
and benefits for system enhancements.
 deleted text end

deleted text begin (b) The report must also identify current regulations on service providers that are either
inefficient, minimally effective, or will be unnecessary with the implementation of an
electronic service delivery documentation system.
 deleted text end

Sec. 42. new text begin DIRECTION TO COMMISSIONER; SKILLED NURSE VISIT RATES.
new text end

new text begin The commissioner of human services shall ensure that skilled nurse visits reimbursed
under Minnesota Statutes, section 256B.0653, are coded, specific to the category of the
nurse performing the visit, using code sets compliant with the Health Insurance Portability
and Accountability Act, Public Law 104-191. "Skilled nurse visit" has the meaning given
in Minnesota Statutes, section 256B.0653, subdivision 2, paragraph (j).
 new text end

Sec. 43. new text begin DIRECTION TO COMMISSIONER; INTERAGENCY AGREEMENTS.
new text end

new text begin By October 1, 2019, the Department of Commerce, Public Utilities Commission, and
Department of Human Services must amend all interagency agreements necessary to
implement sections 1 to 11.
 new text end

Sec. 44. new text begin DIRECTION TO COMMISSIONER; FEDERAL AUTHORITY FOR
RECONFIGURED WAIVER SERVICES.
new text end

new text begin The commissioner of human services shall seek necessary federal authority to implement
new and reconfigured waiver services under section 45. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained and when new services
are fully implemented.
 new text end

Sec. 45. new text begin DISABILITY WAIVER RECONFIGURATION.
new text end

new text begin Subdivision 1. new text end

new text begin Intent. new text end

new text begin It is the intent of the legislature to reform the medical assistance
waiver programs for people with disabilities to simplify administration of the programs,
encourage person-centered supports, enhance each person's personal authority over the
person's service choice, align benefits across waivers, encourage equity across programs
and populations, and promote long-term sustainability of needed services.
 new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin By January 15, 2021, the commissioner of human services shall submit
a report to the members of the legislative committees with jurisdiction over human services
on any necessary waivers, state plan amendments, requests for new funding or realignment
of existing funds, any changes to state statute or rule, and any other federal authority
necessary to implement this section.
 new text end

new text begin Subd. 3. new text end

new text begin Proposal. new text end

new text begin By January 15, 2021, the commissioner shall develop a proposal to
reconfigure the medical assistance waivers provided in sections 256B.092 and 256B.49.
The proposal shall include all necessary plans for implementing two home and
community-based services waiver programs, as authorized under section 1915(c) of the
Social Security Act that serve persons who are determined to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities.
 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. new text begin INDIVIDUAL PROVIDERS OF DIRECT SUPPORT SERVICES.
new text end

new text begin The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota, submitted to the Legislative Coordinating
Commission on ......., is ratified.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 47. new text begin RATE INCREASE FOR DIRECT SUPPORT SERVICES PROVIDERS
WORKFORCE NEGOTIATIONS.
new text end

new text begin (a) If the labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota under Minnesota Statutes, section 179A.54, is
approved pursuant to Minnesota Statutes, section 3.855, the commissioner of human services
shall increase reimbursement rates, individual budgets, grants, or allocations by 2.37 percent
for services provided on or after July 1, 2019, to implement the minimum hourly wage,
holiday, enhanced rate, and paid time off provisions of that agreement.
 new text end

new text begin (b) The rate changes described in this section apply to direct support services provided
through a covered program, as defined in Minnesota Statutes, section 256B.0711, subdivision
1.
 new text end

Sec. 48. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, section 256B.0705, new text end new text begin is repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 252.431; and 252.451, new text end new text begin are repealed.
 new text end

new text begin (c) new text end new text begin Minnesota Statutes 2018, section 252.41, subdivision 8, new text end new text begin is repealed.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective the day following final enactment.
Paragraph (b) is effective September 1, 2019. Paragraph (c) is effective January 1, 2020.
 new text end

ARTICLE 6

CHEMICAL AND MENTAL HEALTH

Section 1.

Minnesota Statutes 2018, 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 severe emotional disturbances who are at risk
of out-of-home placement;

(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 servicesdeleted text begin , including transportation for children receiving
school-linked mental health services when school is not in sessiondeleted text end new text begin under section 245.4901new text end ;

(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; and

(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grants.

(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.

new text begin (d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
 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 [245.4901] SCHOOL-LINKED MENTAL HEALTH 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 mental health grant program to provide early identification and intervention
for students with mental health needs and to build the capacity of schools to support students
with mental health needs in the classroom.
 new text end

new text begin Subd. 2. new text end

new text begin Eligible applicants. new text end

new text begin An eligible applicant for school-linked mental health grants
is an entity that is:
 new text end

new text begin (1) certified under Minnesota Rules, parts 9520.0750 to 9520.0870;
 new text end

new text begin (2) a community mental health center under section 256B.0625, subdivision 5;
 new text end

new text begin (3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
 new text end

new text begin (4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
 new text end

new text begin (5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals as defined
in section 245.4871, subdivision 27, clauses (1) to (6), or two alcohol and drug counselors
licensed or exempt from licensure under chapter 148F who are qualified to provide clinical
services to children and families.
 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 mental health conditions of students;
 new text end

new text begin (2) delivering mental health treatment and services to students and their families,
including via telemedicine consistent with section 256B.0625, subdivision 3b;
 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 mental health 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 mental health
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, set-up fees, and
site fees in order to deliver school-linked mental health 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 this grant program, a third-party reimbursement source
excludes a public school as defined in section 120A.20, subdivision 1. Grantees shall serve
students regardless of health coverage status or ability to pay.
 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 mental
health grant 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. 3.

Minnesota Statutes 2018, 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) deleted text begin to be eligible for the prospective payment system in paragraph (f)deleted text end . Entities that
choose to be CCBHCs must:

(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionalsnew text begin and licensed alcohol and drug counselorsnew text end ,
and staff who are culturally and linguistically trained to deleted text begin servedeleted text end new text begin meetnew text end the needs of the deleted text begin clinic's
patientdeleted text end populationnew text begin the clinic servesnew text end ;

(3) ensure that clinic services are available and accessible to deleted text begin patientsdeleted text end new text begin individuals and
familiesnew text end of all ages and genders and that crisis management services are available 24 hours
per day;

(4) establish fees for clinic services for deleted text begin nonmedical assistance patientsdeleted text end new text begin individuals who
are not enrolled in medical assistancenew text end using a sliding fee scale that ensures that services to
patients are not denied or limited due to deleted text begin a patient'sdeleted text end new text begin an individual'snew text end 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 new text begin and substance use new text end services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; deleted text begin patient-centereddeleted text end new text begin person- and family-centerednew text end 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 veterans;

(7) provide coordination of care across settings and providers to ensure seamless
transitions for deleted text begin patientsdeleted text end new text begin individuals being servednew text end 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;

deleted text begin (9) be certified to provide integrated treatment for co-occurring mental illness and
substance use disorders in adults or children under Minnesota Rules, chapter 9533, effective
July 1, 2017;
 deleted text end

deleted text begin (10)deleted text end new text begin (9)new text end comply with standards relating to mental health services in Minnesota Rules,
parts 9505.0370 to 9505.0372;

deleted text begin (11)deleted text end new text begin (10)new text end be licensed to provide deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end treatment
under chapter 245G;

deleted text begin (12)deleted text end new text begin (11)new text end be certified to provide children's therapeutic services and supports under section
256B.0943;

deleted text begin (13)deleted text end new text begin (12)new text end be certified to provide adult rehabilitative mental health services under section
256B.0623;

deleted text begin (14)deleted text end new text begin (13)new text end be enrolled to provide mental health crisis response services under section
256B.0624;

deleted text begin (15)deleted text end new text begin (14)new text end be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

deleted text begin (16)deleted text end new text begin (15)new text end comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926; deleted text begin and
deleted text end

deleted text begin (17)deleted text end new text begin (16)new text end provide services that comply with the evidence-based practices described in
paragraph (e)deleted text begin .deleted text end new text begin ; and
new text end

new text begin (17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), if peer services are
provided.
 new text end

(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, 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.

(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 deleted text begin paragraph (f)deleted text end new text begin section
256B.0625, subdivision 5m,new text end for those services without a county contract or county approval.
There is no county share when medical assistance pays the CCBHC prospective payment.
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 requirements.
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.new text begin 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.
new text end

(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.

deleted text begin (f) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by certified
community behavioral health clinics, in accordance with guidance issued by the Centers
for Medicare and Medicaid Services. During the operation of the demonstration project,
payments shall comply with federal requirements for an enhanced federal medical assistance
percentage. The commissioner may include quality bonus payment in the prospective
payment system based on federal criteria and on a clinic's provision of the evidence-based
practices in paragraph (e). The prospective payment system does not apply to MinnesotaCare.
Implementation of the prospective payment system is effective July 1, 2017, or upon federal
approval, whichever is later.
 deleted text end

deleted text begin (g) The commissioner shall seek federal approval to continue federal financial
participation in payment for CCBHC services after the federal demonstration period ends
for clinics that were certified as CCBHCs during the demonstration period and that continue
to meet the CCBHC certification standards in paragraph (a). Payment for CCBHC services
shall cease effective July 1, 2019, if continued federal financial participation for the payment
of CCBHC services cannot be obtained.
 deleted text end

deleted text begin (h) The commissioner may certify at least one CCBHC located in an urban area and at
least one CCBHC located in a rural area, as defined by federal criteria. To the extent allowed
by federal law, the commissioner may limit the number of certified clinics so that the
projected claims for certified clinics will not exceed the funds budgeted for this purpose.
The commissioner shall give preference to clinics that:
 deleted text end

deleted text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated; and
 deleted text end

deleted text begin (2) enhance the state's ability to meet the federal priorities to be selected as a CCBHC
demonstration state.
 deleted text end

deleted text begin (i)deleted text end new text begin (f)new text end 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.

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 2018, section 254B.02, subdivision 1, is amended to read:


Subdivision 1.

Chemical dependency treatment allocation.

The chemical dependency
treatment appropriation shall be placed in a special revenue account. deleted text begin The commissioner
shall annually transfer funds from the chemical dependency fund to pay for operation of
the drug and alcohol abuse normative evaluation system and to pay for all costs incurred
by adding two positions for licensing of chemical dependency treatment and rehabilitation
programs located in hospitals for which funds are not otherwise appropriated.deleted text end The deleted text begin remainder
of thedeleted text end money in the special revenue account must be used according to the requirements in
this chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 254B.03, subdivision 2, is amended to read:


Subd. 2.

Chemical dependency fund payment.

(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state that would be required to be
licensed as a chemical dependency program if the program were in the state. Out of state
vendors must also provide the commissioner with assurances that the program complies
substantially with state licensing requirements and possesses all licenses and certifications
required by the host state to provide chemical dependency treatment. Vendors receiving
payments from the chemical dependency fund must not require co-payment from a recipient
of benefits for services provided under this subdivision. The vendor is prohibited from using
the client's public benefits to offset the cost of services paid under this section. The vendor
shall not require the client to use public benefits for room or board costs. This includes but
is not limited to cash assistance benefits under chapters 119B, 256D, and 256J, or SNAP
benefits. Retention of SNAP benefits is a right of a client receiving services through the
consolidated chemical dependency treatment fund or through state contracted managed care
entities. Payment from the chemical dependency fund shall be made for necessary room
and board costs provided by vendors deleted text begin certified according todeleted text end new text begin meeting the criteria under new text end section
254B.05new text begin , subdivision 1anew text end , or in a community hospital licensed by the commissioner of health
according to sections 144.50 to 144.56 to a client who is:

(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and

(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.

(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.

(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 254B.03, subdivision 4, is amended to read:


Subd. 4.

Division of costs.

(a) Except for services provided by a county under section
254B.09, subdivision 1, or services provided under section 256B.69, the county shall, out
of local money, pay the state for 22.95 percent of the cost of chemical dependency services,
deleted text begin includingdeleted text end new text begin except fornew text end those services provided to persons deleted text begin eligible fordeleted text end new text begin enrolled innew text end medical
assistance under chapter 256Bnew text begin and room and board services under section 254B.05,
subdivision 5, paragraph (b), clause (12)new text end . Counties may use the indigent hospitalization
levy for treatment and hospital payments made under this section.

(b) 22.95 percent of any state collections from private or third-party pay, less 15 percent
for the cost of payment and collections, must be distributed to the county that paid for a
portion of the treatment under this section.

deleted text begin (c) For fiscal year 2017 only, the 22.95 percentages under paragraphs (a) and (b) are
equal to 20.2 percent.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 254B.04, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

new text begin (a)new text end Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, deleted text begin and persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 5, and 6, ordeleted text end who meet the
income standards of section 256B.056, subdivision 4,new text begin and are not enrolled in medical
assistance,new text end are entitled to chemical dependency fund services. State money appropriated
for this paragraph must be placed in a separate account established for this purpose.

new text begin (b) new text end Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county shall
pay for out-of-home placement costs, if applicable.

new text begin (c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
(12).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 254B.05, subdivision 1a, is amended to read:


Subd. 1a.

Room and board provider requirements.

(a) Effective January 1, 2000,
vendors of room and board are eligible for chemical dependency fund payment if the vendor:

(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;

(2) is determined to meet applicable health and safety requirements;

(3) is not a jail or prison;

(4) is not concurrently receiving funds under chapter 256I for the recipient;

(5) admits individuals who are 18 years of age or older;

(6) is registered as a board and lodging or lodging establishment according to section
157.17;

(7) has awake staff on site 24 hours per day;

(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);

(9) has emergency behavioral procedures that meet the requirements of section 245G.16;

(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;

(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;

(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;

(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;

(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2; and

(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.

(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).

new text begin (c) Licensed programs providing intensive residential treatment services or residential
crisis services pursuant to section 256B.0622 are eligible vendors of room and board and
are exempt from paragraph (a), clauses (6) to (15).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 254B.06, subdivision 1, is amended to read:


Subdivision 1.

State collections.

The commissioner is responsible for all collections
from persons determined to be partially responsible for the cost of care of an eligible person
receiving services under Laws 1986, chapter 394, sections 8 to 20. The commissioner may
initiate, or request the attorney general to initiate, necessary civil action to recover the unpaid
cost of care. The commissioner may collect all third-party payments for chemical dependency
services provided under Laws 1986, chapter 394, sections 8 to 20, including private insurance
and federal Medicaid and Medicare financial participation. deleted text begin The commissioner shall deposit
in a dedicated account a percentage of collections to pay for the cost of operating the chemical
dependency consolidated treatment fund invoice processing and vendor payment system,
billing, and collections.deleted text end The remaining receipts must be deposited in the chemical dependency
fund.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 254B.06, subdivision 2, is amended to read:


Subd. 2.

Allocation of collections.

deleted text begin (a) The commissioner shall allocate all federal
financial participation collections to a special revenue account.deleted text end The commissioner shall
allocate 77.05 percent of patient payments and third-party payments to the special revenue
account and 22.95 percent to the county financially responsible for the patient.

deleted text begin (b) For fiscal year 2017 only, the commissioner's allocation to the special revenue account
shall be increased from 77.05 percent to 79.8 percent and the county financial responsibility
shall be reduced from 22.95 percent to 20.2 percent.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 11.

Minnesota Statutes 2018, section 256.478, is amended to read:


256.478 deleted text begin HOME AND COMMUNITY-BASED SERVICES TRANSITIONS
GRANTSdeleted text end new text begin TRANSITION TO COMMUNITY INITIATIVEnew text end .

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin (a) An individual is eligible for the transition to community
initiative if the individual meets the following criteria:
 new text end

new text begin (1) without the additional resources available through the transitions to community
initiative the individual would otherwise remain at the Anoka-Metro Regional Treatment
Center, a state-operated community behavioral health hospital, or the Minnesota Security
Hospital;
 new text end

new text begin (2) the individual's discharge would be significantly delayed without the additional
resources available through the transitions to community initiative; and
 new text end

new text begin (3) the individual met treatment objectives and no longer needs hospital-level care or a
secure treatment setting.
 new text end

new text begin (b) An individual who is in a community hospital and on the waiting list for the
Anoka-Metro Regional Treatment Center, but for whom alternative community placement
would be appropriate is eligible for the transition to community initiative upon the
commissioner's approval.
 new text end

new text begin Subd. 2. new text end

new text begin Transition grants. new text end

The commissioner shall make available deleted text begin home and
community-based servicesdeleted text end transition new text begin to community new text end grants to deleted text begin servedeleted text end new text begin assistnew text end individuals deleted text begin who
do not meet eligibility criteria for the medical assistance program under section 256B.056
or 256B.057, but who otherwise meet the criteria under section 256B.092, subdivision 13,
or 256B.49, subdivision 24deleted text end new text begin who met the criteria under subdivision 1new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 12.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 5m. new text end

new text begin Certified community behavioral health clinic services. new text end

new text begin (a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
 new text end

new text begin (b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by a CCBHC, in
accordance with guidance issued by the Centers for Medicare and Medicaid Services. The
commissioner may include a quality bonus payment in the prospective payment system
based on federal criteria and on a CCBHC's provision of the evidence-based practices in
section 245.735, subdivision 3, paragraph (e). The prospective payment system does not
apply to MinnesotaCare.
 new text end

new text begin (c) To the extent allowed by federal law, the commissioner may limit the number of
CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected
claims do not exceed the money appropriated for this purpose. The commissioner shall
apply the following priorities, in the order listed, to give preference to clinics that:
 new text end

new text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated;
 new text end

new text begin (2) are certified as CCBHCs during the federal CCBHC demonstration period;
 new text end

new text begin (3) receive CCBHC grants from the United States Department of Health and Human
Services; or
 new text end

new text begin (4) focus on serving individuals in tribal areas and other underserved communities.
 new text end

new text begin (d) Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal CCBHC
demonstration, except:
 new text end

new text begin (1) the commissioner shall rebase CCBHC rates at least every two years; and
 new text end

new text begin (2) the prospective payment rate under this section does not apply for services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 256B.0625, subdivision 24, is amended to read:


Subd. 24.

Other medical or remedial care.

Medical assistance covers any other medical
or remedial care licensed and recognized under state law unless otherwise prohibited by
lawdeleted text begin , except licensed chemical dependency treatment programs or primary treatment or
extended care treatment units in hospitals that are covered under chapter 254B. The
commissioner shall include chemical dependency services in the state medical assistance
plan for federal reporting purposes, but payment must be made under chapter 254Bdeleted text end . The
commissioner shall publish in the State Register a list of elective surgeries that require a
second medical opinion before medical assistance reimbursement, and the criteria and
standards for deciding whether an elective surgery should require a second medical opinion.
The list and criteria and standards are not subject to the requirements of sections 14.01 to
14.69.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 14.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 24a. new text end

new text begin Substance use disorder services. new text end

new text begin Medical assistance covers substance use
disorder treatment services according to section 254B.05, subdivision 5, except for room
and board.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 15.

Minnesota Statutes 2018, section 256B.0625, subdivision 45a, is amended to
read:


Subd. 45a.

Psychiatric residential treatment facility services for persons younger
than 21 years of age.

(a) Medical assistance covers psychiatric residential treatment facility
services, according to section 256B.0941, for persons younger than 21 years of age.
Individuals who reach age 21 at the time they are receiving services are eligible to continue
receiving services until they no longer require services or until they reach age 22, whichever
occurs first.

(b) For purposes of this subdivision, "psychiatric residential treatment facility" means
a facility other than a hospital that provides psychiatric services, as described in Code of
Federal Regulations, title 42, sections 441.151 to 441.182, to individuals under age 21 in
an inpatient setting.

(c) The commissioner shall enroll up to deleted text begin 150deleted text end new text begin 300new text end certified psychiatric residential treatment
facility services beds deleted text begin at up to six sitesdeleted text end . The commissioner shall select psychiatric residential
treatment facility services providers through a request for proposals process. Providers of
state-operated services may respond to the request for proposals.new text begin The commissioner shall
prioritize programs that demonstrate the capacity to serve children and youth with aggressive
and risky behaviors toward themselves or others, multiple diagnoses, neurodevelopmental
disorders, or complex trauma related issues.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:


Subd. 57.

Payment for Part B Medicare crossover claims.

(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.

(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.

(c) Excluded from this limitation are payments to federally qualified health centers deleted text begin anddeleted text end new text begin ,new text end
rural health clinicsnew text begin , and CCBHCs subject to the prospective payment system under
subdivision 5mnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
 new text end

Sec. 17.

Minnesota Statutes 2018, section 256B.0915, subdivision 3b, is amended to read:


Subd. 3b.

Cost limits for elderly waiver applicants who reside in a nursing facilitynew text begin
or another eligible facilitynew text end .

(a) For a person who is a nursing facility resident at the time
of requesting a determination of eligibility for elderly waivered services, a monthly
conversion budget limit for the cost of elderly waivered services may be requested. The
monthly conversion budget limit for the cost of elderly waiver services shall be deleted text begin the resident
class assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident in
the nursing facility where the resident currently resides until July 1 of the state fiscal year
in which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented. Effective on July 1 of the state fiscal year in which the
resident assessment system as described in section 256B.438 for nursing home rate
determination is implemented, the monthly conversion budget limit for the cost of elderly
waiver services shall bedeleted text end based on the per diem nursing facility rate as determined by the
resident assessment system as described in section deleted text begin 256B.438deleted text end new text begin 256R.17new text end for residents in the
nursing facility where the elderly waiver applicant currently resides. The monthly conversion
budget limit shall be calculated by multiplying the per diem by 365, divided by 12, and
reduced by the recipient's maintenance needs allowance as described in subdivision 1d. The
initially approved monthly conversion budget limit shall be adjusted annually as described
in subdivision 3a, paragraph (a). The limit under this deleted text begin subdivisiondeleted text end new text begin paragraphnew text end only applies to
persons discharged from a nursing facility after a minimum 30-day stay and found eligible
for waivered services on or after July 1, 1997. For conversions from the nursing home to
the elderly waiver with consumer directed community support services, the nursing facility
per diem used to calculate the monthly conversion budget limit must be reduced by a
percentage equal to the percentage difference between the consumer directed services budget
limit that would be assigned according to the federally approved waiver plan and the
corresponding community case mix cap, but not to exceed 50 percent.

(b) new text begin A person who meets elderly waiver eligibility criteria and the eligibility criteria under
section 256.478, subdivision 1, is eligible for a special monthly budget limit for the cost of
elderly waivered services up to $21,610 per month. The special monthly budget limit must
be adjusted annually as described in subdivision 3a, paragraphs (a) and (e). For a person
using a special monthly budget limit under the elderly waiver with consumer-directed
community support services, the special monthly budget limit must be reduced as described
in paragraph (a).
new text end

new text begin (c) The commissioner may provide an additional payment for documented costs between
a threshold determined by the commissioner and the special monthly budget limit to a
managed care plan for elderly waiver services provided to a person who is: (1) eligible for
a special monthly budget limit under paragraph (b); and (2) enrolled in a managed care plan
that provides elderly waiver services under section 256B.69.
 new text end

new text begin (d) For monthly conversion budget limits under paragraph (a) and special monthly budget
limits under paragraph (b), the service rate limits for adult foster care under subdivision 3d
and for customized living under subdivision 3e may be exceeded if necessary for the provider
to meet identified needs and provide services as approved in the coordinated service and
support plan, if the total cost of all services does not exceed the monthly conversion or
special monthly budget limit. Service rates must be established using tools provided by the
commissioner.
 new text end

new text begin (e) new text end The following costs must be included in determining the total monthly costs for the
waiver client:

(1) cost of all waivered services, including specialized supplies and equipment and
environmental accessibility adaptations; and

(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes once federal approval is obtained.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 256B.092, subdivision 13, is amended to read:


Subd. 13.

Waiver allocations for transition populations.

(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peterdeleted text end for individuals who meet the deleted text begin followingdeleted text end new text begin eligibility new text end criteriadeleted text begin :deleted text end new text begin
established under section 256.478, subdivision 1.
new text end

deleted text begin (1) are otherwise eligible for the developmental disabilities waiver under this section;
 deleted text end

deleted text begin (2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
 deleted text end

deleted text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
 deleted text end

deleted text begin (4) who have met treatment objectives and no longer meet hospital level of care.
 deleted text end

(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.

(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 256B.49, subdivision 24, is amended to read:


Subd. 24.

Waiver allocations for transition populations.

(a) The commissioner shall
make available additional waiver allocations and additional necessary resources deleted text begin to assure
timely discharges from the Anoka-Metro Regional Treatment Center and the Minnesota
Security Hospital in St. Peterdeleted text end for individuals who meet the deleted text begin followingdeleted text end new text begin eligibility new text end criteriadeleted text begin :deleted text end new text begin
established under section 256.478, subdivision 1.
new text end

deleted text begin (1) are otherwise eligible for the brain injury, community access for disability inclusion,
or community alternative care waivers under this section;
 deleted text end

deleted text begin (2) who would otherwise remain at the Anoka-Metro Regional Treatment Center or the
Minnesota Security Hospital;
 deleted text end

deleted text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
 deleted text end

deleted text begin (4) who have met treatment objectives and no longer meet hospital level of care.
 deleted text end

(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.

(c) Any corporate foster care home developed under this subdivision must be considered
an exception under section 245A.03, subdivision 7, paragraph (a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 20.

Minnesota Statutes 2018, section 256I.04, subdivision 1, is amended to read:


Subdivision 1.

Individual eligibility requirements.

An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), or (c).

(a) The individual is aged, blind, or is over 18 years of age with a disability as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2, is less than the monthly rate specified in the agency's agreement with the
provider of housing support in which the individual resides.

(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of housing support in which the
individual resides.

(c) The individual deleted text begin receives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.deleted text end new text begin lacks a fixed, adequate, nighttime residence
upon discharge from a residential behavioral health treatment program, as determined by
treatment staff from the residential behavioral health treatment program. An individual is
eligible under this paragraph for up to three months, including a full or partial month from
the individual's move-in date at a setting approved for housing support following discharge
from treatment, plus two full months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
 new text end

Sec. 21.

Minnesota Statutes 2018, section 256I.04, subdivision 2f, is amended to read:


Subd. 2f.

Required services.

new text begin (a) new text end In licensed and registered settings under subdivision
2a, providers shall ensure that participants have at a minimum:

(1) food preparation and service for three nutritional meals a day on site;

(2) a bed, clothing storage, linen, bedding, laundering, and laundry supplies or service;

(3) housekeeping, including cleaning and lavatory supplies or service; and

(4) maintenance and operation of the building and grounds, including heat, water, garbage
removal, electricity, telephone for the site, cooling, supplies, and parts and tools to repair
and maintain equipment and facilities.

new text begin (b) In addition, when providers serve participants described in subdivision 1, paragraph
(c), the providers are required to assist the participants in applying for continuing housing
support payments before the end of the eligibility period.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
 new text end

Sec. 22.

Minnesota Statutes 2018, 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 1c, paragraph (d).

(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 deleted text begin licensed residential crisis stabilization services under
section 256B.0624, subdivision 7,deleted text end new text begin housing support payments under section 256I.04,
subdivision 1, paragraph (c),new text end the amount ofnew text begin thenew text end 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 September 1, 2019.
 new text end

Sec. 23.

Laws 2017, First Special Session chapter 6, article 8, section 71, the effective
date, is amended to read:


EFFECTIVE DATE.

This section is effective for services provided on July 1, 2017,
deleted text begin through April 30, 2019, and expires May 1, 2019deleted text end new text begin and thereafternew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 30, 2019.
 new text end

Sec. 24.

Laws 2017, First Special Session chapter 6, article 8, section 72, the effective
date, is amended to read:


EFFECTIVE DATE.

This section is effective for services provided on July 1, 2017,
deleted text begin through April 30, 2019, and expires May 1, 2019deleted text end new text begin and thereafternew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 30, 2019.
 new text end

Sec. 25. new text begin DIRECTION TO COMMISSIONER; IMPROVING SCHOOL-LINKED
MENTAL HEALTH GRANT PROGRAM.
new text end

new text begin (a) The commissioner of human services, in collaboration with the commissioner of
education, representatives from the education community, mental health providers, and
advocates, shall assess the school-linked mental health grant program under Minnesota
Statutes, section 245.4901, and develop recommendations for improvements. The assessment
must include but is not limited to the following:
 new text end

new text begin (1) promoting stability among current grantees and school partners;
 new text end

new text begin (2) assessing the minimum number of full-time equivalents needed per school site to
effectively carry out the program;
 new text end

new text begin (3) developing a funding formula that promotes sustainability and consistency across
grant cycles;
 new text end

new text begin (4) reviewing current data collection and evaluation; and
 new text end

new text begin (5) analyzing the impact on outcomes when a school has a school-linked mental health
program, a multi-tier system of supports, and sufficient school support personnel to meet
the needs of students.
 new text end

new text begin (b) The commissioner shall provide a report of the findings of the assessment and
recommendations, including any necessary statutory changes, to the legislative committees
with jurisdiction over mental health and education by January 15, 2020.
 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. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, section 254B.03, subdivision 4a, new text end new text begin is repealed.
 new text end

ARTICLE 7

UNIFORM SERVICE STANDARDS

Section 1.

Minnesota Statutes 2018, section 62A.152, subdivision 3, is amended to read:


Subd. 3.

Provider discrimination prohibited.

All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professional,
as defined in sections 245.462, subdivision 18deleted text begin , clauses (1) to (5)deleted text end ; and 245.4871, subdivision
27, deleted text begin clauses (1) to (5),deleted text end to the extent that the services and treatment are within the scope of
mental health professional licensure.

This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.

Sec. 2.

Minnesota Statutes 2018, section 62A.3094, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.

(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.

(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.

(d) "Mental health professional" means a mental health professional as deleted text begin defined in section
245.4871, subdivision 27deleted text end new text begin described in section 245I.16, subdivision 2new text end , clause (1), (2), (3),
(4), or (6), who has training and expertise in autism spectrum disorder and child development.

Sec. 3.

Minnesota Statutes 2018, section 148B.5301, subdivision 2, is amended to read:


Subd. 2.

Supervision.

(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).

(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional as defined in section 245.462, subdivision
18deleted text begin , clauses (1) to (6)deleted text end , or 245.4871, subdivision 27, deleted text begin clauses (1) to (6),deleted text end or by a board-approved
supervisor, who has at least two years of postlicensure experience in the delivery of clinical
services in the diagnosis and treatment of mental illnesses and disorders. All supervisors
must meet the supervisor requirements in Minnesota Rules, part 2150.5010.

(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.

(d) The supervised practice must include at least 1,800 hours of clinical client contact.

(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.

Sec. 4.

Minnesota Statutes 2018, section 148E.0555, subdivision 6, is amended to read:


Subd. 6.

Qualifications during grandfathering for licensure as LICSW.

(a) To be
licensed as a licensed independent clinical social worker, an applicant for licensure under
this section must provide evidence satisfactory to the board that the individual has:

(1) completed a graduate degree in social work from a program accredited by the Council
on Social Work Education, the Canadian Association of Schools of Social Work, or a similar
accrediting body designated by the board; or

(2) completed a graduate degree and is a mental health professional according to section
245.462, subdivision 18deleted text begin , clauses (1) to (6)deleted text end .

(b) To be licensed as a licensed independent clinical social worker, an applicant for
licensure under this section must provide evidence satisfactory to the board that the individual
has:

(1) practiced clinical social work as defined in section 148E.010, subdivision 6, including
both diagnosis and treatment, and has met the supervised practice requirements specified
in sections 148E.100 to 148E.125, excluding the 1,800 hours of direct clinical client contact
specified in section 148E.115, subdivision 1, except that supervised practice hours obtained
prior to August 1, 2011, must meet the requirements in Minnesota Statutes 2010, sections
148D.100 to 148D.125;

(2) submitted a completed, signed application and the license fee in section 148E.180;

(3) for applications submitted electronically, provided an attestation as specified by the
board;

(4) submitted the criminal background check fee and a form provided by the board
authorizing a criminal background check;

(5) paid the license fee in section 148E.180; and

(6) not engaged in conduct that was or would be in violation of the standards of practice
specified in Minnesota Statutes 2010, sections 148D.195 to 148D.240, and sections 148E.195
to 148E.240. If the applicant has engaged in conduct that was or would be in violation of
the standards of practice, the board may take action according to sections 148E.255 to
148E.270.

(c) An application which is not completed, signed, and accompanied by the correct
license fee must be returned to the applicant, along with any fee submitted, and is void.

(d) By submitting an application for licensure, an applicant authorizes the board to
investigate any information provided or requested in the application. The board may request
that the applicant provide additional information, verification, or documentation.

(e) Within one year of the time the board receives an application for licensure, the
applicant must meet all the requirements and provide all of the information requested by
the board.

Sec. 5.

Minnesota Statutes 2018, section 148E.120, subdivision 2, is amended to read:


Subd. 2.

Alternate supervisors.

(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a licensed mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section 245.462, subdivision 18, deleted text begin clauses (1) to (6),deleted text end or 245.4871,
subdivision 27deleted text begin , clauses (1) to (6)deleted text end .

(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:

(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;

(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;

(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or

(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or

(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.

(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:

(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and

(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.

Sec. 6.

Minnesota Statutes 2018, section 148F.11, subdivision 1, is amended to read:


Subdivision 1.

Other professionals.

(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, clauses
(1) deleted text begin and (2)deleted text end new text begin to (4)new text end , providing integrated dual diagnosis treatment in adult mental health
rehabilitative programs certified by the Department of Human Services under section
256B.0622 or 256B.0623.

(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.

(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).

Sec. 7.

Minnesota Statutes 2018, section 245.462, subdivision 6, is amended to read:


Subd. 6.

Community support services program.

"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:

(1) client outreach,

(2) medication monitoring,

(3) assistance in independent living skills,

(4) development of employability and work-related opportunities,

(5) crisis assistance,

(6) psychosocial rehabilitation,

(7) help in applying for government benefits, and

(8) housing support services.

The community support services program must be coordinated with the case management
services specified in section 245.4711.

Sec. 8.

Minnesota Statutes 2018, section 245.462, subdivision 8, is amended to read:


Subd. 8.

Day treatment services.

"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a hospital accredited by the joint commission on accreditation of health
organizations and licensed under sections 144.50 to 144.55; (2) a community mental health
center under section 245.62; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week by a multidisciplinary staff under the clinical supervision of a mental health
professional. Day treatment may include education and consultation provided to families
and other individuals as part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described under
section 256B.0625, subdivision 23new text end .

Sec. 9.

Minnesota Statutes 2018, section 245.462, subdivision 9, is amended to read:


Subd. 9.

Diagnostic assessment.

deleted text begin (a)deleted text end "Diagnostic assessment" deleted text begin has the meaning given indeleted text end
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin means the assessment
described under section 256B.0671, subdivisions 2 to 4new text end .

deleted text begin (b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
 deleted text end

deleted text begin (1) age;
 deleted text end

deleted text begin (2) description of symptoms, including reason for referral;
 deleted text end

deleted text begin (3) history of mental health treatment;
 deleted text end

deleted text begin (4) cultural influences and their impact on the client; and
 deleted text end

deleted text begin (5) mental status examination.
 deleted text end

deleted text begin (c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
 deleted text end

deleted text begin (d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
 deleted text end

deleted text begin (e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
 deleted text end

deleted text begin (f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
 deleted text end

deleted text begin (g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
 deleted text end

Sec. 10.

Minnesota Statutes 2018, section 245.462, subdivision 14, is amended to read:


Subd. 14.

Individual treatment plan.

"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the individual
treatment plan described under section 256B.0671, subdivisions 5 and 6new text end .

Sec. 11.

Minnesota Statutes 2018, section 245.462, subdivision 17, is amended to read:


Subd. 17.

Mental health practitioner.

deleted text begin (a)deleted text end "Mental health practitioner" means a person
deleted text begin providing services to adults with mental illness or children with emotional disturbance who
is qualified in at least one of the ways described in paragraphs (b) to (g). A mental health
practitioner for a child client must have training working with children. A mental health
practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified according
to section 245I.16, subdivision 4new text end .

deleted text begin (b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
 deleted text end

deleted text begin (1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, substance use disorder, or emotional disturbance; or
 deleted text end

deleted text begin (ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
 deleted text end

deleted text begin (2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
 deleted text end

deleted text begin (3) is working in a day treatment program under section 245.4712, subdivision 2; or
 deleted text end

deleted text begin (4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
 deleted text end

deleted text begin (c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
 deleted text end

deleted text begin (1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, substance use disorder, or emotional disturbance; or
 deleted text end

deleted text begin (ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
 deleted text end

deleted text begin (2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
 deleted text end

deleted text begin (i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
 deleted text end

deleted text begin (ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
 deleted text end

deleted text begin (d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
 deleted text end

deleted text begin (e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
 deleted text end

deleted text begin (1) holds a master's or other graduate degree in behavioral sciences or related fields; or
 deleted text end

deleted text begin (2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
 deleted text end

deleted text begin (f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
 deleted text end

deleted text begin (g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
 deleted text end

deleted text begin (1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
 deleted text end

deleted text begin (2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
 deleted text end

deleted text begin (h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
 deleted text end

deleted text begin (i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
 deleted text end

Sec. 12.

Minnesota Statutes 2018, section 245.462, subdivision 18, is amended to read:


Subd. 18.

Mental health professional.

"Mental health professional" means a person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin qualified according to section 245I.16, subdivision 2.
new text end

deleted text begin (1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
 deleted text end

deleted text begin (i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
 deleted text end

deleted text begin (ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
 deleted text end

deleted text begin (2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
 deleted text end

deleted text begin (3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
 deleted text end

deleted text begin (4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry, or an
osteopathic physician licensed under chapter 147 and certified by the American Osteopathic
Board of Neurology and Psychiatry or eligible for board certification in psychiatry;
 deleted text end

deleted text begin (5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness;
 deleted text end

deleted text begin (6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness; or
 deleted text end

deleted text begin (7) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
 deleted text end

Sec. 13.

Minnesota Statutes 2018, section 245.462, subdivision 21, is amended to read:


Subd. 21.

Outpatient services.

"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.

Sec. 14.

Minnesota Statutes 2018, section 245.462, subdivision 23, is amended to read:


Subd. 23.

Residential treatment.

"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted by the
commissioner.

Sec. 15.

Minnesota Statutes 2018, section 245.462, is amended by adding a subdivision
to read:


new text begin Subd. 27. new text end

new text begin Treatment supervision. new text end

new text begin "Treatment supervision" means the treatment
supervision described under section 245I.18.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 245.467, subdivision 2, is amended to read:


Subd. 2.

Diagnostic assessment.

deleted text begin All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B. deleted text end new text begin Providers of services
governed by this section shall complete a diagnostic assessment according to the standards
of section 256B.0671, including for services to a person not eligible for medical assistance.
 new text end

Sec. 17.

Minnesota Statutes 2018, section 245.467, subdivision 3, is amended to read:


Subd. 3.

Individual treatment plans.

deleted text begin All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. 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. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake. deleted text end new text begin Providers of services
governed by this section shall complete an individual treatment plan according to the
standards of section 256B.0671, subdivisions 5 and 6, including for services to a person not
eligible for medical assistance.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 245.469, subdivision 1, is amended to read:


Subdivision 1.

Availability of emergency services.

deleted text begin By July 1, 1988,deleted text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adults in the county who are experiencing an emotional crisis or mental illness. Clients
may be required to pay a fee according to section 245.481. new text begin Emergency service providers
shall not delay the timely provision of emergency service because of delays in determining
this fee or because of the unwillingness or inability of the client to pay the fee. new text end Emergency
services must include assessment, crisis intervention, and appropriate case disposition. new text begin A
tribal authority that accepts crisis grant funding has the same responsibilities as county
boards within the tribal authority's designated service area. new text end Emergency services must:

(1) promote the safety and emotional stability of adults with mental illness or emotional
crises;

(2) minimize further deterioration of adults with mental illness or emotional crises;

(3) help adults with mental illness or emotional crises to obtain ongoing care and
treatment; deleted text begin and
deleted text end

(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (5) provide support, psychoeducation, and referrals to family members, friends, service
providers, or other third parties on behalf of a recipient in need of emergency services.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 245.469, subdivision 2, is amended to read:


Subd. 2.

Specific requirements.

(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional,new text begin a clinical trainee, ornew text end a mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .

(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:

(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;

(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and

(3) the service provider is not also the provider of fire and public safety emergency
services.

(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:

(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services reviewed by the state advisory
council on mental health and then approved by the commissioner;

(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services reviewed by
the state advisory council on mental health and then approved by the commissioner;

(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;

(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;

(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and

(6) the local social service agency describes how it will comply with paragraph (d).

(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.

Sec. 20.

Minnesota Statutes 2018, section 245.470, subdivision 1, is amended to read:


Subdivision 1.

Availability of outpatient services.

(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated mental health centers or mental health clinics approved by the
commissioner under section 245.69, subdivision 2; by contract with privately operated
mental health centers or mental health clinics approved by the commissioner under section
245.69, subdivision 2; by contract with hospital mental health outpatient programs certified
by the Joint Commission on Accreditation of Hospital Organizations; or by contract with
a licensed mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end . Clients may be required to pay a fee according to section 245.481. Outpatient
services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating an adult's mental health needs through therapy;

(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and

(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.

(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.

Sec. 21.

Minnesota Statutes 2018, section 245.4712, subdivision 2, is amended to read:


Subd. 2.

Day treatment services provided.

(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:

(1) provide a structured environment for treatment;

(2) provide support for residing in the community;

(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;

(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and

(5) operate on a continuous basis throughout the year.

(b) For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision specified
in deleted text begin Minnesota Rules, part 9505.0371, subpart 4deleted text end new text begin section 245I.18new text end . deleted text begin The clinical supervision
must be performed by a qualified supervisor who satisfies the requirements of Minnesota
Rules, part 9505.0371, subpart 5.
deleted text end

A day treatment program must demonstrate compliance with this deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirement by the commissioner's review and approval of the program according
to deleted text begin Minnesota Rules, part 9505.0372, subpart 8deleted text end new text begin section 256B.0625, subdivision 23new text end .

(c) County boards may request a waiver from including day treatment services if they
can document that:

(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;

(2) day treatment, if included, would be duplicative of other components of the
community support services; and

(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.

Sec. 22.

Minnesota Statutes 2018, section 245.472, subdivision 2, is amended to read:


Subd. 2.

Specific requirements.

Providers of residential services must be licensed under
applicable rules adopted by the commissioner and must deleted text begin be clinically superviseddeleted text end new text begin provide
treatment supervisionnew text end by a mental health professional. deleted text begin Persons employed in facilities licensed
under Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director
as of July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may
be allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670.
deleted text end

Sec. 23.

Minnesota Statutes 2018, section 245.4863, is amended to read:


245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.

(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.

(b) Notwithstanding paragraph (a), screening is not required when:

(1) the presence of co-occurring disorders was documented for the client in the past 12
months;

(2) the client is currently receiving co-occurring disorders treatment;

(3) the client is being referred for co-occurring disorders treatment; or

(4) a mental health professional, as deleted text begin defined in Minnesota Rules, part 9505.0370, subpart
18deleted text end new text begin provided by section 245I.16, subdivision 2new text end , who is competent to perform diagnostic
assessments of co-occurring disorders is performing a diagnostic assessment that meets the
requirements in Minnesota Rules, part 9533.0090, subpart 5, to identify whether the client
may have co-occurring mental health and chemical dependency disorders. If an individual
is identified to have co-occurring mental health and substance use disorders, the assessing
mental health professional must document what actions will be taken to address the client's
co-occurring disorders.

(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.

(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.

Sec. 24.

Minnesota Statutes 2018, section 245.4871, subdivision 9a, is amended to read:


Subd. 9a.

Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .

"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatment; (2) crisis placement; (3) community resources for follow-up; and (4) emotional
support to the family during crisis. Crisis assistance does not include services designed to
secure the safety of a child who is at risk of abuse or neglect or necessary emergency services.deleted text end new text begin
the development of a written plan to assist a child's family with a potential crisis and is
distinct from the immediate provision of mental health mobile crisis intervention services
as defined in section 256B.0944. The plan must address prevention and intervention strategies
to be used in a crisis. The plan identifies factors that might precipitate a crisis, behaviors
related to the emergence of a crisis, and the resources available to resolve a crisis. The plan
must include planning for the following potential needs: (1) arranging for admission to acute
care hospital inpatient treatment; (2) crisis placement; (3) community resources for follow-up;
and (4) emotional support to the family during crisis. Crisis planning excludes services
designed to secure the safety of a child who is at risk of abuse or neglect or necessary
emergency services.
new text end

Sec. 25.

Minnesota Statutes 2018, section 245.4871, subdivision 10, is amended to read:


Subd. 10.

Day treatment services.

"Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to a child
in:

(1) an outpatient hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;

(2) a community mental health center under section 245.62;

(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475; deleted text begin or
deleted text end

(4) an entity that operates a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is under contract
with an entity that is under contract with a county boarddeleted text begin .deleted text end new text begin ; or
new text end

new text begin (5) an entity that operates a program certified under section 256B.0943.
 new text end

Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
clinical supervision of a mental health professional. Day treatment may include education
and consultation provided to families and other individuals as an extension of the treatment
process. The services are aimed at stabilizing the child's mental health status, and developing
and improving the child's daily independent living and socialization skills. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. Day treatment services are not a part of inpatient hospital or
residential treatment services.

A day treatment service must be available to a child up to 15 hours a week throughout
the year and must be coordinated with, integrated with, or part of an education program
offered by the child's school.

Sec. 26.

Minnesota Statutes 2018, section 245.4871, subdivision 11a, is amended to read:


Subd. 11a.

Diagnostic assessment.

deleted text begin (a)deleted text end "Diagnostic assessment" deleted text begin has the meaning given
in Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult update.deleted text end new text begin means the assessment
described under section 256B.0671, subdivisions 2 to 4.
new text end

deleted text begin (b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
 deleted text end

deleted text begin (1) age;
 deleted text end

deleted text begin (2) description of symptoms, including reason for referral;
 deleted text end

deleted text begin (3) history of mental health treatment;
 deleted text end

deleted text begin (4) cultural influences and their impact on the client; and
 deleted text end

deleted text begin (5) mental status examination.
 deleted text end

deleted text begin (c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
 deleted text end

deleted text begin (d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
 deleted text end

deleted text begin (e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
 deleted text end

deleted text begin (f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
 deleted text end

Sec. 27.

Minnesota Statutes 2018, section 245.4871, subdivision 17, is amended to read:


Subd. 17.

Family community support services.

"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:

(1) client outreach to each child with severe emotional disturbance and the child's family;

(2) medication monitoring where necessary;

(3) assistance in developing independent living skills;

(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;

(5) assistance with leisure and recreational activities;

(6) crisis assistance, including crisis placement and respite care;

(7) professional home-based family treatment;

(8) foster care with therapeutic supports;

(9) day treatment;

(10) assistance in locating respite care and special needs day care; and

(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.

Sec. 28.

Minnesota Statutes 2018, section 245.4871, subdivision 21, is amended to read:


Subd. 21.

Individual treatment plan.

"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the individual treatment plan described under section
256B.0671, subdivisions 5 and 6new text end .

Sec. 29.

Minnesota Statutes 2018, section 245.4871, subdivision 26, is amended to read:


Subd. 26.

Mental health practitioner.

"Mental health practitioner" deleted text begin has the meaning
given indeleted text end new text begin means a person qualified according to new text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.16,
subdivision 4new text end .

Sec. 30.

Minnesota Statutes 2018, section 245.4871, subdivision 27, is amended to read:


Subd. 27.

Mental health professional.

"Mental health professional" means a person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin qualified according
to section 245I.16, subdivision 2.
new text end

deleted text begin (1) in psychiatric nursing, the mental health professional must be a registered nurse who
is licensed under sections 148.171 to 148.285 and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences or
related fields from an accredited college or university or its equivalent, with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
 deleted text end

deleted text begin (2) in clinical social work, the mental health professional must be a person licensed as
an independent clinical social worker under chapter 148D, or a person with a master's degree
in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders;
 deleted text end

deleted text begin (3) in psychology, the mental health professional must be an individual licensed by the
board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
 deleted text end

deleted text begin (4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatry or an osteopathic physician licensed under chapter 147
and certified by the American Osteopathic Board of Neurology and Psychiatry or eligible
for board certification in psychiatry;
 deleted text end

deleted text begin (5) in marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders or emotional disturbances;
 deleted text end

deleted text begin (6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders or emotional disturbances; or
 deleted text end

deleted text begin (7) in allied fields, the mental health professional must be a person with a master's degree
from an accredited college or university in one of the behavioral sciences or related fields,
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of emotional disturbances.
 deleted text end

Sec. 31.

Minnesota Statutes 2018, section 245.4871, subdivision 29, is amended to read:


Subd. 29.

Outpatient services.

"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.

Sec. 32.

Minnesota Statutes 2018, section 245.4871, subdivision 32, is amended to read:


Subd. 32.

Residential treatment.

"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.

Sec. 33.

Minnesota Statutes 2018, section 245.4871, subdivision 34, is amended to read:


Subd. 34.

Therapeutic support of foster care.

"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end

Sec. 34.

Minnesota Statutes 2018, section 245.4876, subdivision 2, is amended to read:


Subd. 2.

Diagnostic assessment.

deleted text begin All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B. deleted text end new text begin Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 256B.0671, including
for services to a person not eligible for medical assistance.
 new text end

Sec. 35.

Minnesota Statutes 2018, section 245.4876, subdivision 3, is amended to read:


Subd. 3.

Individual treatment plans.

deleted text begin 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
intake, 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 9.
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. deleted text end new text begin Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
256B.0671, subdivisions 5 and 6, including for services to a person not eligible for medical
assistance.
 new text end

Sec. 36.

Minnesota Statutes 2018, section 245.4879, subdivision 1, is amended to read:


Subdivision 1.

Availability of emergency services.

County boards must provide or
contract for enough mental health emergency services within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition.new text begin A tribal authority
that accepts crisis grant funding has the same responsibilities as county boards within the
tribal authority's designated service area.new text end Emergency services must:

(1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;

(2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;

(3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; deleted text begin and
deleted text end

(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (5) provide support, psychoeducation, and referrals to family members, service providers,
or other third parties on behalf of a client in need of emergency services.
 new text end

Sec. 37.

Minnesota Statutes 2018, section 245.4879, subdivision 2, is amended to read:


Subd. 2.

Specific requirements.

(a) The county board shall require that all service
providers of emergency services to the child with an emotional disturbance provide immediate
direct access to a mental health professional during regular business hours. For evenings,
weekends, and holidays, the service may be by direct toll-free telephone access to a mental
health professional,new text begin a clinical trainee, ornew text end a mental health practitionerdeleted text begin , or until January 1,
1991, a designated person with training in human services who receives clinical supervision
from a mental health professionaldeleted text end .

(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:

(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;

(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and

(3) the service provider is not also the provider of fire and public safety emergency
services.

(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:

(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services reviewed by the state advisory
council on mental health and then approved by the commissioner;

(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services reviewed by
the state advisory council on mental health and then approved by the commissioner;

(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;

(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;

(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and

(6) the local social service agency describes how it will comply with paragraph (d).

(d) When emergency service during nonbusiness hours is provided by anyone other than
a mental health professional, a mental health professional must be available on call for an
emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.

Sec. 38.

Minnesota Statutes 2018, section 245.488, subdivision 1, is amended to read:


Subdivision 1.

Availability of outpatient services.

(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated mental health centers or mental
health clinics approved by the commissioner under section 245.69, subdivision 2; by contract
with privately operated mental health centers or mental health clinics approved by the
commissioner under section 245.69, subdivision 2; by contract with hospital mental health
outpatient programs certified by the Joint Commission on Accreditation of Hospital
Organizations; or by contract with a licensed mental health professional deleted text begin as defined in section
245.4871, subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to
pay a fee based in accordance with section 245.481. Outpatient services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating the child's mental health needs through therapy; and

(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.

(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.

(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.

Sec. 39.

Minnesota Statutes 2018, section 245.696, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Certification of mental health peer specialists and mental health family
peer specialists. new text end

new text begin The commissioner shall develop a process to certify mental health peer
specialists and mental health family peer specialists according to federal guidelines and
section 245I.16, subdivisions 10 to 13, for a provider entity to bill for reimbursable services.
The training and certification curriculum must teach individuals specific skills relevant to
providing peer support as appropriate for individual or family peers.
 new text end

Sec. 40.

new text begin [245I.01] PURPOSE AND CITATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
 new text end

new text begin Subd. 2. new text end

new text begin Purpose. new text end

new text begin In accordance with sections 245.461 and 245.487, to create a system
of mental health care that is unified, accountable, and comprehensive, and to promote the
recovery of Minnesotans from mental illnesses, the state's public policy is to support quality
outpatient and residential mental health services reimbursable by health insurance programs,
including medical assistance as well as commercial payers. Further, the state's public policy
is to ensure the safety, rights, and well-being of individuals served in these programs.
 new text end

new text begin Subd. 3. new text end

new text begin Variances. new text end

new text begin If the conditions in section 245A.04, subdivision 9, are met, the
commissioner may grant variances to the requirements in this chapter that do not affect a
client's health or safety.
 new text end

Sec. 41.

new text begin [245I.02] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of this chapter the terms in this section have the
meanings given them.
 new text end

new text begin Subd. 2. new text end

new text begin Approval. new text end

new text begin "Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document by a treatment supervisor or by a
client. Approval may be demonstrated by written signature, secure electronic signature, or
documented oral approval.
 new text end

new text begin Subd. 3. new text end

new text begin Behavioral sciences or related fields. new text end

new text begin "Behavioral sciences or related fields"
means an education from an accredited college or university in a field including but not
limited to social work, psychology, sociology, community counseling, family social science,
child development, child psychology, community mental health, addiction counseling,
counseling and guidance, special education, and other similar fields as approved by the
commissioner.
 new text end

new text begin Subd. 4. new text end

new text begin Certified rehabilitation specialist. new text end

new text begin "Certified rehabilitation specialist" means
a staff person qualified according to section 245I.16, subdivision 8.
 new text end

new text begin Subd. 5. new text end

new text begin Child. new text end

new text begin "Child" means a client under 18 years of age, or a client under 21 years
of age who is eligible for a service otherwise provided to persons under 18 years of age.
 new text end

new text begin Subd. 6. new text end

new text begin Client. new text end

new text begin "Client" means a person who is seeking or receiving services regulated
under this chapter. For the purpose of consent to services, this term includes a parent,
guardian, or other individual authorized to consent to services by law.
 new text end

new text begin Subd. 7. new text end

new text begin Clinical trainee. new text end

new text begin "Clinical trainee" means a staff person qualified according
to section 245I.16, subdivision 6.
 new text end

new text begin Subd. 8. new text end

new text begin Clinician. new text end

new text begin "Clinician" means a mental health professional or clinical trainee
who is performing diagnostic assessment, testing, or psychotherapy.
 new text end

new text begin Subd. 9. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of human services
or the commissioner's designee.
 new text end

new text begin Subd. 10. new text end

new text begin Diagnostic assessment. new text end

new text begin "Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses conducted by a clinician. For a client receiving
publicly funded services, a diagnostic assessment must meet the standards of section
256B.0671, subdivisions 2 to 4.
 new text end

new text begin Subd. 11. new text end

new text begin Diagnostic formulation. new text end

new text begin "Diagnostic formulation" means a written analysis
and explanation of the information obtained from a clinical assessment to develop a
hypothesis about the cause and nature of the presenting problems and identify a framework
for developing the most suitable treatment approach.
 new text end

new text begin Subd. 12. new text end

new text begin Individual treatment plan. new text end

new text begin "Individual treatment plan" means the formulation
of planned services that are responsive to the needs and goals of a client. For a client receiving
publicly funded services, an individual treatment plan must meet the standards of section
256B.0671, subdivisions 5 and 6.
 new text end

new text begin Subd. 13. new text end

new text begin Mental health behavioral aide. new text end

new text begin "Mental health behavioral aide" means a
staff person qualified according to section 245I.16, subdivision 16.
 new text end

new text begin Subd. 14. new text end

new text begin Mental health certified family peer specialist. new text end

new text begin "Mental health certified
family peer specialist" means a staff person qualified according to section 245I.16,
subdivision 12.
 new text end

new text begin Subd. 15. new text end

new text begin Mental health certified peer specialist. new text end

new text begin "Mental health certified peer
specialist" means a staff person qualified according to section 245I.16, subdivision 10.
 new text end

new text begin Subd. 16. new text end

new text begin Mental health practitioner. new text end

new text begin "Mental health practitioner" means a staff person
qualified according to section 245I.16, subdivision 4.
 new text end

new text begin Subd. 17. new text end

new text begin Mental health professional. new text end

new text begin "Mental health professional" means a staff person
qualified according to section 245I.16, subdivision 2.
 new text end

new text begin Subd. 18. new text end

new text begin Mental health rehabilitation worker. new text end

new text begin "Mental health rehabilitation worker"
means a staff person qualified according to section 245I.16, subdivision 14.
 new text end

new text begin Subd. 19. new text end

new text begin Personnel file. new text end

new text begin "Personnel file" means the set of records under section 245I.13,
paragraph (a). Personnel files excludes information related to a person's employment not
enumerated in section 245I.13.
 new text end

new text begin Subd. 20. new text end

new text begin Provider entity. new text end

new text begin "Provider entity" means the organization, governmental unit,
corporation, or other legal body that is enrolled, certified, licensed, or otherwise authorized
by the commissioner to provide the services described in this chapter.
 new text end

new text begin Subd. 21. new text end

new text begin Responsivity factors. new text end

new text begin "Responsivity factors" means the factors other than the
diagnostic formulation that may modify an individual's treatment needs. This includes
learning style, ability, cognitive function, cultural background, and personal circumstance.
Documentation of responsivity factors includes an analysis of how an individual's strengths
may be reflected in the planned delivery of services.
 new text end

new text begin Subd. 22. new text end

new text begin Risk factors. new text end

new text begin "Risk factors" means factors that predispose a client to engage
in potentially harmful behaviors to themselves or others.
 new text end

new text begin Subd. 23. new text end

new text begin Strengths. new text end

new text begin "Strengths" means inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to resilience and core
competencies and can be built on to support recovery.
 new text end

new text begin Subd. 24. new text end

new text begin Trauma. new text end

new text begin "Trauma" means an event, series of events, or set of circumstances
that is 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, often associated with racial and ethnic population groups in the country who
have suffered major intergenerational losses.
 new text end

new text begin Subd. 25. new text end

new text begin Treatment supervision. new text end

new text begin "Treatment supervision" means the direction and
evaluation of individual assessment, treatment planning, and service delivery for each client
when services are delivered by an individual who is not a licensed mental health professional
or certified rehabilitation specialist as provided by section 245I.18.
 new text end

Sec. 42.

new text begin [245I.10] TRAINING REQUIRED.
 new text end

new text begin Subdivision 1. new text end

new text begin Training plan. new text end

new text begin A provider entity must develop a plan to ensure that staff
persons receive orientation and ongoing training. The plan must include:
 new text end

new text begin (1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation satisfies this requirement;
 new text end

new text begin (2) a description of how the provider entity conducts annual training, including whether
annual training is based on a staff person's hire date or a specified annual cycle determined
by the program; and
 new text end

new text begin (3) a description of how the provider entity determines when a staff person needs
additional training, including the timelines in which the additional training is provided.
 new text end

new text begin Subd. 2. new text end

new text begin Documentation of orientation and training. new text end

new text begin (a) The provider entity must
provide training in accordance with the training plan and must document that orientation
and training was provided. All training programs and materials used by the provider entity
must be available for review by regulatory agencies. The documentation must include the
following:
 new text end

new text begin (1) topic covered in the training;
 new text end

new text begin (2) identification of the trainee;
 new text end

new text begin (3) name and credentials of the trainer;
 new text end

new text begin (4) method of evaluating competency upon completion of training;
 new text end

new text begin (5) date of training; and
 new text end

new text begin (6) length of training, in hours.
 new text end

new text begin (b) Documentation of a continuing education credit accepted by the governing
health-related licensing board is sufficient for purposes of this subdivision.
 new text end

new text begin Subd. 3. new text end

new text begin Orientation. new text end

new text begin (a) Before providing direct contact services, a staff person must
receive orientation on:
 new text end

new text begin (1) patient rights as identified in section 144.651;
 new text end

new text begin (2) vulnerable adult and minor maltreatment requirements in sections 245A.65,
subdivision 3; 626.556, subdivisions 2, 3, and 7; 626.557; and 626.5572;
 new text end

new text begin (3) the Minnesota Health Records Act, including confidentiality, family engagement
according to section 144.294, and client privacy;
 new text end

new text begin (4) program policies and procedures;
 new text end

new text begin (5) emergency procedures appropriate to the position, including but not limited to fires,
inclement weather, missing persons, and medical emergencies;
 new text end

new text begin (6) professional boundaries;
 new text end

new text begin (7) behavior management, crisis intervention, and stabilization techniques;
 new text end

new text begin (8) specific needs of individuals served by the program, including but not limited to
developmental status, cognitive functioning, and physical and mental abilities; and
 new text end

new text begin (9) training related to the specific activities and job functions for which the staff person
is responsible to carry out, including documentation of the delivery of services.
 new text end

new text begin (b) A staff person must receive orientation on the following topics within 90 calendar
days of a staff person first providing direct contact services:
 new text end

new text begin (1) trauma-informed care;
 new text end

new text begin (2) family- and person-centered individual treatment plans, seeking partnership with
parents and identified supports, and shared decision making and engagement;
 new text end

new text begin (3) treatment for co-occurring substance use problems, including the definitions of
co-occurring disorders, prevalence of co-occurring disorders, common signs and symptoms
of co-occurring disorders, and the etiology of co-occurring disorders;
 new text end

new text begin (4) psychotropic medications, side effects, and safe medication management;
 new text end

new text begin (5) family systems and promoting culturally appropriate support networks;
 new text end

new text begin (6) culturally responsive treatment practices;
 new text end

new text begin (7) recovery concepts and principles;
 new text end

new text begin (8) building resiliency through a strength-based approach;
 new text end

new text begin (9) person-centered planning and positive support strategies; and
 new text end

new text begin (10) other training relevant to the staff person's role and responsibilities.
 new text end

new text begin (c) A provider entity may deem a staff person to have met an orientation requirement
in paragraph (b) if the staff person has received equivalent postsecondary education in the
previous four years or training experience in the previous two years. The training plan must
describe the process and location for verification and documentation of previous training
experience.
 new text end

new text begin (d) A provider entity may deem a mental health professional to have met a requirement
of paragraph (a), clauses (6) to (9), and paragraph (b) after an evaluation of the mental health
professional's competency, including by interview.
 new text end

new text begin Subd. 4. new text end

new text begin Annual training. new text end

new text begin (a) A provider entity shall ensure that staff persons who are
not licensed mental health professionals receive 15 hours of training each year after the first
year of employment.
 new text end

new text begin (b) A licensed mental health professional must follow specific training requirements as
determined by the professional's governing health-related licensing board.
 new text end

new text begin (c) All staff persons, including licensed mental health professionals, must receive annual
training on the topics in subdivision 3, paragraph (a), clauses (2) and (5).
 new text end

new text begin (d) The selection of additional training topics must be based on program needs and staff
persons' competency.
 new text end

new text begin Subd. 5. new text end

new text begin Training for services provided to children. new text end

new text begin (a) Training and orientation
required under this section for a staff person working with children must be aligned to the
developmental characteristics of the children served in the program and address the needs
of children in the context of the family, support system, and culture. This includes orientation
under subdivision 3 on the following topics: (1) child development; (2) working with children
and children's support systems; and (3) adverse childhood experiences, cognitive functioning,
and physical and mental abilities.
 new text end

new text begin (b) For a mental health behavioral aide, orientation in the first 90 days of service must
include a parent team training utilizing a curriculum approved by the commissioner.
 new text end

Sec. 43.

new text begin [245I.13] PERSONNEL FILES.
 new text end

new text begin (a) For each staff person, a provider entity shall maintain a personnel file that includes:
 new text end

new text begin (1) verification of the staff person's qualifications including training, education, and
licensure;
 new text end

new text begin (2) documentation related to the staff person's background study;
 new text end

new text begin (3) the date of hire;
 new text end

new text begin (4) the effective date of specific duties and responsibilities including the date that the
staff person begins direct contact with a client;
 new text end

new text begin (5) documentation of orientation;
 new text end

new text begin (6) records of training, license renewal, and educational activities completed during the
staff person's employment;
 new text end

new text begin (7) annual job performance evaluations; and
 new text end

new text begin (8) records of clinical supervision, if applicable.
 new text end

new text begin (b) Personnel files must be made accessible to the commissioner upon request. Personnel
files must be readily accessible for review but need not be kept in a single location.
 new text end

Sec. 44.

new text begin [245I.16] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
 new text end

new text begin Subdivision 1. new text end

new text begin Tribal providers. new text end

new text begin For purposes of this section, a tribal entity may
credential an individual under section 256B.02, subdivision 7, paragraphs (b) and (c).
 new text end

new text begin Subd. 2. new text end

new text begin Mental health professional qualifications. new text end

new text begin The following individuals may
provide services as a mental health professional:
 new text end

new text begin (1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and mental
health nursing by a national certification organization, or (ii) nurse practitioner in adult or
family psychiatric and mental health nursing by a national nurse certification organization;
 new text end

new text begin (2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
 new text end

new text begin (3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
 new text end

new text begin (4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
 new text end

new text begin (5) a marriage and family therapist licensed under sections 148B.29 to 148B.39; or
 new text end

new text begin (6) a licensed professional clinical counselor licensed under section 148B.5301.
 new text end

new text begin Subd. 3. new text end

new text begin Mental health professional scope of practice. new text end

new text begin A mental health professional
shall maintain a valid license with the mental health professional's governing health-related
licensing board and shall only provide services within the scope of practice as determined
by the health-related licensing board.
 new text end

new text begin Subd. 4. new text end

new text begin Mental health practitioner qualifications. new text end

new text begin (a) An individual who is qualified
in at least one of the ways described in paragraphs (b) to (d) may serve as a mental health
practitioner.
 new text end

new text begin (b) An individual is qualified through relevant coursework if the individual completes
at least 30 semester hours or 45 quarter hours in behavioral sciences or related fields and:
 new text end

new text begin (1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, substance use disorder, or emotional disturbance; or (ii)
traumatic brain injury or developmental disabilities and completes training on mental illness,
recovery from mental illness, mental health de-escalation techniques, co-occurring mental
illness and substance use disorder, and psychotropic medications and side effects;
 new text end

new text begin (2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives treatment
supervision from a mental health professional at least once per week until the requirement
of 2,000 hours of supervised experience is met;
 new text end

new text begin (3) is working in a day treatment program under section 245.4712, subdivision 2; or
 new text end

new text begin (4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
 new text end

new text begin (c) An individual is qualified through work experience if the individual:
 new text end

new text begin (1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, substance use disorder, or emotional disturbance; or (ii)
traumatic brain injury or developmental disabilities and completes training on mental illness,
recovery from mental illness, mental health de-escalation techniques, co-occurring mental
illness and substance use disorder, and psychotropic medications and side effects; or
 new text end

new text begin (2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with: (i) mental illness, emotional disturbance, or substance use disorder, and
receives treatment supervision as required by applicable statutes and rules from a mental
health professional at least once per week until the requirement of 4,000 hours of supervised
experience is met; or (ii) traumatic brain injury or developmental disabilities, completes
training on mental illness, recovery from mental illness, mental health de-escalation
techniques, co-occurring mental illness and substance use disorder, and psychotropic
medications and side effects, and receives treatment supervision as required by applicable
statutes and rules at least once per week from a mental health professional until the
requirement of 4,000 hours of supervised experience is met.
 new text end

new text begin (d) An individual is qualified by a bachelor's or master's degree if the individual: (1)
holds a master's or other graduate degree in behavioral sciences or related fields; or (2)
holds a bachelor's degree in behavioral sciences or related fields and completes a practicum
or internship that (i) requires direct interaction with adults or children served, and (ii) is
focused on behavioral sciences or related fields.
 new text end

new text begin Subd. 5. new text end

new text begin Mental health practitioner scope of practice. new text end

new text begin (a) A mental health practitioner
must perform services under the treatment supervision of a mental health professional.
 new text end

new text begin (b) A mental health practitioner may perform client education, functional assessments
for adult clients, level of care assessments, rehabilitative interventions, and skills building;
provide direction to a mental health rehabilitation worker or mental health behavioral aide;
and propose individual treatment plans.
 new text end

new text begin (c) A mental health practitioner who provides services according to section 256B.0624
or 256B.0944 may perform crisis assessment and intervention.
 new text end

new text begin Subd. 6. new text end

new text begin Clinical trainee qualifications. new text end

new text begin (a) A clinical trainee is a staff person who is
enrolled in or has completed an accredited graduate program of study intended to prepare
the individual for independent licensure as a mental health professional and who: (1)
participates in a practicum or internship supervised by a mental health professional; or (2)
is completing postgraduate hours, according to the requirements of a health-related licensing
board.
 new text end

new text begin (b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure the requirements of the health-related licensing board are met. As permitted
by a health-related licensing board, treatment supervision under this chapter may be integrated
into a plan to meet the supervisory requirements of the health-related licensing board but
does not supersede those requirements.
 new text end

new text begin Subd. 7. new text end

new text begin Clinical trainee scope of practice. new text end

new text begin (a) A clinical trainee, under treatment
supervision of a mental health professional, may perform psychotherapy, diagnostic
assessments, and services that a mental health practitioner may deliver. A clinical trainee
shall not provide treatment supervision. A clinical trainee may provide direction to a mental
health behavioral aide or mental health rehabilitation worker.
 new text end

new text begin (b) A clinical trainee shall not deliver services in violation of the practice act of a
health-related licensing board, including failure to obtain licensure, if required.
 new text end

new text begin Subd. 8. new text end

new text begin Certified rehabilitation specialist qualifications. new text end

new text begin A certified rehabilitation
specialist shall have:
 new text end

new text begin (1) a master's degree from an accredited college or university in behavioral sciences or
related fields as defined in section 245I.02, subdivision 3;
 new text end

new text begin (2) at least 4,000 hours of postmaster's supervised experience in the delivery of mental
health services; and
 new text end

new text begin (3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
 new text end

new text begin Subd. 9. new text end

new text begin Certified rehabilitation specialist scope of practice. new text end

new text begin A certified rehabilitation
specialist shall provide services based on a client's diagnostic assessment. A certified
rehabilitation specialist may provide supervision for mental health certified peer specialists,
mental health practitioners, and mental health rehabilitation workers, but is prohibited from
performing a diagnostic assessment.
 new text end

new text begin Subd. 10. new text end

new text begin Mental health certified peer specialist qualifications. new text end

new text begin A mental health
certified peer specialist shall:
 new text end

new text begin (1) be 21 years of age or older;
 new text end

new text begin (2) have been diagnosed with a mental illness;
 new text end

new text begin (3) be a current or former mental health services client; and
 new text end

new text begin (4) have a valid certification as a mental health certified peer specialist according to
section 245.696, subdivision 3.
 new text end

new text begin Subd. 11. new text end

new text begin Mental health certified peer specialist scope of practice. new text end

new text begin A mental health
certified peer specialist shall:
 new text end

new text begin (1) provide peer support that is individualized to the client;
 new text end

new text begin (2) promote recovery goals, self-sufficiency, self-advocacy, and the development of
natural supports; and
 new text end

new text begin (3) support the maintenance of skills learned in other services.
 new text end

new text begin Subd. 12. new text end

new text begin Mental health certified family peer specialist qualifications. new text end

new text begin A mental
health certified family peer specialist shall:
 new text end

new text begin (1) be 21 years of age or older;
 new text end

new text begin (2) have raised or be currently raising a child with a mental illness;
 new text end

new text begin (3) have experience navigating the children's mental health system; and
 new text end

new text begin (4) have a valid certification as a mental health certified family peer specialist according
to section 245.696, subdivision 3.
 new text end

new text begin Subd. 13. new text end

new text begin Mental health certified family peer specialist scope of practice. new text end

new text begin A mental
health certified family peer specialist shall provide services to increase the child's ability to
function better within the child's home, school, and community. The mental health certified
family peer specialist shall:
 new text end

new text begin (1) provide family peer support, to build on strengths of families and help families
achieve desired outcomes;
 new text end

new text begin (2) provide nonadversarial advocacy that encourages partnership and promotes positive
change and growth;
 new text end

new text begin (3) support families to advocate for culturally appropriate services for a child in each
treatment setting;
 new text end

new text begin (4) promote resiliency, self-advocacy, and development of natural supports;
 new text end

new text begin (5) support the maintenance of skills learned in other services;
 new text end

new text begin (6) establish and lead parent support groups;
 new text end

new text begin (7) assist parents to develop coping and problem-solving skills; and
 new text end

new text begin (8) educate parents on community resources, including resources that connect parents
with similar experiences.
 new text end

new text begin Subd. 14. new text end

new text begin Mental health rehabilitation worker qualifications. new text end

new text begin (a) A mental health
rehabilitation worker shall (1) be 21 years of age or older; (2) have a high school diploma
or equivalent; and (3) meet the qualification requirements in paragraph (b).
 new text end

new text begin (b) In addition to the requirements of paragraph (a), a mental health rehabilitation worker
shall also:
 new text end

new text begin (1)(i) be fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
 new text end

new text begin (ii) during the first 2,000 hours of work, receive monthly documented individual treatment
supervision by a mental health professional; and
 new text end

new text begin (iii) receive direct observation in addition to the direct observation requirements of
section 245I.18, subdivision 5, for a total of not less than twice per month for the first year
of work;
 new text end

new text begin (2) have an associate of arts degree;
 new text end

new text begin (3) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
 new text end

new text begin (4) be a registered nurse;
 new text end

new text begin (5) have within the previous ten years three years of personal life experience with mental
illness;
 new text end

new text begin (6) have within the previous ten years three years of life experience as a primary caregiver
to an adult with a mental illness, traumatic brain injury, substance use disorder, or
developmental disability; or
 new text end

new text begin (7) have within the previous ten years 2,000 hours of supervised work experience in
delivering mental health services to adults with a mental illness, traumatic brain injury,
substance use disorder, or developmental disability.
 new text end

new text begin (c) If the mental health rehabilitation worker provides crisis residential services, intensive
residential treatment services, partial hospitalization, or day treatment services, the mental
health rehabilitation worker shall: (1) satisfy paragraph (b), clause (1); and (2) have 40 hours
of additional continuing education on mental health topics during the first year of
employment.
 new text end

new text begin Subd. 15. new text end

new text begin Mental health rehabilitation worker scope of practice. new text end

new text begin (a) A mental health
rehabilitation worker under supervision of a mental health practitioner or mental health
professional may provide rehabilitative mental health services identified in the client's
individual treatment plan and individual behavior plan.
 new text end

new text begin (b) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is exempt from the additional qualification requirements in subdivision 14, paragraphs
(a), clause (3), and (b).
 new text end

new text begin Subd. 16. new text end

new text begin Mental health behavioral aide qualifications. new text end

new text begin (a) A level 1 mental health
behavioral aide shall:
 new text end

new text begin (1) be 18 years of age or older; and
 new text end

new text begin (2) have a high school diploma or commissioner of education-selected high school
equivalency certification; or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years.
 new text end

new text begin (b) A level 2 mental health behavioral aide shall:
 new text end

new text begin (1) be 18 years of age or older; and
 new text end

new text begin (2) have an associate or bachelor's degree or be certified by a program under section
256B.0943, subdivision 8a.
 new text end

new text begin Subd. 17. new text end

new text begin Mental health behavioral aide scope of practice. new text end

new text begin The mental health
behavioral aid under supervision of a mental health professional may provide rehabilitative
mental health services identified in the client's individual treatment plan and individual
behavior plan.
 new text end

Sec. 45.

new text begin [245I.18] TREATMENT SUPERVISION.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) A provider entity shall ensure that a mental health
professional provides treatment supervision for each staff person who provides services to
a client and who is not a mental health professional or certified rehabilitation specialist.
Treatment supervision shall be based on a staff person's written treatment supervision plan.
 new text end

new text begin (b) Treatment supervision must focus on the client's treatment needs and the ability of
the staff person receiving treatment supervision to provide services, including:
 new text end

new text begin (1) review and evaluation of the interventions delivered;
 new text end

new text begin (2) instruction on alternative strategies if a client is not achieving treatment goals;
 new text end

new text begin (3) review and evaluation of assessments, treatment plans, and progress notes for accuracy
and appropriateness;
 new text end

new text begin (4) approval of diagnostic assessments and individual treatment plans within five business
days of initial completion by the supervisee;
 new text end

new text begin (5) instruction on the cultural norms or values of the clients and communities served by
the provider entity and any impact on treatment;
 new text end

new text begin (6) evaluation of and feedback on the competencies of direct service staff persons; and
 new text end

new text begin (7) coaching, teaching, and practicing skills with staff persons.
 new text end

new text begin (c) A treatment supervisor's responsibility for a supervisee is limited to services provided
by the associated provider entity. If a supervisee is employed by multiple provider entities,
each entity is responsible for furnishing the necessary treatment supervision.
 new text end

new text begin Subd. 2. new text end

new text begin Permitted modalities. new text end

new text begin (a) Treatment supervision must be conducted face-to-face,
including telemedicine, according to the Minnesota Telemedicine Act, sections 62A.67 to
62A.672.
 new text end

new text begin (b) Treatment supervision may be conducted using individual, small group, or team
modalities. "Individual supervision" means one or more mental health professionals and
one staff person receiving treatment supervision. "Small group supervision" means one or
more mental health professionals and two to six staff persons receiving treatment supervision.
"Team supervision" is defined by the service lines for which it may be used.
 new text end

new text begin Subd. 3. new text end

new text begin Treatment supervision planning. new text end

new text begin (a) A written treatment supervision plan
shall be developed by a mental health professional who is qualified to provide treatment
supervision and the staff person receiving the treatment supervision. The treatment
supervision plan must be completed and implemented within 30 days of a new staff person's
employment. The treatment supervision plan must be reviewed and updated at least annually.
 new text end

new text begin (b) The treatment supervision plan must include:
 new text end

new text begin (1) the name and qualifications of the staff person receiving treatment supervision;
 new text end

new text begin (2) the name of the provider entity under which the staff person is receiving treatment
supervision;
 new text end

new text begin (3) the name and licensure of a mental health professional providing treatment
supervision;
 new text end

new text begin (4) the number of hours of individual and group supervision the staff person receiving
treatment supervision must complete and the location of the record if the record is kept
outside of an individual personnel file;
 new text end

new text begin (5) procedures that the staff person receiving treatment supervision shall use to respond
to client emergencies; and
 new text end

new text begin (6) the authorized scope of practice for the staff person receiving treatment supervision,
including a description of responsibilities with the provider entity, a description of client
population, and treatment methods and modalities.
 new text end

new text begin Subd. 4. new text end

new text begin Treatment supervision record. new text end

new text begin (a) A provider entity shall ensure treatment
supervision is documented in each staff person's treatment supervision record.
 new text end

new text begin (b) The treatment supervision record must include:
 new text end

new text begin (1) the date and duration of the supervision;
 new text end

new text begin (2) identification of the supervision type as individual, small group, or team supervision;
 new text end

new text begin (3) the name of the mental health professional providing treatment supervision;
 new text end

new text begin (4) subsequent actions that the staff person receiving treatment supervision shall take;
and
 new text end

new text begin (5) the date and signature of the mental health professional providing treatment
supervision.
 new text end

new text begin Subd. 5. new text end

new text begin Direct observation of mental health rehabilitation workers and behavioral
aides. new text end

new text begin A mental health practitioner, clinical trainee, or mental health professional shall
directly observe a mental health behavioral aide or a mental health rehabilitation worker
while the mental health behavioral aide or mental health rehabilitation worker provides
services to clients. The amount of direct observation shall be no less than twice per month
for the first six months and once per month thereafter. The staff performing the observation
shall approve the progress note for the service observed.
 new text end

Sec. 46.

new text begin [245I.32] CLIENT FILES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin A provider entity must maintain a file of current and accurate
client records on the premises where the service is provided or coordinated. Each entry in
the record must be signed and dated by the staff person making the entry.
 new text end

new text begin Subd. 2. new text end

new text begin Record retention. new text end

new text begin A provider entity must retain client records of a discharged
client for a minimum of seven years from the date of discharge. A provider entity that ceases
to provide treatment service must retain client records for a minimum of seven years from
the date the provider entity stopped providing the service and must notify the commissioner
of the location of the client records and the name of the individual responsible for maintaining
the client records.
 new text end

new text begin Subd. 3. new text end

new text begin Contents. new text end

new text begin Client files must contain the following, as applicable:
 new text end

new text begin (1) diagnostic assessments;
 new text end

new text begin (2) functional assessments;
 new text end

new text begin (3) individual treatment plans;
 new text end

new text begin (4) individual abuse prevention plans;
 new text end

new text begin (5) crisis plans;
 new text end

new text begin (6) documentation of releases of information;
 new text end

new text begin (7) emergency contacts for the client;
 new text end

new text begin (8) documentation of the date of service; signature of the person providing the service;
nature, extent, and units of service; and place of service delivery;
 new text end

new text begin (9) record of all medication prescribed or administered by staff;
 new text end

new text begin (10) documentation of any contact made with the client's other mental health providers,
case manager, family members, primary caregiver, or legal representative or the reason the
provider did not contact the client's family members or primary caregiver;
 new text end

new text begin (11) documentation of any contact made with other persons interested in the client,
including representatives of the courts, corrections systems, or schools;
 new text end

new text begin (12) written information by the client that the client requests be included in the file;
 new text end

new text begin (13) health care directive; and
 new text end

new text begin (14) the date and reason the provider entity's services are discontinued.
 new text end

Sec. 47.

new text begin [245I.33] DOCUMENTATION STANDARDS.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin As a condition of payment, a provider entity must ensure that
documentation complies with this section and Minnesota Rules, parts 9505.2175 and
9505.2197. The department must recover medical assistance payments for a service not
documented in a client file according to this section.
 new text end

new text begin Subd. 2. new text end

new text begin Documentation standards. new text end

new text begin A provider entity must ensure that all documentation
required under this chapter:
 new text end

new text begin (1) is typed or legible, if handwritten;
 new text end

new text begin (2) identifies the client or staff person on each page, as applicable;
 new text end

new text begin (3) is signed and dated by the staff person who completes the documentation, including
the staff person's credentials; and
 new text end

new text begin (4) is cosigned and dated by the staff person providing treatment supervision as required
under this chapter, including the staff person's credentials.
 new text end

new text begin Subd. 3. new text end

new text begin Progress notes. new text end

new text begin A provider entity shall use a progress note to promptly document
each occurrence of a mental health service provided to a client. A progress note must include
the following:
 new text end

new text begin (1) the type of service;
 new text end

new text begin (2) the date of service, including the start and stop time;
 new text end

new text begin (3) the location of service;
 new text end

new text begin (4) the scope of service, including: (i) the goal and objective targeted; (ii) the intervention
delivered and the methods used; (iii) the client's response or reaction to intervention; (iv)
the plan for the next session; and (v) the service modality;
 new text end

new text begin (5) the signature and the printed name and credentials of the staff person who provided
the service;
 new text end

new text begin (6) the mental health provider travel documentation requirements under section
256B.0625, if applicable; and
 new text end

new text begin (7) other significant observations, including new text end new text begin (i) current risk factors the client may be
experiencing; new text end new text begin (ii) emergency interventions; new text end new text begin (iii) consultations with or referrals to other
professionals, family, or significant others; new text end new text begin (iv) a summary of the effectiveness of treatment,
prognosis, or discharge planning; new text end new text begin (v) test results and medications; or new text end new text begin (vi) changes in mental
or physical symptoms.
 new text end

Sec. 48.

Minnesota Statutes 2018, 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) on July 1, 2018, or upon federal approval, whichever is later, comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05deleted text begin , and
Minnesota Rules, part 9530.6422deleted text end ;

(3) on July 1, 2018, or upon federal approval, whichever is later, care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (6);

(4) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (5);

(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, deleted text begin clauses (1) to (6),deleted text end 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.

Sec. 49.

Minnesota Statutes 2018, section 256B.0615, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers mental health certified peer specialist
servicesdeleted text begin , as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
aredeleted text end provided by a certified peer specialist who deleted text begin has completed the training under subdivision
5deleted text end new text begin is qualified according to section 245I.16, subdivision 10new text end .

Sec. 50.

Minnesota Statutes 2018, section 256B.0616, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers mental health certified family peer
specialists servicesdeleted text begin , as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245,deleted text end and are provided by a certified family peer specialist who deleted text begin has completed the
training under subdivision 5deleted text end new text begin is qualified according to section 245I.16, subdivision 12new text end . A
family peer specialist cannot provide services to the peer specialist's family.

Sec. 51.

Minnesota Statutes 2018, section 256B.0616, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment,new text begin intensivenew text end treatmentnew text begin
innew text end foster care, day treatment, children's therapeutic services and supports, or crisis services.

Sec. 52.

Minnesota Statutes 2018, section 256B.0622, subdivision 1, is amended to read:


Subdivision 1.

Scope.

deleted text begin Subject to federal approval,deleted text end Medical assistance covers medically
necessary, assertive community treatment for clients as defined in subdivision 2a and
intensive residential treatment services for clients as defined in subdivision 3, when the
services are provided by an entity meeting the standards in this section.

Sec. 53.

Minnesota Statutes 2018, section 256B.0622, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.

(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.

deleted text begin (d) "Individual treatment plan" means the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomes.
 deleted text end

deleted text begin (e) "Assertive engagement" means the use of collaborative strategies to engage clients
to receive services.
 deleted text end

deleted text begin (f) "Benefits and finance support" means assisting clients in capably managing financial
affairs. Services include, but are not limited to, assisting clients in applying for benefits;
assisting with redetermination of benefits; providing financial crisis management; teaching
and supporting budgeting skills and asset development; and coordinating with a client's
representative payee, if applicable.
 deleted text end

new text begin (d) "Clinical trainee" means a staff person qualified according to section 245I.16,
subdivision 6.
 new text end

deleted text begin (g)deleted text end new text begin (e)new text end "Co-occurring disorder treatment" means the treatment of co-occurring mental
illness and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages of
change, such as outreach and motivational interviewing techniques to work with clients in
earlier stages of change readiness and cognitive behavioral approaches and relapse prevention
to work with clients in later stages of change; and facilitating access to community supports.

deleted text begin (h)deleted text end new text begin (f)new text end "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2, paragraphs (c) to (e).

deleted text begin (i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing individual
client preferences and strengths; ensuring employment services are integrated with mental
health services; conducting rapid job searches and systematic job development according
to client preferences and choices; providing benefits counseling; and offering all services
in an individualized and time-unlimited manner. Services shall also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the work place, and managing work relationships.
 deleted text end

deleted text begin (j) "Family psychoeducation and support" means services provided to the client's family
and other natural supports to restore and strengthen the client's unique social and family
relationships. Services include, but are not limited to, individualized psychoeducation about
the client's illness and the role of the family and other significant people in the therapeutic
process; family intervention to restore contact, resolve conflict, and maintain relationships
with family and other significant people in the client's life; ongoing communication and
collaboration between the ACT team and the family; introduction and referral to family
self-help programs and advocacy organizations that promote recovery and family
engagement, individual supportive counseling, parenting training, and service coordination
to help clients fulfill parenting responsibilities; coordinating services for the child and
restoring relationships with children who are not in the client's custody; and coordinating
with child welfare and family agencies, if applicable. These services must be provided with
the client's agreement and consent.
 deleted text end

deleted text begin (k) "Housing access support" means assisting clients to find, obtain, retain, and move
to safe and adequate housing of their choice. Housing access support includes, but is not
limited to, locating housing options with a focus on integrated independent settings; applying
for housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation.
 deleted text end

new text begin (g) "Individual treatment plan" means a plan described under section 256B.0671,
subdivisions 5 and 6.
 new text end

deleted text begin (l)deleted text end new text begin (h)new text end "Individual treatment team" means a minimum of three members of the ACT
team who are responsible for consistently carrying out most of a client's assertive community
treatment services.

deleted text begin (m)deleted text end new text begin (i)new text end "Intensive residential treatment services treatment team" means all staff who
provide intensive residential treatment services under this section to clients. deleted text begin At a minimum,
this includes the clinical supervisor; mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6); mental health practitioners as defined in section 245.462,
subdivision 17; mental health rehabilitation workers under section 256B.0623, subdivision
5, paragraph (a), clause (4); and mental health certified peer specialists under section
256B.0615.
deleted text end

deleted text begin (n)deleted text end new text begin (j)new text end "Intensive residential treatment services" means short-term, time-limited services
provided in a residential setting to clients who are in need of more restrictive settings and
are at risk of significant functional deterioration if they do not receive these services. Services
are designed to develop and enhance psychiatric stability, personal and emotional adjustment,
self-sufficiency, and skills to live in a more independent setting. Services must be directed
toward a targeted discharge date with specified client outcomes.

deleted text begin (o) "Medication assistance and support" means assisting clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. This includes the prescription, administration, and order of medication
by appropriate medical staff.
 deleted text end

deleted text begin (p) "Medication education" means educating clients on the role and effects of medications
in treating symptoms of mental illness and the side effects of medications.
 deleted text end

new text begin (k) "Mental health certified peer specialist" means a staff person qualified according to
section 245I.16, subdivision 10.
 new text end

new text begin (l) "Mental health practitioner" means a staff person qualified according to section
245I.16, subdivision 4.
 new text end

new text begin (m) "Mental health professional" means a staff person qualified according to section
245I.16, subdivision 2.
 new text end

new text begin (n) "Mental health rehabilitation worker" means a staff person qualified according to
section 245I.16, subdivision 14.
 new text end

deleted text begin (q)deleted text end new text begin (o)new text end "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.

deleted text begin (r) "Mental health certified peer specialist services" has the meaning given in section
256B.0615.
 deleted text end

deleted text begin (s)deleted text end new text begin (p)new text end "Physical health services" means any service or treatment to meet the physical
health needs of the client to support the client's mental health recovery. Services include,
but are not limited to, education on primary health issues, including wellness education;
medication administration and monitoring; providing and coordinating medical screening
and follow-up; scheduling routine and acute medical and dental care visits; tobacco cessation
strategies; assisting clients in attending appointments; communicating with other providers;
and integrating all physical and mental health treatment.

deleted text begin (t)deleted text end new text begin (q)new text end "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.

deleted text begin (u)deleted text end new text begin (r)new text end "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.

deleted text begin (v)deleted text end new text begin (s)new text end "Symptom management" means supporting clients in identifying and targeting
the symptoms and occurrence patterns of their mental illness and developing strategies to
reduce the impact of those symptoms.

deleted text begin (w)deleted text end new text begin (t)new text end "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure therapy,
acceptance and commitment therapy, interpersonal therapy, and motivational interviewing.

deleted text begin (x)deleted text end new text begin (u)new text end "Wellness self-management and prevention" means a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structure.

Sec. 54.

Minnesota Statutes 2018, section 256B.0622, subdivision 3a, is amended to read:


Subd. 3a.

Provider certification and contract requirements for assertive community
treatment.

(a) The assertive community treatment provider must:

(1) have a contract with the host county to provide assertive community treatment
services; and

(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , chapter 245I, andnew text end minimum program fidelity standards as measured by a nationally
recognized fidelity tool approved by the commissioner. Recertification must occur at least
every three years.

(b) An ACT team certified under this subdivision must meet the following standards:

(1) have capacity to recruit, hire, manage, and train required ACT team members;

(2) have adequate administrative ability to ensure availability of services;

deleted text begin (3) ensure adequate preservice and ongoing training for staff;
 deleted text end

deleted text begin (4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
 deleted text end

deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;

deleted text begin (6) develop and maintain client files, individual treatment plans, and contact charting;
 deleted text end

deleted text begin (7) develop and maintain staff training and personnel files;
 deleted text end

deleted text begin (8)deleted text end new text begin (4)new text end submit information as required by the state;

deleted text begin (9)deleted text end new text begin (5)new text end keep all necessary records required by law;

deleted text begin (10) comply with all applicable laws;
 deleted text end

deleted text begin (11)deleted text end new text begin (6)new text end be an enrolled Medicaid provider;

deleted text begin (12)deleted text end new text begin (7)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with services; and

deleted text begin (13)deleted text end new text begin (8)new text end develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.

(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.

Sec. 55.

Minnesota Statutes 2018, section 256B.0622, subdivision 4, is amended to read:


Subd. 4.

Provider entity licensure and contract requirements for intensive residential
treatment services.

(a) The intensive residential treatment services provider entity must:

(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;

(2) not exceed 16 beds per site; and

(3) comply with the additional standards in this sectionnew text begin and chapter 245Inew text end .

(b) The commissioner shall develop procedures for counties and providers to submit
other documentation as needed to allow the commissioner to determine whether the standards
in this section are met.

(c) A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.

(d) A provider entity must submit documentation that the provider entity requested a
statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.

Sec. 56.

Minnesota Statutes 2018, section 256B.0622, subdivision 5a, is amended to read:


Subd. 5a.

Standards for intensive residential rehabilitative mental health services.

(a)
The standards in this subdivision apply to intensive residential mental health services.

(b) The provider of intensive residential treatment services must have sufficient staff to
provide 24-hour-per-day coverage to deliver the rehabilitative services described in the
treatment plan and to safely supervise and direct the activities of clients, given the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider
must have the capacity within the facility to provide integrated services for chemical
dependency, illness management services, and family education, when appropriate.

(c) At a minimum:

(1) staff must provide direction and supervision whenever clients are present in the
facility;

(2) staff must remain awake during all work hours;

(3) there must be a staffing ratio of at least one to nine clients for each day and evening
shift. If more than nine clients are present at the residential site, there must be a minimum
of two staff during day and evening shifts, one of whom must be a mental health practitioner
or mental health professional;

(4) if services are provided to clients who need the services of a medical professional,
the provider shall ensure that these services are provided either by the provider's own medical
staff or through referral to a medical professional; and

(5) the provider must ensure the timely availability of a licensed registered nurse, either
directly employed or under contract, who is responsible for ensuring the effectiveness and
safety of medication administration in the facility and assessing clients for medication side
effects and drug interactions.

(d) Services must be provided by qualified staff as defined in section 256B.0623,
subdivision 5deleted text begin , who are trained and supervised according to section 256B.0623, subdivision
6, except that mental health rehabilitation workers acting as overnight staff are not required
to comply with section 256B.0623, subdivision 5, paragraph (a), clause (4), item (iv)deleted text end .

(e) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be an active member of the intensive residential
services treatment team. The team must meet with the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor at least
weekly to discuss clients' progress and make rapid adjustments to meet clients' needs. The
team meeting shall include client-specific case reviews and general treatment discussions
among team members. Client-specific case reviews and planning must be documented in
the client's treatment record.

(f) Treatment staff must have prompt access in person or by telephone to a mental health
practitioner or mental health professional. The provider must 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.

(g) The initial functional assessment must be completed within ten days of intake and
updated at least every 30 days, or prior to discharge from the service, whichever comes
first.

(h) The initial individual treatment plan must be completed within 24 hours of admission.
Within ten days of admission, the initial treatment plan must be refined and further developed,
except for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180.
The individual treatment plan must be reviewed with the client and updated at least monthly.

Sec. 57.

Minnesota Statutes 2018, section 256B.0622, subdivision 7, is amended to read:


Subd. 7.

Assertive community treatment service standards.

(a) ACT teams must
offer and have the capacity to directly provide the following services:

(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;

(2) benefits and finance supportdeleted text begin ;deleted text end new text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicable;
new text end

(3) co-occurring disorder treatment;

(4) crisis assessment and intervention;

(5) employment servicesdeleted text begin ;deleted text end new text begin that assists clients to work at jobs of their choosing. Services
must follow the principles of the individual placement and support employment model,
including focusing on competitive employment, emphasizing individual client preferences
and strengths, ensuring employment services are integrated with mental health services,
conducting rapid job searches and systematic job development according to client preferences
and choices, providing benefits counseling, and offering all services in an individualized
and time-unlimited manner. Services must also include educating clients about opportunities
and benefits of work and school and assisting the client in learning job skills, navigating
the workplace, and managing work relationships;
new text end

(6) family psychoeducation and supportdeleted text begin ;deleted text end new text begin provided to the client's family and other natural
supports to restore and strengthen the client's unique social and family relationships. Services
include but are not limited to individualized psychoeducation about the client's illness and
the role of the family and other significant people in the therapeutic process; family
intervention to restore contact, resolve conflict, and maintain relationships with family and
other significant people in the client's life; ongoing communication and collaboration between
the ACT team and the family; introduction and referral to family self-help programs and
advocacy organizations that promote recovery and family engagement, individual supportive
counseling, parenting training, and service coordination to help clients fulfill parenting
responsibilities; coordinating services for the child and restoring relationships with children
who are not in the client's custody; and coordinating with child welfare and family agencies,
if applicable. These services must be provided with the client's agreement and consent;
new text end

(7) housing access supportdeleted text begin ;deleted text end new text begin that assists clients to find, obtain, retain, and move to safe
and adequate housing of their choice. Housing access support includes but is not limited to
locating housing options with a focus on integrated independent settings; applying for
housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation;
new text end

(8) medication assistance and supportdeleted text begin ;deleted text end new text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staff;
new text end

(9) medication educationdeleted text begin ;deleted text end new text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medications;
new text end

(10) mental health certified peer specialists services;

(11) physical health services;

(12) rehabilitative mental health services;

(13) symptom management;

(14) therapeutic interventions;

(15) wellness self-management and prevention; and

(16) other services based on client needs as identified in a client's assertive community
treatment individual treatment plan.

(b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.

Sec. 58.

Minnesota Statutes 2018, 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 deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . 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 deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end 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 deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end 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 deleted text begin 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 Adeleted text end new text begin mental health
professionalnew text end . 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 deleted text begin clinicaldeleted text end new text begin
treatmentnew text end 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 not provide specific roles and responsibilities by telemedicine unless approved
by the commissioner; 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) deleted text begin shoulddeleted text end new text begin shallnew text end 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 deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . 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 deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; mental health practitioners deleted text begin as defined in section 245.462, subdivision 17; a mental health
practitioner working as adeleted text end new text begin ;new text end clinical deleted text begin trainee according to Minnesota Rules, part 9505.0371,
subpart 5, item Cdeleted text end new text begin traineesnew text end ; or mental health rehabilitation workers deleted text begin as defined in section
256B.0623, subdivision 5, paragraph (a), clause (4)deleted text end . 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. 59.

Minnesota Statutes 2018, section 256B.0622, subdivision 7b, is amended to read:


Subd. 7b.

Assertive community treatment program size and opportunities.

(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:

(1) a small ACT team must:

(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;

(ii) serve an annual average maximum of no more than 50 clients;

(iii) ensure at least one full-time equivalent position for every eight clients served;

(iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;

(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;

(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;

(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and

(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time substance abuse specialist, one full-time equivalent mental
health certified peer specialist, one full-time vocational specialist, one full-time program
assistant, and at least one additional full-time ACT team member who has mental health
professionalnew text begin , clinical trainee,new text end or new text begin mental health new text end practitioner status; and

(2) a midsize ACT team shall:

(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time substance abuse specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least 1.5 to two additional full-time equivalent ACT
members, with at least one dedicated full-time staff member with mental health professional
status. Remaining team members may have mental health professionalnew text begin , clinical trainee,new text end or
new text begin mental health new text end practitioner status;

(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;

(iii) serve an annual average maximum caseload of 51 to 74 clients;

(iv) ensure at least one full-time equivalent position for every nine clients served;

(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;

(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;

(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and

(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;

(3) a large ACT team must:

(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time substance abuse specialist, one full-time equivalent mental health certified
peer specialist, one full-time vocational specialist, one full-time program assistant, and at
least two additional full-time equivalent ACT team members, with at least one dedicated
full-time staff member with mental health professional status. Remaining team members
may have mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner status;

(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;

(iii) serve an annual average maximum caseload of 75 to 100 clients;

(iv) ensure at least one full-time equivalent position for every nine individuals served;

(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;

(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and

(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.

(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.

Sec. 60.

Minnesota Statutes 2018, section 256B.0622, subdivision 7d, is amended to read:


Subd. 7d.

Assertive community treatment assessment and individual treatment
plan.

(a) An initial assessment, including a diagnostic assessment that meets the requirements
of deleted text begin Minnesota Rules, part 9505.0372, subpart 1,deleted text end new text begin section 256B.0671, subdivisions 2 and 3,new text end
and a 30-day treatment plan shall be completed the day of the client's admission to assertive
community treatment by the ACT team leader or the psychiatric care provider, with
participation by designated ACT team members and the client. The team leader, psychiatric
care provider, or other mental health professional designated by the team leader or psychiatric
care provider, must update the client's diagnostic assessment at least annually.

(b) An initial functional assessment must be completed within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes first.

(c) Within 30 days of the client's assertive community treatment admission, the ACT
team shall complete an in-depth assessment of the domains listed under section 245.462,
subdivision 11a.

(d) Each part of the in-depth assessment areas shall be completed by each respective
team specialist or an ACT team member with skill and knowledge in the area being assessed.
The assessments are based upon all available information, including that from client interview
family and identified natural supports, and written summaries from other agencies, including
police, courts, county social service agencies, outpatient facilities, and inpatient facilities,
where applicable.

(e) Between 30 and 45 days after the client's admission to assertive community treatment,
the entire ACT team must hold a comprehensive case conference, where all team members,
including the psychiatric provider, present information discovered from the completed
in-depth assessments and provide treatment recommendations. The conference must serve
as the basis for the first six-month treatment plan, which must be written by the primary
team member.

(f) The client's psychiatric care provider, primary team member, and individual treatment
team members shall assume responsibility for preparing the written narrative of the results
from the psychiatric and social functioning history timeline and the comprehensive
assessment.

(g) The primary team member and individual treatment team members shall be assigned
by the team leader in collaboration with the psychiatric care provider by the time of the first
treatment planning meeting or 30 days after admission, whichever occurs first.

(h) Individual treatment plans must be developed through the following treatment
planning process:

(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.

(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.

(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.

(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.

(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.

(6) The individual treatment plan and review must be deleted text begin signeddeleted text end new text begin approvednew text end or acknowledged
by the client, the primary team member, the team leader, the psychiatric care provider, and
all individual treatment team members. A copy of the deleted text begin signeddeleted text end individual treatment plan is
made available to the client.

Sec. 61.

Minnesota Statutes 2018, section 256B.0623, subdivision 1, is amended to read:


Subdivision 1.

Scope.

Medical assistance covers adult rehabilitative mental health
services as defined in subdivision 2, deleted text begin subject to federal approval,deleted text end if provided to recipients
as defined in subdivision 3 and provided by a qualified provider entity meeting the standards
in this section and by a qualified individual provider working within the provider's scope
of practice and identified in the recipient's individual treatment plan deleted text begin as defineddeleted text end new text begin describednew text end
in section deleted text begin 245.462, subdivision 14deleted text end new text begin 256B.0671, subdivisions 5 and 6new text end , and if determined to
be medically necessary according to section 62Q.53.

Sec. 62.

Minnesota Statutes 2018, section 256B.0623, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For purposes of this section, the following terms have the meanings
given them.

(a) "Adult rehabilitative mental health services" means mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text begin Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these services.
deleted text end

deleted text begin (1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
 deleted text end

deleted text begin (2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
 deleted text end

(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and 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, physician assistants, or registered nurses.

(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program under Minnesota Rules, chapter
9505, board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.

Sec. 63.

Minnesota Statutes 2018, section 256B.0623, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is age 18 or older;

(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;

(3) has substantial disability and functional impairment in three or more of the areas
listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced; and

(4) has had a recent diagnostic assessment deleted text begin or an adult diagnostic assessment updatedeleted text end by
a qualified professional that documents adult rehabilitative mental health services are
medically necessary to address identified disability and functional impairments and individual
recipient goals.

Sec. 64.

Minnesota Statutes 2018, section 256B.0623, subdivision 4, is amended to read:


Subd. 4.

Provider entity standards.

(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.

(b) The certification process is a determination as to whether the entity meets the standards
in this subdivisionnew text begin and chapter 245Inew text end . The certification must specify which adult rehabilitative
mental health services the entity is qualified to provide.

(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.

(d) new text begin State-level new text end recertification must occur at least every three years.

(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.

(f) The adult rehabilitative mental health services provider entity must meet the following
standards:

(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;

(2) have adequate administrative ability to ensure availability of services;

deleted text begin (3) ensure adequate preservice and inservice and ongoing training for staff;
 deleted text end

deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staff new text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;

deleted text begin (5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
 deleted text end

deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;

deleted text begin (7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
 deleted text end

deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;

deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;

deleted text begin (10) develop and maintain recipient files, individual treatment plans, and contact charting;
 deleted text end

deleted text begin (11) develop and maintain staff training and personnel files;
 deleted text end

deleted text begin (12)deleted text end new text begin (7)new text end submit information as required by the state;

deleted text begin (13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
 deleted text end

deleted text begin (14)deleted text end new text begin (8)new text end keep all necessary records required by law;

deleted text begin (15)deleted text end new text begin (9)new text end deliver services as required by section 245.461;

deleted text begin (16) comply with all applicable laws;
 deleted text end

deleted text begin (17)deleted text end new text begin (10)new text end be an enrolled Medicaid provider;

deleted text begin (18)deleted text end new text begin (11)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with services; and

deleted text begin (19)deleted text end new text begin (12)new text end develop and maintain written policies and procedures regarding service
provision and administration of the provider entity.

Sec. 65.

Minnesota Statutes 2018, section 256B.0623, subdivision 5, is amended to read:


Subd. 5.

Qualifications of provider staff.

deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin underdeleted text end new text begin asnew text end one of the following deleted text begin criteriadeleted text end new text begin providersnew text end :

(1) a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitionerdeleted text end new text begin
qualified according to section 245I.16, subdivision 2new text end ;

new text begin (2) a certified rehabilitation specialist qualified according to section 245I.16, subdivision
8;
 new text end

new text begin (3) a clinical trainee qualified according to section 245I.16, subdivision 6;
 new text end

deleted text begin (2)deleted text end new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professionaldeleted text end new text begin qualified according to section 245I.16, subdivision 4new text end ;

deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.16, subdivision 10new text end ; or

deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin qualified according to section 245I.16,
subdivision 14new text end . deleted text begin A mental health rehabilitation worker means a staff person working under
the direction of a mental health practitioner or mental health professional and under the
clinical supervision of a mental health professional in the implementation of rehabilitative
mental health services as identified in the recipient's individual treatment plan who:
deleted text end

deleted text begin (i) is at least 21 years of age;
 deleted text end

deleted text begin (ii) has a high school diploma or equivalent;
 deleted text end

deleted text begin (iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and
 deleted text end

deleted text begin (iv) meets the qualifications in paragraph (b).
 deleted text end

deleted text begin (b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):
 deleted text end

deleted text begin (1) has an associates of arts degree, two years of full-time postsecondary education, or
a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields; is
a registered nurse; or within the previous ten years has:
 deleted text end

deleted text begin (i) three years of personal life experience with serious mental illness;
 deleted text end

deleted text begin (ii) three years of life experience as a primary caregiver to an adult with a serious mental
illness, traumatic brain injury, substance use disorder, or developmental disability; or
 deleted text end

deleted text begin (iii) 2,000 hours of supervised work experience in the delivery of mental health services
to adults with a serious mental illness, traumatic brain injury, substance use disorder, or
developmental disability;
 deleted text end

deleted text begin (2)(i) is fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
 deleted text end

deleted text begin (ii) receives during the first 2,000 hours of work, monthly documented individual clinical
supervision by a mental health professional;
 deleted text end

deleted text begin (iii) has 18 hours of documented field supervision by a mental health professional or
mental health practitioner during the first 160 hours of contact work with recipients, and at
least six hours of field supervision quarterly during the following year;
 deleted text end

deleted text begin (iv) has review and cosignature of charting of recipient contacts during field supervision
by a mental health professional or mental health practitioner; and
 deleted text end

deleted text begin (v) has 15 hours of additional continuing education on mental health topics during the
first year of employment and 15 hours during every additional year of employment; or
 deleted text end

deleted text begin (3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:
 deleted text end

deleted text begin (i) satisfies clause (2), items (ii) to (iv); and
 deleted text end

deleted text begin (ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.
 deleted text end

deleted text begin (c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).
 deleted text end

deleted text begin (d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.
 deleted text end

Sec. 66.

Minnesota Statutes 2018, section 256B.0623, subdivision 6, is amended to read:


Subd. 6.

Required training and supervision.

(a) deleted text begin Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d)deleted text end new text begin Staff must receive
training in accordance with section 245I.10new text end .

deleted text begin (b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
 deleted text end

deleted text begin (c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.deleted text end new text begin
(b) Treatment supervision must be provided according to section 245I.18.new text end A mental health
professional providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of staff delivering adult rehabilitative
mental health services must provide the following guidance:

deleted text begin (1) review the information in the recipient's file;
 deleted text end

deleted text begin (2) review and approve initial and updates of individual treatment plans;
 deleted text end

deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving directionnew text end at least monthly to discuss treatment topics of
interest deleted text begin to the workers and practitionersdeleted text end ;

deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly todeleted text end new text begin (2)new text end discuss treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;

deleted text begin (5) meet at least monthly with the directing mental health practitioner, if there is one,
todeleted text end new text begin (3)new text end review needs of the adult rehabilitative mental health services program, review staff
on-site observations and evaluate mental health rehabilitation workers, plan staff training,
new text begin and new text end review program evaluation and developmentdeleted text begin , and consult with the directing practitioner;
anddeleted text end new text begin ;
new text end

deleted text begin (6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
 deleted text end

deleted text begin (d) An adult rehabilitative mental health services provider entity must have a treatment
director who is a mental health practitioner or mental health professional. The treatment
director must ensure the following:
 deleted text end

deleted text begin (1) while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker works;
 deleted text end

deleted text begin (2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
 deleted text end

deleted text begin (3)deleted text end new text begin (4) reviewnew text end progress notes deleted text begin are revieweddeleted text end from on-site service observation prepared by
the mental health rehabilitation worker and mental health practitioner for accuracy and
consistency with actual recipient contact and the individual treatment plan and goals;

deleted text begin (4)deleted text end new text begin (5) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professional or a mental health practitioner to the mental health rehabilitation services
worker during service provision;new text begin and
new text end

deleted text begin (5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
 deleted text end

deleted text begin (6) model service practices which: respect the recipient, include the recipient in planning
and implementation of the individual treatment plan, recognize the recipient's strengths,
collaborate and coordinate with other involved parties and providers;
 deleted text end

deleted text begin (7)deleted text end new text begin (6)new text end ensure that mental health practitioners and mental health rehabilitation workers
are able to effectively communicate with the recipients, significant others, and providersdeleted text begin ;
anddeleted text end new text begin .
new text end

deleted text begin (8) oversee the record of the results of on-site observation and charting evaluation and
corrective actions taken to modify the work of the mental health practitioners and mental
health rehabilitation workers.
 deleted text end

deleted text begin (e) A mental health practitioner who is providing treatment direction for a provider entity
must receive supervision at least monthly from a mental health professional to:
 deleted text end

deleted text begin (1) identify and plan for general needs of the recipient population served;
 deleted text end

deleted text begin (2) identify and plan to address provider entity program needs and effectiveness;
 deleted text end

deleted text begin (3) identify and plan provider entity staff training and personnel needs and issues; and
 deleted text end

deleted text begin (4) plan, implement, and evaluate provider entity quality improvement programs.
 deleted text end

Sec. 67.

Minnesota Statutes 2018, section 256B.0623, subdivision 7, is amended to read:


Subd. 7.

Personnel file.

The adult rehabilitative mental health services provider entity
must maintain a personnel file on each staffnew text begin in accordance with section 245I.13new text end . deleted text begin Each file
must contain:
deleted text end

deleted text begin (1) an annual performance review;
 deleted text end

deleted text begin (2) a summary of on-site service observations and charting review;
 deleted text end

deleted text begin (3) a criminal background check of all direct service staff;
 deleted text end

deleted text begin (4) evidence of academic degree and qualifications;
 deleted text end

deleted text begin (5) a copy of professional license;
 deleted text end

deleted text begin (6) any job performance recognition and disciplinary actions;
 deleted text end

deleted text begin (7) any individual staff written input into own personnel file;
 deleted text end

deleted text begin (8) all clinical supervision provided; and
 deleted text end

deleted text begin (9) documentation of compliance with continuing education requirements.
 deleted text end

Sec. 68.

Minnesota Statutes 2018, section 256B.0623, subdivision 8, is amended to read:


Subd. 8.

Diagnostic assessment.

Providers of adult rehabilitative mental health services
must new text begin obtain or new text end complete a diagnostic assessment deleted text begin as defined indeleted text end new text begin according tonew text end section deleted text begin 245.462,
subdivision 9, within five days after the recipient's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available that
reflects the recipient's current status, and has been completed within three years preceding
admission, an adult diagnostic assessment update must be completed. An update shall include
a face-to-face interview with the recipient and a written summary by a mental health
professional of the recipient's current mental health status and service needs. If the recipient's
mental health status has changed significantly since the adult's most recent diagnostic
assessment, a new diagnostic assessment is requireddeleted text end new text begin 256B.0671, subdivisions 2 and 3new text end .

Sec. 69.

Minnesota Statutes 2018, section 256B.0623, subdivision 10, is amended to read:


Subd. 10.

Individual treatment plan.

All providers of adult rehabilitative mental health
services must develop and implement an individual treatment plan for each recipientdeleted text begin . The
provisions in clauses (1) and (2) apply:deleted text end new text begin according to section 256B.0671, subdivisions 5 and
6.
new text end

deleted text begin (1) Individual treatment plan means a plan of intervention, treatment, and services for
an individual recipient written by a mental health professional or by a mental health
practitioner under the clinical supervision of a mental health professional. The individual
treatment plan must be based on diagnostic and functional assessments. To the extent
possible, the development and implementation of a treatment plan must be a collaborative
process involving the recipient, and with the permission of the recipient, the recipient's
family and others in the recipient's support system. Providers of adult rehabilitative mental
health services must develop the individual treatment plan within 30 calendar days of intake.deleted text end
The treatment plan must be updated at least every six months thereafter, or more often when
there is significant change in the recipient's situation or functioning, or in services or service
methods to be used, or at the request of the recipient or the recipient's legal guardian.

deleted text begin (2) The individual treatment plan must include:
 deleted text end

deleted text begin (i) a list of problems identified in the assessment;
 deleted text end

deleted text begin (ii) the recipient's strengths and resources;
 deleted text end

deleted text begin (iii) concrete, measurable goals to be achieved, including time frames for achievement;
 deleted text end

deleted text begin (iv) specific objectives directed toward the achievement of each one of the goals;
 deleted text end

deleted text begin (v) documentation of participants in the treatment planning. The recipient, if possible,
must be a participant. The recipient or the recipient's legal guardian must sign the treatment
plan, or documentation must be provided why this was not possible. A copy of the plan
must be given to the recipient or legal guardian. Referral to formal services must be arranged,
including specific providers where applicable;
 deleted text end

deleted text begin (vi) cultural considerations, resources, and needs of the recipient must be included;
 deleted text end

deleted text begin (vii) planned frequency and type of services must be initiated; and
 deleted text end

deleted text begin (viii) clear progress notes on outcome of goals.
 deleted text end

deleted text begin (3) The individual community support plan defined in section 245.462, subdivision 12,
may serve as the individual treatment plan if there is involvement of a mental health case
manager, and with the approval of the recipient. The individual community support plan
must include the criteria in clause (2).
 deleted text end

Sec. 70.

Minnesota Statutes 2018, section 256B.0623, subdivision 11, is amended to read:


Subd. 11.

Recipient file.

Providers of adult rehabilitative mental health services must
maintain a file for each recipient deleted text begin that contains the following information:deleted text end new text begin according to
section 245I.32.
new text end

deleted text begin (1) diagnostic assessment or verification of its location that is current and that was
reviewed by a mental health professional who is employed by or under contract with the
provider entity;
 deleted text end

deleted text begin (2) functional assessments;
 deleted text end

deleted text begin (3) individual treatment plans signed by the recipient and the mental health professional,
or if the recipient refused to sign the plan, the date and reason stated by the recipient as to
why the recipient would not sign the plan;
 deleted text end

deleted text begin (4) recipient history;
 deleted text end

deleted text begin (5) signed release forms;
 deleted text end

deleted text begin (6) recipient health information and current medications;
 deleted text end

deleted text begin (7) emergency contacts for the recipient;
 deleted text end

deleted text begin (8) case records which document the date of service, the place of service delivery,
signature of the person providing the service, nature, extent and units of service, and place
of service delivery;
 deleted text end

deleted text begin (9) contacts, direct or by telephone, with recipient's family or others, other providers,
or other resources for service coordination;
 deleted text end

deleted text begin (10) summary of recipient case reviews by staff; and
 deleted text end

deleted text begin (11) written information by the recipient that the recipient requests be included in the
file.
 deleted text end

Sec. 71.

Minnesota Statutes 2018, section 256B.0623, subdivision 12, is amended to read:


Subd. 12.

Additional requirements.

(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.

(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36), or an
acute care hospital.

(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and treatment plan. A group is defined
as two to ten clients, at least one of whom is a recipient, who is concurrently receiving a
service which is identified in this section. The service and group must be specified in the
recipient's treatment plan. No more than two qualified staff may bill Medicaid for services
provided to the same group of recipients. If two adult rehabilitative mental health workers
bill for recipients in the same group session, they must each bill for different recipients.

new text begin (d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
 new text end

new text begin (e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
 new text end

Sec. 72.

Minnesota Statutes 2018, section 256B.0624, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For purposes of this section, the following terms have the meanings
given them.

(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.

(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.

A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or deleted text begin crisis mental health
practitionerdeleted text end new text begin qualified member of a crisis teamnew text end with input from the recipient whenever
possible.

(c) "Mental health crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional,deleted text end new text begin qualified member of a crisis teamnew text end following a
screening that suggests that the adult may be experiencing a mental health crisis or mental
health emergency situation. It includes, when feasible, assessing whether the person might
be willing to voluntarily accept treatment, determining whether the person has an advance
directive, and obtaining information and history from involved family members or caretakers.

(d) "Mental health mobile crisis intervention services" means face-to-face, short-term
intensive mental health services initiated during a mental health crisis or mental health
emergency to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.

(1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.

(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.

(3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.

(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.

(5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.

(6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.

(e) "Mental health crisis stabilization services" means individualized mental health
services provided to a recipient following crisis intervention services which are designed
to restore the recipient to the recipient's prior functional level. Mental health crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, or a short-term supervised, licensed
residential program. Mental health crisis stabilization does not include partial hospitalization
or day treatment. Mental health crisis stabilization services includes family psychoeducation.

new text begin (f) "Clinical trainee" means a person qualified according to section 245I.16, subdivision
6.
 new text end

new text begin (g) "Mental health certified family peer specialist" means a person qualified according
to section 245I.16, subdivision 12.
 new text end

new text begin (h) "Mental health certified peer specialist" means a person qualified according to section
245I.16, subdivision 10.
 new text end

new text begin (i) "Mental health practitioner" means a person qualified according to section 245I.16,
subdivision 4.
 new text end

new text begin (j) "Mental health professional" means a person qualified according to section 245I.16,
subdivision 2.
 new text end

new text begin (k) "Mental health rehabilitation worker" means a person qualified according to section
245I.16, subdivision 14.
 new text end

Sec. 73.

Minnesota Statutes 2018, section 256B.0624, subdivision 4, is amended to read:


Subd. 4.

Provider entity standards.

(a) A provider entity is an entity that meets the
standards listed in paragraph (c) and:

(1) is a county board operated entity; deleted text begin or
deleted text end

(2)new text begin is an Indian health service facility or facility owned and operated by a tribe or a tribal
organization operating under United States Code, title 25, section 450f; or
new text end

new text begin (3)new text end is a provider entity that is under contract with the county board in the county where
the potential crisis or emergency is occurring. To provide services under this section, the
provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.

(b) A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of paragraph (a), clauses (1)
deleted text begin and (2)deleted text end new text begin to (3), and paragraph (c), clauses (9), (20), and (21)new text end , but must meet all other
requirements of this subdivision.new text begin Upon approval by the commissioner, a residential crisis
services provider meeting relevant standards for supervision and assessment may allow a
practitioner to perform a crisis assessment to establish eligibility for admission to the
program. A provider performing an assessment under this paragraph shall not bill separately
beyond the daily rate for the residential stabilization program.
new text end

(c) The adult mental health crisis response services provider entity must have the capacity
to meet and carry outnew text begin the requirements in chapter 245I andnew text end the following standards:

(1) has the capacity to recruit, hire, and manage and train deleted text begin mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin qualified staffnew text end ;

(2) has adequate administrative ability to ensure availability of services;

(3) is able to ensure adequate preservice and in-service training;

(4) is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;

(5) is able to ensure that staff are capable of implementing culturally specific treatment
identified in the individual treatment plan that is meaningful and appropriate as determined
by the recipient's culture, beliefs, values, and language;

(6) is able to ensure enough flexibility to respond to the changing intervention and care
needs of a recipient as identified by the recipient during the service partnership between
the recipient and providers;

(7) is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin staffnew text end
have the communication tools and procedures to communicate and consult promptly about
crisis assessment and interventions as services occur;

(8) is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcement, and mental
health crisis services through regularly scheduled interagency meetings;

(9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;

(10) is able to ensure that services are coordinated with other mental health service
providers, county mental health authorities, or federally recognized American Indian
authorities and others as necessary, with the consent of the adult. Services must also be
coordinated with the recipient's case manager if the adult is receiving case management
services;

(11)new text begin is able to coordinate services with detoxification or withdrawal management services
to ensure a recipient receives care that is responsive to the recipient's chemical and mental
health needs;
new text end

new text begin (12)new text end is able to ensure that crisis intervention services are provided in a manner consistent
with sections 245.461 to 245.486;

deleted text begin (12)deleted text end new text begin (13)new text end is able to submit information as required by the state;

deleted text begin (13)deleted text end new text begin (14)new text end maintains staff training and personnel filesnew text begin , including documentation of staff
completion of required training modulesnew text end ;

deleted text begin (14)deleted text end new text begin (15)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfactionnew text begin , including notifying recipients
of the process by which the provider, county, or tribe accepts and responds to concernsnew text end ;

deleted text begin (15)deleted text end new text begin (16)new text end is able to keep records as required by applicable laws;

deleted text begin (16)deleted text end new text begin (17)new text end is able to comply with all applicable laws and statutes;

deleted text begin (17)deleted text end new text begin (18)new text end is an enrolled medical assistance provider; deleted text begin and
deleted text end

deleted text begin (18)deleted text end new text begin (19)new text end develops and maintains written policies and procedures regarding service
provision and administration of the provider entity, including safety of staff and recipients
in high-risk situationsdeleted text begin .deleted text end new text begin ;
new text end

new text begin (20) is able to respond to a call for crisis services in a designated service area or according
to a written agreement with the local mental health authority for an adjacent area; and
 new text end

new text begin (21) documents protocol used when delivering services by telemedicine, according to
sections 62A.67 to 62A.672, including responsibilities of the originating site, means to
promote recipient safety, timeliness for connection and response, and steps to take in the
event of a lost connection.
 new text end

Sec. 74.

Minnesota Statutes 2018, section 256B.0624, subdivision 5, is amended to read:


Subd. 5.

Mobile crisis intervention staff qualifications.

deleted text begin For provision of adult mental
health mobile crisis intervention services, a mobile crisis intervention team is comprised of
at least two mental health professionals as defined in section 245.462, subdivision 18, clauses
(1) to (6), or a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.462, subdivision 17, with the required mental health
crisis training and under the clinical supervision of a mental health professional on the team.
 deleted text end

new text begin (a) Mobile crisis intervention team staff must be qualified to provide services as mental
health professionals, mental health practitioners, clinical trainees, mental health certified
family peer specialists, or mental health certified peer specialists.
 new text end

new text begin (b) A mobile crisis intervention team is comprised of at least two members, one of whom
must be qualified as a mental health professional. A second member must be qualified as
a mental health professional, clinical trainee, or mental health practitioner. A provider entity
must consider the needs of the area served when adding staff.
 new text end

new text begin (c) Mental health crisis assessment and intervention services must be led by a mental
health professional, or under the supervision of a mental health professional according to
subdivision 9, by a clinical trainee or mental health practitioner.
 new text end

new text begin (d)new text end The team must have deleted text begin at least two people withdeleted text end at least one member providing on-site
crisis intervention services when needed. Team members must be experienced in mental
health assessment, crisis intervention techniques, treatment engagement strategies, working
with families, and clinical decision-making under emergency conditions and have knowledge
of local services and resources. The team must recommend and coordinate the team's services
with appropriate local resources such as the county social services agency, mental health
services, and local law enforcement when necessary.

Sec. 75.

Minnesota Statutes 2018, section 256B.0624, subdivision 6, is amended to read:


Subd. 6.

Crisis assessment and mobile intervention treatment planning.

(a) Prior to
initiating mobile crisis intervention services, a screening of the potential crisis situation
must be conducted. The screening may use the resources of crisis deleted text begin assistancedeleted text end new text begin planningnew text end and
emergency services as defined in sections 245.462, subdivision 6, and 245.469, subdivisions
1 and 2. The screening must gather information, determine whether a crisis situation exists,
identify parties involved, and determine an appropriate response.

new text begin (b) In conducting the screening, a provider shall:
 new text end

new text begin (1) employ evidence-based practices as identified by the commissioner in collaboration
with the commissioner of health to reduce the risk of the recipient's suicide and self-injurious
behavior;
 new text end

new text begin (2) work with the recipient to establish a plan and time frame for responding to the crisis,
including immediate needs for support by telephone or text message until a face-to-face
response arrives;
 new text end

new text begin (3) document significant factors related to the determination of a crisis, including prior
calls to the crisis team, recent presentation at an emergency department, known calls to 911
or law enforcement, or the presence of third parties with knowledge of a potential recipient's
history or current needs;
 new text end

new text begin (4) screen for the needs of a third-party caller, including a recipient who primarily
identifies as a family member or a caregiver but also presents signs of a crisis; and
 new text end

new text begin (5) provide psychoeducation, including education on the available means for reducing
self-harm, to relevant third parties, including family members or other persons living in the
home.
 new text end

new text begin (c) A provider entity shall consider the following to indicate a positive screening unless
the provider entity documents specific evidence to show why crisis response was clinically
inappropriate:
 new text end

new text begin (1) the recipient presented in an emergency department or urgent care setting, and the
health care team at that location requested crisis services; or
 new text end

new text begin (2) a peace officer requested crisis services for a recipient who may be subject to
transportation under section 253B.05 for a mental health crisis.
 new text end

deleted text begin (b)deleted text end new text begin (d)new text end If a crisis exists, a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which emergency services are needed and, as time
permits, the recipient's current life situation, sources of stress, mental health problems and
symptoms, strengths, cultural considerations, support network, vulnerabilities, current
functioning, and the recipient's preferences as communicated directly by the recipient, or
as communicated in a health care directive as described in chapters 145C and 253B, the
treatment plan described under paragraph (d), a crisis prevention plan, or a wellness recovery
action plan.

deleted text begin (c)deleted text end new text begin (e)new text end If the crisis assessment determines mobile crisis intervention services are needed,
the intervention services must be provided promptly. As opportunity presents during the
intervention, at least two members of the mobile crisis intervention team must confer directly
or by telephone about the assessment, treatment plan, and actions taken and needed. At least
one of the team members must be on site providing crisis intervention services. If providing
on-site crisis intervention services, a mental health practitioner must seek deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision as required in subdivision 9.

new text begin (f) Direct contact with the recipient is not required before initiating a crisis assessment
or intervention service. A crisis team may gather relevant information from a third party at
the scene to establish the need for services and potential safety factors. A crisis assessment
is provided face-to-face by a mobile crisis intervention team outside of an inpatient hospital
setting. A service must be provided promptly and respond to the recipient's location whenever
possible, including community or clinical settings. As clinically appropriate, a mobile crisis
intervention team must coordinate a response with other health care providers if a recipient
requires detoxification, withdrawal management, or medical stabilization services in addition
to crisis services.
 new text end

deleted text begin (d)deleted text end new text begin (g)new text end The mobile crisis intervention team must develop an initial, brief crisis treatment
plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention.
The plan must address the needs and problems noted in the crisis assessment and include
measurable short-term goals, cultural considerations, and frequency and type of services to
be provided to achieve the goals and reduce or eliminate the crisis. The treatment plan must
be updated as needed to reflect current goals and services.

deleted text begin (e)deleted text end new text begin (h)new text end The team must document which short-term goals have been met and when no
further crisis intervention services are required.new text begin If after an assessment a crisis provider entity
refers a recipient to an intensive setting, including an emergency department, in-patient
hospitalization, or crisis residential treatment, one of the crisis team members who performed
or conferred on the assessment must immediately contact the provider entity and consult
with the triage nurse or other staff responsible for intake. The crisis team member must
convey key findings or concerns that led to the referral. The consultation shall occur with
the recipient's consent, the recipient's legal guardian's consent, or as allowed by section
144.293, subdivision 5. Any available written documentation, including a crisis treatment
plan, must be sent no later than the next business day.
new text end

deleted text begin (f)deleted text end new text begin (i)new text end If the recipient's crisis is stabilized, but the recipient needs a referral to other
services, the team must provide referrals to these services. If the recipient has a case manager,
planning for other services must be coordinated with the case manager. If the recipient is
unable to follow up on the referral, the team must link the recipient to the service and follow
up to ensure the recipient is receiving the service.

deleted text begin (g)deleted text end new text begin (j)new text end If the recipient's crisis is stabilized and the recipient does not have an advance
directive, the case manager or crisis team shall offer to work with the recipient to develop
one.

Sec. 76.

Minnesota Statutes 2018, section 256B.0624, subdivision 8, is amended to read:


Subd. 8.

Adult crisis stabilization staff qualifications.

(a) Adult mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. Individual provider staff must deleted text begin have the following qualificationsdeleted text end new text begin benew text end :

(1) deleted text begin bedeleted text end a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;

(2) deleted text begin bedeleted text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professionaldeleted text end ;

(3) deleted text begin bedeleted text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or

(4) deleted text begin bedeleted text end a mental health rehabilitation worker deleted text begin who meets the criteria in section 256B.0623,
subdivision 5, paragraph (a), clause (4); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a mental
health professional; and works under the clinical supervision of a mental health professionaldeleted text end .

(b) Mental health practitionersnew text begin , clinical trainees,new text end and mental health rehabilitation workers
must have completed at least 30 hours of training in crisis intervention and stabilization
during the past two years.

Sec. 77.

Minnesota Statutes 2018, section 256B.0624, subdivision 9, is amended to read:


Subd. 9.

Supervision.

Mental health practitionersnew text begin or clinical traineesnew text end may provide crisis
assessment and mobile crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:

(1) the mental health provider entity must accept full responsibility for the services
provided;

(2) the mental health professional of the provider entity, who is an employee or under
contract with the provider entity, must be immediately available by phone or in person for
clinical supervision;

(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a mental health practitionernew text begin or clinical traineenew text end provides on-site service;

(4) the mental health professional must:

(i) review and approve of the tentative crisis assessment and crisis treatment plan;

(ii) document the consultation; and

(iii) sign the crisis assessment and treatment plan within the next business day;new text begin and
new text end

deleted text begin (5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
 deleted text end

deleted text begin (6)deleted text end new text begin (5)new text end the on-site observation must be documented in the recipient's record and signed
by the mental health professional.

Sec. 78.

Minnesota Statutes 2018, section 256B.0624, subdivision 10, is amended to read:


Subd. 10.

Recipient file.

Providers of mobile crisis intervention or crisis stabilization
services must maintain a file for each recipient containing the following information:

(1) individual crisis treatment plans signed by the recipient, mental health professional,
and mental health practitioner who developed the crisis treatment plan, or if the recipient
refused to sign the plan, the date and reason stated by the recipient as to why the recipient
would not sign the plan;

(2) signed release forms;

(3) recipient health information and current medications;

(4) emergency contacts for the recipient;

(5) case records which document the date of service, place of service delivery, signature
of the person providing the service, and the nature, extent, and units of service. Direct or
telephone contact with the recipient's family or others should be documented;

(6) required deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision by mental health professionals;

(7) summary of the recipient's case reviews by staff;

(8) any written information by the recipient that the recipient wants in the file; and

(9) an advance directive, if there is one available.

Documentation in the file must comply with all requirements of the commissioner.

Sec. 79.

Minnesota Statutes 2018, section 256B.0624, subdivision 11, is amended to read:


Subd. 11.

Treatment plan.

The individual crisis stabilization treatment plan must include,
at a minimum:

(1) a list of problems identified in the assessment;

(2) a list of the recipient's strengths and resources;

(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;

(4) specific objectives directed toward the achievement of each one of the goals;

(5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;

(6) planned frequency and type of services initiated;

(7) a crisis response action plan if a crisis should occur;

(8) clear progress notes on outcome of goals;

(9) a written plan must be completed within 24 hours of beginning services with the
recipient; and

(10) a treatment plan must be developed by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin under the clinical supervision of a mental health professionaldeleted text end .
The mental health professional must approve and sign all treatment plans.

Sec. 80.

Minnesota Statutes 2018, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week. Telemedicine services
shall be paid at the full allowable rate.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service 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 telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"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.

(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, new text begin a clinical trainee, new text end and a mental health
practitioner defined under section 245.462, subdivision 17deleted text begin , or 245.4871, subdivision 26deleted text end ,
working under the general supervision of a mental health professional; "health care provider"
is defined under section 62A.671, subdivision 3; and "originating site" is defined under
section 62A.671, subdivision 7.

Sec. 81.

Minnesota Statutes 2018, section 256B.0625, subdivision 5, is amended to read:


Subd. 5.

Community mental health center services.

Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).

(a) The provider is licensed under Minnesota Rules, parts 9520.0750 to 9520.0870new text begin , and
in compliance with requirements under chapter 245I and section 256B.0671new text end .

(b) The provider provides mental health services under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professional who is licensed for independent practice at the doctoral level
or by a board-certified psychiatrist or a psychiatrist who is eligible for board certification.
deleted text begin Clinical supervision has the meaning given in Minnesota Rules, part 9505.0370, subpart 6.deleted text end new text begin
Treatment supervision means the treatment supervision described under section 245I.18.
new text end

(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.

(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.

(e) At a minimum, the provider must provide the following outpatient mental health
services: diagnostic assessment; explanation of findings;new text begin andnew text end family, group, and individual
psychotherapy, including crisis intervention psychotherapy servicesdeleted text begin , multiple family group
psychotherapydeleted text end , psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.

(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are new text begin dually new text end diagnosed with deleted text begin bothdeleted text end new text begin anew text end mental illness or emotional disturbancedeleted text begin ,deleted text end
and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individuals new text begin who are new text end dually diagnosed
with a mental illness or emotional disturbance and developmental disability.

(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.

(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).

(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.

(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.

Sec. 82.

Minnesota Statutes 2018, section 256B.0625, subdivision 5l, is amended to read:


Subd. 5l.

Intensive mental health outpatient treatment.

new text begin (a) new text end Medical assistance covers
intensive mental health outpatient treatment for dialectical behavioral therapy for adults.
The commissioner shall establish:

(1) certification procedures to ensure that providers of these services are qualifiednew text begin and
meet the standards in chapter 245Inew text end ; and

(2) treatment protocols including required service components and criteria for admission,
continued treatment, and discharge.

new text begin (b) "Dialectical behavior therapy" means an evidence-based treatment approach provided
in an intensive outpatient treatment program using a combination of individualized
rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program
involves the following service components: individual dialectical behavior therapy, group
skills training, telephone coaching, and team consultation meetings.
 new text end

new text begin (c) To be eligible for dialectical behavior therapy a client must:
 new text end

new text begin (1) be 18 years of age or older;
 new text end

new text begin (2) have mental health needs that cannot be met with other available community-based
services or that must be provided concurrently with other community-based services;
 new text end

new text begin (3) meet one of the following criteria:
 new text end

new text begin (i) have a diagnosis of borderline personality disorder; or
 new text end

new text begin (ii) have multiple mental health diagnoses, exhibit behaviors characterized by impulsivity
or intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction across multiple life areas;
 new text end

new text begin (4) understand and be cognitively capable of participating in dialectical behavior therapy
as an intensive therapy program and be able and willing to follow program policies and
rules ensuring safety of self and others; and
 new text end

new text begin (5) be at significant risk of one or more of the following if dialectical behavior therapy
is not provided:
 new text end

new text begin (i) having a mental health crisis;
 new text end

new text begin (ii) requiring a more restrictive setting including hospitalization;
 new text end

new text begin (iii) decompensation; or
 new text end

new text begin (iv) engaging in intentional self-harm behavior.
 new text end

new text begin (d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and
reinforce the use of adaptive skillful behaviors. Individual dialectical behavior therapy must
be provided by a mental health professional or a clinical trainee. The mental health
professional or clinical trainee must:
 new text end

new text begin (1) identify, prioritize, and sequence behavioral targets;
 new text end

new text begin (2) treat behavioral targets;
 new text end

new text begin (3) generalize dialectical behavior therapy skills to the client's natural environment
through telephone coaching outside of the treatment session;
 new text end

new text begin (4) measure the client's progress toward dialectical behavior therapy targets;
 new text end

new text begin (5) help the client manage mental health crises and life-threatening behaviors; and
 new text end

new text begin (6) help the client learn and apply effective behaviors when working with other treatment
providers.
 new text end

new text begin (e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas:
 new text end

new text begin (1) mindfulness;
 new text end

new text begin (2) interpersonal effectiveness;
 new text end

new text begin (3) emotional regulation; and
 new text end

new text begin (4) distress tolerance.
 new text end

new text begin (f) Group skills training must be provided by two mental health professionals, or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner
as specified in section 245I.16, subdivision 4. Individual skills training must be provided
by a mental health professional, a clinical trainee, or a mental health practitioner as specified
in section 245I.16, subdivision 4.
 new text end

new text begin (g) A program must be certified by the commissioner as a dialectical behavior therapy
provider. To qualify for certification, a provider must:
 new text end

new text begin (1) hold current accreditation as a dialectical behavior therapy program from a nationally
recognized certification body approved by the commissioner;
 new text end

new text begin (2) submit to the commissioner's inspection;
 new text end

new text begin (3) provide evidence that the dialectical behavior therapy program's policies, procedures,
and practices continuously meet the requirements of this subdivision;
 new text end

new text begin (4) be enrolled as a MHCP provider;
 new text end

new text begin (5) collect and report client outcomes as specified by the commissioner; and
 new text end

new text begin (6) have a manual that outlines the dialectical behavior therapy program's policies,
procedures, and practices that meet the requirements of this subdivision.
 new text end

Sec. 83.

Minnesota Statutes 2018, section 256B.0625, subdivision 19c, is amended to
read:


Subd. 19c.

Personal care.

Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.

"Qualified professional" means a mental health professional as defined in section 245.462,
subdivision 18, deleted text begin clauses (1) to (6),deleted text end or 245.4871, subdivision 27deleted text begin , clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.

Sec. 84.

Minnesota Statutes 2018, section 256B.0625, subdivision 23, is amended to read:


Subd. 23.

new text begin Adult new text end day treatment services.

new text begin (a) new text end Medical assistance covers new text begin adult new text end day
treatment services as specified in sections 245.462, subdivision 8, and 245.4871, subdivision
10, that are provided under contract with the county board. The commissioner may set
authorization thresholds for day treatment for adults according to subdivision 25. Medical
assistance covers day treatment services for children as specified under section 256B.0943.new text begin
Adult day treatment payment is limited to the conditions in paragraphs (b) to (e).
new text end

new text begin (b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness to enable the client to benefit from a lower level of care and to
live and function more independently in the community. Adult day treatment services must
stabilize the client's mental health status and develop and improve the client's independent
living and socialization skills. Adult day treatment must consist of at least one hour of group
psychotherapy and must include group time focused on rehabilitative interventions or other
therapeutic services that are provided by a multidisciplinary staff person. Adult day treatment
services are not a part of inpatient or residential treatment services.
 new text end

new text begin (c) To be eligible for medical assistance payment, an adult day treatment service must:
 new text end

new text begin (1) be reviewed by and approved by the commissioner;
 new text end

new text begin (2) be provided to a group of clients by a multidisciplinary staff person under the
treatment supervision of a mental health professional as described under section 245I.18;
 new text end

new text begin (3) be available to the client at least two days a week for at least three consecutive hours
per day. The adult day treatment may be longer than three hours per day, but medical
assistance must not reimburse a provider for more than 15 hours per week;
 new text end

new text begin (4) include group psychotherapy by a mental health professional or clinical trainee and
daily rehabilitative interventions by a mental health professional qualified according to
section 245I.16, subdivision 2, clinical trainee qualified according to section 245I.16,
subdivision 6, or mental health practitioner qualified according to section 245I.16, subdivision
4;
 new text end

new text begin (5) be included in the client's individual treatment plan as described under section
256B.0671, subdivisions 5 and 6, as appropriate. The individual treatment plan must include
attainable, measurable goals related to services and must be completed before the first adult
day treatment session. The vendor must review the client's progress and update the treatment
plan at least every 30 days until the client is discharged and include an available discharge
plan for the client in the treatment plan; and
 new text end

new text begin (6) document the daily interventions provided and the client's response according to
section 245I.33.
 new text end

new text begin (d) To be eligible for adult day treatment, a client must:
 new text end

new text begin (1) be 18 years of age or older;
 new text end

new text begin (2) not be residing in a nursing facility, hospital, institute of mental disease, or regional
treatment center unless the client has an active discharge plan that indicates a move to an
independent living arrangement within 180 days;
 new text end

new text begin (3) have a diagnosis of mental illness as determined by a diagnostic assessment;
 new text end

new text begin (4) have the capacity to engage in the rehabilitative nature, the structured setting, and
the therapeutic parts of psychotherapy and skills activities of an adult day treatment program
and demonstrate measurable improvements in the client's functioning related to the client's
mental illness that would result from participating in the adult day treatment program;
 new text end

new text begin (5) have at least three areas of functional impairment as determined by a functional
assessment with the domains prescribed by section 245.462, subdivision 11a;
 new text end

new text begin (6) have a level of care determination that supports the need for the level of intensity
and duration of an adult day treatment program; and
 new text end

new text begin (7) be determined to need adult day treatment services by a mental health professional
who must deem the adult day treatment services medically necessary.
 new text end

new text begin (e) The following services are not covered by medical assistance as an adult day treatment
service:
 new text end

new text begin (1) a service that is primarily recreation-oriented or that is provided in a setting that is
not medically supervised. This includes sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
 new text end

new text begin (2) a social or educational service that does not have or cannot reasonably be expected
to have a therapeutic outcome related to the client's mental illness;
 new text end

new text begin (3) consultation with other providers or service agency staff persons about the care or
progress of a client;
 new text end

new text begin (4) prevention or education programs provided to the community;
 new text end

new text begin (5) day treatment for clients with primary diagnoses of alcohol or other drug abuse;
 new text end

new text begin (6) day treatment provided in the client's home;
 new text end

new text begin (7) psychotherapy for more than two hours per day; and
 new text end

new text begin (8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
 new text end

Sec. 85.

Minnesota Statutes 2018, section 256B.0625, subdivision 42, is amended to read:


Subd. 42.

Mental health professional.

Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall include a person
who is qualified as specified in section 245.462, subdivision 18deleted text begin , clauses (1) to (6)deleted text end ; or
245.4871, subdivision 27, deleted text begin clauses (1) to (6),deleted text end for the purpose of this section and Minnesota
Rules, parts 9505.0170 to 9505.0475.

Sec. 86.

Minnesota Statutes 2018, section 256B.0625, subdivision 48, is amended to read:


Subd. 48.

Psychiatric consultation to primary care practitioners.

Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5),deleted text end new text begin mental health professional
except one licensed under section 148B.5301new text end via telephone, e-mail, facsimile, or other
means of communication to primary care practitioners, including pediatricians. The need
for consultation and the receipt of the consultation must be documented in the patient record
maintained by the primary care practitioner. If the patient consents, and subject to federal
limitations and data privacy provisions, the consultation may be provided without the patient
present.

Sec. 87.

Minnesota Statutes 2018, section 256B.0625, subdivision 49, is amended to read:


Subd. 49.

Community health worker.

(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin : (1)deleted text end received a certificate from the Minnesota State Colleges
and Universities System approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end

deleted text begin (2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
 deleted text end

deleted text begin Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
 deleted text end

(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional as defined in section 245.462, subdivision 18, deleted text begin clauses (1) to (6),deleted text end and section
245.4871, subdivision 27, deleted text begin clauses (1) to (5),deleted text end or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.

(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.

Sec. 88.

Minnesota Statutes 2018, section 256B.0625, subdivision 56a, is amended to
read:


Subd. 56a.

Post-arrest community-based service coordination.

(a) Medical assistance
covers post-arrest community-based service coordination for an individual who:

(1) has been identified as having a mental illness or substance use disorder using a
screening tool approved by the commissioner;

(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;

(3) meets the eligibility requirements in section 256B.056; and

(4) has agreed to participate in post-arrest community-based service coordination through
a diversion contract in lieu of incarceration.

(b) Post-arrest community-based service coordination means navigating services to
address a client's mental health, chemical health, social, economic, and housing needs, or
any other activity targeted at reducing the incidence of jail utilization and connecting
individuals with existing covered services available to them, including, but not limited to,
targeted case management, waiver case management, or care coordination.

(c) Post-arrest community-based service coordination must be provided by an individual
who is an employee of a county or is under contract with a county to provide post-arrest
community-based coordination and is qualified under one of the following criteria:

(1) a licensed mental health professional as defined in section 245.462, subdivision 18deleted text begin ,
clauses (1) to (6)deleted text end ;

(2) a mental health practitioner as defined in section 245.462, subdivision 17, working
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional; deleted text begin or
deleted text end

(3) a certified peer specialist under section 256B.0615, working under the deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision of a mental health professionaldeleted text begin .deleted text end new text begin ; or
new text end

new text begin (4) a clinical trainee.
 new text end

(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.

(e) Providers of post-arrest community-based service coordination shall annually report
to the commissioner on the number of individuals served, and number of the
community-based services that were accessed by recipients. The commissioner shall ensure
that services and payments provided under post-arrest community-based service coordination
do not duplicate services or payments provided under section 256B.0625, subdivision 20,
256B.0753, 256B.0755, or 256B.0757.

(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
post-arrest community-based service coordination services shall be provided by the county
providing the services, from sources other than federal funds or funds used to match other
federal funds.

Sec. 89.

Minnesota Statutes 2018, section 256B.0625, subdivision 61, is amended to read:


Subd. 61.

Family psychoeducation services.

deleted text begin Effective July 1, 2013, or upon federal
approval, whichever is later,deleted text end Medical assistance covers family psychoeducation services
provided to a child up to age 21 with a diagnosed mental health condition when identified
in the child's individual treatment plan and provided by a licensed mental health professionaldeleted text begin ,
as defined in Minnesota Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as
defined in Minnesota Rules, part 9505.0371, subpart 5, item C,deleted text end who has determined it
medically necessary to involve family members in the child's care. For the purposes of this
subdivision, "family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family in understanding a child's
symptoms of mental illness, the impact on the child's development, and needed components
of treatment and skill development so that the individual, family, or group can help the child
to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental
health and long-term resilience.

Sec. 90.

Minnesota Statutes 2018, section 256B.0625, subdivision 62, is amended to read:


Subd. 62.

Mental health clinical care consultation.

deleted text begin Effective July 1, 2013, or upon
federal approval, whichever is later,deleted text end Medical assistance covers clinical care consultation
for a person up to age 21 who is diagnosed with a complex mental health condition or a
mental health condition that co-occurs with other complex and chronic conditions, when
described in the person's individual treatment plan and provided by a licensed mental health
professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical
traineedeleted text begin , as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end . For the purposes
of this subdivision, "clinical care consultation" means communication from a treating mental
health professional to other providers or educators not under the clinical supervision of the
treating mental health professional who are working with the same client to inform, inquire,
and instruct regarding the client's symptoms; strategies for effective engagement, care, and
intervention needs; and treatment expectations across service settings; and to direct and
coordinate clinical service components provided to the client and family.

Sec. 91.

Minnesota Statutes 2018, section 256B.0625, subdivision 65, is amended to read:


Subd. 65.

Outpatient mental health services.

new text begin For the purposes of this section, "clinical
trainee" has the meaning given in section 245I.16, subdivision 6. new text end Medical assistance covers
diagnostic assessment, explanation of findings, and psychotherapy according to deleted text begin Minnesota
Rules, part 9505.0372,deleted text end new text begin subdivision 69 and section 256B.0671new text end when the mental health
services are performed by deleted text begin a mental health practitioner working asdeleted text end a clinical trainee deleted text begin according
to section 245.462, subdivision 17, paragraph (g)deleted text end .

Sec. 92.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 66. new text end

new text begin Neuropsychological assessment. new text end

new text begin (a) "Neuropsychological assessment" means
a specialized clinical assessment of the client's underlying cognitive abilities related to
thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist. A
neuropsychological assessment must include a face-to-face interview with the client,
interpretation of the test results, and preparation and completion of a report.
 new text end

new text begin (b) A client is eligible for a neuropsychological assessment if at least one of the following
criteria is met:
 new text end

new text begin (1) there is a known or strongly suspected brain disorder based on medical history or
neurological evaluation, including a history of significant head trauma, brain tumor, stroke,
seizure disorder, multiple sclerosis, neurodegenerative disorder, significant exposure to
neurotoxins, central nervous system infection, metabolic or toxic encephalopathy, fetal
alcohol syndrome, or congenital malformation of the brain; or
 new text end

new text begin (2) there are cognitive or behavioral symptoms that suggest that the client has an organic
condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. This includes:
 new text end

new text begin (i) poor memory or impaired problem solving;
 new text end

new text begin (ii) change in mental status evidenced by lethargy, confusion, or disorientation;
 new text end

new text begin (iii) deterioration in level of functioning;
 new text end

new text begin (iv) marked behavioral or personality change;
 new text end

new text begin (v) in children or adolescents, significant delays in academic skill acquisition or poor
attention relative to peers;
 new text end

new text begin (vi) in children or adolescents, significant plateau in expected development of cognitive,
social, emotional, or physical function relative to peers; and
 new text end

new text begin (vii) in children or adolescents, significant inability to develop expected knowledge,
skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or
physical demands.
 new text end

new text begin (c) The neuropsychological assessment must be conducted by a neuropsychologist
competent in the area of neuropsychological assessment who:
 new text end

new text begin (1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
 new text end

new text begin (2) earned a doctoral degree in psychology from an accredited university training program
and:
 new text end

new text begin (i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
 new text end

new text begin (ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
 new text end

new text begin (iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
 new text end

new text begin (3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
 new text end

new text begin (4) was approved by the commissioner as an eligible provider of neuropsychological
assessment prior to December 31, 2010.
 new text end

Sec. 93.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 67. new text end

new text begin Neuropsychological testing. new text end

new text begin (a) "Neuropsychological testing" means
administering standardized tests and measures designed to evaluate the client's ability to
attend to, process, interpret, comprehend, communicate, learn, and recall information and
use problem solving and judgment.
 new text end

new text begin (b) Medical assistance covers neuropsychological testing when the client:
 new text end

new text begin (1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
 new text end

new text begin (2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
 new text end

new text begin (3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities as required to adapt to new or changing cognitive, social, physical, or
emotional demands; or
 new text end

new text begin (4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
 new text end

new text begin (i) traumatic brain injury;
 new text end

new text begin (ii) stroke;
 new text end

new text begin (iii) brain tumor;
 new text end

new text begin (iv) substance use disorder;
 new text end

new text begin (v) cerebral anoxic or hypoxic episode;
 new text end

new text begin (vi) central nervous system infection or other infectious disease;
 new text end

new text begin (vii) neoplasms or vascular injury of the central nervous system;
 new text end

new text begin (viii) neurodegenerative disorders;
 new text end

new text begin (ix) demyelinating disease;
 new text end

new text begin (x) extrapyramidal disease;
 new text end

new text begin (xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
 new text end

new text begin (xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosis,
or celiac disease;
 new text end

new text begin (xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
 new text end

new text begin (xiv) severe or prolonged nutrition or malabsorption syndromes; or
 new text end

new text begin (xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not resulted in improvement in neurocognitive function; or another disorder, including
autism, selective mutism, anxiety disorder, or reactive attachment disorder.
 new text end

new text begin (c) Neuropsychological testing must be administered or clinically supervised by a
neuropsychologist qualified as defined in subdivision 66, paragraph (c).
 new text end

new text begin (d) Neuropsychological testing is not covered when performed: (1) primarily for
educational purposes; (2) primarily for vocational counseling or training; (3) for personnel
or employment testing; (4) as a routine battery of psychological tests given at inpatient
admission or during a continued stay; or (5) for legal or forensic purposes.
 new text end

Sec. 94.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 68. new text end

new text begin Psychological testing. new text end

new text begin (a) "Psychological testing" means the use of tests or
other psychometric instruments to determine the status of the client's mental, intellectual,
and emotional functioning.
 new text end

new text begin (b) The psychological testing must:
 new text end

new text begin (1) be administered or clinically supervised by a licensed psychologist qualified according
to section 245I.16, subdivision 2, clause (3), competent in the area of psychological testing;
and
 new text end

new text begin (2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical psychology trainee qualified according to section 245I.16, subdivision 6, under
the treatment supervision of a licensed psychologist according to section 245I.18.
 new text end

new text begin (c) The administration, scoring, and interpretation of the psychological tests must be
done under the treatment supervision of a licensed psychologist when performed by a
technician, psychometrist, or psychological assistant or as part of a computer-assisted
psychological testing program. The report resulting from the psychological testing must be
signed by the psychologist conducting the face-to-face interview, placed in the client's
record, and released to each person authorized by the client.
 new text end

Sec. 95.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 69. new text end

new text begin Psychotherapy. new text end

new text begin (a) "Psychotherapy" means treatment of a client with mental
illness that applies to the most appropriate psychological, psychiatric, psychosocial, or
interpersonal method that conforms to prevailing community standards of professional
practice to meet the mental health needs of the client. Medical assistance covers
psychotherapy if conducted by a mental health professional qualified according to section
245I.16, subdivision 2, or a clinical trainee qualified according to section 245I.16, subdivision
6.
 new text end

new text begin (b) Individual psychotherapy is psychotherapy designed for one client.
 new text end

new text begin (c) Family psychotherapy is designed for the client and one or more family members or
the client's primary caregiver whose participation is necessary to accomplish the client's
treatment goals. Family members or primary caregivers participating in a therapy session
do not need to be eligible for medical assistance. For purposes of this paragraph, "primary
caregiver whose participation is necessary to accomplish the client's treatment goals" excludes
shift or facility staff persons at the client's residence. Medical assistance payment for family
psychotherapy is limited to face-to-face sessions at which the client is present throughout
the family psychotherapy session unless the mental health professional believes the client's
absence from the family psychotherapy session is necessary to carry out the client's individual
treatment plan. If the client is excluded, the mental health professional must document the
reason for and the length of time of the exclusion. The mental health professional must also
document any reason a member of the client's family is excluded.
 new text end

new text begin (d) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can derive mutual benefit from
treatment in a group setting. For a group of three to eight persons, one mental health
professional or clinical trainee is required to conduct the group. For a group of nine to 12
persons, a team of at least two mental health professionals or two clinical trainees or one
mental health professional and one clinical trainee is required to co-conduct the group.
Medical assistance payment is limited to a group of no more than 12 persons.
 new text end

new text begin (e) A multiple-family group psychotherapy session is eligible for medical assistance
payment if the psychotherapy session is designed for at least two but not more than five
families. Multiple-family group psychotherapy is clearly directed toward meeting the
identified treatment needs of each client as indicated in each client's treatment plan. If the
client is excluded, the mental health professional or clinical trainee must document the
reason for and the length of time of the exclusion. The mental health professional or clinical
trainee must document any reason a member of the client's family is excluded.
 new text end

Sec. 96.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 70. new text end

new text begin Partial hospitalization. new text end

new text begin "Partial hospitalization" means a provider's
time-limited, structured program of psychotherapy and other therapeutic services, as defined
in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x(ff), that
is provided in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services. Partial hospitalization is
a covered service when it is an appropriate alternative to inpatient hospitalization for a client
who is experiencing an acute episode of mental illness that meets the criteria for an inpatient
hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who has the
family and community resources necessary and appropriate to support the client's residence
in the community. Partial hospitalization consists of multiple intensive short-term therapeutic
services provided by a multidisciplinary staff person to treat the client's mental illness.
 new text end

Sec. 97.

new text begin [256B.0671] CLIENT ELIGIBILITY FOR MENTAL HEALTH SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) The provider must use a diagnostic assessment or crisis
assessment to determine a client's eligibility for mental health services, except as provided
in this section.
 new text end

new text begin (b) Prior to completion of a client's initial diagnostic assessment, a client is eligible for:
 new text end

new text begin (1) one explanation of findings;
 new text end

new text begin (2) one psychological testing;
 new text end

new text begin (3) any combination of individual psychotherapy sessions, family psychotherapy sessions,
group psychotherapy sessions, and individual or family psychoeducation sessions not to
exceed three sessions; and
 new text end

new text begin (4) crisis assessment and intervention services provided according to section 256B.0624
or 256B.0944.
 new text end

new text begin (c) Based on the needs identified in a crisis assessment as specified in section 256B.0624
or 256B.0944, a client may receive: (1) crisis stabilization services; and (2) any combination
of individual psychotherapy sessions, family psychotherapy sessions, or family
psychoeducation sessions not to exceed ten sessions within a 12-month period without prior
authorization.
 new text end

new text begin (d) Based on the needs identified in a brief diagnostic assessment, a client may receive
a combination of individual psychotherapy sessions, family psychotherapy sessions, or
family psychoeducation sessions not to exceed ten sessions within a 12-month period without
prior authorization for any new client or for an existing client who is projected to need fewer
than ten sessions in the next 12 months.
 new text end

new text begin (e) If the amount of services or intensity required by the client exceeds the coverage
limits in this section, a provider shall complete a standard diagnostic assessment.
 new text end

new text begin (f) A new standard diagnostic assessment must be completed:
 new text end

new text begin (1) when the client requires services of a greater number or intensity than those permitted
by paragraphs (b) to (d);
 new text end

new text begin (2) at least annually following the initial diagnostic assessment if additional services are
needed and the client does not meet the criteria for brief assessment.
 new text end

new text begin (3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
 new text end

new text begin (4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
 new text end

new text begin (g) For an existing client, a new standard diagnostic assessment shall include a written
update of the parts where significant new or changed information exists, and documentation
where there has not been significant change, including discussion with the client about
changes in the client's life situation, functioning, presenting problems, and progress on
treatment goals since the last diagnostic assessment was completed.
 new text end

new text begin Subd. 1a. new text end

new text begin Continuity of services. new text end

new text begin (a) For any client served with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date,
the diagnostic assessment must be valid for one calendar year after completion.
 new text end

new text begin (b) For any client served with an individual treatment plan completed under section
256B.0622, 256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts
9505.0370 to 9505.0372, the individual treatment plan must be valid until its expiration
date.
 new text end

new text begin (c) This subdivision expires July 1, 2021.
 new text end

new text begin Subd. 2. new text end

new text begin Diagnostic assessment. new text end

new text begin To be eligible for medical assistance payment, a
diagnostic assessment must (1) identify at least one mental health diagnosis and recommend
mental health services to develop the client's mental health services and treatment plan, or
(2) include a finding that the client does not meet the criteria for a mental health disorder.
 new text end

new text begin Subd. 3. new text end

new text begin Standard diagnostic assessment requirements. new text end

new text begin (a) A standard diagnostic
assessment must include a face-to-face interview with the client and contain a written
evaluation of a client by a mental health professional or clinical trainee. The standard
diagnostic assessment must be completed within the cultural context of the client.
 new text end

new text begin (b) The clinician shall gather and document information related to the client's current
life situation and the client's:
 new text end

new text begin (1) age;
 new text end

new text begin (2) current living situation, including household membership and housing status;
 new text end

new text begin (3) basic needs status;
 new text end

new text begin (4) education level and employment status;
 new text end

new text begin (5) significant personal relationships, including the client's evaluation of relationship
quality;
 new text end

new text begin (6) strengths and resources, including the extent and quality of social networks;
 new text end

new text begin (7) belief systems;
 new text end

new text begin (8) current medications; and
 new text end

new text begin (9) immediate risks to health and safety.
 new text end

new text begin (c) The clinician shall gather and document information related to the elements of the
assessment, including the client's:
 new text end

new text begin (1) perceptions of the client's condition;
 new text end

new text begin (2) description of symptoms, including reason for referral;
 new text end

new text begin (3) history of mental health treatment; and
 new text end

new text begin (4) cultural influences and the impact on the client.
 new text end

new text begin (d) A clinician completing a diagnostic assessment shall use professional judgment in
making inquiries under this paragraph. If information cannot be obtained without
retraumatizing the client or harming the client's willingness to engage in treatment, the
clinician shall document which topics require further attention in the course of treatment.
A clinician must, as clinically appropriate, include the following information related to a
client in a diagnostic assessment:
 new text end

new text begin (1) important developmental incidents;
 new text end

new text begin (2) maltreatment, trauma, potential brain injuries, or abuse issues;
 new text end

new text begin (3) history of alcohol and drug usage and treatment; and
 new text end

new text begin (4) health history and family health history, including physical, chemical, and mental
health history.
 new text end

new text begin (e) The clinician must perform and document the following components of the
assessment:
 new text end

new text begin (1) the client's mental status examination;
 new text end

new text begin (2) information gathered concerning the client's baseline measurements; symptoms;
behavior; skills; abilities; resources; vulnerabilities; safety needs, including client data
adequate to support findings based on the current edition of the Diagnostic and Statistical
Manual of Mental Disorders, published by the American Psychiatric Association; and any
differential diagnosis;
 new text end

new text begin (3) for a child younger than 6 years of age, a clinician may use the current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood instead of the Diagnostic and Statistical Manual of Mental Disorders;
 new text end

new text begin (4) the screenings used to determine the client's substance use, abuse, or dependency
and other standardized screening instruments determined by the commissioner;
 new text end

new text begin (5) use of standardized outcome measurements by the provider as determined and
periodically updated by the commissioner; and
 new text end

new text begin (6) a case conceptualization that explains: (i) the diagnostic formulation made based on
the information gathered through the interview, assessment, available psychological testing,
and collateral information; (ii) the needs of the client; (iii) risk factors; (iv) strengths; and
(v) responsivity factors.
 new text end

new text begin (f) The diagnostic assessment must include recommendations, client and family
participation in assessment and service preferences, and referrals to services required by
law.
 new text end

new text begin Subd. 4. new text end

new text begin Brief diagnostic assessment requirements. new text end

new text begin (a) A brief diagnostic assessment
must include a face-to-face interview with the client and a written evaluation of the client
by a mental health professional or a clinical trainee. The mental health professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
 new text end

new text begin (1) age;
 new text end

new text begin (2) description of symptoms, including reason for referral;
 new text end

new text begin (3) history of mental health treatment;
 new text end

new text begin (4) cultural influences and their impact on the client; and
 new text end

new text begin (5) mental status examination.
 new text end

new text begin (b) On the basis of the initial components, the mental health professional or clinical
trainee must draw a provisional diagnostic formulation. The diagnostic formulation may be
used to address the client's immediate needs or presenting problem.
 new text end

new text begin (c) Treatment sessions conducted under authorization of a brief diagnostic assessment
may be used to gather additional information necessary to complete a standard diagnostic
assessment if coverage limits in subdivision 1 will be exceeded.
 new text end

new text begin Subd. 5. new text end

new text begin Individual treatment plan. new text end

new text begin Medical assistance payment is available only for
mental health services provided in accordance with the client's written individual treatment
plan, with the following exceptions: (1) services that do not require a standard diagnostic
assessment prior to service delivery; (2) service plan development; and (3) re-engagement
of a client as described in subdivision 6, clause (6).
 new text end

new text begin Subd. 6. new text end

new text begin Individual treatment plan; required elements. new text end

new text begin An individual treatment plan
must:
 new text end

new text begin (1) be based on the information in the client's diagnostic assessment and baselines;
 new text end

new text begin (2) identify goals and objectives of treatment, the treatment strategy, the schedule for
accomplishing treatment goals and measurable objectives, and the individuals responsible
for providing treatment services and supports;
 new text end

new text begin (3) be developed after completion of the client's diagnostic assessment, within three
visits unless otherwise specified by a service line;
 new text end

new text begin (4) for a child client, 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, assessment, and treatment planning.
For an adult client, the individual treatment plan must be developed through a
person-centered, culturally appropriate planning process, including allowing identified
supports to observe or participate in treatment services, assessment, and treatment planning;
 new text end

new text begin (5) be reviewed at least every 90 days unless otherwise specified by the requirements
of a service line and revised to document treatment progress on each treatment objective
and next goals or, if progress is not documented, to document changes in treatment; and
 new text end

new text begin (6) be approved by the client, the client's parent, or other person authorized by law to
consent to mental health services for the client. If approval cannot be obtained, a mental
health professional shall make efforts to obtain approval from an authorized person for a
period of 30 days following the date the previous individual treatment plan expired. A client
shall not be denied service in this time period solely on the basis of an unapproved individual
treatment plan. A provider entity may continue to bill for otherwise eligible services during
a period of re-engagement.
 new text end

Sec. 98.

Minnesota Statutes 2018, section 256B.0941, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:

(1) before admission, services are determined to be medically necessary by the state's
medical review agent according to Code of Federal Regulations, title 42, section 441.152;

(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;

(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;

(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;

(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;

(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and

(7) was referred for treatment in a psychiatric residential treatment facility by a qualified
mental health professional licensed as defined in section 245.4871, subdivision 27deleted text begin , clauses
(1) to (6)deleted text end .

(b) A mental health professional making a referral shall submit documentation to the
state's medical review agent containing all information necessary to determine medical
necessity, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.

Sec. 99.

Minnesota Statutes 2018, 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 disturbancedeleted text begin , as defined in section 245.4871,
subdivision 15,deleted text end or deleted text begin a diagnoseddeleted text end mental illnessdeleted text begin , as defined in section 245.462, subdivision
20deleted text end . 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.

deleted text begin (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.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin means a staff person
qualified according to section 245I.16, subdivision 6new text end .

deleted text begin (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.
 deleted text end

new text begin (c) "Crisis planning" means the development of a written plan to assist a child's family
with a potential crisis and is distinct from the immediate provision of crisis intervention
services. The plan addresses prevention and intervention strategies to be used in a crisis.
The plan identifies factors that might precipitate a mental health crisis, behaviors related to
the emergence of a crisis, and resources available to resolve a crisis. The plan also must
address the following potentialities: (1) arranging for admission to acute care hospital
inpatient treatment; (2) crisis placement; (3) community resources for follow-up; and (4)
emotional support to the family during crisis.
 new text end

deleted text begin (e)deleted text end new text begin (d)new text end "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.

deleted text begin (f)deleted text end new text begin (e)new text end "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 deleted text begin multidisciplinarydeleted text end new text begin treatmentnew text end team, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision of a mental health professional.

deleted text begin (g)deleted text end new text begin (f)new text end "Diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described under section 256B.0671, subdivisions
2 and 3new text end .

deleted text begin (h)deleted text end new text begin (g)new text end "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 telemedicine services. 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.

deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end 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).

deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.

deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professionalnew text begin , clinical trainee,new text end or mental health
practitioner, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.

deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described under section 256B.0671, subdivisions 5
and 6new text end .

deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary deleted text begin one-on-onedeleted text end
activities performed by a trained paraprofessional deleted text begin qualified as provided in subdivision 7,
paragraph (b), clause (3),deleted text end to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professionalnew text begin , clinical trainee,new text end 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).

new text begin (m) "Mental health certified family peer specialist" means a staff person qualified
according to section 245I.16, subdivision 12.
 new text end

(n) "Mental health practitioner" deleted text begin has the meaning given indeleted text end new text begin means a staff person qualified
according tonew text end section deleted text begin 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 experiencedeleted text end new text begin 245I.16,
subdivision 4new text end .

(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person qualified according to section 245I.16, subdivision
2new text end .

(p) "Mental health service plan development" includes:

(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7deleted text end new text begin according to section 256B.0671,
subdivisions 5 and 6new text end , 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
deleted text begin in accordance with Minnesota Rules, part 9505.0372, subpart 6,deleted text end including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. deleted text begin 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.deleted text end
Psychotherapy new text begin for crisis new text end is appropriate deleted text begin for crisis responsedeleted text end 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 deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end 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
new text begin coordinated new text end 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. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end

(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).

new text begin (u) "Treatment supervision" means the supervision described under section 245I.18.
 new text end

Sec. 100.

Minnesota Statutes 2018, section 256B.0943, subdivision 2, is amended to read:


Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) deleted text begin Subject to federal approval,deleted text end Medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible provider
entity certified under subdivision 4 provides to a client eligible under subdivision 3.

(b) The service components of children's therapeutic services and supports are:

(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;

(2) individual, family, or group skills training provided by a mental health professional
or mental health practitioner;

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;

(4) mental health behavioral aide services;

(5) direction of a mental health behavioral aide;

(6) mental health service plan development; and

(7) children's day treatment.

Sec. 101.

Minnesota Statutes 2018, section 256B.0943, subdivision 3, is amended to read:


Subd. 3.

Determination of client eligibility.

A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a diagnostic
assessment by a mental health professional or deleted text begin a mental health practitioner who meets the
requirements ofdeleted text end a clinical trainee deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart
5, item C,deleted text end that is performed within one year before the initial start of service. The diagnostic
assessment must meet the requirements for a standard deleted text begin or extendeddeleted text end diagnostic assessment
deleted text begin as defined in Minnesota Rules, part 9505.0372, subpart 1, items B and Cdeleted text end , and:

(1) deleted text begin include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or,deleted text end for
children under age deleted text begin five, asdeleted text end new text begin six, follow the requirementsnew text end specified in the current edition of
the Diagnostic Classification of Mental Health Disorders of Infancy and Early Childhood;

(2) determine whether a child under age 18 has a diagnosis of emotional disturbance or,
if the person is between the ages of 18 and 21, whether the person has a mental illness;

(3) document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals;new text begin and
new text end

(4) be used in the development of the individualized treatment plandeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (5) be completed annually until age 18. For individuals between age 18 and 21, unless
a client's mental health condition has changed markedly since the client's most recent
diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
 deleted text end

Sec. 102.

Minnesota Statutes 2018, section 256B.0943, subdivision 4, is amended to read:


Subd. 4.

Provider entity certification.

(a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity and shall require corrective
action, medical assistance repayment, or decertification of a provider entity that no longer
meets the requirements in this section or that fails to meet the clinical quality standards or
administrative standards provided by the commissioner in the application and certification
process.

(b) For purposes of this section, a provider entity must new text begin meet all requirements in chapter
245I and new text end be:

(1) an Indian health services facility or a facility owned and operated by a tribe or tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;

(2) a county-operated entity certified by the state; or

(3) a noncounty entity certified by the state.

Sec. 103.

Minnesota Statutes 2018, section 256B.0943, subdivision 5, is amended to read:


Subd. 5.

Provider entity administrative infrastructure requirements.

(a) To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement. An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.

(b) The administrative infrastructure written policies and procedures new text begin must be in
accordance with sections 245I.10 and 245I.13 and new text end must include:

(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each deleted text begin mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteriadeleted text end new text begin staff person meets the applicable qualifications
under section 245I.16new text end , training criteria under deleted text begin subdivision 8deleted text end new text begin section 245I.10new text end , and deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision deleted text begin or direction of a mental health behavioral aidedeleted text end requirements under
deleted text begin subdivision 6deleted text end new text begin section 245I.18new text end ;

(2) fiscal procedures, including internal fiscal control practices and a process for collecting
revenue that is compliant with federal and state laws;

(3) a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017,deleted text end To be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and

(4) a process to establish and maintain individual client recordsnew text begin in accordance with
section 245I.32new text end . deleted text begin The client's records must include:
deleted text end

deleted text begin (i) the client's personal information;
 deleted text end

deleted text begin (ii) forms applicable to data privacy;
 deleted text end

deleted text begin (iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
 deleted text end

deleted text begin (iv) documentation of service delivery as specified under subdivision 6;
 deleted text end

deleted text begin (v) telephone contacts;
 deleted text end

deleted text begin (vi) discharge plan; and
 deleted text end

deleted text begin (vii) if applicable, insurance information.
 deleted text end

(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.

Sec. 104.

Minnesota Statutes 2018, section 256B.0943, subdivision 6, is amended to read:


Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, individualized treatment plans, service delivery, and individual
treatment plan review that are culturally competent, child-centered, and family-driven to
achieve maximum benefit for the client. The provider entity must review, and update as
necessary, the clinical policies and procedures every three years, must distribute the policies
and procedures to staff initially and upon each subsequent update, and must train staff
accordingly.

(b) The clinical infrastructure written policies and procedures must include policies and
procedures for:

(1) providing or obtaining a client's diagnostic assessment, including a diagnostic
assessment performed by an outside or independent clinician, that identifies acute and
chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.
When required components of the diagnostic assessment, such as baseline measures, are
not provided in an outside or independent assessment or when baseline measures cannot be
attained in a deleted text begin one-sessiondeleted text end standard diagnostic assessment, the provider entity must determine
the missing information within 30 days and amend the child's diagnostic assessment or
incorporate the baselines into the child's individual treatment plan;

(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin according to section 256B.0671,
subdivisions 5 and 6;
new text end

deleted text begin (i) is based on the information in the client's diagnostic assessment and baselines;
 deleted text end

deleted text begin (ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
 deleted text end

deleted text begin (iii) is 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;
 deleted text end

deleted text begin (iv) is 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, assessment, and treatment planning;
 deleted text end

deleted text begin (v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
 deleted text end

deleted text begin (vi) is 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;
 deleted text end

(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:

(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;

(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;

(4) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans deleted text begin for mental health practitioners and
mental health behavioral aidesdeleted text end new text begin according to section 245I.18new text end . deleted text begin A mental health professional
must document the clinical supervision the professional provides by cosigning individual
treatment plans and making entries in the client's record on supervisory activities. The
clinical supervisor also shall document supervisee-specific supervision in the supervisee's
personnel file. Clinicaldeleted text end new text begin Treatmentnew text end supervision does not include the authority to make or
terminate court-ordered placements of the childdeleted text begin . A clinical supervisor must be available for
urgent consultation as required by the individual client's needs or the situation. Clinical
supervision may occur individually or in a small group to discuss treatment and review
progress toward goals. The focus of clinical supervision must be the client's treatment needs
and progress and the mental health practitioner's or behavioral aide's ability to provide
servicesdeleted text end ;

(4a) meeting day treatment program conditions in items (i) to (iii):

(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;

(ii) new text begin the treatment supervisor must review and approve new text end the new text begin client's new text end diagnosis and the
client's individual treatment plan or a change in the diagnosis or individual treatment plan
deleted text begin must be made by or reviewed, approved, and signed by the clinical supervisordeleted text end ; and

(iii) every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;

(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:

deleted text begin (i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
 deleted text end

deleted text begin (ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
 deleted text end

deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the mental health practitioner or
mental health behavioral aide is providing CTSS services; and

deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;

(5) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the individualized treatment plan, and instruct the mental health behavioral
aide on how to implement therapeutic activities and interventions that will lead to goal
attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end giving direction must also instruct the
mental health behavioral aide about the client's diagnosis, functional status, and other
characteristics that are likely to affect service delivery. Direction must also include
determining that the mental health behavioral aide has the skills to interact with the client
and the client's family in ways that convey personal and cultural respect and that the aide
actively solicits information relevant to treatment from the family. The aide must be able
to clearly explain or demonstrate the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision and
requires the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the individualized treatment
plan and the individualized behavior plan. When providing direction, the deleted text begin professional or
practitionerdeleted text end new text begin staffnew text end must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and

(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;

(6) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and

(7) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. deleted text begin Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's parent
or other person authorized by statute to give consent to the mental health services for the
child.
deleted text end

Sec. 105.

Minnesota Statutes 2018, section 256B.0943, subdivision 7, is amended to read:


Subd. 7.

Qualifications of individual and team providers.

(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.

(b) An individual provider must be qualified as:

(1) a mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end

(2) a mental health practitioner or clinical traineedeleted text begin . The mental health practitioner or
clinical trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end

(3) a mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.deleted text end new text begin ; or
new text end

new text begin (4) a mental health certified family peer specialist.
 new text end

deleted text begin (A) A level I mental health behavioral aide must:
 deleted text end

deleted text begin (i) be at least 18 years old;
 deleted text end

deleted text begin (ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
 deleted text end

deleted text begin (iii) meet preservice and continuing education requirements under subdivision 8.
 deleted text end

deleted text begin (B) A level II mental health behavioral aide must:
 deleted text end

deleted text begin (i) be at least 18 years old;
 deleted text end

deleted text begin (ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
 deleted text end

deleted text begin (iii) meet preservice and continuing education requirements in subdivision 8.
 deleted text end

deleted text begin (c) A day treatment multidisciplinary team must include at least one mental health
professional or clinical trainee and one mental health practitioner.
 deleted text end

Sec. 106.

Minnesota Statutes 2018, section 256B.0943, subdivision 8, is amended to read:


Subd. 8.

Required preservice and continuing education.

deleted text begin (a)deleted text end A provider entity shall
establish a plan to provide preservice and continuing education for staffnew text begin according to section
245I.10new text end . deleted text begin The plan must clearly describe the type of training necessary to maintain current
skills and obtain new skills and that relates to the provider entity's goals and objectives for
services offered.
deleted text end

deleted text begin (b) A provider that employs a mental health behavioral aide under this section must
require the mental health behavioral aide to complete 30 hours of preservice training. The
preservice training must include parent team training. The preservice training must include
15 hours of in-person training of a mental health behavioral aide in mental health services
delivery and eight hours of parent team training. Curricula for parent team training must be
approved in advance by the commissioner. Components of parent team training include:
 deleted text end

deleted text begin (1) partnering with parents;
 deleted text end

deleted text begin (2) fundamentals of family support;
 deleted text end

deleted text begin (3) fundamentals of policy and decision making;
 deleted text end

deleted text begin (4) defining equal partnership;
 deleted text end

deleted text begin (5) complexities of the parent and service provider partnership in multiple service delivery
systems due to system strengths and weaknesses;
 deleted text end

deleted text begin (6) sibling impacts;
 deleted text end

deleted text begin (7) support networks; and
 deleted text end

deleted text begin (8) community resources.
 deleted text end

deleted text begin (c) A provider entity that employs a mental health practitioner and a mental health
behavioral aide to provide children's therapeutic services and supports under this section
must require the mental health practitioner and mental health behavioral aide to complete
20 hours of continuing education every two calendar years. The continuing education must
be related to serving the needs of a child with emotional disturbance in the child's home
environment and the child's family.
 deleted text end

deleted text begin (d) The provider entity must document the mental health practitioner's or mental health
behavioral aide's annual completion of the required continuing education. The documentation
must include the date, subject, and number of hours of the continuing education, and
attendance records, as verified by the staff member's signature, job title, and the instructor's
name. The provider entity must keep documentation for each employee, including records
of attendance at professional workshops and conferences, at a central location and in the
employee's personnel file.
 deleted text end

Sec. 107.

Minnesota Statutes 2018, section 256B.0943, subdivision 9, is amended to read:


Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a certified
provider entity must ensure that:

(1) deleted text begin each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs.deleted text end the provider's
caseload size deleted text begin shoulddeleted text end reasonably deleted text begin enabledeleted text end new text begin enablesnew text end the provider to play an active role in service
planning, monitoring, and delivering services to meet the client's and client's family's needs,
as specified in each client's individual treatment plan;

(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and

(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day
treatment program must stabilize the client's mental health status while developing and
improving the client's independent living and socialization skills. The goal of the day
treatment program must be to reduce or relieve the effects of mental illness and provide
training to enable the client to live in the community. The program must be available
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.

(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:

(1) patient and/or family, family, and group psychotherapy must be delivered as specified
in deleted text begin Minnesota Rules, part 9505.0372, subpart 6deleted text end new text begin section 256B.0625, subdivision 69new text end .
Psychotherapy to address the child's underlying mental health disorder must be documented
as part of the child's ongoing treatment. A provider must deliver, or arrange for, medically
necessary psychotherapy, unless the child's parent or caregiver chooses not to receive it.
When a provider delivering other services to a child under this section deems it not medically
necessary to provide psychotherapy to the child for a period of 90 days or longer, the provider
entity must document the medical reasons why psychotherapy is not necessary. When a
provider determines that a child needs psychotherapy but psychotherapy cannot be delivered
due to a shortage of licensed mental health professionals in the child's community, the
provider must document the lack of access in the child's medical record;

(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:

(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;

(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;

(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;

(iv) skills training delivered to the child's family must teach skills needed by parents new text begin or
primary caregivers new text end to enhance the child's skill development, to help the child utilize daily
life skills taught by a mental health professional, clinical trainee, or mental health practitioner,
and to develop or maintain a home environment that supports the child's progressive use of
skills;

(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:

(A) one mental health professional or one clinical trainee or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or

(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;

(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and

(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;

(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3), anddeleted text end which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:

(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;

(ii) performing as a practice partner or role-play partner;

(iii) reinforcing the child's accomplishments;

(iv) generalizing skill-building activities in the child's multiple natural settings;

(v) assigning further practice activities; and

(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.

To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;

(5) direction of a mental health behavioral aide must include deleted text begin the following:
deleted text end

deleted text begin (i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
 deleted text end

deleted text begin (ii)deleted text end immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;new text begin and
new text end

(6) mental health service plan development must be performed in consultation with the
child's family and, when appropriate, with other key participants in the child's life by the
child's treating mental health professional or clinical trainee or by a mental health practitioner
and approved by the treating mental health professional. Treatment plan drafting consists
of development, review, and revision by face-to-face or electronic communication. The
provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7, medical assistance
covers service plan development before completion of the child's individual treatment plan.deleted text end
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
 deleted text end

Sec. 108.

Minnesota Statutes 2018, section 256B.0943, subdivision 11, is amended to
read:


Subd. 11.

Documentation and billing.

(a) A provider entity must document the services
it provides under this sectionnew text begin according to section 245I.33new text end . deleted text begin The provider entity must ensure
that documentation complies with Minnesota Rules, parts 9505.2175 and 9505.2197. Services
billed under this section that are not documented according to this subdivision shall be
subject to monetary recovery by the commissioner. Billing for covered service components
under subdivision 2, paragraph (b), must not include anything other than direct service time.
deleted text end

deleted text begin (b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
 deleted text end

deleted text begin (1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
 deleted text end

deleted text begin (2) the name, dated signature, and credentials of the person who delivered the service;
 deleted text end

deleted text begin (3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
 deleted text end

deleted text begin (4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
 deleted text end

deleted text begin (5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
 deleted text end

deleted text begin (6) the date when services are discontinued and reasons for discontinuation of services.
 deleted text end

Sec. 109.

Minnesota Statutes 2018, section 256B.0944, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation
that, but for the provision of crisis response services to the child, would likely result in
significantly reduced levels of functioning in primary activities of daily living, an emergency
situation, or the child's placement in a more restrictive setting, including, but not limited
to, inpatient hospitalization.

(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric
situation that causes an immediate need for mental health services and is consistent with
section 62Q.55. A physician, mental health professional, or deleted text begin crisis mental health practitionerdeleted text end new text begin
qualified member of a crisis teamnew text end determines a mental health crisis or emergency for medical
assistance reimbursement with input from the client and the client's family, if possible.

(c) "Mental health crisis assessment" means an immediate face-to-face assessment by
a physician, mental health professional, or deleted text begin mental health practitioner under the clinical
deleted text end deleted text begin supervision of a mental health professionaldeleted text end new text begin qualified member of a crisis teamnew text end , following a
screening that suggests the child may be experiencing a mental health crisis or mental health
emergency situation.

(d) "Mental health mobile crisis intervention services" means face-to-face, short-term
intensive mental health services initiated during a mental health crisis or mental health
emergency. Mental health mobile crisis services must help the recipient cope with immediate
stressors, identify and utilize available resources and strengths, and begin to return to the
recipient's baseline level of functioning. Mental health mobile services deleted text begin must be provided
on site by a mobile crisis intervention team outside of an emergency room, urgent care, or
an inpatient hospital setting.deleted text end new text begin , including screening and treatment plan recommendations,
must be culturally and linguistically appropriate.
new text end

(e) "Mental health crisis stabilization services" means individualized mental health
services provided to a recipient following crisis intervention services that are designed to
restore the recipient to the recipient's prior functional level. The individual treatment plan
recommending mental health crisis stabilization must be completed by the intervention team
or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services
may be provided in the recipient's home, the home of a family member or friend of the
recipient, schools, another community setting, or a short-term supervised, licensed residential
program if the service is not included in the facility's cost pool or per diem. Mental health
crisis stabilization is not reimbursable when provided as part of a partial hospitalization or
day treatment program.

new text begin (f) "Clinical trainee" means a person qualified according to section 245I.16, subdivision
6.
 new text end

new text begin (g) "Mental health certified family peer specialist" means a person qualified according
to section 245I.16, subdivision 12.
 new text end

new text begin (h) "Mental health practitioner" means a person qualified according to section 245I.16,
subdivision 4.
 new text end

new text begin (i) "Mental health professional" means a person qualified according to section 245I.16,
subdivision 2.
 new text end

Sec. 110.

Minnesota Statutes 2018, section 256B.0944, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

An eligible recipient is an individual who:

(1) is eligible for medical assistance;

(2) is under age 18 or between the ages of 18 and 21;

(3) is screened as possibly experiencing a mental health crisis or mental health emergency
where a mental health crisis assessment is needed;new text begin and
new text end

(4) is assessed as experiencing a mental health crisis or mental health emergency, and
mental health mobile crisis intervention or mental health crisis stabilization services are
determined to be medically necessarydeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (5) meets the criteria for emotional disturbance or mental illness.
 deleted text end

Sec. 111.

Minnesota Statutes 2018, section 256B.0944, subdivision 4, is amended to read:


Subd. 4.

Provider entity standards.

(a) A crisis intervention and crisis stabilization
provider entity must meet the administrative and clinical standards specified in section
256B.0943, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:

(1) an Indian health service facility or facility owned and operated by a tribe or a tribal
organization operating under deleted text begin Public Law 93-638 as a 638 facilitydeleted text end new text begin United States Code, title
25, section 450fnew text end ;

(2) a county board-operated entity; or

(3) a provider entity that is under contract with the county board in the county where
the potential crisis or emergency is occurring.

(b) The children's mental health crisis response services provider entity must:

(1) ensure that mental health crisis assessment and mobile crisis intervention services
are available 24 hours a day, seven days a week;

(2) new text begin coordinate services with detoxification or withdrawal management services to ensure
a recipient receives care that is responsive to the recipient's chemical and mental health
needs;
new text end

new text begin (3) new text end directly provide the services or, if services are subcontracted, the provider entity
must maintain clinical responsibility for services and billing;

deleted text begin (3)deleted text end new text begin (4)new text end ensure that crisis intervention services are provided in a manner consistent with
sections 245.487 to 245.4889; deleted text begin and
deleted text end

new text begin (5) maintain staff training, documentation, and personnel files, including documentation
of staff completion of required training modules according to sections 245I.32 and 245I.33;
 new text end

new text begin (6) establish and maintain a quality assurance and evaluation plan to evaluate the
outcomes of services and recipient satisfaction, including notifying recipients of the process
by which the county or tribe accepts and responds to concerns;
 new text end

deleted text begin (4)deleted text end new text begin (7)new text end develop and maintain written policies and procedures regarding service provision
that include safety of staff and recipients in high-risk situationsdeleted text begin .deleted text end new text begin ;
new text end

new text begin (8) respond to a call for crisis services in a designated service area, or according to a
written agreement with the local mental health authority for an adjacent area; and
 new text end

new text begin (9) document protocol used when delivering services by telemedicine, according to
sections 62A.67 to 62A.672, including responsibilities of the originating site, the means to
promote recipient safety, the timelines for connection and response, and the steps to take
in the event of a lost connection.
 new text end

Sec. 112.

Minnesota Statutes 2018, section 256B.0944, subdivision 5, is amended to read:


Subd. 5.

Mobile crisis intervention staff qualifications.

deleted text begin (a) To provide children's
mental health mobile crisis intervention services, a mobile crisis intervention team must
include:
 deleted text end

deleted text begin (1) at least two mental health professionals as defined in section 256B.0943, subdivision
1, paragraph (o); or
 deleted text end

deleted text begin (2) a combination of at least one mental health professional and one mental health
practitioner as defined in section 245.4871, subdivision 26, with the required mental health
crisis training and under the clinical supervision of a mental health professional on the team. deleted text end new text begin
(a) Mobile crisis intervention team staff must be qualified to provide services as mental
health professionals, mental health practitioners, clinical trainees, or mental health certified
family peer specialists.
 new text end

new text begin (b) A mobile crisis intervention team is comprised of at least two members, one of whom
must be qualified as a mental health professional. A second member must be qualified as
a mental health professional, clinical trainee, or mental health practitioner. Additional staff
must be added to reflect the needs of the area served.
 new text end

new text begin (c) Mental health crisis assessment and intervention services must be led by a mental
health professional, or under the supervision of a mental health professional according to
subdivision 9, by a clinical trainee or mental health practitioner.
 new text end

deleted text begin (b)deleted text end new text begin (d)new text end The team must have deleted text begin at least two people withdeleted text end at least one member providing
on-site crisis intervention services when needed. Team members must be experienced in
mental health assessment, crisis intervention techniques, and clinical decision making under
emergency conditions and have knowledge of local services and resources. The team must
recommend and coordinate the team's services with appropriate local resources, including
the county social services agency, mental health service providers, and local law enforcement,
if necessary.

Sec. 113.

Minnesota Statutes 2018, section 256B.0944, subdivision 6, is amended to read:


Subd. 6.

Initial screening and crisis assessment planning.

(a) Before initiating mobile
crisis intervention services, a screening of the potential crisis situation must be conducted.
The screening may use the resources of crisis deleted text begin assistancedeleted text end new text begin planningnew text end and emergency services
as defined in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The
screening must gather information, determine whether a crisis situation exists, identify the
parties involved, and determine an appropriate response.

new text begin (b) In conducting the screening, a provider shall:
 new text end

new text begin (1) employ evidence-based practices as identified by the commissioner in collaboration
with the commissioner of health to reduce the risk of the recipient's suicide and self-injurious
behavior;
 new text end

new text begin (2) work with the recipient to establish a plan and time frame for responding to the crisis,
including immediate needs for support by telephone or text message until a face-to-face
response arrives;
 new text end

new text begin (3) document significant factors related to the determination of a crisis, including prior
calls to the crisis team, recent presentation at an emergency department, known calls to 911
or law enforcement, or the presence of third parties with knowledge of a potential recipient's
history or current needs;
 new text end

new text begin (4) screen for the needs of a third-party caller, including a recipient who primarily
identifies as a family member or a caregiver but also presents signs of a crisis; and
 new text end

new text begin (5) provide psychoeducation, including education on the available means for reducing
self-harm, to relevant third parties, including family members or other persons living in the
home.
 new text end

new text begin (c) A provider entity shall consider the following to indicate a positive screening unless
the provider entity documents specific evidence to show why crisis response was clinically
inappropriate:
 new text end

new text begin (1) the recipient presented in an emergency department or urgent care setting, and the
health care team at that location requested crisis services;
 new text end

new text begin (2) a peace officer requested crisis services for a recipient who may be subject to
transportation under section 253B.05 for a mental health crisis.
 new text end

deleted text begin (b)deleted text end new text begin (d)new text end If a crisis exists, a crisis assessment must be completed. A crisis assessment must
evaluate any immediate needs for which emergency services are needed and, as time permits,
the recipient's current life situation, sources of stress, mental health problems and symptoms,
strengths, cultural considerations, support network, vulnerabilities, and current functioning.

deleted text begin (c)deleted text end new text begin (e)new text end If the crisis assessment determines mobile crisis intervention services are needed,
the intervention services must be provided promptly. As the opportunity presents itself
during the intervention, at least two members of the mobile crisis intervention team must
confer directly or by telephone about the assessment, treatment plan, and actions taken and
needed. At least one of the team members must be on site providing crisis intervention
services. If providing on-site crisis intervention services, a mental health practitioner must
seek deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required under subdivision 9.

new text begin (f) Direct contact with the recipient is not required before initiating a crisis assessment
or intervention service. A crisis team may gather relevant information from a third party at
the scene to establish the need for services and potential safety factors. A crisis assessment
is provided face-to-face by a mobile crisis intervention team outside of an inpatient hospital
setting. A service must be provided promptly and respond to the recipient's location whenever
possible, including community or clinical settings. As clinically appropriate, a mobile crisis
intervention team must coordinate a response with other health care providers if a recipient
requires detoxification, withdrawal management, or medical stabilization services in addition
to crisis services.
 new text end

deleted text begin (d)deleted text end new text begin (g)new text end The mobile crisis intervention team must develop an initial, brief crisis treatment
plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention.
The plan must address the needs and problems noted in the crisis assessment and include
measurable short-term goals, cultural considerations, and frequency and type of services to
be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan
must be updated as needed to reflect current goals and services. The team must involve the
client and the client's family in developing and implementing the plan.

deleted text begin (e)deleted text end new text begin (h)new text end The team must document in progress notes which short-term goals have been
met and when no further crisis intervention services are required.new text begin If after an assessment a
crisis provider entity refers a recipient to an intensive setting, including an emergency
department, in-patient hospitalization, or residential treatment, one of the crisis team members
who performed or conferred on the assessment must immediately contact the provider entity
and consult with the triage nurse or other staff responsible for intake. The crisis team member
must convey key findings or concerns that led to the referral. The consultation must occur
with the recipient's consent, the recipient's legal guardian's consent, or as allowed by section
144.293, subdivision 5. Any available written documentation, including a crisis treatment
plan, must be sent no later than the next business day.
new text end

deleted text begin (f)deleted text end new text begin (i)new text end If the client's crisis is stabilized, but the client needs a referral for mental health
crisis stabilization services or to other services, the team must provide a referral to these
services. If the recipient has a case manager, planning for other services must be coordinated
with the case manager.

Sec. 114.

Minnesota Statutes 2018, section 256B.0944, subdivision 7, is amended to read:


Subd. 7.

Crisis stabilization services.

Crisis stabilization services deleted text begin must be provided by
a mental health professional or a mental health practitioner, as defined in section 245.462,
subdivision 17, who works under the clinical supervision of a mental health professional
and for a crisis stabilization services provider entity anddeleted text end must meet the following standards:

(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 8;

(2) 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 the crisis stabilization treatment plan, supportive counseling, skills training, and
collaboration with other service providers in the community; and

(3) new text begin staff other than a new text end mental health deleted text begin practitionersdeleted text end new text begin professionalnew text end must have completed at
least 30 hours of training in crisis intervention and stabilization during the past two years.

Sec. 115.

Minnesota Statutes 2018, section 256B.0944, subdivision 8, is amended to read:


Subd. 8.

Treatment plan.

(a) The individual crisis stabilization treatment plan must
include, at a minimum:

(1) a list of problems identified in the assessment;

(2) a list of the recipient's strengths and resources;

(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement of the goals;

(4) specific objectives directed toward the achievement of each goal;

(5) documentation of the participants involved in the service planning;

(6) planned frequency and type of services initiated;

(7) a crisis response action plan if a crisis should occur; and

(8) clear progress notes on the outcome of goals.

(b) The client, if clinically appropriate, must be a participant in the development of the
crisis stabilization treatment plan. The client or the client's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the client and the client's legal guardian. The plan should include
services arranged, including specific providers where applicable.

(c) A treatment plan must be developed by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin under the clinical supervision of a mental health professionaldeleted text end .
A written plan must be completed within 24 hours of beginning services with the client.

Sec. 116.

Minnesota Statutes 2018, section 256B.0944, subdivision 9, is amended to read:


Subd. 9.

Supervision.

deleted text begin (a)deleted text end A mental health practitioner new text begin or clinical trainee new text end may provide
crisis assessment and mobile crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:

(1) the mental health provider entity must accept full responsibility for the services
provided;

(2) the mental health professional of the provider entity, who is an employee or under
contract with the provider entity, must be immediately available by telephone or in person
for deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;

(3) the mental health professional is consulted, in person or by telephone, during the
first three hours when a mental health practitioner provides on-site service; and

(4) the mental health professional must review and approve the tentative crisis assessment
and crisis treatment plan, document the consultation, and sign the crisis assessment and
treatment plan within the next business day.

deleted text begin (b) If the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the client face-to-face on the second day to provide services
and update the crisis treatment plan. The on-site observation must be documented in the
client's record and signed by the mental health professional.
 deleted text end

Sec. 117.

Minnesota Statutes 2018, section 256B.0946, subdivision 1, is amended to read:


Subdivision 1.

Required covered service components.

(a) deleted text begin Effective May 23, 2013,
and subject to federal approval,deleted text end 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 (5)
are reimbursed by medical assistance when they meet the following standards:

(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;

(2) crisis deleted text begin assistancedeleted text end new text begin planningnew text end 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 deleted text begin (q)deleted text end new text begin (o)new text end , 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; and

(5) service delivery payment requirements as provided under subdivision 4.

Sec. 118.

Minnesota Statutes 2018, section 256B.0946, subdivision 1a, is amended to
read:


Subd. 1a.

Definitions.

For the purposes of this section, the following terms have the
meanings given them.

(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.

deleted text begin (b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.
 deleted text end

deleted text begin (c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
 deleted text end

deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item Cdeleted text end new text begin means a staff person qualified according to section 245I.16, subdivision
6new text end ;

deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a, including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis intervention.

deleted text begin (f)deleted text end new text begin (d)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influencesdeleted text begin , as defined in Minnesota Rules, part 9505.0370,
subpart 9,deleted text end into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.

deleted text begin (g)deleted text end new text begin (e)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.

deleted text begin (h)deleted text end new text begin (f)new text end "Diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means an assessment described under section 256B.0671, subdivisions
2 and 3new text end .

deleted text begin (i)deleted text end new text begin (g)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.

deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.

deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.

deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described under section 256B.0671, subdivisions 5
and 6new text end .

deleted text begin (m) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, and a mental health practitioner working as a clinical trainee according to Minnesota
Rules, part 9505.0371, subpart 5, item C.
 deleted text end

new text begin (k) "Mental health certified family peer specialist" means a staff person qualified
according to section 245I.16, subdivision 12.
 new text end

deleted text begin (n)deleted text end new text begin (1)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person qualified according to section 245I.16,
subdivision 2new text end .

deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245.462, subdivision 20, paragraph (a), and includes emotional disturbance
as defined in section 245.4871, subdivision 15new text end .

deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.

deleted text begin (q)deleted text end new text begin (o)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.

deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin section 256B.0625, subdivision 69new text end .

deleted text begin (s)deleted text end new text begin (q)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.

new text begin (r) "Trauma" has the meaning given in section 245I.02, subdivision 24.
 new text end

new text begin (s) "Treatment supervision" means the supervision described under section 245I.18.
 new text end

new text begin (t) "Treatment supervisor" means the mental health professional who is responsible for
treatment supervision.
 new text end

Sec. 119.

Minnesota Statutes 2018, section 256B.0946, subdivision 2, is amended to read:


Subd. 2.

Determination of client eligibility.

new text begin (a) new text end An eligible recipient is an individual,
from birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic assessment and an
evaluation of level of care needed, as defined in paragraphs deleted text begin (a)deleted text end new text begin (b)new text end and deleted text begin (b)deleted text end new text begin (c)new text end .

deleted text begin (a)deleted text end new text begin (b)new text end The diagnostic assessment must:

deleted text begin (1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
 deleted text end

deleted text begin (2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
 deleted text end

deleted text begin (3)deleted text end new text begin (1)new text end document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;new text begin and
new text end

deleted text begin (4)deleted text end new text begin (2)new text end be performed within 180 days before the start of servicedeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
 deleted text end

deleted text begin (b)deleted text end new text begin (c)new text end The evaluation of level of care must be conducted by the placing county, tribe,
or case manager in conjunction with the diagnostic assessment deleted text begin as described by Minnesota
Rules, part 9505.0372, subpart 1, item Bdeleted text end , using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.

Sec. 120.

Minnesota Statutes 2018, section 256B.0946, subdivision 3, is amended to read:


Subd. 3.

Eligible mental health services providers.

(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the requirements under chapter 245Inew text end .

(b) For purposes of this section, a provider agency must be:

(1) a county-operated entity certified by the state;

(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or

(3) a noncounty entity.

(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.

(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional deleted text begin ordeleted text end new text begin ,new text end a clinical traineenew text begin , or a mental health certified family peer
specialistnew text end .

Sec. 121.

Minnesota Statutes 2018, 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 (m)new text end .

deleted text begin (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.
 deleted text end

deleted text begin (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.
 deleted text end

new text begin (b) For children under age six, each client must receive a diagnostic assessment according
to the requirements in the current edition of the Diagnostic Classification of Mental Health
Disorders of Infancy and Early Childhood.
 new text end

deleted text begin (d)deleted text end new text begin (c)new text end 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.

deleted text begin (e)deleted text end new text begin (d)new text end 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.

deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning process, as defined in subdivision 1a, paragraph deleted text begin (s)deleted text end new text begin (p)new text end .

deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultation, as defined in subdivision 1a, paragraph (a), must be
provided in accordance with the client's individual treatment plan.

deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end 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.

deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end

deleted text begin (j)deleted text end new text begin (i)new text end 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.

deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.

deleted text begin (l)deleted text end new text begin (k)new text end 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.

deleted text begin (m)deleted text end new text begin (l)new text end 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.

deleted text begin (n)deleted text end new text begin (m)new text end 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.

Sec. 122.

Minnesota Statutes 2018, section 256B.0946, subdivision 6, is amended to read:


Subd. 6.

Excluded services.

(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:

(1) inpatient psychiatric hospital treatment;

(2) mental health targeted case management;

(3) partial hospitalization;

(4) medication management;

(5) children's mental health day treatment services;

(6) crisis response services under section 256B.0944; and

(7) transportation.

(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:

(1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0625, subdivision 35b;

(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;

(3) home and community-based waiver services;

(4) mental health residential treatment; and

(5) room and board costs as defined in section 256I.03, subdivision 6.

Sec. 123.

Minnesota Statutes 2018, section 256B.0947, subdivision 1, is amended to read:


Subdivision 1.

Scope.

deleted text begin Effective November 1, 2011, and subject to federal approval,deleted text end
Medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services as defined in subdivision 2, for recipients as defined in subdivision 3, when
the services are provided by an entity meeting the standards in this section.

Sec. 124.

Minnesota Statutes 2018, 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 deleted text begin a total teamdeleted text end new text begin annew text end approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20 with a serious mental illness or co-occurring mental illness and
substance abuse addictiondeleted text end 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" deleted text begin 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,deleted text end new text begin means the assessment described under section 256B.0671,
subdivisions 2 and 3,new text end 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 deleted text begin who:deleted text end new text begin .
new text end

deleted text begin (1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
 deleted text end

deleted text begin (2) assists younger peers to identify and achieve specific life goals;
 deleted text end

deleted text begin (3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
 deleted text end

deleted text begin (4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
 deleted text end

deleted text begin (5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
 deleted text end

deleted text begin (6) meets the following criteria:
 deleted text end

deleted text begin (i) is at least 22 years of age;
 deleted text end

deleted text begin (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;
 deleted text end

deleted text begin (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;
 deleted text end

deleted text begin (iv) has at least a high school diploma or equivalent;
 deleted text end

deleted text begin (v) has successfully completed training requirements determined and periodically updated
by the commissioner;
 deleted text end

deleted text begin (vi) is willing to disclose the individual's own mental health history to team members
and clients; and
 deleted text end

deleted text begin (vii) must be free of substance use problems for at least one year.
 deleted text end

deleted text begin (i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
 deleted text end

deleted text begin (j)deleted text end new text begin (i)new text end "Substance use disorders" means one or more of the disorders defined in the
Diagnostic and Statistical Manual of Mental Disorders, current edition.

deleted text begin (k)deleted text end new text begin (j)new text end "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.

deleted text begin (l)deleted text end new text begin (k)new text end "Treatment team" means all staff who provide services to recipients under this
section.

Sec. 125.

Minnesota Statutes 2018, section 256B.0947, subdivision 3, is amended to read:


Subd. 3.

Client eligibility.

An eligible recipient is an individual who:

(1) is age 16, 17, 18, 19, or 20; and

(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 within the next two years; and

(5) has had a recent diagnostic assessmentdeleted text begin , 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,deleted text end 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. 126.

Minnesota Statutes 2018, section 256B.0947, subdivision 3a, is amended to
read:


Subd. 3a.

Required service components.

deleted text begin (a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
 deleted text end

deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities covered by the single daily rate per client must include the following,
as needed by the individual client:

(1) individual, family, and group psychotherapy;

(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);

(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section deleted text begin 245.4871, subdivision 9a, which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end new text begin 256B.0943, subdivision 1, paragraph (c)new text end ;

(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;

(5) mental health case management as provided in section 256B.0625, subdivision 20;

(6) medication education services deleted text begin as defined in this sectiondeleted text end ;

(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;

(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;

(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;

(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section 256B.0944;

(11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;

(12) transition services as defined in this section;

(13) integrated dual disorders treatment as defined in this section; and

(14) housing access support.

deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:

(1) client access to crisis intervention services, as defined in section 256B.0944, and
available 24 hours per day and seven days per week;new text begin and
new text end

deleted text begin (2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
 deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end determination of the client's needed level of care using an instrument approved
and periodically updated by the commissioner.

Sec. 127.

Minnesota Statutes 2018, 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.

(b) 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) deleted text begin 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.deleted text end 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 includedeleted text begin , but is not limited todeleted text end new text begin at a minimumnew text end :

(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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 deleted text begin as defined in subdivision 2, paragraph (h)deleted text end .

(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 practitionerdeleted text begin , as defined indeleted text end new text begin qualified according tonew text end section deleted text begin 245.4871,
subdivision 26deleted text end new text begin 245I.16, subdivision 4new text end ;

(vi) a mental health manager, as defined in section 245.4871, subdivision 4; deleted text begin and
deleted text end

(vii) a housing access specialistdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (viii) a clinical trainee qualified according to section 245I.16, subdivision 6.
 new text end

(3) A treatment team may include, in addition to those in deleted text begin clausedeleted text end new text begin clausesnew text end (1) deleted text begin ordeleted text end new text begin andnew text end (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 deleted text begin agency at the rate for
a typical session by that provider with that client or at a rate negotiated with the client-specific
memberdeleted text end new text begin entitynew text end . 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.

(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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 deleted text begin clinicaldeleted text end new text begin treatmentnew text end 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.

(d) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.

(e) 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.

(f) 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 assure the health and safety of clients.

(g) 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.

(h) A regional treatment team may serve multiple counties.

Sec. 128.

Minnesota Statutes 2018, 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 shall use team treatment, not an individual treatment model.

(b) Services must be available at times that meet client needs.

(c) The initial functional assessment must be completed within ten days of intake and
updated at least every three months or prior to discharge from the service, whichever comes
first.

(d) An individual treatment plan must be completed for each client, according to criteria
specified in section deleted text begin 256B.0943, subdivision 6, paragraph (b), clause (2)deleted text end new text begin 256B.0671,
subdivisions 5 and 6new text end , and, additionally, must:

(1) 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;

(2) if a need for substance use disorder treatment is indicated by validated assessmentdeleted text begin :deleted text end new text begin ,
new text end

deleted text begin (i)deleted text end 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;new text begin and
new text end

deleted text begin (ii) be reviewed at least once every 90 days and revised, if necessary;
 deleted text end

deleted text begin (3) 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
 deleted text end

deleted text begin (4)deleted text end new text begin (3)new text end 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.

(e) 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.

(f) 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.

(g) The treatment team shall provide interventions to promote positive interpersonal
relationships.

Sec. 129.

Minnesota Statutes 2018, section 256B.0947, subdivision 7a, is amended to
read:


Subd. 7a.

Noncovered services.

(a) The rate for intensive rehabilitative mental health
services does not include medical assistance payment for services in clauses (1) to (7).
Services not covered under this paragraph may be billed separately:

(1) inpatient psychiatric hospital treatment;

(2) partial hospitalization;

(3) children's mental health day treatment services;

(4) physician services outside of care provided by a psychiatrist serving as a member of
the treatment team;

(5) room and board costs, as defined in section 256I.03, subdivision 6;

(6) home and community-based waiver services; and

(7) other mental health services identified in the child's individualized education program.

(b) The following services are not covered under this section and are not eligible for
medical assistance payment while youth are receiving intensive rehabilitative mental health
services:

(1) mental health residential treatment; and

(2) mental health behavioral aide services, as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end .

Sec. 130.

Minnesota Statutes 2018, section 256B.0949, subdivision 2, is amended to read:


Subd. 2.

Definitions.

(a) The terms used in this section have the meanings given in this
subdivision.

(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.

(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:

(1) is severe and chronic;

(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;

(3) requires treatment or services similar to those required for a person with ASD; and

(4) results in substantial functional limitations in three core developmental deficits of
ASD: social interaction; nonverbal or social communication; and restrictive, repetitive
behaviors or hyperreactivity or hyporeactivity to sensory input; and may include deficits or
a high level of support in one or more of the following domains:

(i) self-regulation;

(ii) self-care;

(iii) behavioral challenges;

(iv) expressive communication;

(v) receptive communication;

(vi) cognitive functioning; or

(vii) safety.

(d) "Person" means a person under 21 years of age.

(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.

(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.

(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.

(h) "Department" means the Department of Human Services, unless otherwise specified.

(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved by the
commissioner that are based in behavioral and developmental science consistent with best
practices on effectiveness.

(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.

(k) "Incident" means when any of the following occur:

(1) an illness, accident, or injury that requires first aid treatment;

(2) a bump or blow to the head; or

(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.

(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.

(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.

(n) "Mental health professional" has the meaning given in section 245.4871, subdivision
27deleted text begin , clauses (1) to (6)deleted text end .

(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.

(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.

Sec. 131. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end

new text begin The commissioner of human services, in consultation with counties, tribes, managed
care organizations, provider organizations, advocacy groups, and individuals and families
served, shall develop recommendations to provide a single comprehensive license structure
for mental health service programs, including community mental health centers according
to Minnesota Rules, part 9520.0750, intensive residential treatment services, assertive
community treatment, adult rehabilitative mental health services, children's therapeutic
services and supports, intensive rehabilitative mental health services, intensive treatment
in foster care, and children's residential treatment programs currently approved under
Minnesota Rules, chapter 2960. The recommendations must prioritize program integrity,
the welfare of individuals and families served, improved integration of mental health and
substance use disorder services, and the reduction of administrative burden on providers.
 new text end

Sec. 132. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 245.462, subdivision 4a; 256B.0615, subdivisions
2, 4, and 5; 256B.0616, subdivisions 2, 4, and 5; 256B.0943, subdivision 10; 256B.0944,
subdivision 10; 256B.0946, subdivision 5; and 256B.0947, subdivision 9, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin 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; and 9520.0230, new text end new text begin are repealed.
 new text end

ARTICLE 8

HEALTH CARE

Section 1.

Minnesota Statutes 2018, section 13.69, subdivision 1, is amended to read:


Subdivision 1.

Classifications.

(a) The following government data of the Department
of Public Safety are private data:

(1) medical data on driving instructors, licensed drivers, and applicants for parking
certificates and special license plates issued to physically disabled persons;

(2) other data on holders of a disability certificate under section 169.345, except that (i)
data that are not medical data may be released to law enforcement agencies, and (ii) data
necessary for enforcement of sections 169.345 and 169.346 may be released to parking
enforcement employees or parking enforcement agents of statutory or home rule charter
cities and towns;

(3) Social Security numbers in driver's license and motor vehicle registration records,
except that Social Security numbers must be provided to the Department of Revenue for
purposes of tax administration, the Department of Labor and Industry for purposes of
workers' compensation administration and enforcement, the judicial branch for purposes of
debt collection, and the Department of Natural Resources for purposes of license application
administrationnew text begin , and except that the last four digits of the Social Security number must be
provided to the Department of Human Services for purposes of recovery of Minnesota health
care program benefits paidnew text end ; and

(4) data on persons listed as standby or temporary custodians under section 171.07,
subdivision 11, except that the data must be released to:

(i) law enforcement agencies for the purpose of verifying that an individual is a designated
caregiver; or

(ii) law enforcement agencies who state that the license holder is unable to communicate
at that time and that the information is necessary for notifying the designated caregiver of
the need to care for a child of the license holder.

The department may release the Social Security number only as provided in clause (3)
and must not sell or otherwise provide individual Social Security numbers or lists of Social
Security numbers for any other purpose.

(b) The following government data of the Department of Public Safety are confidential
data: data concerning an individual's driving ability when that data is received from a member
of the individual's family.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 16A.724, subdivision 2, is amended to read:


Subd. 2.

Transfers.

(a) Notwithstanding section 295.581, to the extent available resources
in the health care access fund exceed expenditures in that fund, effective for the biennium
beginning July 1, 2007, the commissioner of management and budget shall transfer the
excess funds from the health care access fund to the general fund on June 30 of each year,
provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the
amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal
biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet
the rate increase required under deleted text begin Laws 2003, First Special Session chapter 14, article 13C,
section 2, subdivision 6deleted text end new text begin section 256B.688new text end .

(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if
necessary, the commissioner shall reduce these transfers from the health care access fund
to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer
sufficient funds from the general fund to the health care access fund to meet annual
MinnesotaCare expenditures.

Sec. 3.

Minnesota Statutes 2018, section 245A.02, subdivision 5a, is amended to read:


Subd. 5a.

Controlling individual.

(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:

(1) each officer of the organization, including the chief executive officer and chief
financial officer;

(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);

(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph deleted text begin (b)deleted text end new text begin (g)new text end ; and

(4) each managerial official whose responsibilities include the direction of the
management or policies of a program.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:

(i) whose securities are exempt under section 80A.45, clause (6); or

(ii) whose transactions are exempt under section 80A.46, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 245D.081, subdivision 3, is amended to read:


Subd. 3.

Program management and oversight.

(a) The license holder must designate
a managerial staff person or persons to provide program management and oversight of the
services provided by the license holder. The designated manager is responsible for the
following:

(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph deleted text begin (b)deleted text end new text begin
(g)new text end ;

(2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;

(3) ensuring the program implements corrective action identified as necessary by the
program following review of incident and emergency reports according to the requirements
in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of
alleged or suspected maltreatment must be conducted according to the requirements in
section 245A.65, subdivision 1, paragraph (b);

(4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress deleted text begin towardsdeleted text end new text begin
towardnew text end accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring
and protecting each person's rights as identified in section 245D.04;

(5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;

(6) ensuring corrective action is taken when ordered by the commissioner and that the
terms and conditions of the license and any variances are met; and

(7) evaluating the information identified in clauses (1) to (6) to develop, document, and
implement ongoing program improvements.

(b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision 2,
paragraph (b), and have a minimum of three years of supervisory level experience in a
program providing direct support services to persons with disabilities or persons age 65 and
older.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 256.962, subdivision 5, is amended to read:


Subd. 5.

Incentive program.

Beginning January 1, 2008, the commissioner shall establish
an incentive program for organizations and licensed insurance producers under chapter 60K
that directly identify and assist potential enrollees in filling out and submitting an application.
For each applicant who is successfully enrolled in MinnesotaCare or medical assistance,
the commissioner, within the available appropriation, shall pay the organization or licensed
insurance producer a deleted text begin $25deleted text end new text begin $70new text end application assistance bonus. The organization or licensed
insurance producer may provide an applicant a gift certificate or other incentive upon
enrollment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 256.969, subdivision 9, is amended to read:


Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.

(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.

(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:

(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;

(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;

(3) a hospital that has received payment from the fee-for-service program for at least 20
transplant services in the base year shall receive a factor of 0.0435;

(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;

(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than three standard
deviations above the mean shall receive a factor of 0.2300; and

(6) a hospital that has a medical assistance utilization rate in the base year that is at least
three standard deviations above the statewide mean utilization rate shall receive a factor of
0.3711.

(e) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that
have a medical assistance utilization rate that is at least one standard deviation above the
mean.

new text begin (f) An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed $1,500,000.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for discharges on or after April 1, 2019.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:


Subd. 21.

Provider enrollment.

(a)new text begin The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E. A provider providing services from multiple locations must enroll each location separately.
The commissioner may deny a provider's incomplete application if a provider fails to respond
to the commissioner's request for additional information within 60 days of the request. The
commissioner must conduct a background study under chapter 245C, including a review
of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5), for a provider
described in this paragraph. The background study requirement may be satisfied if the
commissioner conducted a fingerprint-based background study on the provider that includes
a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5).
new text end

new text begin (b) The commissioner shall revalidate each: (1) provider under this subdivision at least
once every five years; and (2) personal care assistance agency under this subdivision once
every three years.
 new text end

new text begin (c) The commissioner shall conduct revalidation as follows:
 new text end

new text begin (1) provide 30-day notice of the revalidation due date including instructions for
revalidation and a list of materials the provider must submit;
 new text end

new text begin (2) if a provider fails to submit all required materials by the due date, notify the provider
of the deficiency within 30 days after the due date and allow the provider an additional 30
days from the notification date to comply; and
 new text end

new text begin (3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day
notice of termination and immediately suspend the provider's ability to bill. The provider
does not have the right to appeal suspension of ability to bill.
 new text end

new text begin (d) If a provider fails to comply with any individual provider requirement or condition
of participation, the commissioner may suspend the provider's ability to bill until the provider
comes into compliance. The commissioner's decision to suspend the provider is not subject
to an administrative appeal.
 new text end

new text begin (e) All correspondence and notifications, including notifications of termination and other
actions, must be delivered electronically to a provider's MN-ITS mailbox. For a provider
that does not have a MN-ITS account and mailbox, notice must be sent by first-class mail.
This paragraph does not apply to correspondences and notifications related to background
studies.
 new text end

new text begin (f)new text end If the commissioner or the Centers for Medicare and Medicaid Services determines
that a provider is designated "high-risk," the commissioner may withhold payment from
providers within that category upon initial enrollment for a 90-day period. The withholding
for each provider must begin on the date of the first submission of a claim.

deleted text begin (b)deleted text end new text begin (g)new text end An enrolled provider that is also licensed by the commissioner under chapter
245A, or is licensed as a home care provider by the Department of Health under chapter
144A and has a home and community-based services designation on the home care license
under section 144A.484, must designate an individual as the entity's compliance officer.
The compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;

(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

deleted text begin (c)deleted text end new text begin (h)new text end The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.

deleted text begin (d)deleted text end new text begin (i)new text end The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or under
the Medicaid program or Children's Health Insurance Program of any other state.

deleted text begin (e)deleted text end new text begin (j)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

deleted text begin (f)deleted text end new text begin (k)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.

deleted text begin (g)deleted text end new text begin (l)new text end (1) Upon initial enrollment, reenrollment, and notification of revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.

(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.

(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.

deleted text begin (h)deleted text end new text begin (m)new text end The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph deleted text begin (a)deleted text end new text begin (f)new text end and
as per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in
an amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.04, subdivision 22, is amended to read:


Subd. 22.

Application fee.

(a) The commissioner must collect and retain federally
required nonrefundable application fees to pay for provider screening activities in accordance
with Code of Federal Regulations, title 42, section 455, subpart E. The enrollment application
must be made under the procedures specified by the commissioner, in the form specified
by the commissioner, and accompanied by an application fee described in paragraph (b),
or a request for a hardship exception as described in the specified procedures. Application
fees must be deposited in the provider screening account in the special revenue fund.
Amounts in the provider screening account are appropriated to the commissioner for costs
associated with the provider screening activities required in Code of Federal Regulations,
title 42, section 455, subpart E. deleted text begin The commissioner shall conduct screening activities as
required by Code of Federal Regulations, title 42, section 455, subpart E, and as otherwise
provided by law, to include database checks, unannounced pre- and postenrollment site
visits, fingerprinting, and criminal background studies. The commissioner must revalidate
all providers under this subdivision at least once every five years.
deleted text end

(b) The application fee under this subdivision is $532 for the calendar year 2013. For
calendar year 2014 and subsequent years, the fee:

(1) is adjusted by the percentage change to the Consumer Price Index for all urban
consumers, United States city average, for the 12-month period ending with June of the
previous year. The resulting fee must be announced in the Federal Register;

(2) is effective from January 1 to December 31 of a calendar year;

(3) is required on the submission of an initial application, an application to establish a
new practice location, an application for reenrollment when the provider is not enrolled at
the time of application of reenrollment, or at revalidation when required by federal regulation;
and

(4) must be in the amount in effect for the calendar year during which the application
for enrollment, new practice location, or reenrollment is being submitted.

(c) The application fee under this subdivision cannot be charged to:

(1) providers who are enrolled in Medicare or who provide documentation of payment
of the fee to, and enrollment with, another state, unless the commissioner is required to
rescreen the provider;

(2) providers who are enrolled but are required to submit new applications for purposes
of reenrollment;

(3) a provider who enrolls as an individual; and

(4) group practices and clinics that bill on behalf of individually enrolled providers
within the practice who have reassigned their billing privileges to the group practice or
clinic.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 256B.055, subdivision 2, is amended to read:


Subd. 2.

Subsidized foster children.

Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676new text begin , and for a child who is not eligible for
Title IV-E of the Social Security Act but who is determined eligible for foster care or kinship
assistance under chapter 256Nnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, 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. 10.

Minnesota Statutes 2018, section 256B.056, subdivision 3, is amended to read:


Subd. 3.

Asset limitations for certain individuals.

(a) To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. In addition to these maximum amounts, an eligible individual or family may
accrue interest on these amounts, but they must be reduced to the maximum at the time of
an eligibility redetermination. The accumulation of the clothing and personal needs allowance
according to section 256B.35 must also be reduced to the maximum at the time of the
eligibility redetermination. The value of assets that are not considered in determining
eligibility for medical assistance is the value of those assets excluded under the Supplemental
Security Income program for aged, blind, and disabled persons, with the following
exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;

(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;

(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;

(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);

(6) deleted text begin when a person enrolled in medical assistance under section 256B.057, subdivision
9, is age 65 or older and has been enrolled during each of the 24 consecutive deleted text end deleted text begin months deleted text end deleted text begin before
the person's 65th birthday, the assets owned by the person and the person's spouse must be
disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d), when
determining eligibility for medical assistance under section 256B.055, subdivision 7.deleted text end new text begin a
designated employment incentives asset account is disregarded when determining eligibility
for medical assistance for a person age 65 years or older under section 256B.055, subdivision
7. An employment incentives asset account must only be designated by a person who has
been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9.new text end The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; and

(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 11.

Minnesota Statutes 2018, 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, physician assistant, or a nurse practitioner 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 commissioner.

(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. deleted text begin Over-the-counter medications
must be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained
in the manufacturer's original package; (2) the number of dosage units required to complete
the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
from a system using retrospective billing, as provided under subdivision 13e, paragraph
(b).
deleted text end

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019, 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. 12.

Minnesota Statutes 2018, 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 deleted text begin actual acquisitiondeleted text end new text begin ingredientnew text end costs of the drugs deleted text begin or the maximum allowable
cost by the commissionerdeleted text end plus the deleted text begin fixeddeleted text end new text begin professionalnew text end dispensing fee; or the usual and
customary price charged to the public. new text begin 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. new text end The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any new text begin third-party new text end 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 deleted text begin pharmacydeleted text end new text begin professionalnew text end dispensing fee
shall be deleted text begin $3.65deleted text end new text begin $10.48new text end for deleted text begin legend prescription drugs, except thatdeleted text end new text begin prescriptions filled with
legend drugs meeting the definition of "covered outpatient drugs" according to United States
Code, title 42, section 1396r-8(k)(2).new text end The dispensing fee for intravenous solutions deleted text begin whichdeleted text end new text begin
thatnew text end must be compounded by the pharmacist shall be deleted text begin $8deleted text end new text begin $10.48new text end per bagdeleted text begin , $14 per bag for
cancer chemotherapy products, and $30 per bag for total parenteral nutritional products
dispensed in one liter quantities, or $44 per bag for total parenteral nutritional products
dispensed in quantities greater than one literdeleted text end . new text begin The professional dispensing fee for
prescriptions filled with over-the-counter drugs meeting the definition of covered outpatient
drugs shall be $10.48 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.
new text end The pharmacy dispensing fee for new text begin prescribed new text end over-the-counter drugs new text begin not meeting the definition
of covered outpatient drugs new text end shall be $3.65deleted text begin , except that the fee shall be $1.31 for
retrospectively billing pharmacies when billing for quantities less than the number of units
contained in the manufacturer's original package. Actual acquisition cost includes quantity
and other special discounts except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner at wholesale acquisition cost plus four percent
for independently owned pharmacies located in a designated rural area within Minnesota,
and at wholesale acquisition cost plus two percent for all other pharmacies. A pharmacy is
"independently owned" if it is one of four or fewer pharmacies under the same ownership
nationally. A "designated rural area" means an area defined as a small rural area or isolated
rural area according to the four-category classification of the Rural Urban Commuting Area
system developed for the United States Health Resources and Services Administration.
Effective January 1, 2014, the actual acquisitiondeleted text end new text begin 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 ingredientnew text end
cost of a drug deleted text begin acquired throughdeleted text end new text begin for a provider participating innew text end the federal 340B Drug Pricing
Program shall be deleted text begin estimated by the commissioner at wholesale acquisition cost minus 40
percentdeleted text end new text begin either the 340B Drug Pricing Program ceiling price established by the Health
Resources and Services Administration or the National Average Drug Acquisition Cost
(NADAC), whichever is lowernew text end . 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 todeleted text begin , butdeleted text end new text begin the
actual acquisition cost of the drug product andnew text end no higher thandeleted text begin , the maximum amount paid
by other third-party payors in this state who have maximum allowable cost programsdeleted text end new text begin the
NADAC of the generic productnew text end . 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) deleted text begin An additional dispensing fee of $.30 may be added to the dispensing fee paid to
pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
when a unit dose blister card system, approved by the department, is used. Under this type
of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister card must be identified
on the claim to the department. The unit dose blister card containing the drug must meet
the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
of unused drugs to the pharmacy for reuse.deleted text end 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) deleted text begin Whenever a maximum allowable cost has been set fordeleted text end new text begin If a pharmacy dispensesnew text end a
multisource drug, deleted text begin payment shall be the lower of the usual and customary price charged to
the public ordeleted text end new text begin the ingredient cost shall be the NADAC of the generic product ornew text end 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.
deleted text begin Effective January 1, 2014,deleted text end The commissioner shall discount the payment rate for drugs
obtained through the federal 340B Drug Pricing Program by deleted text begin 20deleted text end new text begin 28.6new text end 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 deleted text begin negotiate lower reimbursementdeleted text end new text begin establish maximum allowable
costnew text end rates for specialty pharmacy products deleted text begin than the ratesdeleted text end new text begin that are lower than the ingredient
cost formulasnew text end 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
deleted text begin this paragraphdeleted text end new text begin maximum allowable cost reimbursementnew text end . 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 deleted text begin reimbursement ratedeleted text end new text begin maximum allowable costnew text end 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.

new text begin (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 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.
 new text end

new text begin (i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by two percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019, or upon federal approval,
whichever is later. Paragraph (i) expires if federal approval is denied. The commissioner
of human services shall inform the revisor of statutes when federal approval is obtained or
denied.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 256B.0625, subdivision 13f, is amended to read:


Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.

deleted text begin (d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.
 deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2.

deleted text begin (f)deleted text end new text begin (e)new text end Notwithstanding this subdivision, the commissioner may automatically require
prior authorization, for a period not to exceed 180 days, for any drug that is approved by
the United States Food and Drug Administration on or after July 1, 2005. The 180-day
period begins no later than the first day that a drug is available for shipment to pharmacies
within the state. The Formulary Committee shall recommend to the commissioner general
criteria to be used for the prior authorization of the drugs, but the committee is not required
to review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.

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 2018, section 256B.0625, subdivision 17, is amended to read:


Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and deleted text begin in consultation with the Minnesota Department of
Transportationdeleted text end new text begin all drivers must be individually enrolled with the commissioner and reported
on the claim as the individual who provided the servicenew text end . All nonemergency medical
transportation providers shall bill for nonemergency medical transportation services in
accordance with Minnesota health care programs criteria. Publicly operated transit systems,
volunteers, and not-for-hire vehicles are exempt from the requirements outlined in this
paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician or a medical
or mental health professional to certify that the recipient requires nonemergency medical
transportation services. Nonemergency medical transportation providers shall perform
driver-assisted services for eligible individuals, when appropriate. Driver-assisted service
includes passenger pickup at and return to the individual's residence or place of business,
assistance with admittance of the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.

(k) The commissioner shall:

(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;

(4) $13 for the base rate and $1.30 per mile for assisted transport;

(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 15.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 17d. new text end

new text begin Transportation services oversight. new text end

new text begin The commissioner shall contract with
a vendor or dedicate staff to oversee providers of nonemergency medical transportation
services pursuant to the commissioner's authority in section 256B.04 and Minnesota Rules,
parts 9505.2160 to 9505.2245.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 17e. new text end

new text begin Transportation provider termination. new text end

new text begin (a) A terminated nonemergency
medical transportation provider, including all named individuals on the current enrollment
disclosure form and known or discovered affiliates of the nonemergency medical
transportation provider, is not eligible to enroll as a nonemergency medical transportation
provider for five years following the termination.
 new text end

new text begin (b) After the five-year period in paragraph (a), if a provider seeks to reenroll as a
nonemergency medical transportation provider, the provider must be placed on a one-year
probation period. During a provider's probation period the commissioner shall complete
unannounced site visits and request documentation to review compliance with program
requirements.
 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. 17.

Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:


Subd. 57.

Payment for Part B Medicare crossover claims.

(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.

(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.

(c) Excluded from this limitation are payments to federally qualified health centersnew text begin ,
Indian Health Services,new text end and rural health clinics.

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 2018, section 256B.064, subdivision 1a, is amended to read:


Subd. 1a.

Grounds for sanctions against vendors.

new text begin (a) new text end The commissioner may impose
sanctions against a vendor of medical care for any of the following: (1) fraud, theft, or abuse
in connection with the provision of medical care to recipients of public assistance; (2) a
pattern of presentment of false or duplicate claims or claims for services not medically
necessary; (3) a pattern of making false statements of material facts for the purpose of
obtaining greater compensation than that to which the vendor is legally entitled; (4)
suspension or termination as a Medicare vendor; (5) refusal to grant the state agency access
during regular business hours to examine all records necessary to disclose the extent of
services provided to program recipients and appropriateness of claims for payment; (6)
failure to repay an overpayment or a fine finally established under this section; (7) failure
to correct errors in the maintenance of health service or financial records for which a fine
was imposed or after issuance of a warning by the commissioner; and (8) any reason for
which a vendor could be excluded from participation in the Medicare program under section
1128, 1128A, or 1866(b)(2) of the Social Security Act.

new text begin (b) The commissioner may impose sanctions against a pharmacy provider for failure to
respond to a cost of dispensing survey under section 256B.0625, subdivision 13e, paragraph
(h).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:

(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;

(2) proof of surety bond coveragenew text begin for each business location providing servicesnew text end . Upon
new enrollment, or if the provider's Medicaid revenue in the previous calendar year is up
to and including $300,000, the provider agency must purchase a surety bond of $50,000. If
the Medicaid revenue in the previous year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000new text begin for each business location
providing servicenew text end ;

(4) proof of workers' compensation insurance coveragenew text begin identifying the business location
where personal care assistance services are providednew text end ;

(5) proof of liability insurancenew text begin coverage identifying the business location where personal
care assistance services are provided and naming the department as a certificate holdernew text end ;

deleted text begin (6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;
 deleted text end

deleted text begin (7)deleted text end new text begin (6)new text end a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;

deleted text begin (8)deleted text end new text begin (7)new text end copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

deleted text begin (9)deleted text end new text begin (8)new text end a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

deleted text begin (10)deleted text end new text begin (9)new text end documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;

deleted text begin (11)deleted text end new text begin (10)new text end documentation of the agency's marketing practices;

deleted text begin (12)deleted text end new text begin (11)new text end disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;

deleted text begin (13)deleted text end new text begin (12)new text end documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

deleted text begin (14)deleted text end new text begin (13)new text end effective May 15, 2010, documentation that the agency does not burden
recipients' free exercise of their right to choose service providers by requiring personal care
assistants to sign an agreement not to work with any particular personal care assistance
recipient or for another personal care assistance provider agency after leaving the agency
and that the agency is not taking action on any such agreements or requirements regardless
of the date signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner beforenew text begin submitting an application fornew text end enrollment of the
agency as a provider.new text begin All personal care assistance provider agencies shall also require
qualified professionals to complete the training required by subdivision 13 before submitting
an application for enrollment of the agency as a provider.new text end Employees in management and
supervisory positions and owners who are active in the day-to-day operations of an agency
who have completed the required training as an employee with 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 past three years. By September 1,
2010, 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. Personal care assistance provider agency billing staff shall complete
training about personal care assistance program financial management. This training is
effective July 1, 2009. Any personal care assistance provider agency enrolled before that
date shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new owners or employees in management and supervisory positions involved
in the day-to-day operations are required to complete mandatory training as a requisite of
working for the agency. Personal care assistance provider agencies certified for participation
in Medicare as home health agencies are exempt from the training required in this
subdivision. When available, Medicare-certified home health agency owners, supervisors,
or managers must successfully complete the competency test.

new text begin (d) All surety bonds, fidelity bonds, workers compensation insurance, and liability
insurance required by this subdivision must be maintained continuously. After initial
enrollment, a provider must submit proof of bonds and required coverages at any time at
the request of the commissioner. Services provided while there are lapses in coverage are
not eligible for payment. Lapses in coverage may result in sanctions, including termination.
The commissioner shall send instructions and a due date to submit the requested information
to the personal care assistance provider agency.
 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.

new text begin [256B.688] PROVIDER TAX RATE INCREASE.
 new text end

new text begin (a) The commissioner shall increase the total payments to managed care plans under
section 256B.69 by an amount equal to the cost increases to the managed care plans from
the elimination of:
 new text end

new text begin (1) the exemption from the taxes imposed under section 297I.05, subdivision 5, for
premiums paid by the state for medical assistance and the MinnesotaCare program; and
 new text end

new text begin (2) the exemption of gross revenues subject to the taxes imposed under sections 295.50
to 295.57, for payments paid by the state for services provided under medical assistance
and the MinnesotaCare program. Any increase based on clause (2) must be reflected in
provider rates paid by the managed care plan unless the managed care plan is a staff model
health plan company.
 new text end

new text begin (b) The commissioner shall increase by two percent the fee-for-service payments under
medical assistance and the MinnesotaCare program for services subject to the hospital,
surgical center, or health care provider taxes under sections 295.50 to 295.57.
 new text end

Sec. 21.

Minnesota Statutes 2018, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

(a) Effective for services provided on or after July 1, 2009,
total payments for basic care services, shall be reduced by three percent, except that for the
period July 1, 2009, through June 30, 2011, total payments shall be reduced by 4.5 percent
for the medical assistance and general assistance medical care programs, prior to third-party
liability and spenddown calculation. Effective July 1, 2010, the commissioner shall classify
physical therapy services, occupational therapy services, and speech-language pathology
and related services as basic care services. The reduction in this paragraph shall apply to
physical therapy services, occupational therapy services, and speech-language pathology
and related services provided on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall be
reduced for services provided on or after October 1, 2009, to reflect the reduction effective
July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010,
to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for outpatient hospital facility fees shall be reduced by five percent from the
rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for ambulatory surgery centers facility fees, medical supplies and durable
medical equipment not subject to a volume purchase contract, prosthetics and orthotics,
renal dialysis services, laboratory services, public health nursing services, physical therapy
services, occupational therapy services, speech therapy services, eyeglasses not subject to
a volume purchase contract, hearing aids not subject to a volume purchase contract, and
anesthesia services shall be reduced by three percent from the rates in effect on August 31,
2011.

(e) Effective for services provided on or after September 1, 2014, payments for
ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory
services, public health nursing services, eyeglasses not subject to a volume purchase contract,
and hearing aids not subject to a volume purchase contract shall be increased by three percent
and payments for outpatient hospital facility fees shall be increased by three percent.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a volume
purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through
June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable
medical equipment not subject to a volume purchase contract, and prosthetics and orthotics,
provided on or after July 1, 2015, shall be increased by three percent from the rates as
determined under paragraphs (i) and (j).

(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
from the rates in effect on June 30, 2015. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.

(h) This deleted text begin sectiondeleted text end new text begin subdivisionnew text end does not apply to physician and professional services,
inpatient hospital services, family planning services, mental health services, dental services,
prescription drugs, medical transportation, federally qualified health centers, rural health
centers, Indian health services, and Medicare cost-sharing.

deleted text begin (i) Effective for services provided on or after July 1, 2015, the following categories of
medical supplies and durable medical equipment shall be individually priced items: enteral
nutrition and supplies, customized and other specialized tracheostomy tubes and supplies,
electric patient lifts, and durable medical equipment repair and service. This paragraph does
not apply to medical supplies and durable medical equipment subject to a volume purchase
contract, products subject to the preferred diabetic testing supply program, and items provided
to dually eligible recipients when Medicare is the primary payer for the item. The
commissioner shall not apply any medical assistance rate reductions to durable medical
equipment as a result of Medicare competitive bidding.
 deleted text end

deleted text begin (j) Effective for services provided on or after July 1, 2015, medical assistance payment
rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased
as follows:
 deleted text end

deleted text begin (1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and
 deleted text end

deleted text begin (2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).
 deleted text end

deleted text begin This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.
 deleted text end

deleted text begin (k)deleted text end new text begin (i)new text end Effective for nonpressure support ventilators provided on or after January 1, 2016,
the rate shall be the lower of the submitted charge or the Medicare fee schedule rate. Effective
for pressure support ventilators provided on or after January 1, 2016, the rate shall be the
lower of the submitted charge or 47 percent above the Medicare fee schedule rate. For
payments made in accordance with this paragraph, if, and to the extent that, the commissioner
identifies that the state has received federal financial participation for ventilators in excess
of the amount allowed effective January 1, 2018, under United States Code, title 42, section
1396b(i)(27), the state shall repay the excess amount to the Centers for Medicare and
Medicaid Services with state funds and maintain the full payment rate under this paragraph.

new text begin Subd. 2. new text end

new text begin Durable medical equipment. new text end

new text begin (a) Notwithstanding Minnesota Rules, part
9505.0445, item S, this subdivision governs medical assistance rates for medical supplies
and equipment described under this subdivision. Payment rates for all durable medical
equipment, prosthetics, orthotics, or supplies that are not subject to a volume purchase
contract, preferred product program, or competitively bid contract, and not reimbursed under
paragraph (b), shall be the lesser of the provider's submitted charges or the Medicare non-rural
fee schedule amount applicable on the date of service, with no increase or decrease described
in subdivision 1.
 new text end

new text begin (b) Payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
are not subject to a volume purchase contract, preferred product program, or competitively
bid contract for which Medicare has not established a payment amount shall be the lesser
of the provider's submitted charges, or the alternative payment methodology rate described
in paragraphs (c) to (h), with no increase or decrease described in subdivision 1.
 new text end

new text begin (c) The alternate payment methodology rate is calculated from either:
 new text end

new text begin (1) at least 100 paid claim lines, as priced under paragraph (f), provided by at least ten
different providers within one calendar month for services that are provided at least 100
times in a calendar month; or
 new text end

new text begin (2) at least 20 paid claim lines, as priced under paragraph (f), submitted by at least five
different providers within two consecutive quarters for services that are not provided 100
times in a calendar month.
 new text end

new text begin (d) The alternate payment methodology rate is the mean of the payment per unit of the
claim lines, with the top and bottom ten percent of claim lines, by amount of payment per
unit, excluded from the calculation of the mean.
 new text end

new text begin (e) The alternate payment methodology rate is added to the commissioner's fee schedule
on the first day of a calendar month, or the first day of a calendar quarter if claims from
more than one month are used to determine the rate. The alternate payment methodology
rate is subject to Medicare's inflation or deflation factor on January 1 of each year unless
the rate was calculated and posted to the fee schedule after July 1 of the previous year.
 new text end

new text begin (f) Not more than once every three years, the commissioner must evaluate the alternate
payment methodology rate for reasonableness by reviewing invoices from at least 20 paid
claim lines and five different providers for services provided during one calendar month,
or one quarter if necessary to obtain the required sample. If the evaluation demonstrates
that the alternate payment methodology rate is more than five percent higher or lower than
the provider's actual acquisition cost plus 20 percent, the commissioner shall recalculate
and update the alternate payment methodology fee schedule according to paragraphs (c) to
(e). If the evaluation demonstrates that the alternate payment methodology fee schedule
rate is not five percent higher or lower than the provider's actual acquisition cost plus 20
percent, or a sufficient sample of claims according to paragraph (a) cannot be collected due
to low utilization, the commissioner shall maintain the previously calculated alternate
payment methodology fee schedule.
 new text end

new text begin (g) Until sufficient data is available to calculate the alternative payment methodology
rate, the payment is based on the provider's actual acquisition cost plus 20 percent as
documented on an invoice submitted by the provider. The payment may be based on a quote
the provider received from a vendor showing the provider's actual acquisition cost only if
the durable medical equipment, prosthetic, orthotic, or supply requires authorization and
the rate is required to complete the authorization.
 new text end

new text begin (h) When procuring goods or services under competitive bidding authority in section
256B.04, the commissioner may establish a payment rate for the procured services, or
establish a fee schedule, based on the following:
 new text end

new text begin (1) the contracted rate established through a competitive procurement process;
 new text end

new text begin (2) actual acquisition cost plus 20 percent consistent with paragraph (f); or
 new text end

new text begin (3) a rate or rate methodology established by an administrative rule.
 new text end

Sec. 22.

Minnesota Statutes 2018, section 256B.767, is amended to read:


256B.767 MEDICARE PAYMENT LIMIT.

(a) Effective for services rendered on or after July 1, 2010, fee-for-service payment rates
for physician and professional services under section 256B.76, subdivision 1, and basic care
services subject to the rate reduction specified in section 256B.766, shall not exceed the
Medicare payment rate for the applicable service, as adjusted for any changes in Medicare
payment rates after July 1, 2010. The commissioner shall implement this section after any
other rate adjustment that is effective July 1, 2010, and shall reduce rates under this section
by first reducing or eliminating provider rate add-ons.

(b) This section does not apply to services provided by advanced practice certified nurse
midwives licensed under chapter 148 or traditional midwives licensed under chapter 147D.
Notwithstanding this exemption, medical assistance fee-for-service payment rates for
advanced practice certified nurse midwives and licensed traditional midwives shall equal
and shall not exceed the medical assistance payment rate to physicians for the applicable
service.

(c) This section does not apply to mental health services or physician services billed by
a psychiatrist or an advanced practice registered nurse with a specialty in mental health.

(d) deleted text begin Effective July 1, 2015,deleted text end This section shall not apply to durable medical equipment,
prosthetics, orthotics, or suppliesnew text begin specified in section 256B.766, paragraph (k)new text end .

(e) This section does not apply to physical therapy, occupational therapy, speech
pathology and related services, and basic care services provided by a hospital meeting the
criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4).

Sec. 23.

Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision
6, as amended by Laws 2004, chapter 272, article 2, section 4; Laws 2005, First Special
Session chapter 4, article 5, section 18; and Laws 2005, First Special Session chapter 4,
article 9, section 11, is amended to read:


Subd. 6.

Basic Health Care Grants
Summary by Fund
General
 1,290,454,000
 1,475,996,000
Health Care Access
 254,121,000
 282,689,000

UPDATING FEDERAL POVERTY
GUIDELINES. Annual updates to the federal
poverty guidelines are effective each July 1,
following publication by the United States
Department of Health and Human Services
for health care programs under Minnesota
Statutes, chapters 256, 256B, 256D, and 256L.

The amounts that may be spent from this
appropriation for each purpose are as follows:

(a) MinnesotaCare Grants

Health Care Access
 253,371,000
 281,939,000

MINNESOTACARE FEDERAL
RECEIPTS. Receipts received as a result of
federal participation pertaining to
administrative costs of the Minnesota health
care reform waiver shall be deposited as
nondedicated revenue in the health care access
fund. Receipts received as a result of federal
participation pertaining to grants shall be
deposited in the federal fund and shall offset
health care access funds for payments to
providers.

MINNESOTACARE FUNDING. The
commissioner may expend money
appropriated from the health care access fund
for MinnesotaCare in either fiscal year of the
biennium.

(b) MA Basic Health Care Grants - Families
and Children

General
 427,769,000
 489,545,000

SERVICES TO PREGNANT WOMEN.
The commissioner shall use available federal
money for the State-Children's Health
Insurance Program for medical assistance
services provided to pregnant women who are
not otherwise eligible for federal financial
participation beginning in fiscal year 2003.
This federal money shall be deposited in the
federal fund and shall offset general funds for
payments to providers. Notwithstanding
section 14, this paragraph shall not expire.

MANAGED CARE RATE INCREASE. deleted text begin (a)
Effective January 1, 2004, the commissioner
of human services shall increase the total
payments to managed care plans under
Minnesota Statutes, section 256B.69, by an
amount equal to the cost increases to the
managed care plans from by the elimination
of: (1) the exemption from the taxes imposed
under Minnesota Statutes, section 297I.05,
subdivision 5, for premiums paid by the state
deleted text end deleted text begin for medical assistance, general assistance
medical care, and the MinnesotaCare program;
and (2) the exemption of gross revenues
subject to the taxes imposed under Minnesota
Statutes, sections 295.50 to 295.57, for
payments paid by the state for services
provided under medical assistance, general
assistance medical care, and the
MinnesotaCare program. Any increase based
on clause (2) must be reflected in provider
rates paid by the managed care plan unless the
managed care plan is a staff model health plan
company.
deleted text end

deleted text begin (b) The commissioner of human services shall
increase by the applicable tax rate in effect
under Minnesota Statutes, section 295.52, the
fee-for-service payments under medical
assistance, general assistance medical care,
and the MinnesotaCare program for services
subject to the hospital, surgical center, or
health care provider taxes under Minnesota
Statutes, sections 295.50 to 295.57, effective
for services rendered on or after January 1,
2004.
 deleted text end

(c) The commissioner of finance shall transfer
from the health care access fund to the general
fund the following amounts in the fiscal years
indicated: 2004, $16,587,000; 2005,
$46,322,000; 2006, $49,413,000; and 2007,
$58,695,000.

(d) Notwithstanding section 14, these
provisions shall not expire.

(c) MA Basic Health Care Grants - Elderly
and Disabled

General
 610,518,000
 743,858,000

DELAY MEDICAL ASSISTANCE
FEE-FOR-SERVICE - ACUTE CARE. The
following payments in fiscal year 2005 from
the Medicaid Management Information
System that would otherwise have been made
to providers for medical assistance and general
assistance medical care services shall be
delayed and included in the first payment in
fiscal year 2006:

(1) for hospitals, the last two payments; and

(2) for nonhospital providers, the last payment.

This payment delay shall not include payments
to skilled nursing facilities, intermediate care
facilities for mental retardation, prepaid health
plans, home health agencies, personal care
nursing providers, and providers of only
waiver services. The provisions of Minnesota
Statutes, section 16A.124, shall not apply to
these delayed payments. Notwithstanding
section 14, this provision shall not expire.

DEAF AND HARD-OF-HEARING
SERVICES. If, after making reasonable
efforts, the service provider for mental health
services to persons who are deaf or hearing
impaired is not able to earn $227,000 through
participation in medical assistance intensive
rehabilitation services in fiscal year 2005, the
commissioner shall transfer $227,000 minus
medical assistance earnings achieved by the
grantee to deaf and hard-of-hearing grants to
enable the provider to continue providing
services to eligible persons.

(d) General Assistance Medical Care Grants

General
 239,861,000
 229,960,000

(e) Health Care Grants - Other Assistance

General
 3,067,000
 3,407,000
Health Care Access
 750,000
 750,000

MINNESOTA PRESCRIPTION DRUG
DEDICATED FUND. Of the general fund
appropriation, $284,000 in fiscal year 2005 is
appropriated to the commissioner for the
prescription drug dedicated fund established
under the prescription drug discount program.

DENTAL ACCESS GRANTS
CARRYOVER AUTHORITY. Any unspent
portion of the appropriation from the health
care access fund in fiscal years 2002 and 2003
for dental access grants under Minnesota
Statutes, section 256B.53, shall not cancel but
shall be allowed to carry forward to be spent
in the biennium beginning July 1, 2003, for
these purposes.

STOP-LOSS FUND ACCOUNT. The
appropriation to the purchasing alliance
stop-loss fund account established under
Minnesota Statutes, section 256.956,
subdivision 2, for fiscal years 2004 and 2005
shall only be available for claim
reimbursements for qualifying enrollees who
are members of purchasing alliances that meet
the requirements described under Minnesota
Statutes, section 256.956, subdivision 1,
paragraph (f), clauses (1), (2), and (3).

(f) Prescription Drug Program

General
 9,239,000
 9,226,000

PRESCRIPTION DRUG ASSISTANCE
PROGRAM. Of the general fund
appropriation, $702,000 in fiscal year 2004
and $887,000 in fiscal year 2005 are for the
commissioner to establish and administer the
prescription drug assistance program through
the Minnesota board on aging.

REBATE REVENUE RECAPTURE. Any
funds received by the state from a drug
manufacturer due to errors in the
pharmaceutical pricing used by the
manufacturer in determining the prescription
drug rebate are appropriated to the
commissioner to augment funding of the
prescription drug program established in
Minnesota Statutes, section 256.955.

Sec. 24. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, section 256B.0659, subdivision 22, new text end new text begin is repealed.
 new text end

ARTICLE 9

ONECARE BUY-IN

Section 1.

Minnesota Statutes 2018, section 62J.497, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For the purposes of this section, the following terms have
the meanings given.

(b) "Backward compatible" means that the newer version of a data transmission standard
would retain, at a minimum, the full functionality of the versions previously adopted, and
would permit the successful completion of the applicable transactions with entities that
continue to use the older versions.

(c) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 30.
Dispensing does not include the direct administering of a controlled substance to a patient
by a licensed health care professional.

(d) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.

(e) "Electronic media" has the meaning given under Code of Federal Regulations, title
45, part 160.103.

(f) "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.

(g) "Electronic prescription drug program" means a program that provides for
e-prescribing.

(h) "Group purchaser" has the meaning given in section 62J.03, subdivision 6deleted text begin .deleted text end new text begin , excluding
state and federal health care programs under chapters 256B, 256L, and 256T.
new text end

(i) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.

(j) "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.

(k) "NCPDP" means the National Council for Prescription Drug Programs, Inc.

(l) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.

(m) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug
Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide Version
8, Release 1 (Version 8.1), October 2005, or the most recent standard adopted by the Centers
for Medicare and Medicaid Services for e-prescribing under Medicare Part D as required
by section 1860D-4(e)(4)(D) of the Social Security Act, and regulations adopted under it.
The standards shall be implemented according to the Centers for Medicare and Medicaid
Services schedule for compliance. Subsequently released versions of the NCPDP SCRIPT
Standard may be used, provided that the new version of the standard is backward compatible
to the current version adopted by the Centers for Medicare and Medicaid Services.

(n) "Pharmacy" has the meaning given in section 151.01, subdivision 2.

(o) "Prescriber" means a licensed health care practitioner, other than a veterinarian, as
defined in section 151.01, subdivision 23.

(p) "Prescription-related information" means information regarding eligibility for drug
benefits, medication history, or related health or drug information.

(q) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
 new text end

Sec. 2.

new text begin [256B.0371] ADMINISTRATION OF DENTAL SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Contract for dental administration services. new text end

new text begin (a) Effective January 1,
2022, the commissioner shall contract with up to two dental administrators to administer
dental services for all recipients of medical assistance and MinnesotaCare.
 new text end

new text begin (b) The dental administrator must provide administrative services including but not
limited to:
 new text end

new text begin (1) provider recruitment, contracting, and assistance;
 new text end

new text begin (2) recipient outreach and assistance;
 new text end

new text begin (3) utilization management and review for medical necessity of dental services;
 new text end

new text begin (4) dental claims processing;
 new text end

new text begin (5) coordination with other services;
 new text end

new text begin (6) management of fraud and abuse;
 new text end

new text begin (7) monitoring of access to dental services;
 new text end

new text begin (8) performance measurement;
 new text end

new text begin (9) quality improvement and evaluation requirements; and
 new text end

new text begin (10) management of third-party liability requirements.
 new text end

new text begin (c) Payments to contracted dental providers must be at the rates established under section
256B.76.
 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. 3.

Minnesota Statutes 2018, section 256B.0644, is amended to read:


256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a health
maintenance organization, as defined in chapter 62D, must participate as a provider or
contractor in the medical assistance program and MinnesotaCare as a condition of
participating as a provider in health insurance plans and programs or contractor for state
employees established under section 43A.18, the public employees insurance program under
section 43A.316, for health insurance plans offered to local statutory or home rule charter
city, county, and school district employees, the workers' compensation system under section
176.135, and insurance plans provided through the Minnesota Comprehensive Health
Association under sections 62E.01 to 62E.19. The limitations on insurance plans offered to
local government employees shall not be applicable in geographic areas where provider
participation is limited by managed care contracts with the Department of Human Services.
This section does not apply to dental service providers providing dental services outside
the seven-county metropolitan area.

(b) For providers other than health maintenance organizations, participation in the medical
assistance program means that:

(1) the provider accepts new medical assistance and MinnesotaCare patients;

(2) for providers other than dental service providers, at least 20 percent of the provider's
patients are covered by medical assistance and MinnesotaCare as their primary source of
coverage; or

(3) for dental service providers providing dental services in the seven-county metropolitan
area, at least ten percent of the provider's patients are covered by medical assistance and
MinnesotaCare as their primary source of coverage, or the provider accepts new medical
assistance and MinnesotaCare patients who are children with special health care needs. For
purposes of this section, "children with special health care needs" means children up to age
18 who: (i) require health and related services beyond that required by children generally;
and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
neurological diseases; visual impairment or deafness; Down syndrome and other genetic
disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and
consumers.

(c) Patients seen on a volunteer basis by the provider at a location other than the provider's
usual place of practice may be considered in meeting the participation requirement in this
section. The commissioner shall establish participation requirements for health maintenance
organizations. The commissioner shall provide lists of participating medical assistance
providers on a quarterly basis to the commissioner of management and budget, the
commissioner of labor and industry, and the commissioner of commerce. Each of the
commissioners shall develop and implement procedures to exclude as participating providers
in the program or programs under their jurisdiction those providers who do not participate
in the medical assistance program. The commissioner of management and budget shall
implement this section through contracts with participating health and dental carriers.

(d) A volunteer dentist who has signed a volunteer agreement under section 256B.0625,
subdivision 9a, shall not be considered to be participating in medical assistance or
MinnesotaCare for the purpose of this section.

new text begin (e) A vendor of medical care, as defined in section 256B.02, subdivision 7, that dispenses
outpatient prescription drugs in accordance with chapter 151 must participate as a provider
or contractor in the MinnesotaCare program as a condition of participating as a provider in
the medical assistance program.
 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. 4.

Minnesota Statutes 2018, section 256B.69, subdivision 6d, is amended to read:


Subd. 6d.

Prescription drugs.

The commissioner may exclude or modify coverage for
prescription drugs from the prepaid managed care contracts entered into under this section
deleted text begin 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 rebatesdeleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 256B.76, subdivision 2, is amended to read:


Subd. 2.

Dental reimbursement.

(a) Effective for services rendered on or after October
1, 1992, the commissioner shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) Effective for services rendered on or after January 1, 2000, payment rates for dental
services shall be increased by three percent over the rates in effect on December 31, 1999.

(d) Effective for services provided on or after January 1, 2002, payment for diagnostic
examinations and dental x-rays provided to children under age 21 shall be the lower of (1)
the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for dental services shall be reduced by three percent. This reduction does not
apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, payment rates for dental
services shall be increased by five percent from the rates in effect on December 31, 2013.
This increase does not apply to state-operated dental clinics in paragraph (f), federally
qualified health centers, rural health centers, and Indian health services. Effective January
1, 2014, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase described in
this paragraph.

(k) Effective for services rendered on or after July 1, 2015, through December 31, 2016,
the commissioner shall increase payment rates for services furnished by dental providers
located outside of the seven-county metropolitan area by the maximum percentage possible
above the rates in effect on June 30, 2015, while remaining within the limits of funding
appropriated for this purpose. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2016, through December 31, 2016, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph. The commissioner shall require managed
care and county-based purchasing plans to pass on the full amount of the increase, in the
form of higher payment rates to dental providers located outside of the seven-county
metropolitan area.

(l) Effective for services provided on or after January 1, 2017new text begin , through December 31,
2021new text end , the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph.

(m) Effective for services provided on or after July 1, 2017new text begin , through December 31, 2021new text end ,
the commissioner shall increase payment rates by 23.8 percent for dental services provided
to enrollees under the age of 21. This rate increase does not apply to state-operated dental
clinics in paragraph (f), federally qualified health centers, rural health centers, or Indian
health centers. This rate increase does not apply to managed care plans and county-based
purchasing plans.

new text begin (n) Effective for dental services provided on or after January 1, 2022, the commissioner
shall increase payment rates by 54 percent. This rate increase does not apply to state-operated
dental clinics in paragraph (f), federally qualified health centers, rural health centers, or
Indian health centers.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 256B.76, subdivision 4, is amended to read:


Subd. 4.

Critical access dental providers.

(a) The commissioner shall increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. For dental services rendered on or after July 1, 2016, new text begin through
December 31, 2021, new text end the commissioner shall increase reimbursement by 37.5 percent above
the reimbursement rate that would otherwise be paid to the critical access dental provider,
except as specified under paragraph (b). The commissioner shall pay the managed care
plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) For dental services rendered on or after July 1, 2016, by a dental clinic or dental
group that meets the critical access dental provider designation under paragraph (d), clause
(4), and is owned and operated by a health maintenance organization licensed under chapter
62D, the commissioner shall increase reimbursement by 35 percent above the reimbursement
rate that would otherwise be paid to the critical access provider.

(c) Critical access dental payments made under paragraph (a) or (b) for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.

(d) The commissioner shall designate the following dentists and dental clinics as critical
access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's patients;

(v) charge for services on a sliding fee scale designed to provide assistance to low-income
patients based on current poverty income guidelines and family size;

(vi) do not restrict access or services because of a patient's financial limitations or public
assistance status; and

(vii) have free care available as needed;

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) hospital-based dental clinics owned and operated by a city, county, or former state
hospital as defined in section 62Q.19, subdivision 1, paragraph (a), clause (4);

(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;

(5) a dental clinic owned and operated by the University of Minnesota or the Minnesota
State Colleges and Universities system; and

(6) private practicing dentists if:

(i) the dentist's office is located within the seven-county metropolitan area and more
than 50 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare; or

(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare.

Sec. 7.

Minnesota Statutes 2018, section 256L.03, is amended by adding a subdivision to
read:


new text begin Subd. 7. new text end

new text begin Outpatient prescription drugs. new text end

new text begin Outpatient prescription drugs are covered
according to section 256L.30. This subdivision applies to all individuals enrolled in the
MinnesotaCare program.
 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. 8.

Minnesota Statutes 2018, section 256L.11, subdivision 7, is amended to read:


Subd. 7.

Critical access dental providers.

Effective for dental services provided to
MinnesotaCare enrollees on or after July 1, 2017new text begin , through December 31, 2021new text end , the
commissioner shall increase payment rates to dentists and dental clinics deemed by the
commissioner to be critical access providers under section 256B.76, subdivision 4, by 20
percent above the payment rate that would otherwise be paid to the provider. The
commissioner shall pay the prepaid health plans under contract with the commissioner
amounts sufficient to reflect this rate increase. The prepaid health plan must pass this rate
increase to providers who have been identified by the commissioner as critical access dental
providers under section 256B.76, subdivision 4.

Sec. 9.

new text begin [256L.30] OUTPATIENT PRESCRIPTION DRUGS.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment of program. new text end

new text begin The commissioner shall administer and
oversee the outpatient prescription drug program for MinnesotaCare. The commissioner
shall not include the outpatient pharmacy benefit in a contract with a public or private entity.
 new text end

new text begin Subd. 2. new text end

new text begin Covered outpatient prescription drugs. new text end

new text begin (a) In consultation with the Drug
Formulary Committee under section 256B.0625, subdivision 13d, the commissioner shall
establish an outpatient prescription drug formulary for MinnesotaCare that satisfies the
requirements for an essential health benefit under Code of Federal Regulations, title 45,
section 156.122. The commissioner may modify the formulary after consulting with the
Drug Formulary Committee and providing public notice and the opportunity for public
comment. The commissioner is exempt from the rulemaking requirements of chapter 14 to
establish the drug formulary, and section 14.386 does not apply. The commissioner shall
make the drug formulary available to the public on the agency website.
 new text end

new text begin (b) The MinnesotaCare formulary must contain at least one drug in every United States
Pharmacopeia category and class or the same number of prescription drugs in each category
and class as the essential health benefit benchmark plan, whichever is greater.
 new text end

new text begin (c) The commissioner may negotiate drug rebates or discounts directly with a drug
manufacturer to place a drug on the formulary. The commissioner may also negotiate drug
rebates, or discounts, with a drug manufacturer through a contract with a vendor.
 new text end

new text begin (d) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Drug Formulary Committee may recommend drugs for
prior authorization directly to the commissioner. The commissioner may also request that
the Drug Formulary Committee review a drug for prior authorization.
 new text end

new text begin (e) Before the commissioner requires prior authorization for a drug:
 new text end

new text begin (1) the commissioner must provide the Drug Formulary Committee with information
on the impact that placing the drug on prior authorization may have on the quality of patient
care and on program costs and information regarding whether the drug is subject to clinical
abuse or misuse if such data is available; and
 new text end

new text begin (2) the Drug Formulary Committee must hold a public forum and receive public comment
for an additional 15 days from the date of the public forum.
 new text end

new text begin (f) Notwithstanding paragraph (e), the commissioner may automatically require prior
authorization for a period not to exceed 180 days for any drug that is approved by the United
States Food and Drug Administration after July 1, 2019. The 180-day period begins no later
than the first day that a drug is available for shipment to pharmacies within the state. The
Drug Formulary Committee shall recommend to the commissioner general criteria to use
for determining prior authorization of the drugs, but the Drug Formulary Committee is not
required to review each individual drug.
 new text end

new text begin (g) The commissioner may also require prior authorization before nonformulary drugs
are eligible for payment.
 new text end

new text begin (h) Prior authorization requests must be processed in accordance with Code of Federal
Regulations, title 45, section 156.122.
 new text end

new text begin Subd. 3. new text end

new text begin Pharmacy provider participation. new text end

new text begin (a) A pharmacy enrolled to dispense
prescription drugs to medical assistance enrollees under section 256B.0625 must participate
as a provider in the MinnesotaCare outpatient prescription drug program.
 new text end

new text begin (b) A pharmacy that is enrolled to dispense prescription drugs to MinnesotaCare enrollees
is not permitted to refuse service to an enrollee unless:
 new text end

new text begin (1) the pharmacy does not have a prescription drug in stock and cannot obtain the drug
in time to treat the enrollee's medical condition;
 new text end

new text begin (2) the enrollee is unable or unwilling to pay the enrollee's co-payment at the time the
drug is dispensed;
 new text end

new text begin (3) after performing drug utilization review, the pharmacist identifies the prescription
drug as being a therapeutic duplication, having a drug-disease contraindication, having a
drug-drug interaction, having been prescribed for the incorrect dosage or duration of
treatment, having a drug-allergy interaction, or having issues related to clinical abuse or
misuse by the enrollee;
 new text end

new text begin (4) the prescription drug is not covered by MinnesotaCare; or
 new text end

new text begin (5) dispensing the drug would violate a provision of chapter 151.
 new text end

new text begin Subd. 4. new text end

new text begin Covered outpatient prescription drug reimbursement rate. new text end

new text begin (a) The basis
for determining the amount of payment shall be the lowest of the National Average Drug
Acquisition Cost; the maximum allowable cost established under section 256B.0625,
subdivision 13e, plus a fixed dispensing fee; or the usual and customary price. The fixed
dispensing fee shall be $1.50 for covered outpatient prescription drugs.
 new text end

new text begin (b) The basis for determining the amount of payment for a pharmacy that acquires drugs
through the federal 340B Drug Pricing Program shall be the lowest of (1) the National
Average Drug Acquisition Cost minus 30 percent; (2) the maximum allowable cost
established under section 256B.0625, subdivision 13e, minus 30 percent, plus a fixed
dispensing fee; or (3) the usual and customary price. The fixed dispensing fee shall be $1.50
for covered outpatient prescription drugs.
 new text end

new text begin (c) For purposes of this subdivision, the usual and customary price is the lowest price
charged by the provider to a patient who pays for the prescription by cash, check, or charge
account and includes the prices the pharmacy charges to customers enrolled in a prescription
savings club or prescription discount club administered by the pharmacy, pharmacy chain,
or contractor to the provider.
 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. 10.

new text begin [256T.01] PURPOSE.
 new text end

new text begin (a) The legislature finds that the staggering growth in health care costs is having a
devastating effect on the health and cost of living of Minnesota residents. The legislature
further finds that the number of uninsured and underinsured residents is growing each year
and that the cost of health care coverage for our insured residents often far exceeds their
ability to pay.
 new text end

new text begin (b) The legislature further finds that it must enact immediate and intensive cost
containment measures to limit the growth of health care expenditures, reform insurance
practices, and finance a plan that offers access to affordable health care for Minnesota
residents by capturing dollars now lost to inefficiencies in Minnesota's health care system.
 new text end

new text begin (c) The legislature further finds that providing affordable access to health care is essential
to quality of life in Minnesota.
 new text end

new text begin (d) It is, therefore, the intent of the legislature to establish the OneCare Buy-In to address
the immediate challenges of affordability and access related to prescription drugs and dental
care and to offer comprehensive coverage options that establish contingencies for failures
in the individual market.
 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.

new text begin [256T.02] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin For purposes of this chapter, the terms in this section have
the meanings given.
 new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of human services.
 new text end

new text begin Subd. 3. new text end

new text begin Department. new text end

new text begin "Department" means the Department of Human Services.
 new text end

new text begin Subd. 4. new text end

new text begin Essential health benefits. new text end

new text begin "Essential health benefits" has the meaning given
in section 62Q.81, subdivision 4.
 new text end

new text begin Subd. 5. new text end

new text begin Individual market. new text end

new text begin "Individual market" has the meaning given in section
62A.011, subdivision 5.
 new text end

new text begin Subd. 6. new text end

new text begin MNsure website. new text end

new text begin "MNsure website" has the meaning given in section 62V.02,
subdivision 13.
 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.

new text begin [256T.03] ONECARE BUY-IN.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin (a) The commissioner shall establish a program consistent
with this section to offer products developed for the OneCare Buy-In through the MNsure
website.
 new text end

new text begin (b) The commissioner, in collaboration with the commissioner of commerce and the
MNsure Board, shall:
 new text end

new text begin (1) establish a cost allocation methodology to reimburse MNsure operations in lieu of
the premium withhold for qualified health plans under section 62V.05;
 new text end

new text begin (2) implement mechanisms to ensure the long-term financial sustainability of Minnesota's
public health care programs and mitigate any adverse financial impacts to the state and
MNsure. These mechanisms must minimize adverse selection, state financial risk and
contribution, and negative impacts to premiums in the individual and group health insurance
markets; and
 new text end

new text begin (3) coordinate eligibility and coverage to ensure that persons, to the extent possible,
transitioning between medical assistance, MinnesotaCare, and the OneCare Buy-In have
continuity of care.
 new text end

new text begin (c) The OneCare Buy-In shall be considered: (1) a public health care program for purposes
of chapter 62V; and (2) the MinnesotaCare program for purposes of requirements for health
maintenance organizations under section 62D.04, subdivision 5, and providers under section
256B.0644.
 new text end

new text begin (d) The Department of Human Services is deemed to meet and receive certification and
authority under section 62D.03 and be in compliance with sections 62D.01 to 62D.30. The
commissioner has the authority to accept and expend all federal funds made available under
this chapter upon federal approval.
 new text end

new text begin Subd. 2. new text end

new text begin Premium administration and payment. new text end

new text begin (a) The commissioner shall establish
annually a per-enrollee monthly premium rate. The commissioner shall publish the premium
rate by August 1 of each year.
 new text end

new text begin (b) OneCare Buy-In premium administration shall be consistent with requirements under
the federal Affordable Care Act for qualified health plan premium administration. Premium
rates shall be established in accordance with section 62A.65, subdivision 3.
 new text end

new text begin Subd. 3. new text end

new text begin Rates to providers. new text end

new text begin The commissioner shall establish rates for provider
payments that are targeted to the current rates established under chapter 256L, plus the
aggregate difference between those rates and Medicare rates. The aggregate must not consider
services that receive a Medicare encounter payment.
 new text end

new text begin Subd. 4. new text end

new text begin Reserve requirements. new text end

new text begin A OneCare Buy-In reserve account is established in
the state treasury. Enrollee premiums collected under subdivision 2 shall be deposited into
the reserve account. The reserve account shall be used to cover expenditures related to
operation of the OneCare Buy-In, including the payment of claims and all other accrued
liabilities. No other account within the state treasury shall be used to finance the reserve
account except as otherwise specified in state law.
 new text end

new text begin Subd. 5. new text end

new text begin Covered benefits. new text end

new text begin Each health plan established under this chapter must include
the essential health benefits package required under section 1302(a) of the Affordable Care
Act and as described in section 62Q.81; dental services described in section 256B.0625,
subdivision 9, paragraphs (b) and (c); and vision services described in Minnesota Rules,
part 9505.0277, and may include other services under section 256L.03, subdivision 1.
 new text end

new text begin Subd. 6. new text end

new text begin Third-party administrator. new text end

new text begin (a) The commissioner may enter into a contract
with a third-party administrator to perform the operational management of the OneCare
Buy-In. Duties of the third-party administrator include but are not limited to the following:
 new text end

new text begin (1) development and distribution of plan materials for potential enrollees;
 new text end

new text begin (2) receipt and processing of electronic enrollment files sent from the state;
 new text end

new text begin (3) creation and distribution of plan enrollee materials including identification cards,
certificates of coverage, plan formulary, provider directory, and premium billing statements;
 new text end

new text begin (4) processing premium payments and sending termination notices for nonpayment to
enrollees and the state;
 new text end

new text begin (5) payment and adjudication of claims;
 new text end

new text begin (6) utilization management;
 new text end

new text begin (7) coordination of benefits;
 new text end

new text begin (8) grievance and appeals activities; and
 new text end

new text begin (9) fraud, waste, and abuse prevention activities.
 new text end

new text begin (b) Any solicitation of vendors to serve as the third-party administrator is subject to the
requirements under section 16C.06.
 new text end

new text begin Subd. 7. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for the OneCare Buy-In, a person must:
 new text end

new text begin (1) be a resident of Minnesota; and
 new text end

new text begin (2) not be eligible for government-sponsored programs as defined in United States Code,
title 26, section 5000A(f)(1)(A). For purposes of this subdivision, an applicant or enrollee
who is entitled to Medicare Part A or enrolled in Medicare Part B coverage under title XVIII
of the Social Security Act, United States Code, title 42, sections 1395c to 1395w-152, is
considered eligible for government-sponsored programs. An applicant or enrollee who is
entitled to premium-free Medicare Part A shall not refuse to apply for or enroll in Medicare
coverage to establish eligibility for the OneCare Buy-In.
 new text end

new text begin (b) A person who is determined eligible for enrollment in a qualified health plan with
or without advance payments of the premium tax credit and with or without cost-sharing
reductions according to Code of Federal Regulations, title 45, section 155.305, paragraphs
(a), (f), and (g), is eligible to purchase and enroll in the OneCare Buy-In instead of purchasing
a qualified health plan as defined under section 62V.02.
 new text end

new text begin Subd. 8. new text end

new text begin Enrollment. new text end

new text begin (a) A person may apply for the OneCare Buy-In during the annual
open and special enrollment periods established for MNsure as defined in Code of Federal
Regulations, title 45, sections 155.410 and 155.420 through the MNsure website.
 new text end

new text begin (b) A person must annually reenroll for the OneCare Buy-In during open and special
enrollment periods.
 new text end

new text begin Subd. 9. new text end

new text begin Premium tax credits, cost-sharing reductions, and subsidies. new text end

new text begin A person who
is eligible under this chapter, and whose income is less than or equal to 400 percent of the
federal poverty guidelines, may qualify for advance premium tax credits and cost-sharing
reductions under Code of Federal Regulations, title 45, section 155.305, paragraphs (a), (f),
and (g), to purchase a health plan established under this chapter.
 new text end

new text begin Subd. 10. new text end

new text begin Covered benefits and payment rate modifications. new text end

new text begin The commissioner, after
providing public notice and an opportunity for public comment, may modify the covered
benefits and payment rates to carry out this chapter.
 new text end

new text begin Subd. 11. new text end

new text begin Request for federal authority. new text end

new text begin The commissioner shall seek all necessary
federal waivers to establish the OneCare Buy-In under this chapter.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin (a) Subdivisions 1 to 10 are effective January 1, 2023.
 new text end

new text begin (b) Subdivision 11 is effective the day following final enactment.
 new text end

Sec. 13.

new text begin [256T.04] ONECARE BUY-IN PRODUCTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Platinum product. new text end

new text begin The commissioner of human services shall establish
a OneCare Buy-In coverage option that provides platinum level of coverage in accordance
with the Affordable Care Act and benefits that are actuarially equivalent to 90 percent of
the full actuarial value of the benefits provided under the OneCare Buy-In coverage option.
This product must be made available in all rating areas in the state.
 new text end

new text begin Subd. 2. new text end

new text begin Silver and gold products. new text end

new text begin (a) If any rating area lacks an affordable or
comprehensive health care coverage option according to standards developed by the
commissioner of health, the following year the commissioner of human services shall offer
silver and gold products established under paragraph (b) in the rating area for a five-year
period. Notwithstanding section 62U.04, subdivision 11, the commissioner of health may
use data collected under section 62U.04, subdivisions 4 and 5, to monitor triggers in the
individual market under this chapter. Effective January 1, 2020, the commissioner of health
may require submission of additional data elements under section 62U.04, subdivisions 4
and 5, in a manner specified by the commissioner, to conduct the analysis necessary to
monitor the individual market under this chapter.
 new text end

new text begin (b) The commissioner shall establish the following OneCare Buy-In coverage options:
one coverage option shall provide silver level of coverage in accordance with the Affordable
Care Act and benefits that are actuarially equivalent to 70 percent of the full actuarial value
of the benefits provided under the OneCare Buy-In coverage option, and one coverage
option shall provide gold level of coverage in accordance with the Affordable Care Act and
benefits that are actuarially equivalent to 80 percent of the full actuarial value of the benefits
provided under the OneCare Buy-In coverage option.
 new text end

new text begin Subd. 3. new text end

new text begin Qualified health plan rules. new text end

new text begin (a) The coverage options developed under this
section are subject to the process under section 62K.06. The coverage options developed
under this section are deemed to meet requirements of chapters 62A, 62K, and 62V that
apply to qualified health plans.
 new text end

new text begin (b) Notwithstanding any other law to the contrary, benefits under this section are
secondary to a plan of insurance or benefit program under which an eligible person may
have coverage. The commissioner shall use cost-avoidance techniques to coordinate any
other health coverage for eligible persons and identify eligible persons who may have
coverage or benefits under other plans of insurance.
 new text end

new text begin (c) The Department of Human Services is not an insurance company for purposes of
this chapter.
 new text end

new text begin Subd. 4. new text end

new text begin Actuarial value. new text end

new text begin Determination of the actuarial value of coverage options under
this section must be calculated in accordance with Code of Federal Regulations, title 45,
section 156.135.
 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. 14.

new text begin [256T.30] OUTPATIENT PRESCRIPTION DRUGS.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment of program. new text end

new text begin The commissioner shall administer and
oversee the outpatient prescription drug program. The commissioner shall not include the
outpatient pharmacy benefit in a contract with a public or private entity.
 new text end

new text begin Subd. 2. new text end

new text begin Covered outpatient prescription drugs. new text end

new text begin Outpatient prescription drugs are
covered in accordance with chapter 256L.
 new text end

new text begin Subd. 3. new text end

new text begin Pharmacy provider participation. new text end

new text begin (a) A pharmacy enrolled to dispense
prescription drugs to medical assistance enrollees under section 256B.0625 must participate
as a provider in the outpatient prescription drug program under this section.
 new text end

new text begin (b) A pharmacy that is enrolled to dispense prescription drugs under this section is not
permitted to refuse service to an enrollee unless:
 new text end

new text begin (1) the pharmacy does not have a prescription drug in stock and cannot obtain the drug
in time to treat the enrollee's medical condition;
 new text end

new text begin (2) the enrollee is unable or unwilling to pay the enrollee's co-payment at the time the
drug is dispensed;
 new text end

new text begin (3) after performing drug utilization review, the pharmacist identifies the prescription
drug as being a therapeutic duplication, having a drug-disease contraindication, having a
drug-drug interaction, having been prescribed for the incorrect dosage or duration of
treatment, having a drug-allergy interaction, or having issues related to clinical abuse or
misuse by the enrollee;
 new text end

new text begin (4) the prescription drug is not covered by the plan; or
 new text end

new text begin (5) dispensing the drug would violate a provision of chapter 151.
 new text end

new text begin Subd. 4. new text end

new text begin Reimbursement rate. new text end

new text begin The commissioner shall establish outpatient prescription
drug reimbursement rates according to chapter 256L.
 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. 15. new text begin DIRECTION TO COMMISSIONER; STATE-BASED RISK ADJUSTMENT
ANALYSIS.
new text end

new text begin The commissioner of commerce, in consultation with the commissioner of health, shall
conduct a study on the design and implementation of a state-based risk adjustment program.
The commissioner shall report on the findings of the study and any recommendations to
the legislative committees with jurisdiction over the individual health insurance market by
February 15, 2021.
 new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, section 256L.11, subdivision 6a, 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 January 1, 2022.
 new text end

ARTICLE 10

OPIOIDS

Section 1.

Minnesota Statutes 2018, section 151.01, is amended by adding a subdivision
to read:


new text begin Subd. 2b. new text end

new text begin Chain pharmacy. new text end

new text begin "Chain pharmacy" means any pharmacy that is part of a
group of ten or more establishments that (1) conduct business under the same business
name, or (2) operate under common ownership or management or pursuant to a franchise
agreement with the same franchisor.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 151.01, is amended by adding a subdivision to
read:


new text begin Subd. 42. new text end

new text begin Unit. new text end

new text begin "Unit" means, with respect to a particular drug product, the individual
dosage form of the drug product that is most commonly prescribed to a patient, including
but not limited to tablet, capsule, patch, syringe, milliliter, or gram.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 151.065, is amended by adding a subdivision to
read:


new text begin Subd. 3a. new text end

new text begin Controlled substance registration fees. new text end

new text begin (a) Initial and annual renewal
controlled substance registration fees are as follows:
 new text end

new text begin (1) controlled substance drug manufacturer, large, $75,000;
 new text end

new text begin (2) controlled substance drug manufacturer, medium, $5,000;
 new text end

new text begin (3) controlled substance drug manufacturer, small, $500;
 new text end

new text begin (4) drug wholesaler distributing controlled substances, large, $75,000;
 new text end

new text begin (5) drug wholesaler distributing controlled substances, small, $2,500;
 new text end

new text begin (6) pharmacy dispensing controlled substances, other than hospital or chain pharmacy,
$2,500;
 new text end

new text begin (7) pharmacy other than a hospital, independent, $500;
 new text end

new text begin (8) pharmacy, hospital (50 or more beds), $2,500;
 new text end

new text begin (9) pharmacy, hospital (fewer than 50 beds), $500;
 new text end

new text begin (10) practitioner prescribing, administering, or dispensing controlled substances, $125;
and
 new text end

new text begin (11) controlled substances researcher, $125.
 new text end

new text begin (b) For the purposes of this subdivision:
 new text end

new text begin (1) a controlled substance drug manufacturer shall be subject to the fee established under
paragraph (a), clause (1), if the data collected through the prescription monitoring program
established under section 152.126 indicates that 5,000,000 or more units of the manufacturer's
controlled substance products have been dispensed to residents of this state during the
previous calendar year;
 new text end

new text begin (2) a controlled substance drug manufacturer shall be subject to the fee established under
paragraph (a), clause (2), if the data collected through the prescription monitoring program
established under section 152.126 indicates that more than 1,000,000 but less than 5,000,000
units of the manufacturer's controlled substance products have been dispensed to residents
of this state during the previous calendar year;
 new text end

new text begin (3) a controlled substance drug manufacturer shall be subject to the fee established under
paragraph (a), clause (3), if the data collected through the prescription monitoring program
established under section 152.126 indicates that 1,000,000 or fewer units of the
manufacturer's controlled substance products have been dispensed to residents of this state
during the previous calendar year;
 new text end

new text begin (4) a wholesaler of controlled substances shall be subject to the fee established under
paragraph (a), clause (4), if the data collected pursuant to section 152.10, subdivision 4,
indicates that the wholesaler has distributed 5,000,000 or more units of controlled substances
within or into this state; and
 new text end

new text begin (5) a wholesaler of controlled substances shall be subject to the fee established under
paragraph (a), clause (5), if the data collected pursuant to section 152.10, subdivision 4,
indicates that the wholesaler has distributed less than 5,000,000 units of controlled substances
within or into this state.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 151.252, subdivision 1, is amended to read:


Subdivision 1.

Requirements.

(a) No person shall act as a drug manufacturer without
first obtaining a license from the board and paying any applicable fee specified in section
151.065.

new text begin (b) In addition to the license required under paragraph (a), a manufacturer of a Schedule
II through IV opiate controlled substance must pay the applicable registration fee specified
in section 151.77, subdivision 3, by June 1 of each year, beginning June 1, 2020. In the
event of a change of ownership of the manufacturer, the new owner must pay the registration
fee specified under section 151.77, subdivision 3, that the original owner would have been
assessed had it retained ownership. The board may assess a late fee of ten percent per month
for every portion of a month that the registration fee is paid after the due date.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end Application for a drug manufacturer license under this section shall be made in
a manner specified by the board.

deleted text begin (c)deleted text end new text begin (d)new text end No license shall be issued or renewed for a drug manufacturer unless the applicant
agrees to operate in a manner prescribed by federal and state law and according to Minnesota
Rules.

deleted text begin (d)deleted text end new text begin (e)new text end No license shall be issued or renewed for a drug manufacturer that is required to
be registered pursuant to United States Code, title 21, section 360, unless the applicant
supplies the board with proof of registration. The board may establish by rule the standards
for licensure of drug manufacturers that are not required to be registered under United States
Code, title 21, section 360.

deleted text begin (e)deleted text end new text begin (f)new text end No license shall be issued or renewed for a drug 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, by rule,
standards for the licensure of a drug manufacturer that is not required to be licensed or
registered by the state in which it is physically located.

deleted text begin (f)deleted text end new text begin (g)new text end The board shall require a separate license for each facility located within the state
at which drug manufacturing occurs and for each facility located outside of the state at
which drugs that are shipped into the state are manufactured.

deleted text begin (g)deleted text end new text begin (h)new text end The board shall not issue an initial or renewed license for a drug manufacturing
facility unless the facility passes an inspection conducted by an authorized representative
of the board. In the case of a drug 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 or by the United
States Food and Drug Administration, 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.

Sec. 5.

Minnesota Statutes 2018, section 151.47, is amended by adding a subdivision to
read:


new text begin Subd. 1a. new text end

new text begin Controlled substance wholesale drug distributor requirements. new text end

new text begin In addition
to the license required under subdivision 1, a wholesale drug distributor distributing a
Schedule II through IV opiate controlled substance must pay the applicable registration fee
specified in section 151.77, subdivision 4, by June 1 of each year beginning June 1, 2020.
In the event of a change in ownership of the wholesale drug distributor, the new owner must
pay the registration fee specified in section 151.77, subdivision 4, that the original owner
would have been assessed had it retained ownership. The board may assess a late fee of ten
percent per month for every portion of a month that the registration fee is paid after the due
date.
 new text end

Sec. 6.

new text begin [151.77] OPIATE PRODUCT REGISTRATION FEE.
 new text end

new text begin Subdivision 1. 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 them:
 new text end

new text begin (1) "manufacturer" means a manufacturer licensed under section 151.252 that is engaged
in the manufacturing of an opiate;
 new text end

new text begin (2) "opiate" means any opiate-containing controlled substance listed in section 152.02,
subdivisions 3 to 5, that is distributed, delivered, sold, or dispensed into or within this state;
and
 new text end

new text begin (3) "wholesaler" means a wholesale drug distributor who is licensed under section 151.47,
and is engaged in the wholesale drug distribution of an opiate.
 new text end

new text begin Subd. 2. new text end

new text begin Reporting requirements. new text end

new text begin (a) By March 1 of each year, beginning March 1,
2020, each manufacturer and each wholesale drug distributor must report to the board every
sale, delivery, or other distribution within or into this state of any opiate that is made to any
practitioner, pharmacy, hospital, veterinary hospital, or other person who is permitted by
section 151.37 to possess controlled substances for administration or dispensing to patients
that occurred during the previous calendar year. Reporting must be in the automation of
reports and consolidated orders system format unless otherwise specified by the board. If
a manufacturer or wholesaler fails to provide information required under this paragraph on
a timely basis, the board may assess an administrative penalty of $500 per day. This penalty
shall not be considered a form of disciplinary action.
 new text end

new text begin (b) By March 1 of each year, beginning March 1, 2020, each owner of a pharmacy with
at least one location within this state must report to the board the intracompany delivery or
distribution into this state of any opiate, to the extent that those deliveries and distributions
are not reported to the board by a licensed wholesale drug distributor owned by, under
contract to, or otherwise operating on behalf of the owner of the pharmacy. Reporting must
be in the manner and format specified by the board for deliveries and distributions that
occurred during the previous calendar year. The report must include the name of the
manufacturer or wholesaler from which the owner of the pharmacy ultimately purchased
the opiate, and the amount and date that the purchases occurred.
 new text end

new text begin Subd. 3. new text end

new text begin Determination of each manufacturer's registration fee. new text end

new text begin (a) The board shall
annually assess manufacturer registration fees that in an aggregate amount total $12,000,000.
The board shall determine each manufacturer's annual registration fee that is prorated and
based on the manufacturer's percentage of the total number of units reported to the board
under subdivision 2.
 new text end

new text begin (b) By April 1 of each year, beginning April 1, 2020, the board shall notify each
manufacturer of the annual amount of the manufacturer's registration fee to be paid by June
1, in accordance with section 151.252, subdivision 1, paragraph (b).
 new text end

new text begin (c) 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 the manufacturer registration fees required under this subdivision.
 new text end

new text begin (d) A manufacturer may dispute the registration fee as determined by the board 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 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 original fee was incorrect, the
board must adjust the manufacturer's registration fee due the next year by the amount that
is in excess of the correct fee that should have been paid.
 new text end

new text begin Subd. 4. new text end

new text begin Determination of each wholesaler's registration fee. new text end

new text begin (a) The board shall
annually assess wholesaler registration fees that in an aggregate amount total $8,000,000.
The board shall determine each wholesaler's annual registration fee that is prorated and
based on the wholesaler's percentage of the total number of units reported to the board under
subdivision 2. This paragraph does not apply to a wholesaler if the wholesaler is also licensed
as a drug manufacturer under section 151.252.
 new text end

new text begin (b) By April 1 of each year, beginning April 1, 2020, the board shall notify each
wholesaler of the annual amount of the wholesaler's registration fee to be paid by June 1,
in accordance with section 151.47, subdivision 1a.
 new text end

new text begin (c) A wholesaler may dispute the registration fee as determined by the board no later
than 30 days after the date of notification. However, the wholesaler must still remit the fee
as required by section 151.47, subdivision 1a. The dispute must be filed with the board in
the manner and using the forms specified by the board. A wholesaler must submit, with the
required forms, data satisfactory to the board that demonstrates that 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 wholesaler has
satisfactorily demonstrated that the original fee was incorrect, the board must adjust the
wholesaler's registration fee due the next year by the amount that is in excess of the correct
fee that should have been paid.
 new text end

new text begin Subd. 5. new text end

new text begin Report. new text end

new text begin (a) The Board of Pharmacy shall evaluate the registration fee on drug
manufacturers and wholesalers established under this section, and whether the fee has
impacted the prescribing practices for opiates by reducing the number of opiate prescriptions
issued during calendar years 2020, 2021, and 2022, to the extent the board has the ability
to effectively identify a correlation. Notwithstanding section 152.126, subdivision 6, the
board may access the data reported under section 152.126, subdivision 4, to conduct this
evaluation.
 new text end

new text begin (b) The board shall submit the results of its evaluation to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by March 1, 2023.
 new text end

new text begin Subd. 6. new text end

new text begin Legislative review. new text end

new text begin The legislature shall review the reports from the Opioid
Addiction Advisory Council under section 151.255, subdivision 1, paragraph (c), the report
from the Board of Pharmacy under subdivision 5, and any other relevant report or information
related to the opioid crisis in Minnesota, to make a determination about whether the opiate
product registration fee assessed under this section should continue beyond July 1, 2023.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 152.01, is amended by adding a subdivision to
read:


new text begin Subd. 25. new text end

new text begin Practitioner. new text end

new text begin "Practitioner" has the meaning given in section 151.01,
subdivision 23.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 152.10, is amended to read:


152.10 deleted text begin SALES, PERSONS ELIGIBLEdeleted text end new text begin CONTROLLED SUBSTANCE
REGISTRATIONnew text end .

new text begin Subdivision 1. new text end

new text begin Generally. new text end

No person deleted text begin other than a licensed pharmacist, assistant
pharmacist or pharmacist intern under the supervision of a pharmacistdeleted text end shall sell a deleted text begin stimulant
or depressant drug and then only as provided in sections 152.021 to 152.12 and 152.0262.deleted text end new text begin
controlled substance except (1) as provided in this chapter, and (2) when any registration
required under this section has been obtained and is active.
new text end

new text begin Subd. 2. new text end

new text begin Registration requirement. new text end

new text begin (a) A person must obtain a registration issued by
the Board of Pharmacy in order to:
 new text end

new text begin (1) manufacture, distribute, prescribe, or dispense any controlled substance within the
state;
 new text end

new text begin (2) propose to engage in the manufacture, distribution, prescription, or dispensing of
any controlled substance within the state;
 new text end

new text begin (3) dispense, distribute, or propose to dispense or distribute any controlled substance
for use in the state by shipping, mailing, or otherwise delivering the controlled substance
from a location outside this state; or
 new text end

new text begin (4) use or propose to use controlled substances in the course of a bona fide research
project.
 new text end

new text begin (b) Persons registered by the Board of Pharmacy under this section to manufacture,
distribute, prescribe, dispense, store, or conduct research with controlled substances may
possess, manufacture, distribute, prescribe, dispense, store, or conduct research with the
controlled substances to the extent authorized by the registration and in conformity with
this section. Registered persons must also comply with any other statutes or rules applicable
to the manufacture, distribution, prescribing, dispensing, or storage of, or research with,
prescription drugs.
 new text end

new text begin (c) Except as otherwise provided by law, the following persons and entities are not
required to register and may lawfully possess controlled substances under this chapter:
 new text end

new text begin (1) an agent or employee of any registered manufacturer, registered drug wholesaler, or
registered pharmacy while acting in the course of employment only;
 new text end

new text begin (2) a common carrier, or an employee of a common carrier, whose possession of a
controlled substance is in the usual course of the person's business or employment;
 new text end

new text begin (3) a licensed hospital or other licensed institution where sick and injured persons are
cared for or treated, bona fide hospitals where animals are treated, or employees of a licensed
hospital or institution acting in the course of employment, except that (i) employees who
are licensed practitioners must be registered to the extent that they engage in the prescribing
of controlled substances, and (ii) hospital pharmacies licensed by the board must be
registered;
 new text end

new text begin (4) a licensed or registered health care professional who acts as the authorized agent of
a practitioner and who administers controlled substances at the direction of the practitioner,
provided that the practitioner is authorized to prescribe controlled substances pursuant to
section 152.12;
 new text end

new text begin (5) an analytical laboratory, or employee of an analytical laboratory when acting in the
course of employment, when conducting an anonymous analysis service and when the
analytical laboratory is registered by the federal Drug Enforcement Administration;
 new text end

new text begin (6) a medical cannabis manufacturer registered under section 152.25;
 new text end

new text begin (7) a person in possession of any controlled substance prescribed for that person pursuant
to section 152.12, subdivision 1, or obtained pursuant to the requirements of the medical
cannabis program established under this chapter; or
 new text end

new text begin (8) the owner of an animal for which a controlled substance has been prescribed pursuant
to section 152.12, subdivision 2.
 new text end

new text begin (d) Nothing in this section prohibits a person for whom a controlled substance has been
dispensed in accordance with a prescription issued pursuant to section 152.12 from
designating a family member, caregiver, or other individual to assist the person in obtaining
or administering the controlled substance, or disposing of the controlled substance pursuant
to section 152.105.
 new text end

new text begin (e) A separate registration is required at each principal place of business or professional
practice where the applicant manufactures, distributes, prescribes, dispenses, or conducts
research with controlled substances. This paragraph does not apply to an office used by a
practitioner who is registered at another location, where controlled substances are prescribed
but neither administered nor otherwise dispensed as a regular part of the professional practice
of the practitioner at the office, and where no supplies of controlled substances are
maintained.
 new text end

new text begin (f) The Board of Pharmacy, through its authorized representative, has the authority to
inspect the establishment of a registrant or applicant for registration. This authority is granted
for routine inspections and for the purpose of conducting investigations of complaints made
against registrants.
 new text end

new text begin (g) The board may require a registrant to submit documents or written statements of fact
relevant to a registration that the board deems necessary to determine whether the registration
should be granted or denied. If the registrant fails to provide the documents or statements
within a reasonable time after being requested to do so, the registrant shall be deemed to
have waived the opportunity to present the documents or statements for consideration by
the board in granting or denying the registration.
 new text end

new text begin (h) Failure to renew the controlled substance registration on a timely basis shall cause
the registration to be automatically forfeited. A forfeited registration may be reinstated
pursuant to section 151.065, subdivision 7.
 new text end

new text begin Subd. 3. new text end

new text begin Registration. new text end

new text begin (a) The Board of Pharmacy shall register an applicant to
manufacture, dispense, prescribe, distribute, or conduct research with controlled substances
included in section 152.02, subdivisions 3 to 6, unless it determines that the issuance of that
registration would be inconsistent with the public interest. In determining the public interest,
the board shall consider the following factors:
 new text end

new text begin (1) maintaining effective controls against diversion of controlled substances into other
than legitimate medical, scientific, or industrial channels;
 new text end

new text begin (2) complying with applicable federal, state, and local law;
 new text end

new text begin (3) whether the applicant has been convicted under any federal or state laws relating to
any controlled substance;
 new text end

new text begin (4) past experience in the manufacture, distribution, or dispensing of controlled substances
or in research involving controlled substances, and the existence in the applicant's
establishment of effective controls against diversion;
 new text end

new text begin (5) whether the applicant has furnished false or fraudulent material in any application
filed under this chapter;
 new text end

new text begin (6) suspension or revocation of the applicant's federal registration to manufacture,
distribute, prescribe, dispense, or conduct research with controlled substances as authorized
by federal law; and
 new text end

new text begin (7) any other factor relevant to and consistent with public health and safety.
 new text end

new text begin (b) Registration under paragraph (a) does not entitle a registrant to manufacture, dispense,
prescribe, and distribute controlled substances included in section 152.02, subdivision 2.
Manufacturing, dispensing, prescribing, and distribution of controlled substances included
in section 152.02, subdivision 2, may only occur as part of a bona fide research project
pursuant to section 152.12, subdivision 3, or 152.21 and as allowed under federal law and
regulations. However, medical cannabis, as defined in section 152.22, subdivision 6, may
be produced and distributed as allowed under section 152.29.
 new text end

new text begin (c) A practitioner must be registered under this section in order to dispense or prescribe
any controlled substances included in section 152.02, subdivisions 3 to 6.
 new text end

new text begin Subd. 4. new text end

new text begin Revocation and suspension of registration. new text end

new text begin (a) A registration under this
section to manufacture, dispense, prescribe, distribute, or conduct research with a controlled
substance may be suspended or revoked by the Board of Pharmacy upon finding probable
cause that the registrant has:
 new text end

new text begin (1) furnished false or fraudulent material information in any application filed under this
chapter;
 new text end

new text begin (2) been convicted of a felony pursuant to any state or federal law relating to any
controlled substance;
 new text end

new text begin (3) had the registrant's federal controlled substance registration to manufacture, distribute,
prescribe, dispense, or conduct research with controlled substances suspended or revoked;
 new text end

new text begin (4) had the registrant's state license to practice the registrant's profession suspended or
revoked by the applicable health-related licensing board;
 new text end

new text begin (5) had the registrant's state license to practice the registrant's profession placed on
conditional status by the applicable health-related licensing board when the conditions
prohibit the registrant from prescribing, administering, dispensing, or otherwise handling
controlled substances; or
 new text end

new text begin (6) violated federal or state statutes or regulations related to the manufacture, distribution,
prescribing, dispensing, or research of a controlled substance in a manner that places the
public at imminent risk of serious harm.
 new text end

new text begin (b) The Board of Pharmacy may limit revocation or suspension of a registration to the
particular controlled substance with respect to which grounds for revocation or suspension
exist.
 new text end

new text begin Subd. 5. new text end

new text begin Reporting. new text end

new text begin On at least a quarterly basis, drug wholesalers must report to the
board all distributions, within or into the state, of all Schedule II controlled substance
products, and of all Schedule III controlled substance products that contain narcotics or
gamma hydroxybutyric acid. Reporting must be in the automation of reports and consolidated
orders system format unless otherwise specified by the board. This reporting shall also meet
any other requirement for reporting distribution data to the board found in this chapter or
in chapter 151.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 152.11, subdivision 1, is amended to read:


Subdivision 1.

General prescription requirements for controlled substances.

(a) A
written prescription or an oral prescription reduced to writing, when issued for a controlled
substance in Schedule II, III, IV, or V, is void unlessnew text begin :new text end (1) it is written in ink and contains
the name and address of the person for whose use it is intended; (2) it states the amount of
the controlled substance to be deleted text begin compounded ordeleted text end dispensed, with directions for its use; (3) if
a written prescription, it contains the handwritten signaturenew text begin of the prescribernew text end ,new text begin the prescriber'snew text end
address, deleted text begin and federal registry number of the prescriberdeleted text end and a designation of the branch of
the healing art pursued by the prescriber; and if an oral prescription, the name and address
of the prescriber and a designation of the prescriber's branch of the healing art; deleted text begin anddeleted text end (4) it
shows the date when signed by the prescriber, or the date of acceptance in the pharmacy if
an oral prescriptiondeleted text begin .deleted text end new text begin ; and (5) it includes the prescriber's current state and federal controlled
substance registration numbers.
new text end

(b) An electronic prescription for a controlled substance in Schedule II, III, IV, or V is
void unlessnew text begin : (1)new text end it complies with the standards established pursuant to section 62J.497 and
with those portions of Code of Federal Regulations, title 21, parts 1300, 1304, 1306, and
1311, that pertain to electronic prescriptionsdeleted text begin .deleted text end new text begin ; and (2) it includes the prescriber's current
state controlled substance registration number.
new text end

(c) A prescription for a controlled substance in Schedule II, III, IV, or V that is transmitted
by facsimile, either computer to facsimile machine or facsimile machine to facsimile machine,
is void unlessnew text begin : (1)new text end it complies with the applicable requirements of Code of Federal
Regulations, title 21, part 1306deleted text begin .deleted text end new text begin ; and (2) it includes the prescriber's current state controlled
substance registration number.
new text end

(d) Every licensed pharmacy that dispenses a controlled substance prescription shall
retain the original prescription in a file for a period of not less than two years, open to
inspection by any officer of the state, county, or municipal government whose duty it is to
aid and assist with the enforcement of this chapter. An original electronic or facsimile
prescription may be stored in an electronic database, provided that the database provides a
means by which original prescriptions can be retrieved, as transmitted to the pharmacy, for
a period of not less than two years.

(e) Every licensed pharmacy shall distinctly label the container in which a controlled
substance is dispensed with the directions contained in the prescription for the use of that
controlled substance.

Sec. 10.

Minnesota Statutes 2018, section 152.11, subdivision 1a, is amended to read:


Subd. 1a.

Prescription requirements for Schedule II controlled substances.

new text begin (a) new text end No
person may dispense a controlled substance included in Schedule II of section 152.02 without
a prescription issued bynew text begin (1)new text end a deleted text begin doctor of medicine, a doctor of osteopathic medicine licensed
to practice medicine, a doctor of dental surgery, a doctor of dental medicine, a doctor of
podiatry, or a doctor of veterinary medicine,deleted text end new text begin practitionernew text end lawfully licensed to prescribe in
this statenew text begin , acting within the practitioner's scope of practice, and having a current federal
controlled substance registration number and a state controlled substance registration number
issued pursuant to section 152.10,new text end or deleted text begin bydeleted text end new text begin (2)new text end a practitioner licensed to prescribe controlled
substances by the state in which the prescription is issued, and having a current federal deleted text begin Drug
Enforcement Administrationdeleted text end new text begin controlled substancenew text end registration numbernew text begin and, if required, a
controlled substance registration number issued by the other statenew text end .

new text begin (b)new text end The prescription must either be printed or written in ink and contain the handwritten
signature of the prescriber or be transmitted electronically or by facsimile as permitted under
subdivision 1. Provided that in emergency situations, as authorized by federal law, such
drug may be dispensed upon oral prescription reduced promptly to writing and filed by the
pharmacist. Such prescriptions shall be retained in conformity with section 152.101. No
prescription for a Schedule II substance may be refilled.

Sec. 11.

Minnesota Statutes 2018, section 152.11, subdivision 2, is amended to read:


Subd. 2.

Prescription requirements for Schedule III or IV controlled substances.

new text begin (a)
new text end No person may dispense a controlled substance included in Schedule III or IV of section
152.02 without a prescription issued, as permitted under subdivision 1, bynew text begin (1)new text end a deleted text begin doctor of
medicine, a doctor of osteopathic medicine licensed to practice medicine, a doctor of dental
surgery, a doctor of dental medicine, a doctor of podiatry, a doctor of optometry limited to
Schedule IV, or a doctor of veterinary medicine,deleted text end new text begin practitionernew text end lawfully licensed to prescribe
in this statenew text begin , acting within the practitioner's scope of practice, and having a current federal
controlled substance registration number and a state controlled substance registration number
issued pursuant to section 152.10,new text end or deleted text begin fromdeleted text end new text begin (2)new text end a practitioner licensed to prescribe controlled
substances by the state in which the prescription is issued, and having a current federal deleted text begin drug
enforcement administrationdeleted text end new text begin controlled substancenew text end registration numbernew text begin and, if required, a
controlled substance registration number issued by the other statenew text end .

new text begin (b)new text end Such prescription may not be dispensed or refilled except with the documented
consent of the prescriber, and in no event more than six months after the date on which such
prescription was issued and no such prescription may be refilled more than five times.

Sec. 12.

Minnesota Statutes 2018, section 152.11, subdivision 2a, is amended to read:


Subd. 2a.

Federalnew text begin and statenew text end registration number exemption.

A prescription need not
bear a federal drug enforcement administration registration number deleted text begin that authorizes the
prescriber to prescribe controlled substancesdeleted text end new text begin or a state controlled substance registration
numbernew text end if the drug prescribed is not a controlled substance in Schedule II, III, IV, or V. No
person shall impose a requirement inconsistent with this subdivision.

Sec. 13.

Minnesota Statutes 2018, section 152.11, subdivision 2b, is amended to read:


Subd. 2b.

Restriction on release of federalnew text begin and statenew text end registration number.

No person
or entity may offer for sale, sell, lease, or otherwise release a federal drug enforcement
administration registration numbernew text begin or a state controlled substance registration numbernew text end for
any reason, except for drug enforcement purposes authorized by this chapter and the federal
controlled substances registration system. For purposes of this section, an entity includes a
state governmental agency or regulatory board, a health plan company as defined under
section 62Q.01, subdivision 4, a managed care organization as defined under section 62Q.01,
subdivision 5, or any other entity that maintains prescription data.

Sec. 14.

Minnesota Statutes 2018, section 152.11, subdivision 2c, is amended to read:


Subd. 2c.

Restriction on use of federalnew text begin and statenew text end registration number.

No entity may
use a federal drug enforcement administration registration numbernew text begin or a state controlled
substance registration numbernew text end to identify or monitor the prescribing practices of a prescriber
to whom that number has been assigned, except for drug enforcement purposes authorized
by this chapter and the federal controlled substances registration system. For purposes of
this section, an entity includes a health plan company as defined under section 62Q.01,
subdivision 4, a managed care organization as defined under section 62Q.01, subdivision
5, or any other entity that maintains prescription data.

Sec. 15.

Minnesota Statutes 2018, section 152.12, subdivision 1, is amended to read:


Subdivision 1.

Prescribing, dispensing, administering controlled substances in
Schedules II through V.

A deleted text begin licensed doctor of medicine, a doctor of osteopathic medicine,
duly licensed to practice medicine, a doctor of dental surgery, a doctor of dental medicine,
a licensed doctor of podiatry, a licensed advanced practice registered nurse, or a licensed
doctor of optometry limited to Schedules IV and V, anddeleted text end new text begin practitionernew text end in the course of
professional practice deleted text begin onlydeleted text end new text begin and within the practitioner's scope of practicenew text end , may prescribe,
administer, and dispense a controlled substance included in Schedules II through V of section
152.02, may cause the same to be administered by a nurse, an intern or an assistant under
the direction and supervision of the deleted text begin doctordeleted text end new text begin practitionernew text end , and may cause a person who is an
appropriately certified and licensed health care professional to prescribe and administer the
same within the expressed legal scope of the person's practice as defined in Minnesota
Statutes.new text begin An individual who prescribes under this subdivision must be registered pursuant
to section 152.10 and must have a current federal controlled substance registration number.
new text end

Sec. 16.

Minnesota Statutes 2018, section 152.12, subdivision 2, is amended to read:


Subd. 2.

Doctor of veterinary medicine.

A licensed doctor of veterinary medicinenew text begin who
is registered pursuant to section 152.10 and who has a current federal controlled substance
registration numbernew text end , in good faith, and in the course of professional practice only, and not
for use by a human being, may prescribe, administer, and dispense a controlled substance
included in Schedules II through V of section 152.02, and may cause the same to be
administered by an assistant under the direction and supervision of the doctor.

Sec. 17.

Minnesota Statutes 2018, section 152.12, subdivision 3, is amended to read:


Subd. 3.

Research project use of controlled substances.

Any qualified person may
use controlled substances in the course of a bona fide research project but cannot administer
or dispense such drugs to human beings unless such drugs are prescribed, dispensed and
administered by a person lawfully authorized to do so. Every person who engages in research
involving the use of such substances deleted text begin shall apply annually for registration bydeleted text end new text begin must register
withnew text end the deleted text begin statedeleted text end Board of Pharmacy deleted text begin and shall pay any applicable fee specified in section
151.065, provided that such registration shall not be required if the person is covered by
and has complied with federal laws covering such research projectsdeleted text end new text begin pursuant to section
152.10new text end .

Sec. 18.

Minnesota Statutes 2018, section 152.12, subdivision 4, is amended to read:


Subd. 4.

Sale of controlled substances not prohibited for certain persons and
entities.

new text begin (a) Provided that the registration requirements in section 152.10 are met, new text end nothing
in this chapter shall prohibit the sale to, or the possession of, a controlled substance in
Schedule II, III, IV or V by: deleted text begin Registereddeleted text end new text begin licensednew text end drug wholesalers, deleted text begin registereddeleted text end new text begin licensednew text end
manufacturers, deleted text begin registereddeleted text end new text begin licensednew text end pharmacies, or any licensed hospital or other licensed
institutions wherein sick and injured persons are cared for or treated, or bona fide hospitals
wherein animals are treated; or by licensed pharmacistsdeleted text begin ,deleted text end new text begin ornew text end licensed deleted text begin doctors of medicine,
doctors of osteopathic medicine duly licensed to practice medicine, licensed doctors of
dental surgery, licensed doctors of dental medicine, licensed doctors of podiatry, licensed
doctors of optometry limited to Schedules IV and V, or licensed doctors of veterinary
medicine when suchdeleted text end practitioners deleted text begin use controlled substancesdeleted text end new text begin actingnew text end within the coursenew text begin and
scopenew text end of their professional practice only.

new text begin (b) Provided that the registration requirements in section 152.10 are met, new text end nothing in this
chapter shall prohibit the possession of a controlled substance in Schedule II, III, IV or V
by an employee or agent of a deleted text begin registereddeleted text end new text begin licensednew text end drug wholesaler, deleted text begin registereddeleted text end new text begin licensednew text end
manufacturer, or deleted text begin registereddeleted text end new text begin licensednew text end pharmacy, while acting in the course of employment;
by a patient of a licensed deleted text begin doctor of medicine, a doctor of osteopathic medicine duly licensed
to practice medicine, a licensed doctor of dental surgery, a licensed doctor of dental medicine,
or a licensed doctor of optometry limited to Schedules IV and Vdeleted text end new text begin practitionernew text end ; or by the
owner of an animal for which a controlled substance has been prescribed by a licensed
doctor of veterinary medicine, when such controlled substances arenew text begin prescribed andnew text end dispensed
according to law.

Sec. 19.

Minnesota Statutes 2018, section 152.125, subdivision 2, is amended to read:


Subd. 2.

Prescription and administration of controlled substances for intractable
pain.

Notwithstanding any other provision of this chapter, a deleted text begin physiciandeleted text end new text begin practitioner lawfully
licensed to prescribe controlled substances in this state and registered pursuant to section
152.10new text end may prescribe or administer a controlled substance in Schedules II to V of section
152.02 to an individual in the course of the deleted text begin physician'sdeleted text end new text begin practitioner'snew text end treatment of the
individual for a diagnosed condition causing intractable pain. No deleted text begin physiciandeleted text end new text begin practitionernew text end
shall be subject to disciplinary action by deleted text begin the Board of Medical Practicedeleted text end new text begin a health-related
licensing boardnew text end for appropriately prescribing or administering a controlled substance in
Schedules II to V of section 152.02 in the course of treatment of an individual for intractable
pain, provided the deleted text begin physiciandeleted text end new text begin practitionernew text end keeps accurate records of the purpose, use,
prescription, and disposal of controlled substances, writes accurate prescriptions, and
prescribes medications in conformance withnew text begin thenew text end chapter deleted text begin 147deleted text end new text begin of law under which the
practitioner is licensednew text end .

Sec. 20.

Minnesota Statutes 2018, section 152.125, subdivision 3, is amended to read:


Subd. 3.

Limits on applicability.

This section does not apply to:

(1) a deleted text begin physician'sdeleted text end new text begin practitioner'snew text end treatment of an individual for chemical dependency
resulting from the use of controlled substances in Schedules II to V of section 152.02;

(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to an individual whom the deleted text begin physiciandeleted text end new text begin practitionernew text end knows to be using the
controlled substances for nontherapeutic purposes;

(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of an individual having intractable
pain; or

(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.

Sec. 21.

Minnesota Statutes 2018, section 152.125, subdivision 4, is amended to read:


Subd. 4.

Notice of risks.

Prior to treating an individual for intractable pain in accordance
with subdivision 2, a deleted text begin physiciandeleted text end new text begin practitionernew text end shall discuss with the individual the risks
associated with the controlled substances in Schedules II to V of section 152.02 to be
prescribed or administered in the course of the deleted text begin physician'sdeleted text end new text begin practitioner'snew text end treatment of an
individual, and document the discussion in the individual's record.

Sec. 22.

Minnesota Statutes 2018, section 245.4661, subdivision 9, is amended to read:


Subd. 9.

Services and programs.

(a) The following three distinct grant programs are
funded under this section:

(1) mental health crisis services;

(2) housing with supports for adults with serious mental illness; and

(3) projects for assistance in transitioning from homelessness (PATH program).

(b) In addition, the following are eligible for grant funds:

(1) community education and prevention;

(2) client outreach;

(3) early identification and intervention;

(4) adult outpatient diagnostic assessment and psychological testing;

(5) peer support services;

(6) community support program services (CSP);

(7) adult residential crisis stabilization;

(8) supported employment;

(9) assertive community treatment (ACT);

(10) housing subsidies;

(11) basic living, social skills, and community intervention;

(12) emergency response services;

(13) adult outpatient psychotherapy;

(14) adult outpatient medication management;

(15) adult mobile crisis services;

(16) adult day treatment;

(17) partial hospitalization;

(18) adult residential treatment;

(19) adult mental health targeted case management;

(20) intensive community rehabilitative services (ICRS); deleted text begin and
deleted text end

(21) transportationdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (22) traditional healing provided to American Indians.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 23.

Minnesota Statutes 2018, section 254A.03, subdivision 3, is amended to read:


Subd. 3.

Rules for substance use disorder care.

(a) The commissioner of human
services shall establish by rule criteria to be used in determining the appropriate level of
chemical dependency care for each recipient of public assistance seeking treatment for
substance misuse or substance use disorder. Upon federal approval of a comprehensive
assessment as a Medicaid benefit, or on July 1, 2018, whichever is later, and notwithstanding
the criteria in Minnesota Rules, parts 9530.6600 to 9530.6655, an eligible vendor of
comprehensive assessments under section 254B.05 may determine and approve the
appropriate level of substance use disorder treatment for a recipient of public assistance.
The process for determining an individual's financial eligibility for the consolidated chemical
dependency treatment fund or determining an individual's enrollment in or eligibility for a
publicly subsidized health plan is not affected by the individual's choice to access a
comprehensive assessment for placement.

(b) The commissioner shall develop and implement a utilization review process for
publicly funded treatment placements to monitor and review the clinical appropriateness
and timeliness of all publicly funded placements in treatment.

new text begin (c) If a screen result is positive for alcohol or substance misuse, a brief screening for
alcohol or substance use disorder that is provided to a recipient of public assistance within
a primary care clinic, hospital, or other medical setting or school setting establishes medical
necessity and approval for an initial set of substance use disorder services identified in
section 254B.05, subdivision 5. The initial set of services approved for a recipient whose
screen result is positive may include four hours of individual or group substance use disorder
treatment, two hours of substance use disorder treatment coordination, or two hours of
substance use disorder peer support services provided by a qualified individual according
to chapter 245G. A recipient must obtain an assessment pursuant to paragraph (a) to be
approved for additional treatment services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
 new text end

Sec. 24.

new text begin [256.042] OPIOID STEWARDSHIP ADVISORY COUNCIL.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment of the advisory council. new text end

new text begin (a) The Opioid Stewardship
Advisory Council is established to develop and implement a comprehensive and effective
statewide effort to address the opioid addiction and overdose epidemic in Minnesota. The
council shall focus on:
 new text end

new text begin (1) prevention and education, including public education and awareness for adults and
youth, prescriber education, the development and sustainability of opioid overdose prevention
and education programs, and providing financial support to local law enforcement agencies
for opiate antagonist programs;
 new text end

new text begin (2) treatment, including statewide access to effective treatment and recovery services
that is aligned with Minnesota's model of care approach to promoting access to treatment
and recovery services. This includes ensuring that individuals throughout the state have
access to treatment and recovery services, including care coordination services; peer recovery
services; medication-assisted treatment and office-based opioid treatment; integrative and
multidisciplinary therapies; and culturally specific services; and
 new text end

new text begin (3) innovation and capacity building, including development of evidence-based practices
and using research and evaluation to understand which policies and programs promote
efficient and effective prevention, treatment, and recovery results. This also includes ensuring
that there are qualified providers and a comprehensive set of treatment and recovery services
throughout the state.
 new text end

new text begin (b) The council shall:
 new text end

new text begin (1) review local, state, and federal initiatives and funding related to prevention and
education, treatment, and services for individuals and families experiencing and affected
by opioid abuse, and promoting innovation and capacity building to address the opioid
addiction and overdose epidemic;
 new text end

new text begin (2) establish priorities to address the state's opioid addiction and overdose epidemic for
the purpose of allocating funds and consult with the commissioner of management and
budget and the commissioner of human services to determine whether proposals are for
evidence-based practices, promising practices, or theory-based practices and whether
proposals align with evidence-based practices for opioid use disorder and co-occurring
conditions according to the Substance Abuse and Mental Health Services Administration
and the American Society for Addiction Medicine;
 new text end

new text begin (3) ensure that available funding under this section is allocated to align with existing
state and federal funding to achieve the greatest impact and ensure a coordinated state effort
to address the opioid addiction and overdose epidemic;
 new text end

new text begin (4) develop criteria and procedures to be used in awarding grants and allocating available
funds from the opiate epidemic response account and select proposals to receive grant
funding. The council is encouraged to select proposals that are promising practices or
theory-based practices, in addition to evidence-based practices, to help identify new
approaches to effective prevention, treatment, and recovery; and
 new text end

new text begin (5) in consultation with the commissioner of management and budget, and within
available appropriations, select from the awarded grants projects that include promising
practices or theory-based activities for which the commissioner of management and budget
shall conduct evaluations using experimental or quasi-experimental design. Grants awarded
to proposals that include promising practices or theory-based activities and that are selected
for an evaluation shall be administered to support the experimental or quasi-experimental
evaluation and require grantees to collect and report information that is needed to complete
the evaluation. The commissioner of management and budget, under section 15.08, may
obtain additional relevant data to support the experimental or quasi-experimental evaluation
studies.
 new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin (a) The council shall consist of 19 members appointed by the
commissioner of human services, except as otherwise specified:
 new text end

new text begin (1) two members of the house of representatives, one from the majority party appointed
by the speaker of the house and one from the minority party appointed by the minority
leader;
 new text end

new text begin (2) two members of the senate, one from the majority party appointed by the senate
majority leader and one from the minority party appointed by the senate minority leader;
 new text end

new text begin (3) one member appointed by the Board of Pharmacy;
 new text end

new text begin (4) one member who is a physician appointed by the Minnesota chapter of the American
College of Emergency Physicians;
 new text end

new text begin (5) one member representing opioid treatment programs or other medication-assisted
treatment programs;
 new text end

new text begin (6) one member who is a physician appointed by the Minnesota Hospital Association;
 new text end

new text begin (7) one member who is a physician appointed by the Minnesota Society of Addiction
Medicine;
 new text end

new text begin (8) one member who is a pain psychologist;
 new text end

new text begin (9) one member appointed by the Steve Rummler Hope Network;
 new text end

new text begin (10) one member appointed by the Minnesota Ambulance Association;
 new text end

new text begin (11) one member representing the Minnesota courts who is a judge or law enforcement
officer;
 new text end

new text begin (12) two public members who are Minnesota residents and who have been impacted by
the opioid epidemic;
 new text end

new text begin (13) two members representing an Indian tribe;
 new text end

new text begin (14) the commissioner of human services or designee; and
 new text end

new text begin (15) the commissioner of health or designee.
 new text end

new text begin (b) The commissioner of human services shall coordinate appointments to provide
geographic diversity and shall ensure that at least one-half of the council members appointed
by the commissioner reside outside of the seven-county metropolitan area.
 new text end

new text begin (c) The council is governed by section 15.059, except that members of the council who
are receiving compensation for the member's appointed role shall receive no compensation
other than reimbursement for expenses. Notwithstanding section 15.059, subdivision 6, the
council shall not expire.
 new text end

new text begin (d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.
 new text end

new text begin (e) The commissioner of human services shall provide staff and administrative services
for the advisory council.
 new text end

new text begin (f) The council is subject to chapter 13D.
 new text end

new text begin Subd. 3. new text end

new text begin Conflict of interest. new text end

new text begin Advisory council members must disclose to the council
and recuse themselves from voting on any matter before the council if the member has a
conflict of interest. A conflict of interest means a financial association that has the potential
to bias or have the appearance of biasing a council member's decision related to the opiate
epidemic response grant decision process or other council activities under this section.
 new text end

new text begin Subd. 4. new text end

new text begin Council recommendations. new text end

new text begin The council shall make recommendations on the
funds annually appropriated to the commissioner of human services from the opioid
stewardship fund to be awarded for the upcoming fiscal year.
 new text end

new text begin Subd. 5. new text end

new text begin Grants. new text end

new text begin The commissioner of human services shall award grants within
appropriations from the opioid stewardship fund under section 256.043. The grants shall
be awarded based on recommendations from the advisory council that address the priorities
in subdivision 1, paragraph (a), clauses (1) to (3).
 new text end

new text begin Subd. 6. new text end

new text begin Reports. new text end

new text begin (a) The commissioner, in consultation with the advisory council, shall
report annually 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, 2022, information about the individual projects that receive grants
and the overall role of the project in addressing the opioid addiction and overdose epidemic
in Minnesota. The report must describe the grantees and the activities implemented, along
with measurable outcomes as determined by the council in consultation with the
commissioner of human services and the commissioner of management and budget. At a
minimum, the report must include information about the number of individuals who received
information or treatment, the outcomes the individuals achieved, and demographic
information about the individuals participating in the project; an assessment of the progress
toward achieving statewide access to qualified providers and comprehensive treatment and
recovery services; and an update on the evaluation implemented by the commissioner of
management and budget for the promising practices and theory-based projects that receive
funding. Each report must also identify instances in which the commissioner did not follow
recommendations of the advisory council and the commissioner's rationale for not doing
so.
 new text end

new text begin (b) The commissioner of management and budget, in consultation with the Opioid
Stewardship Advisory Council and the commissioner of human services, shall report to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance when an evaluation study described in
subdivision 1, paragraph (b), clause (5), is complete on the promising practices or
theory-based projects that are selected for evaluation activities. The report shall include
demographic information; outcome information for the individuals in the program; the
results for the program in promoting recovery, employment, family reunification, and
reducing involvement with the criminal justice system; and other relevant outcomes
determined by the commissioner of management and budget that are specific to the projects
that are evaluated. The report shall include information about the ability of grant programs
to be scaled to achieve the statewide results that the grant project demonstrated.
 new text end

Sec. 25.

new text begin [256.043] OPIOID STEWARDSHIP FUND.
 new text end

new text begin The opioid stewardship fund is established in the state treasury. The registration fees
assessed by the Board of Pharmacy under section 151.77 and the license fees identified in
section 151.065, subdivision 3a, shall be deposited into the fund. All interest earnings shall
be credited to the fund.
 new text end

Sec. 26. new text begin OPIOID STEWARDSHIP ADVISORY COUNCIL FIRST MEETING.
new text end

new text begin The commissioner of human services shall convene the first meeting of the Opioid
Stewardship Advisory Council established under Minnesota Statutes, section 256.042, no
later than October 1, 2019. The members shall elect a chair at the first meeting.
 new text end

ARTICLE 11

HEALTH-RELATED LICENSING BOARDS

Section 1.

new text begin [144A.39] FEES.
 new text end

new text begin Subdivision 1. new text end

new text begin Nonrefundable fees. new text end

new text begin All fees are nonrefundable.
 new text end

new text begin Subd. 2. new text end

new text begin Amounts. new text end

new text begin (a) Fees may not exceed the following amounts but may be adjusted
lower by board direction and are for the exclusive use of the board as required to sustain
board operations. The maximum amounts of fees are:
 new text end

new text begin (1) application for licensure, $200;
 new text end

new text begin (2) for a prospective applicant for a review of education and experience advisory to the
license application, $100, to be applied to the fee for application for licensure if the latter
is submitted within one year of the request for review of education and experience;
 new text end

new text begin (3) state examination, $125;
 new text end

new text begin (4) initial license, $250 if issued between July 1 and December 31, $100 if issued between
January 1 and June 30;
 new text end

new text begin (5) acting administrator permit, $400;
 new text end

new text begin (6) renewal license, $250;
 new text end

new text begin (7) duplicate license, $50;
 new text end

new text begin (8) reinstatement fee, $250;
 new text end

new text begin (9) health services executive initial license, $200;
 new text end

new text begin (10) health services executive renewal license, $200;
 new text end

new text begin (11) reciprocity verification fee, $50;
 new text end

new text begin (12) second shared administrator assignment, $250;
 new text end

new text begin (13) continuing education fees:
 new text end

new text begin (i) greater than 6 hours, $50; and
 new text end

new text begin (ii) 7 hours or more, $75;
 new text end

new text begin (14) education review, $100;
 new text end

new text begin (15) fee to a sponsor for review of individual continuing education seminars, institutes,
workshops, or home study courses:
 new text end

new text begin (i) for less than seven clock hours, $30; and
 new text end

new text begin (ii) for seven or more clock hours, $50;
 new text end

new text begin (16) fee to a licensee for review of continuing education seminars, institutes, workshops,
or home study courses not previously approved for a sponsor and submitted with an
application for license renewal:
 new text end

new text begin (i) for less than seven clock hours total, $30; and
 new text end

new text begin (ii) for seven or more clock hours total, $50;
 new text end

new text begin (17) late renewal fee, $75;
 new text end

new text begin (18) fee to a licensee for verification of licensure status and examination scores, $30;
 new text end

new text begin (19) registration as a registered continuing education sponsor, $1,000; and
 new text end

new text begin (20) mail labels, $75.
 new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 147D.27, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Additional fees. new text end

new text begin (a) The following fees also apply:
 new text end

new text begin (1) traditional midwifery annual registration fee, $100;
 new text end

new text begin (2) traditional midwifery application fee, $100;
 new text end

new text begin (3) traditional midwifery late fee, $75;
 new text end

new text begin (4) traditional midwifery inactive status, $50;
 new text end

new text begin (5) traditional midwifery temporary permit, $75;
 new text end

new text begin (6) traditional midwifery certification fee, $25;
 new text end

new text begin (7) duplicate license or registration fee, $20;
 new text end

new text begin (8) certification letter, $25;
 new text end

new text begin (9) education or training program approval fee, $100; and
 new text end

new text begin (10) report creation and generation, $60 per hour billed in quarter-hour increments with
a quarter-hour minimum.
 new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
 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. 3.

Minnesota Statutes 2018, section 147E.40, subdivision 1, is amended to read:


Subdivision 1.

Fees.

new text begin (a) new text end Fees are as follows:

(1) registration application fee, $200;

(2) renewal fee, $150;

(3) late fee, $75;

(4) inactive status fee, $50; deleted text begin and
deleted text end

(5) temporary permit fee, $25deleted text begin .deleted text end new text begin ;
new text end

new text begin (6) naturopathic doctor certification fee, $25;
 new text end

new text begin (7) naturopathic doctor duplicate license fee, $20;
 new text end

new text begin (8) naturopathic doctor emeritus registration fee, $50;
 new text end

new text begin (9) naturopathic doctor certification fee, $25;
 new text end

new text begin (10) duplicate license or registration fee, $20;
 new text end

new text begin (11) education or training program approval fee, $100; and
 new text end

new text begin (12) report creation and generation, $60 per hour billed in quarter-hour increments with
a quarter-hour minimum.
 new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
 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 2018, section 147F.17, subdivision 1, is amended to read:


Subdivision 1.

Fees.

new text begin (a) new text end Fees are as follows:

(1) license application fee, $200;

(2) initial licensure and annual renewal, $150; deleted text begin and
deleted text end

(3) late fee, $75deleted text begin .deleted text end new text begin ;
new text end

new text begin (4) genetic counselor certification fee, $25;
 new text end

new text begin (5) duplicate license fee, $20;
 new text end

new text begin (6) education or training program approval fee, $100; and
 new text end

new text begin (7) report creation and generation, $60 per hour billed in quarter-hour increments with
a quarter-hour minimum.
 new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
 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 2018, section 148.59, is amended to read:


148.59 LICENSE RENEWAL; LICENSE AND REGISTRATION FEES.

A licensed optometrist shall pay to the state Board of Optometry a fee as set by the board
in order to renew a license as provided by board rule. No fees shall be refunded. Fees may
not exceed the following amounts but may be adjusted lower by board direction and are for
the exclusive use of the board:

(1) optometry licensure application, $160;

(2) optometry annual licensure renewal, deleted text begin $135deleted text end new text begin $200new text end ;

(3) optometry late penalty fee, $75;

(4) annual license renewal card, $10;

(5) continuing education provider application, $45;

(6) emeritus registration, $10;

(7) endorsement/reciprocity application, $160;

(8) replacement of initial license, $12; deleted text begin and
deleted text end

(9) license verification, $50deleted text begin .deleted text end new text begin ;
new text end

new text begin (10) state juris prudence examination, $75; and
 new text end

new text begin (11) miscellaneous labels and data retrieval, $50.
 new text end

Sec. 6.

Minnesota Statutes 2018, section 148.6445, subdivision 1, is amended to read:


Subdivision 1.

Initial licensure fee.

The initial licensure fee for occupational therapists
is deleted text begin $145deleted text end new text begin $185new text end . The initial licensure fee for occupational therapy assistants is deleted text begin $80deleted text end new text begin $105new text end . deleted text begin The
board shall prorate fees based on the number of quarters remaining in the biennial licensure
period.
deleted text end

Sec. 7.

Minnesota Statutes 2018, section 148.6445, subdivision 2, is amended to read:


Subd. 2.

Licensure renewal fee.

The biennial licensure renewal fee for occupational
therapists is deleted text begin $145deleted text end new text begin $185new text end . The biennial licensure renewal fee for occupational therapy assistants
is deleted text begin $80deleted text end new text begin $105new text end .

Sec. 8.

Minnesota Statutes 2018, section 148.6445, subdivision 2a, is amended to read:


Subd. 2a.

Duplicate license fee.

The fee for a duplicate license is deleted text begin $25deleted text end new text begin $30new text end .

Sec. 9.

Minnesota Statutes 2018, section 148.6445, subdivision 3, is amended to read:


Subd. 3.

Late fee.

The fee for late submission of a renewal application is deleted text begin $25deleted text end new text begin $50new text end .

Sec. 10.

Minnesota Statutes 2018, section 148.6445, subdivision 4, is amended to read:


Subd. 4.

Temporary licensure fee.

The fee for temporary licensure is deleted text begin $50deleted text end new text begin $75new text end .

Sec. 11.

Minnesota Statutes 2018, section 148.6445, subdivision 5, is amended to read:


Subd. 5.

Limited licensure fee.

The fee for limited licensure is deleted text begin $96deleted text end new text begin $100new text end .

Sec. 12.

Minnesota Statutes 2018, section 148.6445, subdivision 6, is amended to read:


Subd. 6.

Fee for course approval after lapse of licensure.

The fee for course approval
after lapse of licensure is deleted text begin $96deleted text end new text begin $100new text end .

Sec. 13.

Minnesota Statutes 2018, section 148.6445, subdivision 10, is amended to read:


Subd. 10.

Use of fees.

new text begin (a) new text end All fees are nonrefundable. The board shall only use fees
collected under this section for the purposes of administering this chapter. The legislature
must not transfer money generated by these fees from the state government special revenue
fund to the general fund.

new text begin (b) Licensure fees are for the exclusive use of the board and shall be established by the
board not to exceed the nonrefundable amounts in this section.
 new text end

Sec. 14.

Minnesota Statutes 2018, section 148.7815, subdivision 1, is amended to read:


Subdivision 1.

Fees.

new text begin (a) new text end The board shall establish fees as follows:

(1) application fee, $50; deleted text begin and
deleted text end

(2) annual license fee, $100deleted text begin .deleted text end new text begin ;
new text end

new text begin (3) athletic trainer certification fee, $25;
 new text end

new text begin (4) athletic trainer duplicate license fee, $20;
 new text end

new text begin (5) naturopathic doctor certification fee, $25;
 new text end

new text begin (6) duplicate license or registration fee, $20;
 new text end

new text begin (7) education or training program approval fee, $100;
 new text end

new text begin (8) report creation and generation, $60 per hour billed in quarter-hour increments with
a quarter-hour minimum; and
 new text end

new text begin (9) examination administrative fee:
 new text end

new text begin (i) half day, $50; and
 new text end

new text begin (ii) full day, $80.
 new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
 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. 15.

new text begin [148.981] FEES.
 new text end

new text begin Subdivision 1. new text end

new text begin Licensing fees. new text end

new text begin The nonrefundable fees for licensure shall be established
by the board, not to exceed the following amounts:
 new text end

new text begin (1) application for admission to national standardized examination, $150;
 new text end

new text begin (2) application for professional responsibility examination, $150;
 new text end

new text begin (3) application for licensure as a licensed psychologist, $500;
 new text end

new text begin (4) renewal of license for a licensed psychologist, $500;
 new text end

new text begin (5) late renewal of license for a licensed psychologist, $250;
 new text end

new text begin (6) application for converting from master's to doctoral level licensure, $150;
 new text end

new text begin (7) application for guest licensure, $150;
 new text end

new text begin (8) certificate replacement fee, $25;
 new text end

new text begin (9) mailing and duplication fee, $5;
 new text end

new text begin (10) statute and rule book fee, $10;
 new text end

new text begin (11) verification fee, $20; and
 new text end

new text begin (12) fee for optional preapproval of postdoctoral supervision, $50.
 new text end

new text begin Subd. 2. new text end

new text begin Continuing education sponsor fee. new text end

new text begin A sponsor applying for approval of a
continuing education activity pursuant to Minnesota Rules, part 7200.3830, subpart 2, shall
submit with the application a fee to be established by the board, not to exceed $80 for each
activity.
 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. 16.

Minnesota Statutes 2018, section 148E.180, is amended to read:


148E.180 FEE AMOUNTS.

Subdivision 1.

Application fees.

new text begin Nonrefundable new text end application fees for licensure deleted text begin are as
followsdeleted text end new text begin may not exceed the following amounts but may be adjusted lower by board actionnew text end :

(1) for a licensed social worker, deleted text begin $45deleted text end new text begin $75new text end ;

(2) for a licensed graduate social worker, deleted text begin $45deleted text end new text begin $75new text end ;

(3) for a licensed independent social worker, deleted text begin $45deleted text end new text begin $75new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $45deleted text end new text begin $75new text end ;

(5) for a temporary license, $50; and

(6) for a deleted text begin licensuredeleted text end new text begin licensenew text end by endorsement, deleted text begin $85deleted text end new text begin $115new text end .

The fee for criminal background checks is the fee charged by the Bureau of Criminal
Apprehension. The criminal background check fee must be included with the application
fee as required according to section 148E.055.

Subd. 2.

License fees.

new text begin Nonrefundable new text end license fees deleted text begin are as followsdeleted text end new text begin may not exceed the
following amounts but may be adjusted lower by board actionnew text end :

(1) for a licensed social worker, deleted text begin $81deleted text end new text begin $115new text end ;

(2) for a licensed graduate social worker, deleted text begin $144deleted text end new text begin $210new text end ;

(3) for a licensed independent social worker, deleted text begin $216deleted text end new text begin $305new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $238.50deleted text end new text begin $335new text end ;

(5) for an emeritus inactive license, deleted text begin $43.20deleted text end new text begin $65new text end ;

(6) for an emeritus active license, one-half of the renewal fee specified in subdivision
3; and

(7) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.

If the licensee's initial license term is less or more than 24 months, the required license
fees must be prorated proportionately.

Subd. 3.

Renewal fees.

new text begin Nonrefundable new text end renewal fees for licensure deleted text begin are as followsdeleted text end new text begin may
not exceed the following amounts but may be adjusted lower by board actionnew text end :

(1) for a licensed social worker, deleted text begin $81deleted text end new text begin $115new text end ;

(2) for a licensed graduate social worker, deleted text begin $144deleted text end new text begin $210new text end ;

(3) for a licensed independent social worker, deleted text begin $216deleted text end new text begin $305new text end ; and

(4) for a licensed independent clinical social worker, deleted text begin $238.50deleted text end new text begin $335new text end .

Subd. 4.

Continuing education provider fees.

Continuing education provider fees are
deleted text begin as followsdeleted text end new text begin the following nonrefundable amountsnew text end :

(1) for a provider who offers programs totaling one to eight clock hours in a one-year
period according to section 148E.145, $50;

(2) for a provider who offers programs totaling nine to 16 clock hours in a one-year
period according to section 148E.145, $100;

(3) for a provider who offers programs totaling 17 to 32 clock hours in a one-year period
according to section 148E.145, $200;

(4) for a provider who offers programs totaling 33 to 48 clock hours in a one-year period
according to section 148E.145, $400; and

(5) for a provider who offers programs totaling 49 or more clock hours in a one-year
period according to section 148E.145, $600.

Subd. 5.

Late fees.

Late fees are deleted text begin as followsdeleted text end new text begin the following nonrefundable amountsnew text end :

(1) renewal late fee, one-fourth of the renewal fee specified in subdivision 3;

(2) supervision plan late fee, $40; and

(3) license late fee, $100 plus the prorated share of the license fee specified in subdivision
2 for the number of months during which the individual practiced social work without a
license.

Subd. 6.

License cards and wall certificates.

(a) The new text begin nonrefundable new text end fee for a license
card as specified in section 148E.095 is $10.

(b) The new text begin nonrefundable new text end fee for a license wall certificate as specified in section 148E.095
is $30.

Subd. 7.

Reactivation fees.

Reactivation fees are deleted text begin as followsdeleted text end new text begin the following nonrefundable
amountsnew text end :

(1) reactivation from a temporary leave or emeritus status, the prorated share of the
renewal fee specified in subdivision 3; and

(2) reactivation of an expired license, 1-1/2 times the renewal fees specified in subdivision
3.

Sec. 17.

Minnesota Statutes 2018, section 150A.06, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Emeritus inactive license. new text end

new text begin A person licensed to practice dentistry, dental
therapy, dental hygiene, or dental assisting pursuant to section 150A.05 or Minnesota Rules,
part 3100.8500, who retires from active practice in the state may apply to the board for
emeritus inactive licensure. An application for emeritus inactive licensure may be made on
the biennial licensing form or by petitioning the board, and the applicant must pay a onetime
application fee pursuant to section 150A.091, subdivision 19. In order to receive emeritus
inactive licensure, the applicant must be in compliance with board requirements and cannot
be the subject of current disciplinary action resulting in suspension, revocation,
disqualification, condition, or restriction of the licensee to practice dentistry, dental therapy,
dental hygiene, or dental assisting. An emeritus inactive license is not a license to practice,
but is a formal recognition of completion of a person's dental career in good standing.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 18.

Minnesota Statutes 2018, section 150A.06, is amended by adding a subdivision
to read:


new text begin Subd. 11. new text end

new text begin Emeritus active licensure. new text end

new text begin (a) A person licensed to practice dentistry, dental
therapy, dental hygiene, or dental assisting may apply for an emeritus active license if the
person is retired from active practice, is in compliance with board requirements, and is not
the subject of current disciplinary action resulting in suspension, revocation, disqualification,
condition, or restriction of the license to practice dentistry, dental therapy, dental hygiene,
or dental assisting.
 new text end

new text begin (b) An emeritus active licensee may engage only in the following types of practice:
 new text end

new text begin (1) pro bono or volunteer dental practice;
 new text end

new text begin (2) paid practice not to exceed 500 hours per calendar year for the exclusive purpose of
providing licensing supervision to meet the board's requirements; or
 new text end

new text begin (3) paid consulting services not to exceed 500 hours per calendar year.
 new text end

new text begin (c) An emeritus active licensee shall not hold out as a full licensee and may only hold
out as authorized to practice as described in this subdivision. The board may take disciplinary
or corrective action against an emeritus active licensee based on violations of applicable
law or board requirements.
 new text end

new text begin (d) A person may apply for an emeritus active license by completing an application form
specified by the board and must pay the application fee pursuant to section 150A.091,
subdivision 20.
 new text end

new text begin (e) If an emeritus active license is not renewed every two years, the license expires. The
renewal date is the same as the licensee's renewal date when the licensee was in active
practice. In order to renew an emeritus active license, the licensee must:
 new text end

new text begin (1) complete an application form as specified by the board;
 new text end

new text begin (2) pay the required renewal fee pursuant to section 150A.091, subdivision 20; and
 new text end

new text begin (3) report at least 25 continuing education hours completed since the last renewal, which
must include:
 new text end

new text begin (i) at least one hour in two different required CORE areas;
 new text end

new text begin (ii) at least one hour of mandatory infection control;
 new text end

new text begin (iii) for dentists and dental therapists, at least 15 hours of fundamental credits for dentists
and dental therapists, and for dental hygienists and dental assistants, at least seven hours of
fundamental credits; and
 new text end

new text begin (iv) for dentists and dental therapists, no more than ten elective credits, and for dental
hygienists and dental assistants, no more than six elective credits.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 19.

Minnesota Statutes 2018, section 150A.091, is amended by adding a subdivision
to read:


new text begin Subd. 19. new text end

new text begin Emeritus inactive license. new text end

new text begin An individual applying for emeritus inactive
licensure under section 150A.06, subdivision 10, must pay a onetime fee of $50. There is
no renewal fee for an emeritus inactive license.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 20.

Minnesota Statutes 2018, section 150A.091, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin Emeritus active license. new text end

new text begin An individual applying for emeritus active licensure
under section 150A.06, subdivision 11, must pay a fee upon application and upon renewal
every two years. The fees for emeritus active license application and renewal are as follows:
dentist, $212; dental therapist, $100; dental hygienist, $75; and dental assistant, $55.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 21.

Minnesota Statutes 2018, 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, deleted text begin $145deleted text end new text begin $175new text end ;

(2) pharmacist licensed by reciprocity, deleted text begin $240deleted text end new text begin $275new text end ;

(3) pharmacy intern, deleted text begin $37.50deleted text end new text begin $50new text end ;

(4) pharmacy technician, deleted text begin $37.50deleted text end new text begin $50new text end ;

(5) pharmacy, deleted text begin $225deleted text end new text begin $260new text end ;

(6) drug wholesaler, legend drugs only, deleted text begin $235deleted text end new text begin $260new text end ;

(7) drug wholesaler, legend and nonlegend drugs, deleted text begin $235deleted text end new text begin $260new text end ;

(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin $210deleted text end new text begin $260new text end ;

(9) drug wholesaler, medical gases, deleted text begin $175deleted text end new text begin $260new text end ;

(10) drug wholesaler, also licensed as a pharmacy in Minnesota, deleted text begin $150deleted text end new text begin $260new text end ;

(11) drug manufacturer, legend drugs only, deleted text begin $235deleted text end new text begin $260new text end ;

(12) drug manufacturer, legend and nonlegend drugs, deleted text begin $235deleted text end new text begin $260new text end ;

(13) drug manufacturer, nonlegend or veterinary legend drugs, deleted text begin $210deleted text end new text begin $260new text end ;

(14) drug manufacturer, medical gases, deleted text begin $185deleted text end new text begin $260new text end ;

(15) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin $150deleted text end new text begin $260new text end ;

(16) medical gas distributor, deleted text begin $110deleted text end new text begin $260new text end ;new text begin and
new text end

deleted text begin (17) controlled substance researcher, $75; and
 deleted text end

deleted text begin (18)deleted text end new text begin (17)new text end pharmacy professional corporation, deleted text begin $125deleted text end new text begin $150new text end .

Sec. 22.

Minnesota Statutes 2018, section 151.065, subdivision 2, is amended to read:


Subd. 2.

Original license fee.

The pharmacist original licensure fee, deleted text begin $145deleted text end new text begin $175new text end .

Sec. 23.

Minnesota Statutes 2018, 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, deleted text begin $145deleted text end new text begin $175new text end ;

(2) pharmacy technician, deleted text begin $37.50deleted text end new text begin $50new text end ;

(3) pharmacy, deleted text begin $225deleted text end new text begin $260new text end ;

(4) drug wholesaler, legend drugs only, deleted text begin $235deleted text end new text begin $260new text end ;

(5) drug wholesaler, legend and nonlegend drugs, deleted text begin $235deleted text end new text begin $260new text end ;

(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin $210deleted text end new text begin $260new text end ;

(7) drug wholesaler, medical gases, deleted text begin $185deleted text end new text begin $260new text end ;

(8) drug wholesaler, also licensed as a pharmacy in Minnesota, deleted text begin $150deleted text end new text begin $260new text end ;

(9) drug manufacturer, legend drugs only, deleted text begin $235deleted text end new text begin $260new text end ;

(10) drug manufacturer, legend and nonlegend drugs, deleted text begin $235deleted text end new text begin $260new text end ;

(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, deleted text begin $210deleted text end new text begin $260new text end ;

(12) drug manufacturer, medical gases, deleted text begin $185deleted text end new text begin $260new text end ;

(13) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin $150deleted text end new text begin $260new text end ;

(14) medical gas distributor, deleted text begin $110deleted text end new text begin $260new text end ;new text begin and
new text end

deleted text begin (15) controlled substance researcher, $75; and
 deleted text end

deleted text begin (16)deleted text end new text begin (15)new text end pharmacy professional corporation, deleted text begin $75deleted text end new text begin $100new text end .

Sec. 24.

Minnesota Statutes 2018, section 151.065, subdivision 6, is amended to read:


Subd. 6.

Reinstatement fees.

(a) A pharmacist who has allowed the pharmacist's license
to lapse may reinstate the license with board approval and upon payment of any fees and
late fees in arrears, up to a maximum of $1,000.

(b) A pharmacy technician who has allowed the technician's registration to lapse may
reinstate the registration with board approval and upon payment of any fees and late fees
in arrears, up to a maximum of $90.

(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, or a medical gas
distributor who has allowed the license of the establishment to lapse may reinstate the license
with board approval and upon payment of any fees and late fees in arrears.

(d) A controlled substance deleted text begin researcherdeleted text end new text begin registrantnew text end who has allowed deleted text begin the researcher'sdeleted text end new text begin anew text end
registration new text begin issued pursuant to subdivision 4 new text end to lapse may reinstate the registration with
board approval and upon payment of any fees and late fees in arrears.

(e) A pharmacist owner of a professional corporation who has allowed the corporation's
registration to lapse may reinstate the registration with board approval and upon payment
of any fees and late fees in arrears.

Sec. 25. new text begin REPEALER.
new text end

new text begin Minnesota Rules, parts 6400.6970; 7200.6100; and 7200.6105, 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 12

HEALTH DEPARTMENT

Section 1.

Minnesota Statutes 2018, section 144.3831, subdivision 1, is amended to read:


Subdivision 1.

Fee setting.

The commissioner of health may assess an annual fee of
deleted text begin $6.36deleted text end new text begin $9.72new text end for every service connection to a public water supply that is owned or operated
by a home rule charter city, a statutory city, a city of the first class, or a town. The
commissioner of health may also assess an annual fee for every service connection served
by a water user district defined in section 110A.02.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
 new text end

Sec. 2.

new text begin [144.397] STATEWIDE TOBACCO CESSATION SERVICES.
 new text end

new text begin (a) The commissioner of health shall administer, or contract for the administration of,
statewide tobacco cessation services to assist Minnesotans who are seeking advice or services
to help them quit using tobacco products. The commissioner shall establish statewide public
awareness activities to inform the public of the availability of the services and encourage
the public to utilize the services because of the dangers and harm of tobacco use and
dependence.
 new text end

new text begin (b) Services to be provided may include but are not limited to:
 new text end

new text begin (1) telephone-based coaching and counseling;
 new text end

new text begin (2) referrals;
 new text end

new text begin (3) written materials mailed upon request;
 new text end

new text begin (4) web-based texting or e-mail services; and
 new text end

new text begin (5) free Food and Drug Administration-approved tobacco cessation medications.
 new text end

new text begin (c) Services provided must be consistent with evidence-based best practices in tobacco
cessation services. Services provided must be coordinated with health plan company tobacco
prevention and cessation services that may be available to individuals depending on their
health coverage.
 new text end

Sec. 3.

new text begin [145.9275] COMMUNITY-BASED OPIOID AND OTHER DRUG ABUSE
PREVENTION; PILOT GRANT PROGRAM.
 new text end

new text begin Subdivision 1. new text end

new text begin Community pilot prevention projects. new text end

new text begin To the extent funds are
appropriated for the purposes of this subdivision, the commissioner shall establish a grant
program to fund community opioid abuse prevention pilot grants to reduce emergency room
and other health care provider visits resulting from opioid use or abuse and to reduce rates
of opioid addiction in the community using the following six activities:
 new text end

new text begin (1) establishing multidisciplinary controlled substance care teams that may consist of
physicians, pharmacists, social workers, nurse care coordinators, and mental health
professionals;
 new text end

new text begin (2) delivering health care services and care coordination, through controlled substance
care teams, to reduce the inappropriate use of opioids by patients and rates of opioid
addiction;
 new text end

new text begin (3) addressing any unmet social services needs that create barriers to managing pain
effectively and obtaining optimal health outcomes;
 new text end

new text begin (4) providing prescriber and dispenser education and assistance to reduce the inappropriate
prescribing and dispensing of opioids;
 new text end

new text begin (5) promoting the adoption of best practices related to opioid disposal and reducing
opportunities for illegal access to opioids; and
 new text end

new text begin (6) engaging partners outside of the health care system, including schools, law
enforcement, and social services, to address root causes of opioid abuse and addiction at
the community level.
 new text end

new text begin Subd. 2. new text end

new text begin Culture as health; preventing disparities. new text end

new text begin To the extent funds are appropriated
for the purposes of this subdivision, the commissioner shall establish a grant program to
fund organizations working directly with African Americans, urban American Indians, and
Minnesota's 11 Tribal Nations. For grants to Tribal Nations, the tribal governments shall
determine how to best use allocated funds to address and prevent substance use disorder
and overdoses within their communities.
 new text end

Sec. 4.

new text begin [145.9285] COMMUNITY SOLUTIONS FOR HEALTHY CHILD
DEVELOPMENT GRANT PROGRAM.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall establish the community solutions
for healthy child development grant program. The purpose of the program is to:
 new text end

new text begin (1) improve child development outcomes as related to the well-being of children of color
and American Indian children from prenatal to grade 3 and their families, including but not
limited to the goals outlined by the Department of Human Service's early childhood systems
reform effort: early learning; health and well-being; economic security; and safe, stable,
nurturing relationships and environments by funding community-based solutions for
challenges that are identified by the affected community;
 new text end

new text begin (2) reduce racial disparities in children's health and development, from prenatal to grade
3; and
 new text end

new text begin (3) promote racial and geographic equity.
 new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin The commissioner of health shall:
 new text end

new text begin (1) develop a request for proposals for the healthy child development grant program in
consultation with the Community Solutions Advisory Council;
 new text end

new text begin (2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing service providers in order to better meet statewide needs,
particularly in greater Minnesota and areas where services to reduce health disparities have
not been established;
 new text end

new text begin (3) review responses to requests for proposals, in consultation with the Community
Solutions Advisory Council, and award grants under this section;
 new text end

new text begin (4) ensure communication with the ethnic councils, Minnesota Indian Affairs Council,
and the governor's early learning council on the request for proposal process;
 new text end

new text begin (5) establish a transparent and objective accountability process, in consultation with the
Community Solutions Advisory Council, focused on outcomes that grantees agree to achieve;
 new text end

new text begin (6) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions;
 new text end

new text begin (7) maintain data on outcomes reported by grantees; and
 new text end

new text begin (8) contract with an independent third-party entity to evaluate the success of the grant
program and to build the evidence base for effective community solutions in reducing health
disparities of children of color and American Indian children from prenatal to grade 3.
 new text end

new text begin Subd. 3. new text end

new text begin Community Solutions Advisory Council; establishment; duties;
compensation. new text end

new text begin (a) No later than October 1, 2019, the commissioner shall convene a
12-member Community Solutions Advisory Council as follows:
 new text end

new text begin (1) two members representing the African Heritage community;
 new text end

new text begin (2) two members representing the Latino community;
 new text end

new text begin (3) two members representing the Asian-Pacific Islander community;
 new text end

new text begin (4) two members representing the American Indian community;
 new text end

new text begin (5) two parents of children of color or that are American Indian with children under nine
years of age;
 new text end

new text begin (6) one member with research or academic expertise in racial equity and healthy child
development; and
 new text end

new text begin (7) one member representing an organization that advocates on behalf of communities
of color or American Indians.
 new text end

new text begin (b) At least three of the 12 members of the advisory council must come from outside
the seven-county metropolitan area.
 new text end

new text begin (c) The Community Solutions Advisory Council shall:
 new text end

new text begin (1) advise the commissioner on the development of the request for proposals for
community solutions healthy child development grants. In advising the commissioner, the
council must consider how to build on the capacity of communities to promote child and
family well-being and address social determinants of healthy child development;
 new text end

new text begin (2) review responses to requests for proposals and advise the commissioner on the
selection of grantees and grant awards;
 new text end

new text begin (3) advise the commissioner on the establishment of a transparent and objective
accountability process focused on outcomes the grantees agree to achieve;
 new text end

new text begin (4) advise the commissioner on ongoing oversight and necessary support in the
implementation of the program; and
 new text end

new text begin (5) support the commissioner on other racial equity and early childhood grant efforts.
 new text end

new text begin (d) Each advisory council member shall be compensated in accordance with section
15.059, subdivision 3.
 new text end

new text begin Subd. 4. new text end

new text begin Eligible grantees. new text end

new text begin Organizations eligible to receive grant funding under this
section include:
 new text end

new text begin (1) organizations or entities that work with communities of color and American Indian
communities;
 new text end

new text begin (2) tribal nations and tribal organizations as defined in section 658P of the Child Care
and Development Block Grant Act of 1990; and
 new text end

new text begin (3) organizations or entities focused on supporting healthy child development.
 new text end

new text begin Subd. 5. new text end

new text begin Strategic consideration and priority of proposals; eligible populations;
grant awards. new text end

new text begin (a) The commissioner, in consultation with the Community Solutions
Advisory Council, shall develop a request for proposals for healthy child development
grants. In developing the proposals and awarding the grants, the commissioner shall consider
building on the capacity of communities to promote child and family well-being and address
social determinants of healthy child development. Proposals must focus on increasing racial
equity and healthy child development and reducing health disparities experienced by children
of color and American Indian children from prenatal to grade 3 and their families.
 new text end

new text begin (b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from:
 new text end

new text begin (1) organizations or entities led by people of color and serving communities of color;
 new text end

new text begin (2) organizations or entities led by American Indians and serving American Indians,
including tribal nations and tribal organizations;
 new text end

new text begin (3) organizations or entities with proposals focused on healthy development from prenatal
to age three;
 new text end

new text begin (4) organizations or entities with proposals focusing on multigenerational solutions;
 new text end

new text begin (5) organizations or entities located in or with proposals to serve communities located
in counties that are moderate to high risk according to the Wilder Research Risk and Reach
Report; and
 new text end

new text begin (6) community-based organizations that have historically served communities of color
and American Indians and have not traditionally had access to state grant funding.
 new text end

new text begin The advisory council may recommend additional strategic considerations and priorities to
the commissioner.
 new text end

new text begin (c) The first round of grants must be awarded no later than April 15, 2020. Grants must
be awarded annually thereafter. Grants are awarded for a period of three years.
 new text end

new text begin Subd. 6. new text end

new text begin Geographic distribution of grants. new text end

new text begin The commissioner and the advisory council
shall ensure that grant funds are prioritized and awarded to organizations and entities that
are within counties that have a higher proportion of people of color and American Indians
than the state average, to the extent possible.
 new text end

new text begin Subd. 7. new text end

new text begin Report. new text end

new text begin Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
 new text end

Sec. 5.

Minnesota Statutes 2018, section 152.22, subdivision 13, is amended to read:


Subd. 13.

Registry verification.

"Registry verification" means the verification provided
by the commissioner that a patient is enrolled in the registry program and that includes the
patient's name, registry number, and qualifying medical condition and, if applicable, the
name of the patient's registered designated caregiver or parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end .

Sec. 6.

Minnesota Statutes 2018, section 152.25, subdivision 1c, is amended to read:


Subd. 1c.

Notice to patients.

Upon the revocation or nonrenewal of a manufacturer's
registration under subdivision 1a or implementation of an enforcement action under
subdivision 1b that may affect the ability of a registered patient, registered designated
caregiver, or a registered patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end to obtain medical
cannabis from the manufacturer subject to the enforcement action, the commissioner shall
notify in writing each registered patient and the patient's registered designated caregiver or
registered patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end about the outcome of the proceeding
and information regarding alternative registered manufacturers. This notice must be provided
two or more business days prior to the effective date of the revocation, nonrenewal, or other
enforcement action.

Sec. 7.

Minnesota Statutes 2018, section 152.27, subdivision 3, is amended to read:


Subd. 3.

Patient application.

(a) The commissioner shall develop a patient application
for enrollment into the registry program. The application shall be available to the patient
and given to health care practitioners in the state who are eligible to serve as health care
practitioners. The application must include:

(1) the name, mailing address, and date of birth of the patient;

(2) the name, mailing address, and telephone number of the patient's health care
practitioner;

(3) the name, mailing address, and date of birth of the patient's designated caregiver, if
any, or the patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end if the parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or
spousenew text end will be acting as a caregiver;

(4) a copy of the certification from the patient's health care practitioner that is dated
within 90 days prior to submitting the application which certifies that the patient has been
diagnosed with a qualifying medical condition and, if applicable, that, in the health care
practitioner's medical opinion, the patient is developmentally or physically disabled and,
as a result of that disability, the patient is unable to self-administer medication or acquire
medical cannabis from a distribution facility; and

(5) all other signed affidavits and enrollment forms required by the commissioner under
sections 152.22 to 152.37, including, but not limited to, the disclosure form required under
paragraph (c).

(b) The commissioner shall require a patient to resubmit a copy of the certification from
the patient's health care practitioner on a yearly basis and shall require that the recertification
be dated within 90 days of submission.

(c) The commissioner shall develop a disclosure form and require, as a condition of
enrollment, all patients to sign a copy of the disclosure. The disclosure must include:

(1) a statement that, notwithstanding any law to the contrary, the commissioner, or an
employee of any state agency, may not be held civilly or criminally liable for any injury,
loss of property, personal injury, or death caused by any act or omission while acting within
the scope of office or employment under sections 152.22 to 152.37; and

(2) the patient's deleted text begin acknowledgementdeleted text end new text begin acknowledgment new text end that enrollment in the patient registry
program is conditional on the patient's agreement to meet all of the requirements of sections
152.22 to 152.37.

Sec. 8.

Minnesota Statutes 2018, section 152.27, subdivision 4, is amended to read:


Subd. 4.

Registered designated caregiver.

(a) The commissioner shall register a
designated caregiver for a patient if the patient's health care practitioner has certified that
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability, the patient is unable to self-administer medication
or acquire medical cannabis from a distribution facility and the caregiver has agreed, in
writing, to be the patient's designated caregiver. As a condition of registration as a designated
caregiver, the commissioner shall require the person to:

(1) be at least 21 years of age;

(2) agree to only possess any medical cannabis for purposes of assisting the patient; and

(3) agree that if the application is approved, the person will not be a registered designated
caregiver for more than one patient, unless the patients reside in the same residence.

(b) The commissioner shall conduct a criminal background check on the designated
caregiver prior to registration to ensure that the person does not have a conviction for a
disqualifying felony offense. Any cost of the background check shall be paid by the person
seeking registration as a designated caregiver.new text begin A designated caregiver must have the criminal
background check renewed every two years.
new text end

Sec. 9.

Minnesota Statutes 2018, section 152.27, subdivision 5, is amended to read:


Subd. 5.

Parents deleted text begin ordeleted text end new text begin ,new text end legal guardiansnew text begin , and spousesnew text end .

A parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or
spousenew text end of a patient may act as the caregiver to the patient without having to register as a
designated caregiver. The parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end shall follow all of the
requirements of parents deleted text begin anddeleted text end new text begin ,new text end legal guardiansnew text begin , and spousesnew text end listed in sections 152.22 to 152.37.
Nothing in sections 152.22 to 152.37 limits any legal authority a parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin ,
or spousenew text end may have for the patient under any other law.

Sec. 10.

Minnesota Statutes 2018, section 152.27, subdivision 6, is amended to read:


Subd. 6.

Patient enrollment.

(a) After receipt of a patient's application, application fees,
and signed disclosure, the commissioner shall enroll the patient in the registry program and
issue the patient and patient's registered designated caregiver or parent deleted text begin ordeleted text end new text begin ,new text end legal guardian,
new text begin or spouse, new text end if applicable, a registry verification. The commissioner shall approve or deny a
patient's application for participation in the registry program within 30 days after the
commissioner receives the patient's application and application fee. The commissioner may
approve applications up to 60 days after the receipt of a patient's application and application
fees until January 1, 2016. A patient's enrollment in the registry program shall only be
denied if the patient:

(1) does not have certification from a health care practitioner that the patient has been
diagnosed with a qualifying medical condition;

(2) has not signed and returned the disclosure form required under subdivision 3,
paragraph (c), to the commissioner;

(3) does not provide the information required;

(4) has previously been removed from the registry program for violations of section
152.30 or 152.33; or

(5) provides false information.

(b) The commissioner shall give written notice to a patient of the reason for denying
enrollment in the registry program.

(c) Denial of enrollment into the registry program is considered a final decision of the
commissioner and is subject to judicial review under the Administrative Procedure Act
pursuant to chapter 14.

(d) A patient's enrollment in the registry program may only be revoked upon the death
of the patient or if a patient violates a requirement under section 152.30 or 152.33.

(e) The commissioner shall develop a registry verification to provide to the patient, the
health care practitioner identified in the patient's application, and to the manufacturer. The
registry verification shall include:

(1) the patient's name and date of birth;

(2) the patient registry number assigned to the patient;

(3) the patient's qualifying medical condition as provided by the patient's health care
practitioner in the certification; and

(4) the name and date of birth of the patient's registered designated caregiver, if any, or
the name of the patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end if the parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin ,
or spousenew text end will be acting as a caregiver.

Sec. 11.

Minnesota Statutes 2018, section 152.28, subdivision 1, is amended to read:


Subdivision 1.

Health care practitioner duties.

(a) Prior to a patient's enrollment in
the registry program, a health care practitioner shall:

(1) determine, in the health care practitioner's medical judgment, whether a patient suffers
from a qualifying medical condition, and, if so determined, provide the patient with a
certification of that diagnosis;

(2) determine whether a patient is developmentally or physically disabled and, as a result
of that disability, the patient is unable to self-administer medication or acquire medical
cannabis from a distribution facility, and, if so determined, include that determination on
the patient's certification of diagnosis;

(3) advise patients, registered designated caregivers, and parents deleted text begin ordeleted text end new text begin ,new text end legal guardiansnew text begin , or
spousesnew text end who are acting as caregivers of the existence of any nonprofit patient support groups
or organizations;

(4) provide explanatory information from the commissioner to patients with qualifying
medical conditions, including disclosure to all patients about the experimental nature of
therapeutic use of medical cannabis; the possible risks, benefits, and side effects of the
proposed treatment; the application and other materials from the commissioner; and provide
patients with the Tennessen warning as required by section 13.04, subdivision 2; and

(5) agree to continue treatment of the patient's qualifying medical condition and report
medical findings to the commissioner.

(b) Upon notification from the commissioner of the patient's enrollment in the registry
program, the health care practitioner shall:

(1) participate in the patient registry reporting system under the guidance and supervision
of the commissioner;

(2) report health records of the patient throughout the ongoing treatment of the patient
to the commissioner in a manner determined by the commissioner and in accordance with
subdivision 2;

(3) determine, on a yearly basis, if the patient continues to suffer from a qualifying
medical condition and, if so, issue the patient a new certification of that diagnosis; and

(4) otherwise comply with all requirements developed by the commissioner.

(c) Nothing in this section requires a health care practitioner to participate in the registry
program.

Sec. 12.

Minnesota Statutes 2018, section 152.29, subdivision 3, is amended to read:


Subd. 3.

Manufacturer; distribution.

(a) A manufacturer shall require that employees
licensed as pharmacists pursuant to chapter 151 be the only employees to give final approval
for the distribution of medical cannabis to a patient.

(b) A manufacturer may dispense medical cannabis products, whether or not the products
have been manufactured by the manufacturer, but is not required to dispense medical cannabis
products.

(c) Prior to distribution of any medical cannabis, the manufacturer shall:

(1) verify that the manufacturer has received the registry verification from the
commissioner for that individual patient;

(2) verify that the person requesting the distribution of medical cannabis is the patient,
the patient's registered designated caregiver, or the patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or
spousenew text end listed in the registry verification using the procedures described in section 152.11,
subdivision 2d;

(3) assign a tracking number to any medical cannabis distributed from the manufacturer;

(4) ensure that any employee of the manufacturer licensed as a pharmacist pursuant to
chapter 151 has consulted with the patient to determine the proper dosage for the individual
patient after reviewing the ranges of chemical compositions of the medical cannabis and
the ranges of proper dosages reported by the commissioner. For purposes of this clause, a
consultation may be conducted remotely using a videoconference, so long as the employee
providing the consultation is able to confirm the identity of the patient, the consultation
occurs while the patient is at a distribution facility, and the consultation adheres to patient
privacy requirements that apply to health care services delivered through telemedicine;

(5) properly package medical cannabis in compliance with the United States Poison
Prevention Packing Act regarding child-resistant packaging and exemptions for packaging
for elderly patients, and label distributed medical cannabis with a list of all active ingredients
and individually identifying information, including:

(i) the patient's name and date of birth;

(ii) the name and date of birth of the patient's registered designated caregiver or, if listed
on the registry verification, the name of the patient's parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end , if
applicable;

(iii) the patient's registry identification number;

(iv) the chemical composition of the medical cannabis; and

(v) the dosage; and

(6) ensure that the medical cannabis distributed contains a maximum of a 30-day supply
of the dosage determined for that patient.

(d) A manufacturer shall require any employee of the manufacturer who is transporting
medical cannabis or medical cannabis products to a distribution facility to carry identification
showing that the person is an employee of the manufacturer.

Sec. 13.

Minnesota Statutes 2018, section 152.32, subdivision 2, is amended to read:


Subd. 2.

Criminal and civil protections.

(a) Subject to section 152.23, the following
are not violations under this chapter:

(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end of a patient if the parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end
is listed on the registry verification;

(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and

(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.

(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.

(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.

(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.

(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.

(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.

(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.

(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.

(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.

(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.

Sec. 14.

Minnesota Statutes 2018, section 152.33, subdivision 1, is amended to read:


Subdivision 1.

Intentional diversion; criminal penalty.

In addition to any other
applicable penalty in law, a manufacturer or an agent of a manufacturer who intentionally
transfers medical cannabis to a person other than a patient, a registered designated caregiver
or, if listed on the registry verification, a parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end of a patient is
guilty of a felony punishable by imprisonment for not more than two years or by payment
of a fine of not more than $3,000, or both. A person convicted under this subdivision may
not continue to be affiliated with the manufacturer and is disqualified from further
participation under sections 152.22 to 152.37.

Sec. 15.

Minnesota Statutes 2018, section 152.33, subdivision 2, is amended to read:


Subd. 2.

Diversion by patient, registered designated caregiver, deleted text begin ordeleted text end parentnew text begin , legal
guardian, or patient's spousenew text end ; criminal penalty.

In addition to any other applicable penalty
in law, a patient, registered designated caregiver or, if listed on the registry verification, a
parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end of a patient who intentionally sells or otherwise transfers
medical cannabis to a person other than a patient, designated registered caregiver or, if listed
on the registry verification, a parent deleted text begin ordeleted text end new text begin ,new text end legal guardiannew text begin , or spousenew text end of a patient is guilty of a
felony punishable by imprisonment for not more than two years or by payment of a fine of
not more than $3,000, or both.

Sec. 16.

Minnesota Statutes 2018, section 214.25, subdivision 2, is amended to read:


Subd. 2.

Commissioner of health data.

deleted text begin (a)deleted text end All data collected or maintained as part of
the commissioner of health's duties under new text begin Minnesota Statutes 2018, new text end sections 214.19, 214.23,
and 214.24new text begin ,new text end shall be classified as investigative data under section 13.39, except that inactive
investigative data shall be classified as private data under section 13.02, subdivision 12, or
nonpublic data under section 13.02, subdivision 9, in the case of data not on individuals.

deleted text begin (b) Notwithstanding section 13.05, subdivision 9, data addressed in this subdivision
shall not be disclosed except as provided in this subdivision or section 13.04; except that
the commissioner may disclose to the boards under section 214.23.
 deleted text end

deleted text begin (c) The commissioner may disclose data addressed under this subdivision as necessary:
to identify, establish, implement, and enforce a monitoring plan; to investigate a regulated
person; to alert persons who may be threatened by illness as evidenced by epidemiologic
data; to control or prevent the spread of HIV, HBV, or HCV disease; or to diminish an
imminent threat to the public health.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective on January 1, 2020, and no new cases
shall be investigated under this subdivision after June 1, 2019.
 new text end

Sec. 17. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes shall correct any internal cross-references to sections 214.17 to
214.25 that occur as a result of the repealed language and may make changes necessary to
correct punctuation, grammar, or structure of the remaining text and preserve its meaning.
 new text end

Sec. 18. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 214.17; 214.18; 214.19; 214.20; 214.21; 214.22;
214.23; and 214.24, new text end new text begin are repealed on January 1, 2020, and no new cases shall be investigated
under these sections after June 1, 2019.
 new text end

ARTICLE 13

ADULT PROTECTION

Section 1.

new text begin [256M.42] ADULT PROTECTION GRANT ALLOCATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Formula. new text end

new text begin (a) The commissioner shall allocate state money appropriated
under this section to each county board and tribal government approved by the commissioner
to assume county agency duties for adult protective services or as a lead investigative agency
under section 626.557 on an annual basis in an amount determined according to the following
formula:
 new text end

new text begin (1) 25 percent must be allocated on the basis of the number of reports of suspected
vulnerable adult maltreatment under sections 626.557 and 626.5572, when the county or
tribe is responsible as determined by the most recent data of the commissioner; and
 new text end

new text begin (2) 75 percent must be allocated on the basis of the number of screened-in reports for
adult protective services or vulnerable adult maltreatment investigations under sections
626.557 and 626.5572, when the county or tribe is responsible as determined by the most
recent data of the commissioner.
 new text end

new text begin (b) The commissioner is precluded from changing the formula under this subdivision
or recommending a change to the legislature without public review and input.
 new text end

new text begin Subd. 2. new text end

new text begin Payment. new text end

new text begin The commissioner shall make allocations under subdivision 1 to
each county board or tribal government each year on or before July 10.
 new text end

new text begin Subd. 3. new text end

new text begin Prohibition on supplanting existing money. new text end

new text begin Money received under this section
must be used for staffing for protection of vulnerable adults or to expand adult protective
services. Money must not be used to supplant current county or tribe expenditures for these
purposes.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
 new text end

ARTICLE 14

ASSISTED LIVING LICENSURE

Section 1.

new text begin [144I.01] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For the purposes of this chapter, the definitions in this
section have the meanings given.
 new text end

new text begin Subd. 2. new text end

new text begin Activities of daily living. new text end

new text begin "Activities of daily living" has the meaning given in
section 256B.0659, subdivision 1, paragraph (b).
 new text end

new text begin Subd. 3. new text end

new text begin Adult. new text end

new text begin "Adult" means a natural person who has attained the age of 18 years.
 new text end

new text begin Subd. 4. new text end

new text begin Assisted living. new text end

new text begin "Assisted living" means a licensed establishment that: (1)
provides sleeping accommodations to one or more adults; and (2) provides home care
services. For purposes of this chapter, assisted living does not include:
 new text end

new text begin (i) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
 new text end

new text begin (ii) a housing with services establishment registered under section 144D.025;
 new text end

new text begin (iii) a nursing home licensed under chapter 144A;
 new text end

new text begin (iv) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
 new text end

new text begin (v) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D or 245G, except lodging establishments
that provide dementia care services;
 new text end

new text begin (vi) a lodging establishment serving as a shelter for individuals fleeing domestic violence;
 new text end

new text begin (vii) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
 new text end

new text begin (viii) private homes where the residents own or rent the home and control all aspects of
the property and building;
 new text end

new text begin (ix) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
 new text end

new text begin (x) temporary family health care dwellings as defined in sections 394.307 and 462.3593;
 new text end

new text begin (xi) settings offering services conducted by and for the adherents of any recognized
church or religious denomination for its members through spiritual means or by prayer for
healing; or
 new text end

new text begin (xii) housing financed pursuant to sections 462A.37 to 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless.
 new text end

new text begin Subd. 5. new text end

new text begin Assisted living resident or resident. new text end

new text begin "Assisted living resident" or "resident"
means a person who resides in a licensed assisted living that is subject to the requirements
of this chapter.
 new text end

new text begin Subd. 6. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
 new text end

new text begin Subd. 7. new text end

new text begin Controlling person. new text end

new text begin (a) "Controlling person" means any public body,
governmental agency, business entity, officer, nursing home administrator, assisted living
administrator, or director whose responsibilities include the direction of the management
or policies of an assisted living. Controlling person also means any person who, directly or
indirectly, beneficially owns any interest in:
 new text end

new text begin (1) any corporation, partnership, limited liability company, real estate investment trust
(REIT), or other business association that is a controlling person;
 new text end

new text begin (2) the land on which the assisted living is located;
 new text end

new text begin (3) the structure in which an assisted living is located;
 new text end

new text begin (4) any mortgage, contract for deed, or other obligation secured in whole or in part by
the land or structure comprising the assisted living; or
 new text end

new text begin (5) any lease or sublease of the land, structure, or facilities comprising the assisted living.
 new text end

new text begin (b) For purposes of this chapter, controlling person does not include:
 new text end

new text begin (1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
directly or through a subsidiary operates a nursing home;
 new text end

new text begin (2) an individual state official or employee, or a member or employee of the governing
body of a political subdivision of the state that operates one or more assisted livings, unless
the individual is also an officer or director of a nursing home, receives any remuneration
from an assisted living, or owns any of the beneficial interests not excluded in this
subdivision;
 new text end

new text begin (3) a natural person who is a member of a tax-exempt organization under section 290.05,
subdivision 2, unless the individual is also an officer or director of an assisted living, or
owns any of the beneficial interests not excluded in this subdivision; and
 new text end

new text begin (4) a natural person who owns less than five percent of the outstanding common shares
of a corporation:
 new text end

new text begin (i) whose securities are exempt by virtue of section 80A.45, clause (6); or
 new text end

new text begin (ii) whose transactions are exempt by virtue of section 80A.46, clause (7).
 new text end

new text begin Subd. 8. new text end

new text begin Home care services. new text end

new text begin "Home care services" means services as defined in section
144A.43, subdivision 3, and comprehensive PLUS services as defined in section 144I.02.
 new text end

new text begin Subd. 9. new text end

new text begin Licensee. new text end

new text begin "Licensee" means a person or entity to whom the commissioner
issues an assisted living license and is a controlling person.
 new text end

new text begin Subd. 10. new text end

new text begin Management agreement. new text end

new text begin "Management agreement" means a written, executed
agreement between a licensee and manager regarding the provision of certain services on
behalf of the licensee.
 new text end

new text begin Subd. 11. new text end

new text begin Manager or operator. new text end

new text begin "Manager" or "operator" means an entity or person
possessing the right to exercise operational or management control over, or directly or
indirectly conduct, the day-to-day operation of an establishment.
 new text end

new text begin Subd. 12. new text end

new text begin New construction. new text end

new text begin "New construction" means a new building, renovation,
modification, reconstruction, physical changes altering the use of occupancy, or an addition
to a building.
 new text end

new text begin Subd. 13. new text end

new text begin Person-centered planning and service delivery. new text end

new text begin "Person-centered planning
and service delivery" means services as defined in section 245D.07, subdivision 1a, paragraph
(b).
 new text end

new text begin Subd. 14. new text end

new text begin Supportive services. new text end

new text begin "Supportive services" means services that may be offered
or provided by an assisted living provider as part of the assisted living license and means
help with personal laundry, handling or assisting with personal funds of residents, or
arranging for medical services, health-related services, social services, housekeeping, central
dining, recreation, or transportation. Arranging for services does not include making referrals,
or contacting a service provider in an emergency.
 new text end

Sec. 2.

new text begin [144I.02] ASSISTED LIVING LICENSE; APPLICABLE LAWS;
APPLICATION AND RENEWAL.
 new text end

new text begin Subdivision 1. new text end

new text begin License required. new text end

new text begin (a) Beginning July 1, 2021, no newly formed entity
may open, operate, maintain, advertise, or hold itself out as an assisted living in Minnesota
unless it is licensed under this chapter.
 new text end

new text begin (b) Entities that operated as a housing with services establishment under chapter 144D
with an arranged home care provider licensed under section 144A.471, must convert to the
assisted living license beginning July 1, 2021, in compliance with the commissioner's process
so that all assisted living settings are licensed by July 1, 2022.
 new text end

new text begin (c) After July 1, 2022, it shall be a criminal gross misdemeanor to open, operate, maintain,
advertise, or hold oneself out as an assisted living without a license pursuant to section
609.0341, subdivision 1.
 new text end

new text begin (d) No person or business shall provide both housing combined with health services
without first obtaining an assisted living license from the commissioner.
 new text end

new text begin Subd. 2. new text end

new text begin Licensure levels. new text end

new text begin (a) The levels in this subdivision are established for assisted
living licensure:
 new text end

new text begin (b) Basic License - For assisted living facilities that provide basic home care services
as defined in section 144A.471, subdivision 6. In addition to the services defined in section
144A.471, basic license includes:
 new text end

new text begin (1) assistance with activities of daily living such as bathing, dressing, grooming, eating,
transfers, mobility, positioning, and toileting; and assistance with instrumental activities of
daily living such as meal planning and preparation, paying bills, shopping, performing
household tasks, and communication by telephone or other media; and
 new text end

new text begin (2) assisting with self-administered medications.
 new text end

new text begin (c) Comprehensive License - For assisted living facilities that provide services as defined
in section 144A.471, subdivision 7.
 new text end

new text begin (d) Comprehensive PLUS License - For assisted living facilities that provide both
comprehensive home care services and services in a secure or separate dementia care unit
or wing and complies with requirements in sections 144I.13 to 144I.18.
 new text end

new text begin Subd. 3. new text end

new text begin Licensed home care provider requirements applicable to assisted living
licensing. new text end

new text begin The following sections apply to assisted living licensees in this chapter:
 new text end

new text begin (1) section 144A.43, subdivisions 1d, 1e, 2a to 2e, 3, 3a, 7, 10 to 16, 18 to 25, 27 to 33,
35 to 38;
 new text end

new text begin (2) section 144A.44, Home Care Bill of Rights, and section 144A.441, assisted living
bill of rights addendum;
 new text end

new text begin (3) section 144A.45, subdivision 6, relating to tuberculosis prevention and control;
 new text end

new text begin (4) section 144A.474, subdivisions 4 to 8, 11, and 12, relating to surveys, fines, and
reconsiderations;
 new text end

new text begin (5) section 144A.475, relating to enforcement;
 new text end

new text begin (6) section 144A.476, relating to background studies;
 new text end

new text begin (7) section 144A.477, relating to medicare certified home health agencies;
 new text end

new text begin (8) section 144A.478, relating to innovation variance;
 new text end

new text begin (9) section 144A.479, relating to quality management, handling resident's finances and
property, reporting maltreatment, and employee records;
 new text end

new text begin (10) section 144A.4791, relating to providers' responsibilities to clients;
 new text end

new text begin (11) section 144A.4792, relating to medication management;
 new text end

new text begin (12) section 144A.4793, relating to treatment and therapy management services;
 new text end

new text begin (13) section 144A.4794, relating to client record requirements;
 new text end

new text begin (14) section 144A.4795, relating to home care provider responsibilities regarding their
staff;
 new text end

new text begin (15) section 144A.4796, relating to orientation and annual training requirements;
 new text end

new text begin (16) section 144A.4797, relating to provision of services;
 new text end

new text begin (17) section 144A.4798, relating to employee health status;
 new text end

new text begin (18) section 144A.4799, relating to Department of Health licensed home care provider
advisory council;
 new text end

new text begin (19) section 144A.484, relating to integrated licensure and home and community-based
services designation;
 new text end

new text begin (20) sections 144D.065, 144D.066, and 144D.10, relating to dementia care training,
manager training, and commissioner enforcement;
 new text end

new text begin (21) section 144D.07, relating to prohibition of restraints;
 new text end

new text begin (22) section 144D.08, relating to uniform consumer information guide;
 new text end

new text begin (23) section 144D.11, relating to emergency planning; and
 new text end

new text begin (24) section 144.051, subdivisions 3 to 6.
 new text end

new text begin Subd. 4. new text end

new text begin Provisional license. new text end

new text begin (a) Beginning July 1, 2021, for new assisted living license
applicants, the commissioner shall issue a provisional license to each of the licensure levels
specified in subdivision 2 which is effective for up to one year from the license effective
date, except that a provisional license may be extended according to paragraph (d).
 new text end

new text begin (b) During the provisional license period, the commissioner shall survey the provisional
licensee after the commissioner is notified or has evidence that the provisional licensee has
residents and is providing services.
 new text end

new text begin (c) Within two days of beginning to provide services, the provisional licensee must
provide notice to the commissioner that it is serving residents by sending an e-mail to the
e-mail address provided by the commissioner. If the provisional licensee does not provide
assisted living services during the provisional license year period, then the provisional
license expires at the end of the period and the applicant must reapply for the provisional
assisted living license.
 new text end

new text begin (d) If the provisional licensee notifies the commissioner that the licensee has residents
within 45 days prior to the provisional license expiration, the commissioner may extend the
provisional license for up to 60 days in order to allow the commissioner to complete the
on-site survey required under this section and follow-up survey visits.
 new text end

new text begin (e) If the provisional licensee is in substantial compliance with the survey, the
commissioner shall issue an assisted living license. If the provisional licensee is not in
substantial compliance with the survey, the commissioner shall either: (1) not issue the
assisted living license and terminate the provisional license; or (2) extend the provisional
license for a period not to exceed 90 days and apply conditions, to the extension of the
provisional license. If the provisional licensee is not in substantial compliance with the
survey within the time period of the extension or if the provisional licensee does not satisfy
the license conditions, the commissioner may deny the license.
 new text end

new text begin (f) If a provisional licensee whose assisted living license has been denied or extended
with conditions disagrees with the conclusions of the commissioner, then the provisional
licensee may request a reconsideration by the commissioner or commissioner's designee.
The reconsideration request process must be conducted internally by the commissioner or
designee, and chapter 14 does not apply.
 new text end

new text begin (g) The provisional licensee requesting the reconsideration must make the request in
writing and must list and describe the reasons why the provisional licensee disagrees with
the decision to deny the assisted living license or the decision to extend the provisional
license with conditions.
 new text end

new text begin (h) The reconsideration request and supporting documentation must be received by the
commissioner within 15 calendar days after the date the provisional license receives the
denial or provisional license with conditions.
 new text end

new text begin (i) A provisional licensee whose license is denied is permitted to continue operating as
an assisted living during the period of time when:
 new text end

new text begin (1) a reconsideration is in process;
 new text end

new text begin (2) an extension of the provisional license and terms associated with it is in active
negotiation between the commissioner and the licensee and the commissioner confirms the
negotiation is active; or
 new text end

new text begin (3) a transfer of residents to a new assisted living establishment is underway and not all
the residents have relocated.
 new text end

new text begin Subd. 5. new text end

new text begin License applications. new text end

new text begin (a) Each application for an assisted living license,
including a provisional license, must include information sufficient to show that the applicant
meets the requirements of licensure, including:
 new text end

new text begin (1) the business name and legal entity name of the operating entity, street address and
mailing address of the assisted living; the names, e-mail addresses, telephone numbers, and
mailing addresses of the owner or owners, direct and indirect, and managerial officials of
the assisted living; and if the owner or owners are not natural persons, identification of the
type of business entity of the owner or owners and the names, e-mail addresses, telephone
numbers of the officers and members of the governing body, or comparable persons for
partnerships, limited liability corporations, or other types of business organizations of the
owner or owners;
 new text end

new text begin (2) the name and mailing address of the managing agent, whether through management
agreement or lease agreement, of the establishment, if different from the owner or owners,
and the name of the on-site administrator;
 new text end

new text begin (3) the license fee in the amount specified in subdivision 11;
 new text end

new text begin (4) the e-mail address, physical address, mailing address, and telephone number of the
principal administrative office;
 new text end

new text begin (5) any state or federal court judgments, bankruptcy filings, tax liens, administrative
actions, or investigations by any state or federal government agency against the applicant
or the controlling person, or all persons involved in the management, operation, or control
of the assisted living occurring within the last ten years;
 new text end

new text begin (6) documentation of compliance with the background study requirements of section
144A.476 for the owner, controlling person, and all persons involved in the management,
operation, or control of the assisted living establishment. Each application for a new license
must include documentation for the applicant and for each individual with five percent or
more direct or indirect ownership in the applicant;
 new text end

new text begin (7) documentation of a background study as required by section 144.057 for any
individual seeking employment, paid or volunteer, with the assisted living establishment;
 new text end

new text begin (8) evidence of workers' compensation coverage as required by sections 176.181 and
176.182;
 new text end

new text begin (9) documentation of liability coverage, if the provider has it;
 new text end

new text begin (10) documentation that identifies the manager or operator who is in charge of day-to-day
operations and attestation that the person has reviewed and understands the assisted living
provider regulations;
 new text end

new text begin (11) documentation that the applicant has designated one or more owners, controlling
persons, or employees as an agent or agents, which shall not affect the legal responsibility
of any other owner or controlling person under this chapter;
 new text end

new text begin (12) the signature of the controlling person on behalf of the assisted living applicant;
 new text end

new text begin (13) documentation of whether the assisted living health or supportive services are
included in the monthly base rate to be paid by the resident;
 new text end

new text begin (14) attestation that the applicant will comply with the prohibitions against deceptive
marketing and business practices required by section 144I.21;
 new text end

new text begin (15) documentation showing that the applicant has at least one year's worth of capital
or revenue sufficient to operate the assisted living;
 new text end

new text begin (16) verification that the applicant has the following policies and procedures in place so
that if a license is issued, the applicant will implement the policies and procedures and keep
them current:
 new text end

new text begin (i) requirements in section 626.556, reporting of maltreatment of minors; and section
626.557, reporting of maltreatment of vulnerable adults;
 new text end

new text begin (ii) conducting and handling background studies on employees;
 new text end

new text begin (iii) orientation, training, and competency evaluations of assisted living staff, and a
process for evaluating staff performance;
 new text end

new text begin (iv) handling complaints from residents, family members, or resident representatives
regarding staff or services provided by staff, the building, physical plant, or environment;
 new text end

new text begin (v) conducting initial evaluation of residents' needs, move-in assessments, and the
providers' ability to provide those services, including the services the residents request;
 new text end

new text begin (vi) conducting initial and ongoing resident evaluations and assessments from a
person-centered perspective, and how changes in a resident's condition are identified,
managed, and communicated to staff and other health care providers as appropriate;
 new text end

new text begin (vii) orientation to and implementation of the home care client bill of rights in sections
144A.44 and 144A.4791 with assisted living addendum;
 new text end

new text begin (viii) infection control practices;
 new text end

new text begin (ix) reminders for medications, treatments, or exercises, if provided as services;
 new text end

new text begin (x) conducting appropriate screenings, or documentation of prior screenings, to show
that staff are free of tuberculosis, consistent with current United States Centers for Disease
Control and Prevention standards;
 new text end

new text begin (xi) procedures about ensuring resident rights to information about and appeals from
residency contracts and services terminations; and
 new text end

new text begin (xii) policies and procedures for updating the staffing plan that ensures resident care
needs are met, including a description of what factors are necessary to meet resident care
needs and procedures for quality control reviews assessing the effectiveness of the staffing
plans;
 new text end

new text begin (17) for comprehensive and comprehensive PLUS applicants, in addition to the
requirements in clause (16), the applicant must provide verification that the applicant has
policies and procedures in place so that if a license is issued, the applicant will implement
the policies and procedures and keep them current as required by section 144A.472,
subdivision 2;
 new text end

new text begin (18) identification of financial interest of any individual, including stockholders who
have an incident of ownership in the applicant representing an interest of five percent or
more. For the purposes of this chapter, an individual with a five percent or more direct or
indirect ownership is presumed to have an effect on the operation of the facility with respect
to factors affecting the care or training provided;
 new text end

new text begin (19) identification of any individual with a five percent or more direct or indirect
ownership that has ever been convicted of a crime associated with the operation of a
long-term care, community-based, or health care facility or agency under federal law or the
laws of any state;
 new text end

new text begin (20) identification of all states where the applicant, or individual having a five percent
or more ownership, currently or previously has been licensed as owner or operator of a
long-term care, community-based, or health care facility or agency where its license or
federal certification has been denied, suspended, restricted, conditioned, or revoked under
a private or state-controlled receivership, or where these same actions are pending under
the laws of any state or federal authority; and
 new text end

new text begin (21) any other information required by the commissioner.
 new text end

new text begin (b) If the owner of the facility is a different entity from the operator or management
company of the facility, both the operator and the owner must complete an application for
licensure for review under the same application process. Only one license fee is required.
 new text end

new text begin Subd. 6. new text end

new text begin Transfers prohibited; changes in ownership. new text end

new text begin Any assisted living license
issued by the commissioner may not be transferred to another party. Before acquiring
ownership of an assisted living provider business, a prospective applicant must apply for a
new license. A change of ownership is a transfer of operational control to a different business
entity and includes:
 new text end

new text begin (1) transfer of the business to a different or new corporation;
 new text end

new text begin (2) in the case of a partnership, the dissolution or termination of the partnership under
chapter 323A, with the business continuing by a successor partnership or other entity;
 new text end

new text begin (3) relinquishment of control of the provider to another party, including to a contract
management firm that is not under the control of the owner of the business's assets;
 new text end

new text begin (4) transfer of the business by a sole proprietor to another party or entity; or
 new text end

new text begin (5) in the case of a privately held corporation, the change in ownership or control of 50
percent or more of the outstanding voting stock.
 new text end

new text begin Subd. 7. new text end

new text begin License renewal. new text end

new text begin Except as provided in section 144A.475, a license that is not
a provisional license may be renewed for a period of one year if the licensee satisfies the
following:
 new text end

new text begin (1) submits an application for renewal in the format provided by the commissioner at
least 60 days before expiration of the license;
 new text end

new text begin (2) submits the renewal fee of $8,000;
 new text end

new text begin (3) submits the late fee pursuant to subdivision 11 if the renewal application is received
less than 30 days before the expiration date of the license;
 new text end

new text begin (4) complies with sections 144A.43 to 144A.4798 and the provisions of this chapter;
 new text end

new text begin (5) provides information sufficient to show that the applicant meets the requirements of
licensure, including items required under subdivision 5;
 new text end

new text begin (6) provides verification that all policies under subdivision 5 are current;
 new text end

new text begin (7) updates the information required by subdivision 5, paragraph (a), clause (18); and
 new text end

new text begin (8) provides any other information deemed necessary by the commissioner.
 new text end

new text begin Subd. 8. new text end

new text begin Notification of changes of information. new text end

new text begin The provisional licensee or licensee
shall notify the commissioner in writing prior to any financial or contractual change and
within 60 calendar days after any change in the information required in subdivision 5.
 new text end

new text begin Subd. 9. new text end

new text begin Actions on licenses. new text end

new text begin (a) The commissioner shall consider an applicant's
performance history, in Minnesota and in other states, including repeat violations or rule
violations, before issuing a provisional license, license, or renewal license.
 new text end

new text begin (b) An applicant must not have a history within the last five years in Minnesota or in
any other state of a license or certification involuntarily suspended or voluntarily terminated
during any enforcement process in a facility that provides care to children, the elderly or ill
individuals, or individuals with disabilities.
 new text end

new text begin (c) Failure to provide accurate information or demonstrate required performance history
may result in the denial of a license.
 new text end

new text begin (d) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license
or impose conditions if:
 new text end

new text begin (1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license shall be granted;
 new text end

new text begin (2) the assisted living, knowingly or with reason to know, made a false statement of a
material fact in an application for the license or any data attached to the application, or in
any matter under investigation by the department;
 new text end

new text begin (3) the assisted living refused to allow representatives or agents of the department to
inspect its books, records, and files, or any portion of the premises;
 new text end

new text begin (4) willfully prevented, interfered with, or attempted to impede in any way: (i) the work
of any authorized representative of the department, the ombudsman for long-term care or
the ombudsman for mental health and developmental disabilities; or (ii) the duties of the
commissioner, local law enforcement, city or county attorneys, adult protection, county
case managers, or other local government personnel;
 new text end

new text begin (5) the assisted living has been the subject of a substantiated maltreatment violation,
had level 2 widespread determination on a survey, had a level 3 or level 4 violation as
specified in section 144A.474, subdivision 11, or the assisted living engaged in conduct
that was detrimental to the health, welfare, or safety of the resident;
 new text end

new text begin (6) the assisted living has a history of noncompliance with federal or state regulations
in providing care or services. The factors the commissioner may consider include but are
not limited to the gravity and frequency of the noncompliance; and
 new text end

new text begin (7) the assisted living engages in conduct in section 144A.475, subdivision 1; or
 new text end

new text begin (8) the assisted living violates any requirement in this chapter.
 new text end

new text begin (e) For all new licensees after a change in ownership, the commissioner shall complete
a survey within six months after the new license is issued.
 new text end

new text begin Subd. 10. new text end

new text begin Fees. new text end

new text begin (a) An initial applicant seeking assisted living licensure must submit
the following application fee to the commissioner along with a completed application:
 new text end

new text begin (1) for a basic assisted living facility providing basic home care services, $5,500;
 new text end

new text begin (2) for a comprehensive assisted living facility providing comprehensive home care
services, $9,500; and
 new text end

new text begin (3) for a comprehensive PLUS assisted living facility providing comprehensive home
care services and dementia care, $14,250.
 new text end

new text begin (b) An assisted living filing a change of ownership as required under subdivision 6 must
submit the following application fee to the commissioner, along with the documentation
required for the change of ownership:
 new text end

new text begin (1) for a basic assisted living, $5,500;
 new text end

new text begin (2) for a comprehensive assisted living, $9,500; or
 new text end

new text begin (3) for a comprehensive PLUS assisted living, $10,000.
 new text end

new text begin (c) The penalty for late submission of the renewal application before expiration of the
license is $200. The penalty for practicing after expiration of the assisted living license and
before a renewal license is issued is $250 per each day after expiration of the license until
the renewal license issuance date. The assisted living is still subject to the criminal gross
misdemeanor penalties for operating after license expiration.
 new text end

new text begin (d) Fees collected under this section shall be deposited in the state treasury and credited
to the state government special revenue fund. All fees are nonrefundable.
 new text end

new text begin (e) Fines collected under this subdivision shall be deposited in a dedicated special revenue
account. On an annual basis, the balance in the special revenue account shall be appropriated
to the commissioner to implement the recommendations of the advisory council established
in section 144A.4799.
 new text end

Sec. 3.

new text begin [144I.03] ASSISTED LIVING LICENSES PRACTICE REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Requirements. new text end

new text begin All licensed assisted living shall:
 new text end

new text begin (1) distribute to residents, families, and resident representatives and enforce the home
care bill of rights requirements in section 144A.44 and the assisted living bill of rights in
section 144A.441 except that the advance notice period for termination of housing and
services shall be no less than 30 days;
 new text end

new text begin (2) provide health-related services in a manner that complies with applicable home care
licensure requirements in chapter 144A and the Nurse Practice Act in sections 148.171 to
148.285;
 new text end

new text begin (3) utilize person-centered planning and service delivery process as defined in section
245D.07;
 new text end

new text begin (4) have and maintain a system for delegation of health care activities to unlicensed
personnel by a registered nurse, including supervision and evaluation of the delegated
activities as required by applicable home care licensure requirements in chapter 144A and
the Nurse Practice Act in sections 148.171 to 148.285;
 new text end

new text begin (5) have, maintain, and document a system to visually check on each assisted living
resident a minimum of once daily or more than once daily depending on the person-centered
care plan;
 new text end

new text begin (6) provide a means for assisted living residents to request assistance for health and
safety needs 24 hours per day, seven days per week;
 new text end

new text begin (7) have an on-site registered nurse or licensed practical nurse available 24 hours per
day, seven days per week, who is responsible for responding to the requests of assisted
living residents for assistance with health or safety needs, who shall be:
 new text end

new text begin (i) awake;
 new text end

new text begin (ii) located in the same building, in an attached building, or on a contiguous campus
with the housing with services establishment in order to respond within a reasonable amount
of time;
 new text end

new text begin (iii) capable of communicating with assisted living residents; and
 new text end

new text begin (iv) capable of providing either the assistance required or, if the person on-site is a
licensed practical nurse, have access to an on-call registered nurse;
 new text end

new text begin (8) offer to provide or make available at least the following supportive services to assisted
living residents:
 new text end

new text begin (i) at least two daily nutritious meals with snacks available seven days per week,
according to the recommended dietary allowances in the United States Department of
Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The
following apply:
 new text end

new text begin (A) modified special diets that are appropriate to residents' needs and choices;
 new text end

new text begin (B) menus prepared at least one week in advance, and made available to all residents.
The facility must encourage residents' involvement in menu planning. Meal substitutions
must be of similar nutritional value if a resident refuses a food that is served. Residents
must be informed in advance of menu changes;
 new text end

new text begin (C) food must be prepared and served according to the Minnesota Food Code, Minnesota
Rules, chapter 4626; and
 new text end

new text begin (D) the assisted living cannot require a resident to include and pay for meals in their
residency contract;
 new text end

new text begin (ii) weekly housekeeping;
 new text end

new text begin (iii) weekly laundry service;
 new text end

new text begin (iv) upon the request of the resident, provide direct or reasonable assistance with arranging
for transportation to medical and social services appointments, shopping, and other recreation,
and provide the name of or other identifying information about the person or persons
responsible for providing this assistance;
 new text end

new text begin (v) upon the request of the resident, provide reasonable assistance with accessing
community resources and social services available in the community, and provide the name
of or other identifying information about the person or persons responsible for providing
this assistance; and
 new text end

new text begin (vi) have a daily program of social and recreational activities that are based upon
individual and group interests, physical, mental, and psychosocial needs, and that creates
opportunities for active participation in the community at large;
 new text end

new text begin (9) make available to all prospective and current assisted living clients a copy of the
uniform consumer information guide required by section 144G.06;
 new text end

new text begin (10) maintain a safe, clean, sanitary, functional, comfortable, and home-like physical
environment; and
 new text end

new text begin (11) establish and maintain an infection control program.
 new text end

new text begin Subd. 2. new text end

new text begin Nursing assessment. new text end

new text begin (a) A licensed assisted living shall:
 new text end

new text begin (1) have the arranged home care provider conduct a nursing assessment by a registered
nurse of the physical and cognitive needs of the prospective resident and propose a temporary
service plan prior to the date on which a prospective resident executes a contract with an
assisted living establishment or the date on which a prospective resident moves in, whichever
is earlier. If necessitated by either the geographic distance between the prospective resident
and the provider, or urgent or unexpected circumstances exist, the assessment may be
conducted using telecommunication methods based on practice standards that meet the
individual resident's needs and reflect person-centered planning and service delivery; and
 new text end

new text begin (2) inform the prospective resident of the availability of and contact information for
long-term care consultation services under section 256B.0911 prior to the date on which a
prospective resident executes a contract with a licensed assisted living establishment or the
date on which a prospective resident moves in, whichever is earlier.
 new text end

new text begin (b) The arranged home care provider shall comply with applicable home care licensure
requirements in chapter 144A and the Nurse Practice Act in sections 148.171 to 148.285
with respect to conducting a nursing assessment prior to the delivery of nursing services
and the execution of a home care service plan or service agreement.
 new text end

new text begin Subd. 3. new text end

new text begin Services oversight and information. new text end

new text begin The assisted living shall provide each
assisted living resident with identifying and contact information about the persons who can
assist with health care or supportive services being provided. The assisted living shall keep
each resident informed of changes in personnel referenced in this subdivision.
 new text end

new text begin Subd. 4. new text end

new text begin Governing body. new text end

new text begin Every basic, comprehensive, and comprehensive PLUS
assisted living licensee shall have a governing body that assumes full legal responsibility
for determining, implementing, and monitoring policies governing the licensee's operation.
 new text end

new text begin Subd. 5. new text end

new text begin Administrator. new text end

new text begin Every basic, comprehensive, and comprehensive PLUS assisted
living licensee shall have an administrator who is responsible for: (1) the day-to-day
management of both the housing and the services provided including the overall responsibility
for the medical services components for comprehensive and comprehensive PLUS; (2)
implementing the policies and procedures; and (3) leading the staff.
 new text end

new text begin Subd. 6. new text end

new text begin Clinical nurse supervision. new text end

new text begin All comprehensive and comprehensive PLUS
licensees must have a clinical nurse supervisor who is a registered nurse licensed in
Minnesota.
 new text end

new text begin Subd. 7. new text end

new text begin Resident councils. new text end

new text begin All basic, comprehensive, and comprehensive PLUS
licensees shall establish both a resident council whose members are residents living at that
location and a family or resident representative council. The licensee shall support the
council's establishment and provide meeting space; materials; any necessary equipment
such as computers, printers, and assistive listening devices for use with hearing aids;
microphones; and tables. The licensee shall offer a staff person to attend to take minutes
for the council. Resident council minutes are public data and must be available to all residents
in the assisted living. Family or resident representatives may attend resident councils if
invited by a resident on the council.
 new text end

new text begin Subd. 8. new text end

new text begin Resident grievances. new text end

new text begin All basic, comprehensive, and comprehensive PLUS
licensees must post in a conspicuous place information about the assisted living's grievance
procedure, and the name, telephone number, and e-mail contact information for the
individuals who are responsible for handling resident grievances. The notice must also have
the contact information for the Minnesota Adult Abuse Reporting Center, the common entry
point, and the state and applicable regional Office of Ombudsman for Long-Term Care.
 new text end

new text begin Subd. 9. new text end

new text begin Reporting suspected crime and maltreatment. new text end

new text begin An assisted living shall support
protection and safety through access to the state's systems for reporting suspected criminal
activity and suspected vulnerable adult maltreatment by:
 new text end

new text begin (1) posting the 911 emergency number in common areas and near telephones provided
by the assisted living;
 new text end

new text begin (2) posting information and the reporting number for the common entry point to report
suspected maltreatment of a vulnerable adult under section 626.557; and
 new text end

new text begin (3) providing reasonable accommodations with information and notices in plain language.
 new text end

new text begin Subd. 10. new text end

new text begin Protecting resident rights. new text end

new text begin An assisted living shall ensure that every resident
has access to consumer advocacy or legal services by:
 new text end

new text begin (1) encouraging and assisting each resident to access these protection services;
 new text end

new text begin (2) providing names and contact information, including telephone numbers and e-mail
addresses of at least three individuals or organizations that provide advocacy or legal services
to residents;
 new text end

new text begin (3) providing the name and contact information for the Minnesota Office of Ombudsman
for Long-Term Care, including both the state and regional contact information;
 new text end

new text begin (4) making every effort to assist residents in obtaining information on whether Medicare
or medical assistance will pay for services;
 new text end

new text begin (5) making reasonable accommodations for people who have communication disabilities
and those who speak a language other than English; and
 new text end

new text begin (6) providing all information and notices in plain language and in terms the residents
can understand.
 new text end

new text begin Subd. 11. new text end

new text begin Protection-related rights. new text end

new text begin (a) In addition to the rights required in sections
144A.44 and 144A.441, the following rights must be provided to all assisted living residents.
The assisted living must promote and protect these rights for each resident by making
residents aware of these rights and ensuring staff are trained to support these rights:
 new text end

new text begin (1) the right to furnish and decorate the resident's unit within the terms of the lease;
 new text end

new text begin (2) the right to access food at any time;
 new text end

new text begin (3) the right to choose visitors and the times of visits;
 new text end

new text begin (4) the right to choose a roommate if sharing a unit;
 new text end

new text begin (5) the right to personal privacy including the right to have and use a lockable door on
the resident's unit. The assisted living provider shall provide the locks on the resident's unit.
Only a staff member with a specific need to enter the unit shall have keys, and advance
notice must be given to the resident before entrance, when possible;
 new text end

new text begin (6) the right to engage in chosen activities;
 new text end

new text begin (7) the right to engage in community life;
 new text end

new text begin (8) the right to control personal resources; and
 new text end

new text begin (9) the right to individual autonomy, initiative, and independence in making life choices
including a daily schedule and with whom to interact.
 new text end

new text begin (b) The resident's rights in paragraph (a), clauses (2), (3), and (5), may be restricted for
an individual resident only if determined necessary for health and safety reasons identified
by the assisted living provider through an initial assessment or reassessment, as defined
under section 144A.4791 and documented in the written service plan under section 144A.43.
Any restrictions of those rights for people served under sections 256B.0915 and 256B.49
must be documented by the case manager in the resident's coordinated service and support
plan (CSSP), as defined in sections 256B.0915, subdivision 6, and 256B.49, subdivision
15.
 new text end

new text begin Subd. 12. new text end

new text begin Retaliation prohibited. new text end

new text begin (a) An assisted living must not retaliate by taking an
adverse action against a resident, resident representative, assisted living employee, or other
interested person who:
 new text end

new text begin (1) files a complaint or grievance or asserts any rights on behalf of themselves or the
resident;
 new text end

new text begin (2) submits a report to law enforcement, the common entry point, or any other agency,
whether voluntarily or due to a mandatory reporting requirement;
 new text end

new text begin (3) advocates on behalf of the resident for services or enforcement of the resident's rights;
or
 new text end

new text begin (4) enters into a contract with a home care provider, health professional, or pharmacy
of the person's own choice who is not the arranged or preferred provider associated with
the assisted living.
 new text end

new text begin (b) For purposes of this section, "adverse action" means an action taken by the assisted
living and its agents, including but not limited to:
 new text end

new text begin (1) discharging or transferring from the assisted living, or terminating services or the
residency contract;
 new text end

new text begin (2) discharging from or terminating employment or demoting unless for good cause;
 new text end

new text begin (3) suddenly establishing new fees or increasing fees or costs for services when the costs
are not also applied to all residents;
 new text end

new text begin (4) restricting access to or use of amenities or services;
 new text end

new text begin (5) infringing or violating any resident rights in the client bills of rights as required by
sections 144A.44 and 144A.441;
 new text end

new text begin (6) communicating verbally or in writing to the assisted living employees or residents
and their families false information about any person who advocated on behalf of the resident;
and
 new text end

new text begin (7) restricting or prohibiting access to the assisted living or to the resident, including
issuing a no trespass order under section 609.605.
 new text end

new text begin Subd. 13. new text end

new text begin Payment for services under disability waivers. new text end

new text begin For new assisted living as
defined in section 144I.01, home and community-based services under section 256B.49 are
not available when the new assisted living setting is adjoined to, or on the same property
as, an institution as defined by the Federal Centers for Medicare and Medicaid Services in
Code of Federal Regulations, title 42, section 441.301(c).
 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. 4.

new text begin [144I.04] MANAGEMENT AGREEMENTS; GENERAL REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Notification. new text end

new text begin (a) If the proposed or current licensee uses a manager, the
licensee must have a written management agreement that is consistent with this chapter.
 new text end

new text begin (b) The proposed or current licensee must notify the commissioner of its use of a manager
upon:
 new text end

new text begin (1) initial application for a license;
 new text end

new text begin (2) retention of a manager following initial application;
 new text end

new text begin (3) change of managers; and
 new text end

new text begin (4) modification of an existing management agreement.
 new text end

new text begin (c) The proposed or current licensee must provide to the commissioner a written
management agreement, including an organizational chart showing the relationship between
the proposed or current licensee, management company, and all related organizations.
 new text end

new text begin (d) The written management agreement must be submitted:
 new text end

new text begin (1) 60 days before:
 new text end

new text begin (i) the initial licensure date;
 new text end

new text begin (ii) the proposed change of ownership date; or
 new text end

new text begin (iii) the effective date of the management agreement; or
 new text end

new text begin (2) 30 days before the effective date of any amendment to an existing management
agreement.
 new text end

new text begin (e) The proposed licensee or the current licensee must notify the residents and their
representatives 60 days before entering into a new management agreement.
 new text end

new text begin (f) A proposed licensee must submit a management agreement attestation form, as
required by the assisted living application.
 new text end

new text begin Subd. 2. new text end

new text begin Management agreement; licensee. new text end

new text begin (a) The licensee is responsible for:
 new text end

new text begin (1) the daily operations and provisions of services in the assisted living;
 new text end

new text begin (2) ensuring the assisted living is operated in a manner consistent with all applicable
laws and rules;
 new text end

new text begin (3) ensuring the manager acts in conformance with the management agreement; and
 new text end

new text begin (4) ensuring the manager does not present as, or give the appearance that the manager
is the licensee.
 new text end

new text begin (b) The licensee must not give the manager responsibilities that are so extensive that the
licensee is relieved of daily responsibility for the daily operations and provision of services
in the assisted living facility. If the licensee does so, the commissioner must determine that
a change of ownership has occurred.
 new text end

new text begin (c) The licensee and manager must act in accordance with the terms of the management
agreement. If the commissioner determines they are not, then the department may impose
enforcement remedies.
 new text end

new text begin (d) The licensee may enter into a management agreement only if the management
agreement creates a principal/agent relationship between the licensee and manager.
 new text end

new text begin Subd. 3. new text end

new text begin Terms of agreement. new text end

new text begin A management agreement at a minimum must:
 new text end

new text begin (1) describe the responsibilities of the licensee and manager, including items, services,
and activities to be provided;
 new text end

new text begin (2) require the licensee's governing body, board of directors, or similar authority to
appoint the administrator;
 new text end

new text begin (3) provide for the maintenance and retention of all records in accordance with this
chapter and other applicable laws;
 new text end

new text begin (4) allow unlimited access by the commissioner to documentation and records according
to applicable laws or regulations;
 new text end

new text begin (5) require the manager to immediately send copies of inspections and notices of
noncompliance to the licensee;
 new text end

new text begin (6) state that the licensee is responsible for reviewing, acknowledging, and signing all
assisted living initial and renewal license applications;
 new text end

new text begin (7) state that the manager and licensee shall review the management agreement annually
and notify the commissioner of any change according to applicable regulations;
 new text end

new text begin (8) acknowledge that the licensee is the party responsible for complying with all laws
and rules applicable to the assisted living;
 new text end

new text begin (9) require the licensee to maintain ultimate responsibility over personnel issues relating
to the operation of the assisted living and care of the residents including but not limited to
staffing plans, hiring, and performance management of employees, orientation, and training;
 new text end

new text begin (10) state the manager will not present as, or give the appearance that the manager is
the licensee; and
 new text end

new text begin (11) state that a duly authorized manager may execute resident leases or agreements on
behalf of the licensee, but all such resident leases or agreements must be between the licensee
and the resident.
 new text end

new text begin Subd. 4. new text end

new text begin Commissioner review. new text end

new text begin The commissioner may review a management agreement
at any time. Following the review, the department may require:
 new text end

new text begin (1) the proposed or current licensee or manager to provide additional information or
clarification;
 new text end

new text begin (2) any changes necessary to:
 new text end

new text begin (i) bring the management agreement into compliance with this chapter; and
 new text end

new text begin (ii) ensure that the licensee has not been relieved of the responsibility for the daily
operations of the assisted living; and
 new text end

new text begin (3) the licensee to participate in monthly meetings and quarterly on-site visits to the
assisted living.
 new text end

new text begin Subd. 5. new text end

new text begin Resident funds. new text end

new text begin (a) If the management agreement delegates day-to-day
management of resident funds to the manager, the licensee:
 new text end

new text begin (1) retains all fiduciary and custodial responsibility for funds that have been deposited
with the assisted living by the resident;
 new text end

new text begin (2) is directly accountable to the resident for such funds; and
 new text end

new text begin (3) must ensure any party responsible for holding or managing residents' personal funds
is bonded or obtains insurance in sufficient amounts to specifically cover losses of resident
funds and provides proof of bond or insurance.
 new text end

new text begin (b) If responsibilities for the day-to-day management of the resident funds are delegated
to the manager, the manager must:
 new text end

new text begin (1) provide the licensee with a monthly accounting of the resident funds; and
 new text end

new text begin (2) meet all legal requirements related to holding and accounting for resident funds.
 new text end

Sec. 5.

new text begin [144I.05] MINIMUM SITE REQUIREMENTS AND FIRE SAFETY.
 new text end

new text begin Subdivision 1. new text end

new text begin Site requirements. new text end

new text begin (a) Effective July 1, 2019, the following items are
required:
 new text end

new text begin (1) each assisted living must be located so that all residents are protected in their health,
comfort, and safety;
 new text end

new text begin (2) public utilities must be available and working;
 new text end

new text begin (3) inspected and approved water and septic systems are in place;
 new text end

new text begin (4) the location of the assisted living is located no closer than 300 feet to the right-of-way
of a railroad mainline or to the property line of industrial sites that are hazardous to health;
 new text end

new text begin (5) the location of the assisted living is not located within 85 feet of underground or 300
feet of aboveground storage tanks or warehouses containing flammable liquids;
 new text end

new text begin (6) the location of the assisted living is publicly accessible to fire department services
and emergency medical services;
 new text end

new text begin (7) the topography of the location of the assisted living provides good natural drainage
and is not subject to flooding;
 new text end

new text begin (8) all-weather roads and walks are within the lot lines to the primary entrance and the
service entrance, including employees' and visitors' parking at the site;
 new text end

new text begin (9) the primary entrance is accessible for persons with disabilities; and
 new text end

new text begin (10) the location of the assisted living includes space for outdoor activities for residents.
 new text end

new text begin (b) The assisted living must be in compliance with all applicable state and local laws,
regulation standards, ordinances, codes for fire safety, and building, accessibility, and zoning
requirements including ongoing obligations under the Americans with Disabilities Act and
the Minnesota Human Rights Act.
 new text end

new text begin Subd. 2. new text end

new text begin Fire protection. new text end

new text begin (a) Effective July 1, 2019, each assisted living building must
have a comprehensive fire protection system that includes:
 new text end

new text begin (1) protection throughout by an approved, supervised automatic sprinkler system
according to building code requirements established in Minnesota Rules, part 1305.0903,
or smoke detectors installed in each occupiable room and maintained in accordance with
NFPA 72; and
 new text end

new text begin (2) portable fire extinguishers installed and tested in accordance with NFPA 10.
 new text end

new text begin (b) Beginning July 1, 2019, fire drills must be conducted in accordance with the
residential board and care requirements in the Life Safety Code.
 new text end

new text begin (c) After June 30, 2022, all new construction in an assisted living must meet the provisions
relevant to licensed assisted living in the most current edition of the Facility Guidelines
Institute's Guidelines for Design and Construction of Residential Health, Care and Support
Facilities and of adopted rules. In addition to the guidelines, assisted livings shall provide
the option of a bath in addition to a shower for all residents.
 new text end

new text begin (d) For all new construction beginning July 1, 2022, the requirements in clauses (1) to
(7) must be provided to the commissioner:
 new text end

new text begin (1) Architectural and engineering plans and specifications for new construction must be
prepared and signed by architects and engineers who are registered in Minnesota. Final
working drawings and specifications for proposed construction must be submitted to the
commissioner for review and approval.
 new text end

new text begin (2) Preliminary plans must be drawn in scale, show basic dimensions, and indicate the
general layout and space arrangement of the proposed building or area and must include a
site plan when applicable. Plans must indicate assignments of rooms and areas, and must
show bed capacities and fixed equipment.
 new text end

new text begin (3) Final architectural plans and specifications must include elevations and sections
throughout the building showing types of construction, and must indicate dimensions and
assignment of rooms and areas, room finishes, door types and hardware, elevations and
details of nurses' work areas, utility rooms, toilets and bathing areas, and large-scale layouts
of dietary and laundry areas. Plans must show the location of fixed equipment and sections
and details of elevators, chutes, and other conveying systems. Fire walls and smoke partitions
must be indicated. The roof plan must show all mechanical installations. The site plan must
indicate the proposed and existing buildings, topography, roadways, walks, and utility
service lines.
 new text end

new text begin (4) Final mechanical and electrical plans and specifications must address the complete
layout and type of all installations, systems, and equipment to be provided. Heating plans
must include heating elements, piping, thermostatic controls, pumps, tanks, heat exchangers,
boilers, breeching, and accessories. Ventilation plans must include room air quantities,
ducts, fire and smoke dampers, exhaust fans, humidifiers, and air handling units. Plumbing
plans must include a fixtures and equipment fixture schedule; water supply and circulating
piping, pumps, tanks, riser diagrams, and building drains; the size, location, and elevation
of water and sewer services; and the building fire protection systems. Electrical plans must
include fixtures and equipment, receptacles, switches, power outlets, circuits, power and
light panels, transformers, and service feeders. Plans must show the location of nurse call
signals, cable lines, fire alarm stations, and detectors and emergency lighting.
 new text end

new text begin (5) Unless construction is begun within one year after approval of the final working
drawing and specifications, the drawings must be resubmitted for review and approval. All
construction must be executed according to the approved final plans and specifications.
Subsequent construction changes must be made in accordance with the adopted requirements,
and must be reviewed by the commissioner before the changes are made.
 new text end

new text begin (6) The commissioner must be notified within 30 days before completion of construction
so that the commissioner can make arrangements for a final inspection by the commissioner.
 new text end

new text begin (7) At least one set of complete life safety plans including changes resulting from
remodeling or alterations must be kept on file in the assisted living.
 new text end

new text begin (e) After July 1, 2022, all newly licensed buildings where assisted living services are
provided must ensure that 20 percent of the assisted living resident rooms are accessible
under the Minnesota Accessibility Code.
 new text end

new text begin (f) An assisted living may request that the commissioner grant a variance or waiver from
the provisions of this section. A request for a waiver must be submitted to the commissioner
in writing. Each request must contain:
 new text end

new text begin (1) the specific requirement for which the variance or waiver is requested;
 new text end

new text begin (2) the reasons for the request;
 new text end

new text begin (3) the alternative measures that will be taken if a variance or waiver is granted;
 new text end

new text begin (4) the length of time for which the variance or waiver is requested; and
 new text end

new text begin (5) other relevant information deemed necessary by the commissioner to properly evaluate
the request for the waiver.
 new text end

new text begin (g) The decision to grant or deny a variance or waiver must be based on the
commissioner's evaluation of the following criteria:
 new text end

new text begin (1) whether the waiver will adversely affect the health, treatment, comfort, safety, or
well-being of a patient;
 new text end

new text begin (2) whether the alternative measures to be taken, if any, are equivalent to or superior to
those prescribed in this section; and
 new text end

new text begin (3) whether compliance with any requirement would impose an undue burden upon the
applicant.
 new text end

Sec. 6.

new text begin [144I.06] RESIDENCY CONTRACT REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Contract required. new text end

new text begin (a) No assisted living may operate in Minnesota
unless a written residency contract is executed between the assisted living licensee and each
resident or resident's representative and unless the assisted living complies with the terms
of the contract.
 new text end

new text begin (b) No other lease or contract shall be in effect in addition to the residency contract.
 new text end

new text begin Subd. 2. new text end

new text begin Contents. new text end

new text begin A residency contract, which must be titled as such, shall include the
following items:
 new text end

new text begin (1) the name, street address, and mailing address of the assisted living;
 new text end

new text begin (2) the name and mailing address of the owner or owners of the assisted living and if
the owner or owners are not a natural person, identification of the type of business entity
of the owner or owners;
 new text end

new text begin (3) the name and mailing address of the managing agent through a management agreement
or lease agreement if different from the owner or owners;
 new text end

new text begin (4) the name and address of at least one natural person who is authorized to accept service
of process on behalf of the owner or owners and managing agent;
 new text end

new text begin (5) the name and contact information for 24 hours per day, seven days per week, for the
administrator, clinical nurse supervisor, registered nurse manager, governing body members,
and a statement that this information is subject to change and whenever there is a change,
the assisted living will notify each resident within one week of the change;
 new text end

new text begin (6) a statement describing the registration and licensure status of the location and any
provider providing health-related or supportive services;
 new text end

new text begin (7) the term period of the contract;
 new text end

new text begin (8) a description of the services to be provided to the resident and the base rate to be
paid for the resident including a delineation of the portion of the base rate that constitutes
rent and a delineation of charges for each service included in the base rate;
 new text end

new text begin (9) a description of any additional services, including home care services available for
additional fees from the assisted living directly or through arrangements with the assisted
living, and a schedule of fees charged for these services;
 new text end

new text begin (10) a conspicuous notice informing the resident of policies concerning the conditions
under which the process for modifying the resident contract including whether a move to
a different room or sharing a room would be required in the event the resident can no longer
pay the service fees or rent;
 new text end

new text begin (11) a description of the assisted living's policies related to medical assistance waivers
under sections 256B.0915 and 256B.092, including:
 new text end

new text begin (i) whether the provider is enrolled with the Department of Human Services to provide
customized living services under medical assistance waivers;
 new text end

new text begin (ii) whether there is a limit on the number of people residing at the assisted living who
can receive customized living services at any point in time. If so, the limit must be provided;
 new text end

new text begin (iii) a statement explaining that medical assistance waivers provide payment for services,
but do not cover the cost of rent;
 new text end

new text begin (iv) a statement explaining that residents may be eligible for assistance with rent through
the housing support program; and
 new text end

new text begin (v) a description of the rent requirements for people who are eligible for medical
assistance waivers but who are not eligible for assistance through the housing support
program;
 new text end

new text begin (12) a description of the assisted living's internal complaint process including the names
and contact information of staff who may receive complaints, plus the toll-free complaint
line for the Office of Ombudsman for Long-Term Care;
 new text end

new text begin (13) billing and payment procedures and requirements;
 new text end

new text begin (14) a statement regarding the freedom of choice a resident has to choose services from
providers they want and that there will be no additional fees imposed by the assisted living
for making those choices;
 new text end

new text begin (15) the service agreement shall be attached to the residency contract when the service
agreement is completed.
 new text end

new text begin Subd. 3. new text end

new text begin Filing. new text end

new text begin Residency contracts will be maintained by the assisted living in files
from the date of execution until three years after the contract is terminated. The contracts
and all associated documents will be available for on-site inspection by the commissioner
at any time. The documents shall be available for viewing or copies shall be made available
to the resident and resident's representative at any time.
 new text end

Sec. 7.

new text begin [144I.07] RESIDENCY CONTRACT TERMINATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Limitations. new text end

new text begin (a) An assisted living licensee may terminate a residency
contract only if:
 new text end

new text begin (1) the resident has not paid the rent;
 new text end

new text begin (2) the safety or health of other individuals in the assisted living is endangered;
 new text end

new text begin (3) the assisted living licensee intends to cease operation; or
 new text end

new text begin (4) the assisted living's license is being restricted by the commissioner of health or human
services.
 new text end

new text begin A breach of a service agreement does not constitute a breach of a residency contract.
 new text end

new text begin (b) Prior to terminating a residency contract, an assisted living licensee must provide a
resident with at least:
 new text end

new text begin (1) 30 days' advance written notice of termination in cases of nonpayment of rent;
 new text end

new text begin (2) 30 days' advance written notice of termination in cases of alleged breach of contract;
 new text end

new text begin (3) 60 days' advance written notice of closure of the assisted living licensee unless the
closure is due to a commissioner license enforcement action pursuant to section 144I.02,
subdivision 9; and
 new text end

new text begin (4) a comprehensive discharge plan.
 new text end

new text begin (c) Notwithstanding paragraphs (a) and (b), an assisted living licensee may immediately
commence residency contract termination if:
 new text end

new text begin (1) the alleged breach involves any of the acts listed in section 504B.171, subdivision
1;
 new text end

new text begin (2) the assisted living resident holds over beyond the date to vacate mutually agreed
upon in writing by the resident and the assisted living licensee; or
 new text end

new text begin (3) the assisted living resident holds over beyond the date provided by the resident to
the assisted living licensee in a notice of voluntary termination of the lease. The resident
retains their appeal rights pursuant to subdivision 3.
 new text end

new text begin (d) Nothing in this section affects other rights and remedies available under chapter
504B.
 new text end

new text begin Subd. 2. new text end

new text begin Contents of notice. new text end

new text begin (a) The notice required under subdivision 1 must include:
 new text end

new text begin (1) a detailed explanation of the reason for the termination;
 new text end

new text begin (2) the date termination will occur;
 new text end

new text begin (3) an adequate and safe discharge location; and
 new text end

new text begin (4) a statement that the recipient of the notice may contact the Office of Ombudsman
for Long-Term Care regarding the residency contract termination issues and the address
and telephone number of the Office of Ombudsman for Long-Term Care, the Office of
Administrative Hearings, and a protection and advocacy agency.
 new text end

new text begin (b) The notice must also include the following statements:
 new text end

new text begin (1) that the resident has a right to request a meeting with the assisted living licensee to
discuss and attempt to resolve the alleged breach to avoid termination;
 new text end

new text begin (2) that the resident has a right to appeal the termination of the residency contract to the
Office of Administrative Hearings and the date and time by which the resident must submit
an appeal request;
 new text end

new text begin (3) that the resident has a right to avoid termination of the residency contract by paying
the rent in full within ten days of receiving written notice of nonpayment; and
 new text end

new text begin (4) that the resident has the right to cure the breach within 30 days of receiving written
notice of the breach.
 new text end

new text begin Subd. 3. new text end

new text begin Right to appeal termination of the residency contract. new text end

new text begin (a) At any time prior
to the expiration of the notice period provided under subdivision 2, a resident may appeal
the termination by making a written request for a hearing to the Office of Administrative
Hearings, which must schedule the hearing no later than 14 days after receiving the appeal
request. In the case of an immediate notice of eviction, the resident has ten days to appeal
after receipt of the notice to appeal. The hearing must be held at the location where the
resident resides, unless it is impractical or the parties agree otherwise. The hearing is not a
formal evidentiary hearing. The hearing may be attended by telephone as allowed by the
administrative law judge. The hearing shall be limited to the amount of time necessary for
the participants to expeditiously present the facts about the proposed termination. The
administrative law judge shall issue a recommendation to the commissioner within ten
business days after the hearing. Attorney representation is not required at the hearing nor
does appearing without an attorney constitute the unauthorized practice of law.
 new text end

new text begin (b) A resident who makes a timely appeal of a notice of residency contract termination
may not be evicted by the assisted living licensee until the Office of Administrative Hearings
makes a final determination on the appeal in favor of the assisted living licensee.
 new text end

new text begin (c) The commissioner may direct the assisted living licensee to rescind the residency
contract termination or readmit the resident if:
 new text end

new text begin (1) the residency contract termination was in violation of state or federal law;
 new text end

new text begin (2) the resident cures the alleged breach of lease or pays the rent owed on or before the
date of the administrative hearing; or
 new text end

new text begin (3) the discharge plan is in violation of state or federal law.
 new text end

new text begin (d) The assisted living licensee must readmit the resident if the resident is hospitalized
for medical necessity before the resolution of the appeal.
 new text end

new text begin (e) Residents are not required to request a meeting as provided in subdivision 2 prior to
submitting an appeal hearing request.
 new text end

new text begin (f) Nothing in this section limits the rights of a resident or the resident's representative
to request or receive assistance from the Office of Ombudsman for Long-Term Care and a
protection and advocacy agency concerning the proposed residency contract termination.
 new text end

new text begin Subd. 4. new text end

new text begin Discharge plan and transfer of information to new residence. new text end

new text begin (a) Sufficiently
in advance of discharging a resident, an assisted living licensee must prepare an adequate
discharge plan that:
 new text end

new text begin (1) is based on the resident's discharge goals;
 new text end

new text begin (2) includes in discharge planning the resident, the resident's case manager, and the
resident's representative, if any;
 new text end

new text begin (3) contains a plan for appropriate and sufficient postdischarge care; and
 new text end

new text begin (4) proposes a safe discharge location which does not include a private home where the
occupant is unwilling or unable to care for the resident, a homeless shelter, a hotel, or a
motel.
 new text end

new text begin (b) An assisted living licensee may not discharge a resident if the resident will, upon
discharge, become homeless as defined in section 116L.361, subdivision 5.
 new text end

new text begin (c) An assisted living licensee that proposes to discharge a resident must assist the
resident with applying for and locating a safe and adequate discharge location, including
coordinating with the county case manager, if any.
 new text end

new text begin (d) Prior to discharge, an assisted living licensee must provide to the receiving facility
or setting all information known to the licensee related to the resident that is necessary to
ensure continuity of care and services including, at a minimum:
 new text end

new text begin (1) the resident's full name, date of birth, and insurance information;
 new text end

new text begin (2) the name, telephone number, and address of the resident's representative, if any;
 new text end

new text begin (3) the resident's current documented diagnoses;
 new text end

new text begin (4) the resident's known allergies;
 new text end

new text begin (5) the name and telephone number of the resident's physician and the current physician
orders, if known;
 new text end

new text begin (6) any and all medication administration records;
 new text end

new text begin (7) the most recent resident assessment; and
 new text end

new text begin (8) copies of health care directives, do not resuscitate orders, and any guardianship orders
or powers of attorney.
 new text end

new text begin (e) For purposes of this subdivision, "discharge" means the involuntary relocation of a
resident due to a termination of a residency contract. If a residential contract is initiated by
the assisted living provider, it is considered a discharge.
 new text end

new text begin Subd. 5. new text end

new text begin Final accounting; return of money and property. new text end

new text begin (a) Within 30 days of the
date of discharge, the assisted living licensee shall:
 new text end

new text begin (1) provide to the resident or resident's representative a final statement of account;
 new text end

new text begin (2) provide any refunds due; and
 new text end

new text begin (3) return any money, property, or valuables held in trust or custody by the assisted
living licensee.
 new text end

new text begin (b) As required by section 504B.178, an assisted living licensee may not collect a
nonrefundable security deposit unless it is applied to the first month's charges.
 new text end

Sec. 8.

new text begin [144I.08] TERMINATION OF SERVICES; ARRANGED HOME CARE
PROVIDER.
 new text end

new text begin Subdivision 1. new text end

new text begin Notice; permissible reason to terminate services. new text end

new text begin (a) Except as provided
in paragraph (b), the assisted living must provide at least 30 days' notice prior to terminating
a service contract. Notwithstanding any other provision of law, the assisted living may
terminate services only if:
 new text end

new text begin (1) the resident engages in conduct that interferes with the assisted living's ability to
carry out the terms of the service plan and cannot be cured by updating or changing the
terms of the service plan; or
 new text end

new text begin (2) the resident fails to pay for services, provided the resident has not cured the breach
within 30 days of receiving written notice of nonpayment.
 new text end

new text begin (b) Notwithstanding paragraph (a), the assisted living may terminate services with ten
days' notice if a doctor or treating physician documents that an emergency or a significant
change in the resident's condition has resulted in service needs that exceed the current service
plan and that cannot be safely met by the assisted living. In this situation, the assisted living
must assist the resident in obtaining services from a home care provider wherever the resident
chooses to receive the services.
 new text end

new text begin (c) If the license of the assisted living is restricted by the commissioner, then the licensee
must follow the directions of the commissioner for ceasing services to residents and the
notice provisions in this subdivision may not apply.
 new text end

new text begin Subd. 2. new text end

new text begin Contents of service termination notice. new text end

new text begin If an arranged home care provider
who is not Medicare certified terminates a service agreement or service plan with a resident
in an assisted living setting, the home care provider shall provide the resident and the legal
representative or resident representative, if any, with advance written notice of service
termination according to subdivision 1 that must include:
 new text end

new text begin (1) the effective date of service termination;
 new text end

new text begin (2) the reason for service termination;
 new text end

new text begin (3) without extending the termination notice period, an affirmative offer to meet with
the resident or the resident's representative within five business days of the date of the
service termination notice to discuss the termination;
 new text end

new text begin (4) contact information for other assisted living licensees in the geographic area of the
resident;
 new text end

new text begin (5) a statement that the provider will participate in a coordinated transfer of care of the
client to another provider;
 new text end

new text begin (6) a statement that the resident has a right to request a meeting with the arranged home
care provider to discuss and attempt to avoid the service termination;
 new text end

new text begin (7) the name and contact information of a representative of the arranged home care
provider with whom the resident may discuss the notice of service termination;
 new text end

new text begin (8) a copy of the home care bill of rights;
 new text end

new text begin (9) a statement that the notice of service termination of home care services by the home
care provider does not constitute notice of termination of the lease of the assisted living;
and
 new text end

new text begin (10) a statement that the recipient of the notice may contact the Office of Ombudsman
for Long-Term Care regarding the lease termination issues and a statement that the resident
has the right to appeal the service termination to the Office of Administrative Hearings and
provide the contact information for the Office of Administrative Hearings, including the
mailing address, fax number, e-mail address, and telephone number.
 new text end

new text begin Subd. 3. new text end

new text begin Right to appeal service termination. new text end

new text begin (a) At any time prior to the expiration
of the notice period provided in subdivision 1, a resident may appeal the service termination
by making a written request for a hearing to the Office of Administrative Hearings. The
Office of Administrative Hearings must conduct the hearing no later than 14 days after the
office receives the appeal request from the resident. The hearing must be held in the place
where the resident resides unless it is impractical or the parties agree to a different place.
Attorney representation is not required at the hearing, nor does appearing without an attorney
constitute the unauthorized practice of law. The hearing is not a formal evidentiary hearing.
The hearing may also be attended by telephone as allowed by the administrative law judge.
The hearing shall be limited to the amount of time necessary for the participants to
expeditiously present the facts about the proposed termination. The administrative law judge
shall issue a recommendation to the commissioner within ten business days after the hearing.
 new text end

new text begin (b) The arranged home care provider may not discontinue services to a resident who
timely appeals a notice of service termination until the Office of Administrative Hearings
has made a final determination on the appeal in favor of the assisted living licensee.
 new text end

new text begin (c) Residents are not required to request a meeting under subdivision 1 prior to submitting
a request for an appeal hearing.
 new text end

new text begin (d) The commissioner may direct the assisted living licensee to rescind the service
contract termination if the Office of Administrative Hearings decides that the proposed
termination was in violation of state or federal law.
 new text end

new text begin (e) Nothing in this section limits the right of a resident or a resident's representative to
request or receive assistance from the Office of Ombudsman for Long-Term Care and a
protection and advocacy agency concerning the proposed service termination.
 new text end

Sec. 9.

new text begin [144I.09] RELOCATIONS WITHIN ASSISTED LIVING LOCATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Notice required before relocation within location. new text end

new text begin An assisted living
licensee must:
 new text end

new text begin (1) notify a resident and the resident's representative, if any, at least 14 days prior to a
proposed nonemergency relocation to a different room at the same location; and
 new text end

new text begin (2) obtain consent from the resident and the resident's representative, if any.
 new text end

new text begin A resident must be allowed to stay in the resident's room or reasonable modifications
must be made to another room to accommodate the resident.
 new text end

new text begin Subd. 2. new text end

new text begin Evaluation. new text end

new text begin An assisted living licensee shall evaluate the resident's individual
needs before deciding whether the room the resident will be moved to fits the resident's
psychological, cognitive, and health care needs, including the accessibility of the bathroom.
 new text end

new text begin Subd. 3. new text end

new text begin Restriction on relocation. new text end

new text begin A person who has been a private-pay resident for
at least one year and resides in a private room, and whose payments subsequently will be
made under the medical assistance program, may not be relocated to a shared room without
the consent of the resident or the resident's representative, if any.
 new text end

Sec. 10.

new text begin [144I.10] COMMISSIONER OVERSIGHT AND AUTHORITY.
 new text end

new text begin (a) The commissioner shall license, survey, and monitor without advance notice assisted
living licensees in accordance with this chapter.
 new text end

new text begin (b) The commissioner shall survey assisted living licensees on a frequency of once per
year.
 new text end

new text begin (c) After July 1, 2022, the commissioner shall provide blueprint review for all new
assisted living construction and must approve the plans before construction is commenced.
 new text end

new text begin (d) The commissioner shall provide on-site reviews of the construction to ensure that
all physical plant standards are met before the assisted living license is complete.
 new text end

Sec. 11.

new text begin [144I.11] EXPEDITED RULEMAKING AUTHORIZED.
 new text end

new text begin (a) The commissioner shall adopt rules for all assisted living licenses that promote
person-centered planning and service and optimal quality of life, and that ensure resident
rights are protected, resident choice is allowed, and public health and safety is ensured.
 new text end

new text begin (b) On July 1, 2019, the commissioner shall begin expedited rulemaking using the process
in section 14.389, except that the rulemaking process is exempt from section 14.389,
subdivision 5.
 new text end

new text begin (c) The commissioner shall adopt rules that include but are not limited to the following:
 new text end

new text begin (1) building design, physical plant standards, environmental health and safety minimum
standards from the most recent version of the Facility Guide Institute's Guidelines for Design
and Construction of Residential Health, Care, and Support Facilities, including appendices;
 new text end

new text begin (2) staffing minimums and ratios for each level of licensure to best protect the health
and safety of residents no matter their vulnerability;
 new text end

new text begin (3) require provider notices and disclosures to residents and their families;
 new text end

new text begin (4) training prerequisites and ongoing training for administrators and caregiving staff;
 new text end

new text begin (5) minimum requirements for move-in assessments and ongoing assessments and
practice standards in sections 144A.43 to 144A.47;
 new text end

new text begin (6) requirements for licensees to ensure minimum nutrition and dietary standards required
by section 144I.03 are provided;
 new text end

new text begin (7) requirements for supportive services provided by assisted living licensees;
 new text end

new text begin (8) identifying personnel in assisted living providers aside from those already required
to obtain background studies as required in sections 144.057, 144.0572, 144A.476, and
144I.02 who need to obtain background studies and establish a process for obtaining those
results;
 new text end

new text begin (9) procedures for discharge planning and ensuring resident appeal rights;
 new text end

new text begin (10) procedures for ensuring that licensees establish resident and family councils;
 new text end

new text begin (11) content requirements for all license or provisional license applications;
 new text end

new text begin (12) requirements that support for assisted living providers to comply with home and
community-based requirements in Code of Federal Regulations, title 42, section 441.301(c);
 new text end

new text begin (13) core dementia care requirements and training in all levels of licensure;
 new text end

new text begin (14) requirements for a comprehensive PLUS license in terms of training, care standards,
noticing changes of condition, assessments, and health care; and
 new text end

new text begin (15) preadmission criteria, initial assessments, and continuing assessments.
 new text end

new text begin (d) The commissioner shall publish the proposed rules by December 31, 2019, and shall
publish final rules by December 31, 2020.
 new text end

Sec. 12. new text begin TRANSITION PERIOD.
new text end

new text begin (a) From July 1, 2019, to June 30, 2020, the commissioner shall engage in the expedited
rulemaking process.
 new text end

new text begin (b) From July 1, 2020, to June 30, 2021, the commissioner shall hire staff, develop forms,
and communicate with stakeholders about the new assisted living licensing.
 new text end

new text begin (c) From July 1, 2021, to June 30, 2022, all existing housing with services establishments
with arranged home care providers must convert their registration and license to an assisted
living license.
 new text end

new text begin (d) After June 30, 2021, all new assisted living providers must be licensed by the
commissioner.
 new text end

new text begin (e) Beginning July 1, 2022, all assisted living providers must have a license issued by
the commissioner.
 new text end

Sec. 13. new text begin RESIDENT QUALITY OF CARE AND OUTCOMES IMPROVEMENT
TASK FORCE.
new text end

new text begin The commissioner shall establish an expert task force to examine and make
recommendations, on an ongoing basis, on how to apply proven safety and quality
improvement practices and infrastructure to settings and providers that provide long-term
services and supports. The task force shall include representation from nonprofit
Minnesota-based organizations dedicated to patient safety and innovation in health care
safety and quality, Department of Health staff with expertise in issues related to safety and
adverse health events, consumer organizations, direct care providers or their representatives,
organizations representing long-term care providers and home care providers in Minnesota,
national patient safety experts, and other experts in the safety and quality improvement
field. The task force shall have at least two public members who are either home care
recipients in an assisted living setting or have family members living in assisted living
settings, either past or present. The task force shall periodically provide recommendations
to the commissioner and the legislature on changes needed to promote safety and quality
improvement practices in long-term care settings and with long-term care providers. The
membership shall be voluntary except that public members can be reimbursed under the
provisions of Minnesota Statutes, section 15.059, subdivision 3. The task force will meet
no fewer than four times per year. The task force must be established by July 1, 2020.
 new text end

Sec. 14. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 144G.01; 144G.02; 144G.03; 144G.04; 144G.05; and
144G.06, new text end new text begin are repealed effective July 1, 2021.
 new text end

ARTICLE 15

DEMENTIA CARE SERVICES FOR COMPREHENSIVE PLUS LICENSEES

Section 1.

new text begin [144I.12] DEFINITIONS.
 new text end

new text begin (a) For purposes of sections 144I.13 to 144I.18, the definitions in this section apply.
 new text end

new text begin (b) "Advertise" means to make publicly and generally known, usually by printed notice,
broadcast, verbal marketing, website, or electronic communication.
 new text end

new text begin (c) "Alzheimer's disease" means a type of dementia that gradually destroys an individual's
memory and ability to learn, reason, make judgments, communicate, and carry out daily
activities.
 new text end

new text begin (d) "Applicant" means the person, persons, or entity, required to complete an application
for a comprehensive PLUS license. Applicant includes a sole proprietor, each partner in a
partnership, and each member in a limited liability company, corporation, or entity that
owns the assisted living facility. Applicant also includes the sole proprietor, each partner
in a partnership, and each member in a limited liability company, corporation, or entity that
operates the assisted living facility on behalf of the facility business owner.
 new text end

new text begin (e) "Comprehensive PLUS" means the license described in section 144I.02, subdivision
2.
 new text end

new text begin (f) "Dementia" means the loss of intellectual function of sufficient severity that interferes
with an individual's daily functioning. Dementia affects an individual's memory and ability
to think, reason, speak, and move. Symptoms may also include changes in personality,
mood, and behavior. Irreversible dementias include but are not limited to:
 new text end

new text begin (1) Alzheimer's disease;
 new text end

new text begin (2) vascular dementia;
 new text end

new text begin (3) Lewy body dementia;
 new text end

new text begin (4) frontal-temporal lobe dementia;
 new text end

new text begin (5) alcohol dementia;
 new text end

new text begin (6) Huntington's disease; and
 new text end

new text begin (7) Creutzfeldt-Jakob disease.
 new text end

new text begin (g) "Dementia care unit" means a special care unit in a designated, separate area for
individuals with Alzheimer's disease or other dementia that is locked, segregated, or secured
to prevent or limit access by a resident outside the designated or separated area.
 new text end

new text begin (h) "Dementia trained staff" means an employee that has completed the minimum training
requirements and has demonstrated knowledge and understanding in supporting individuals
with dementia.
 new text end

new text begin (i) "Direct care staff" means a person employed by the assisted living facility whose
primary responsibility is to provide personal care services to residents. These personal care
services may include:
 new text end

new text begin (1) medication administration;
 new text end

new text begin (2) resident-focused activities;
 new text end

new text begin (3) assistance with activities of daily living;
 new text end

new text begin (4) supervision and support of residents; and
 new text end

new text begin (5) serving meals, but not meal preparation.
 new text end

new text begin (j) "Disclosure statement" means the written information the assisted living facility is
required to provide to consumers to enhance the understanding of comprehensive PLUS
services, costs, and operations.
 new text end

new text begin (k) "Emergency situation" means a disruption to normal care and services caused by an
unforeseen event beyond the control of the licensee whether natural, technological, or
manmade where staff that are trained as required by adopted rules are not available.
 new text end

new text begin (l) "Preservice training" means training that must be completed before staff takes
responsibility for their job duties.
 new text end

new text begin (m) "Resident" means an individual with dementia.
 new text end

Sec. 2.

new text begin [144I.13] APPLICATION FOR COMPREHENSIVE PLUS LICENSE.
 new text end

new text begin Subdivision 1. new text end

new text begin Comprehensive PLUS license required. new text end

new text begin A licensed assisted living
establishment that offers or provides care to residents with dementia in a dementia care unit
must obtain a comprehensive PLUS license.
 new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin The applicant seeking a comprehensive PLUS license must submit
to the commissioner a completed license application 60 days prior to receiving an initial
license, the expiration of the current PLUS license, or a change in ownership.
 new text end

new text begin Subd. 3. new text end

new text begin Contents of application. new text end

new text begin The applicant must also include the following with
the initial application and fee:
 new text end

new text begin (1) comprehensive PLUS uniform disclosure statement;
 new text end

new text begin (2) employee training curricula;
 new text end

new text begin (3) policies and procedures;
 new text end

new text begin (4) floor plan;
 new text end

new text begin (5) residency or admission agreement;
 new text end

new text begin (6) copy of the service or care planning tool; and
 new text end

new text begin (7) copies of brochures or advertisements that are used to advertise the facility and the
facility's services.
 new text end

new text begin Subd. 4. new text end

new text begin Demonstrated capacity. new text end

new text begin (a) The applicant must have the ability to provide
services in a manner that is consistent with the requirements of this chapter.
 new text end

new text begin (b) The commissioner shall consider the following criteria, including but not limited to:
 new text end

new text begin (1) the experience of the applicant in managing residents with dementia or previous
long-term care experience; and
 new text end

new text begin (2) the compliance history of the applicant in the operation of any care facility licensed,
certified, or registered under federal or state laws.
 new text end

new text begin (c) If the applicant does not have experience in managing residents with dementia, the
applicant must employ a consultant or management company for at least the first year of
operation. The consultant or management company must have experience in dementia care
operations and must be approved by the commissioner. The applicant must implement the
recommendations of the consultant or management company or present an acceptable plan
to the commissioner to address the consultant's identified concerns.
 new text end

new text begin (d) The commissioner shall conduct an on-site inspection prior to the issuance of a
comprehensive PLUS license to ensure compliance with the physical plant requirements.
 new text end

new text begin (e) The label "Comprehensive PLUS" shall be identified on the license.
 new text end

new text begin Subd. 5. new text end

new text begin Relinquishing comprehensive PLUS license. new text end

new text begin The licensee must notify the
commissioner in writing at least 60 days prior to the voluntary relinquishment of the
comprehensive PLUS license. For voluntary relinquishment, the facility must:
 new text end

new text begin (1) give all residents and their designated representatives 45-day notice. The notice must
include:
 new text end

new text begin (i) the proposed effective date of the relinquishment;
 new text end

new text begin (ii) changes in staffing;
 new text end

new text begin (iii) changes in services including the elimination or addition of services; and
 new text end

new text begin (iv) staff training that must occur when the relinquishment becomes effective;
 new text end

new text begin (2) submit a transitional plan to the commissioner demonstrating how the current residents
shall be evaluated and assessed to reside in other housing settings that are not an assisted
living facility with a comprehensive PLUS license, that are physically unsecured, or that
would require move-out or transfer to other settings;
 new text end

new text begin (3) change service or care plans as appropriate to address any needs the residents may
have with the transition;
 new text end

new text begin (4) notify the commissioner when the relinquishment process has been completed; and
 new text end

new text begin (5) revise advertising materials and disclosure information to remove any reference that
the facility is an assisted living establishment with a comprehensive PLUS license.
 new text end

Sec. 3.

new text begin [144I.14] ADVERTISING OF COMPREHENSIVE PLUS LICENSE.
 new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin An applicant may not advertise as having a comprehensive
PLUS license until the applicant has obtained a comprehensive PLUS license from the
commissioner. A prospective assisted living establishment seeking a comprehensive PLUS
license may advertise that they have submitted an application for a license to the
commissioner.
 new text end

new text begin Subd. 2. new text end

new text begin Advertising comprehensive PLUS license. new text end

new text begin An assisted living establishment
with a comprehensive PLUS license may advertise that it has a comprehensive PLUS license.
However, the advertising materials may not imply or state that the commissioner recommends
or supports a specific assisted living establishment with a comprehensive PLUS license.
 new text end

new text begin Subd. 3. new text end

new text begin Truth in advertising. new text end

new text begin All advertising material must be truthful and must not
include or use misleading information about the type or status of home care license connected
to any housing with services establishment, including an assisted living establishment with
a comprehensive PLUS license.
 new text end

new text begin Subd. 4. new text end

new text begin Notice of false advertising. new text end

new text begin Upon the determination that a housing with services
establishment inaccurately implies or advertises that they have a comprehensive PLUS
license, the commissioner shall send a notice to the licensee to cease the advertising
immediately. Failure to comply may result in a civil penalty as outlined in section 144I.21.
 new text end

Sec. 4.

new text begin [144I.15] RESPONSIBILITIES OF ADMINISTRATION FOR
COMPREHENSIVE PLUS LICENSEES.
 new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin The comprehensive PLUS licensee is responsible for the care
and housing of the persons with dementia and the provision of person-centered care that
promotes each resident's dignity, independence, and comfort. This includes the supervision,
training, and overall conduct of the staff.
 new text end

new text begin Subd. 2. new text end

new text begin Additional requirements. new text end

new text begin (a) The comprehensive PLUS licensee must follow
the comprehensive assisted living license requirements in section 144I.02, home care
licensing under chapter 144A, and the criteria in this section.
 new text end

new text begin (b) The administrator of the assisted living establishment with a comprehensive PLUS
license must complete and document that at least ten hours of the required annual continuing
educational requirements relate to the care of individuals with dementia. Continuing education
credits must be obtained through commissioner-approved sources that may include college
courses, preceptor credits, self-directed activities, course instructor credits, corporate training,
in-service training, professional association training, web-based training, correspondence
courses, telecourses, seminars, and workshops.
 new text end

new text begin (c) The comprehensive PLUS licensee must provide a uniform disclosure statement
designated by the commissioner to each person who requests information that explains the
services, costs, and operations for a resident at an assisted living establishment with a
comprehensive PLUS license.
 new text end

new text begin Subd. 3. new text end

new text begin Policies. new text end

new text begin In addition to the policies and procedures required in the licensing of
home care services in chapter 144A, the comprehensive PLUS licensee must develop and
implement policies and procedures that address the:
 new text end

new text begin (1) philosophy of how services are provided based upon the assisted living licensee's
values, mission, and promotion of person-centered care and how the philosophy shall be
implemented;
 new text end

new text begin (2) evaluation of behavioral symptoms and design of supports for intervention plans;
 new text end

new text begin (3) wandering and egress prevention that provides detailed instructions to staff in the
event a resident elopes;
 new text end

new text begin (4) assessment of residents for the use and effects of medications, including psychotropic
medications;
 new text end

new text begin (5) use of supportive devices with restraining qualities;
 new text end

new text begin (6) staffing plan to ensure that residents' needs are met including a quality control system
that periodically reviews how well the staffing plan is working;
 new text end

new text begin (7) staff training specific to dementia care;
 new text end

new text begin (8) description of life enrichment programs and how activities are implemented;
 new text end

new text begin (9) description of family support programs and efforts to keep the family engaged;
 new text end

new text begin (10) limiting the use of public address and intercom systems for emergencies and
evacuation drills only;
 new text end

new text begin (11) transportation coordination and assistance to and from outside medical appointments;
and
 new text end

new text begin (12) safekeeping of resident's possessions.
 new text end

new text begin The policies and procedures must be provided to residents and the resident's representative
at the time of move-in.
 new text end

Sec. 5.

new text begin [144I.16] STAFFING AND STAFF TRAINING FOR COMPREHENSIVE
PLUS LICENSEES.
 new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin (a) The comprehensive PLUS licensee must provide residents
with dementia-trained staff who have been instructed in the person-centered care approach.
All direct care and other community staff assigned to care for dementia residents must be
specially trained to work with residents with Alzheimer's disease and other dementias.
 new text end

new text begin (b) Only staff trained as specified in subdivisions 2 and 3 shall be assigned to care for
dementia residents.
 new text end

new text begin (c) Staffing levels must be sufficient to meet the scheduled and unscheduled needs of
residents. Staffing levels during nighttime hours shall be based on the sleep patterns and
needs of residents.
 new text end

new text begin (d) In an emergency situation when trained staff are not available to provide services,
the assisted living facility may assign staff who have not completed the required training.
The particular emergency situation must be documented and must address:
 new text end

new text begin (1) the nature of the emergency;
 new text end

new text begin (2) how long the emergency lasted; and
 new text end

new text begin (3) the names and positions of staff that provided coverage.
 new text end

new text begin Subd. 2. new text end

new text begin Staffing requirements. new text end

new text begin A comprehensive PLUS licensee must ensure that staff
who provide support to residents with dementia have a basic understanding and fundamental
knowledge of the residents' emotional and unique health care needs using person-centered
planning delivery. Direct care dementia-trained staff and other staff must be trained on the
topics identified during the expedited rulemaking process. These requirements are in addition
to the licensing requirements for training.
 new text end

new text begin Subd. 3. new text end

new text begin Supervising staff training. new text end

new text begin Persons providing or overseeing staff training must
have experience and knowledge in the care of individuals with dementia.
 new text end

new text begin Subd. 4. new text end

new text begin Preservice and in-service training. new text end

new text begin Preservice and in-service training may
include various methods of instruction, such as classroom style, web-based training, video,
or one-to-one training. The dementia care unit must have a method for determining and
documenting each staff person's knowledge and understanding of the training provided. All
training must be documented.
 new text end

Sec. 6.

new text begin [144I.17] SERVICES FOR RESIDENTS WITH DEMENTIA.
 new text end

new text begin Subdivision 1. new text end

new text begin Move-in assessment. new text end

new text begin (a) At the time of move-in, dementia-trained staff
must make reasonable attempts to identify the customary routines of each resident and the
resident's preferences in how services may be delivered. Minimum services to be provided
include:
 new text end

new text begin (1) assistance with activities of daily living that address the needs of each resident with
dementia due to cognitive or physical limitations. These services must meet or be in addition
to the requirements in the licensing rules for the facility. Services must be provided in a
person-centered manner that promotes resident choice, dignity, and sustains the resident's
abilities;
 new text end

new text begin (2) health care services provided according to the licensing statutes and rules of the
facility;
 new text end

new text begin (3) a daily meal program for nutrition and hydration must be provided and available
throughout each resident's waking hours. The individualized nutritional plan for each resident
must be documented in the resident's service or care plan. In addition, the assisted living
must:
 new text end

new text begin (i) provide visual contrast between plates, eating utensils, and the table to maximize the
independence of each resident; and
 new text end

new text begin (ii) provide adaptive eating utensils for those residents who have been evaluated as
needing them to maintain their eating skills; and
 new text end

new text begin (4) meaningful activities that promote or help sustain the physical and emotional
well-being of residents. The activities must be person-directed and available during residents'
waking hours.
 new text end

new text begin (b) Each resident must be evaluated for activities according to the licensing rules
governing assisted living. In addition, the evaluation must address the following:
 new text end

new text begin (1) past and current interests;
 new text end

new text begin (2) current abilities and skills;
 new text end

new text begin (3) emotional and social needs and patterns;
 new text end

new text begin (4) physical abilities and limitations;
 new text end

new text begin (5) adaptations necessary for the resident to participate; and
 new text end

new text begin (6) identification of activities for behavioral interventions.
 new text end

new text begin (c) An individualized activity plan must be developed for each resident based on their
activity evaluation. The plan must reflect the resident's activity preferences and needs.
 new text end

new text begin (d) A selection of daily structured and non-structured activities must be provided and
included on the resident's activity service or care plan as appropriate. Daily activity options
based on resident evaluation may include but are not limited to:
 new text end

new text begin (1) occupation or chore related tasks;
 new text end

new text begin (2) scheduled and planned events such as entertainment or outings;
 new text end

new text begin (3) spontaneous activities for enjoyment or those that may help defuse a behavior;
 new text end

new text begin (4) one-to-one activities that encourage positive relationships between residents and
staff such as telling a life story, reminiscing, or playing music;
 new text end

new text begin (5) spiritual, creative, and intellectual activities;
 new text end

new text begin (6) sensory stimulation activities;
 new text end

new text begin (7) physical activities that enhance or maintain a resident's ability to ambulate or move;
and
 new text end

new text begin (8) outdoor activities.
 new text end

new text begin (e) Behavioral symptoms that negatively impact the resident and others in the assisted
living must be evaluated and included on the service or care plan. The staff must initiate
and coordinate outside consultation or acute care when indicated.
 new text end

new text begin (f) Support must be offered to family and other significant relationships on a regularly
scheduled basis but not less than quarterly. Examples in which support may be provided
include support groups, community gatherings, social events, or meetings that address the
needs of individual residents or their family or significant relationships.
 new text end

new text begin (g) Access to secured outdoor space and walkways that allow residents to enter and
return without staff assistance must be provided.
 new text end

Sec. 7.

new text begin [144I.18] PHYSICAL DESIGN, ENVIRONMENT, AND SAFETY OF
DEMENTIA CARE UNITS.
 new text end

new text begin Subdivision 1. new text end

new text begin Life safety code. new text end

new text begin A comprehensive PLUS licensee must comply with
the most current edition of NFPA.101, life safety code, health care chapter.
 new text end

new text begin Subd. 2. new text end

new text begin Comprehensive PLUS and dementia care units located on ground
level. new text end

new text begin Dementia care units must be located on the ground level of the building to ensure
access to outdoor space and safe evacuation.
 new text end

new text begin Subd. 3. new text end

new text begin Secure outdoor recreation area. new text end

new text begin The assisted living establishment with a
comprehensive PLUS license must provide:
 new text end

new text begin (1) outdoor recreation space that is a minimum of 600 square feet or 15 square feet per
resident, whichever is greater, and is exclusive of normal walkways and landscaping. The
space must have a minimum dimension of 15 feet in any direction;
 new text end

new text begin (2) fences surrounding the perimeter of the outdoor recreation area must be no less than
six feet in height, constructed to reduce the risk of resident elopement, and maintained in
functional condition;
 new text end

new text begin (3) walkways must meet applicable federal, state, and accessibility codes. Walkway
surfaces must be of a medium to dark reflectance value to prevent glare from reflected
sunlight;
 new text end

new text begin (4) outdoor furniture must be of a sufficient weight, stability, and design, and be
maintained to prevent resident injury or prevent aid in elopement; and
 new text end

new text begin (5) doors to the outdoor recreation area may be locked during nighttime hours or during
severe weather per facility policy.
 new text end

new text begin Subd. 4. new text end

new text begin Common areas in dementia care unit. new text end

new text begin (a) Common areas must include the
following requirements:
 new text end

new text begin (1) freedom of movement for the residents to common areas and to the resident's personal
spaces;
 new text end

new text begin (2) a multipurpose room for dining, group and individual activities, and family visits
that complies with the facility licensing requirements for common space;
 new text end

new text begin (3) comfortable seating;
 new text end

new text begin (4) safe corridors and passageways through the common areas that are free of objects
that may cause falls; and
 new text end

new text begin (5) windows or skylights that are at least as large as 12 percent of the square footage of
the common area.
 new text end

new text begin (b) A public address or intercom system is not required, however if one exists it must
be used within the dementia care unit only for emergencies.
 new text end

new text begin Subd. 5. new text end

new text begin Resident rooms in dementia care unit. new text end

new text begin (a) Residents may not be locked out
of or inside of their rooms at any time.
 new text end

new text begin (b) Residents must be encouraged to decorate and furnish their rooms with personal
items and furnishings based on the resident's needs, preferences, and appropriateness.
 new text end

new text begin (c) The dementia care unit must individually identify residents' rooms to assist residents
in recognizing their room.
 new text end

ARTICLE 16

DECEPTIVE MARKETING AND BUSINESS PRACTICES

Section 1.

new text begin [144I.20] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For the purposes of this section and section 144I.21, the
definitions in this section have the meanings given.
 new text end

new text begin Subd. 2. new text end

new text begin Facility. new text end

new text begin "Facility" means a facility that is licensed as a nursing home under
chapter 144A or a boarding care home under sections 144.50 to 144.56; a registered housing
with services establishment under chapter 144D; the licensed home care provider providing
services in a housing with services establishment; or an assisted living licensed under this
chapter.
 new text end

new text begin Subd. 3. new text end

new text begin Resident representative. new text end

new text begin "Resident representative" means a court-appointed
guardian, health care agent under section 145C.01, subdivision 2, or person chosen by the
resident and identified in the resident's records on file with the facility.
 new text end

Sec. 2.

new text begin [144I.21] DECEPTIVE MARKETING AND BUSINESS PRACTICES.
 new text end

new text begin (a) Facilities are prohibited from engaging in deceptive marketing and business practices
as follows:
 new text end

new text begin (1) making any false, fraudulent, deceptive, or misleading statements in marketing,
advertising, or other oral or written description or representation of cares or services, whether
in oral, written, or electronic form;
 new text end

new text begin (2) arranging for or providing health or supportive care services that are substantially
different from or more expensive than those offered, promised, marketed, or advertised;
 new text end

new text begin (3) failing to deliver any health or supportive care or services the provider or facility
promised or represented that the facility was able to provide;
 new text end

new text begin (4) failing to inform the resident in writing of any limitations to services available prior
to executing a contract for a service plan or lease agreement;
 new text end

new text begin (5) discharging or terminating the lease or services of a resident following a required
period of private pay when the next form of payment will be from the medical assistance
waivers under sections 256B.0915 and 256B.49 after the licensee has promised to continue
the same services after private pay ceases;
 new text end

new text begin (6) discharging or terminating the lease or services of a resident following a required
period of private pay when the next form of payment will be from the medical assistance
elderly waiver program after the licensee has promised to continue the same services after
private pay ceases;
 new text end

new text begin (7) failing to disclose and clearly explain the purpose of any nonrefundable fee prior to
executing a contract for the service plan or lease;
 new text end

new text begin (8) advertising or representing orally or in writing that the licensee has a special care
unit, such as for dementia or memory care, without complying with training and disclosure
requirements under sections 144D.065 and 325F.72 and any other applicable law; and
 new text end

new text begin (9) misstating or falsely asserting statutory requirements as being the cause of a business
decision.
 new text end

new text begin (b) A violation of this section shall result in no less than a level 2 fine, but may result
in a level 3 or level 4 fine if, as a result of the deceptive marketing and business practices,
the resulting harm was equal to or greater than that described in section 144A.47, subdivision
11.
 new text end

new text begin (c) The commissioner may suspend, refuse to renew, or revoke a license or provisional
license for a repeated violation of 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

ARTICLE 17

HOUSING WITH SERVICES CONFORMING CHANGES

Section 1.

Minnesota Statutes 2018, section 144D.01, subdivision 4, is amended to read:


Subd. 4.

Housing with services establishment or establishment.

(a) "Housing with
services establishment" or "establishment" means:

(1) an establishment providing sleeping accommodations to one or more adult residents,
at least 80 percent of which are 55 years of age or older, and offering or providing, for a
fee, deleted text begin one or more regularly scheduled health-related services ordeleted text end two or more regularly
scheduled supportive services, whether offered or provided directly by the establishment
or by another entity arranged for by the establishment; or

(2) an establishment that registers under section 144D.025.

(b) Housing with services establishment does not include:

(1) a nursing home licensed under chapter 144A;

(2) a hospital, certified boarding care home, or supervised living facility licensed under
sections 144.50 to 144.56;

(3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules,
parts 9520.0500 to 9520.0670, or under chapter 245D or 245G;

new text begin (4) an assisted living licensed under chapter 144I;
 new text end

deleted text begin (4)deleted text end new text begin (5)new text end a board and lodging establishment which serves as a shelter for battered women
or other similar purpose;

deleted text begin (5)deleted text end new text begin (6)new text end a family adult foster care home licensed by the Department of Human Services;

deleted text begin (6)deleted text end new text begin (7)new text end private homes in which the residents are related by kinship, law, or affinity with
the providers of services;

deleted text begin (7)deleted text end new text begin (8)new text end residential settings for persons with developmental disabilities in which the
services are licensed under chapter 245D;

deleted text begin (8)deleted text end new text begin (9)new text end a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person in
exchange for services or rent, or both;

deleted text begin (9)deleted text end new text begin (10)new text end a duly organized condominium, cooperative, common interest community, or
owners' association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units;

deleted text begin (10)deleted text end new text begin (11)new text end services for persons with developmental disabilities that are provided under a
license under chapter 245D; or

deleted text begin (11)deleted text end new text begin (12)new text end a temporary family health care dwelling as defined in sections 394.307 and
462.3593.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022.
 new text end

Sec. 2.

Minnesota Statutes 2018, section 144D.015, is amended to read:


144D.015 DEFINITION FOR PURPOSES OF LONG-TERM CARE INSURANCE.

For purposes of consistency with terminology commonly used in long-term care insurance
policies and notwithstanding chapter 144G, a housing with services establishment that is
registered under section 144D.03 and that holds, or makes arrangements with an individual
or entity that holds any type of home care license and all other licenses, permits, registrations,
or other governmental approvals legally required for delivery of the services the establishment
offers or provides to its residents, constitutes an "assisted living facility" or "assisted living
residence."new text begin A housing with services that provides home care services must be licensed as
an assisted living pursuant to chapter 144I.
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. 3.

Minnesota Statutes 2018, section 144D.04, subdivision 2, is amended to read:


Subd. 2.

Contents of contract.

A housing with services contract, which need not be
entitled as such to comply with this section, shall include at least the following elements in
itself or through supporting documents or attachments:

(1) the name, street address, and mailing address of the establishment;

(2) the name and mailing address of the owner or owners of the establishment and, if
the owner or owners is not a natural person, identification of the type of business entity of
the owner or owners;

(3) the name and mailing address of the managing agent, through management agreement
or lease agreement, of the establishment, if different from the owner or owners;

(4) the name and address of at least one natural person who is authorized to accept service
of process on behalf of the owner or owners and managing agent;

(5) a statement describing the registration and licensure status of the establishment and
any provider providing health-related or supportive services under an arrangement with the
establishment;

(6) the term of the contract;

(7) a description of the services to be provided to the resident in the base rate to be paid
by the resident, including a delineation of the portion of the base rate that constitutes rent
and a delineation of charges for each service included in the base rate;

(8) a description of any additional services, deleted text begin including home care services,deleted text end available for
an additional fee from the establishment directly or through arrangements with the
establishment, and a schedule of fees charged for these services;

(9) a conspicuous notice informing the tenant of the policy concerning the conditions
under which and the process through which the contract may be modified, amended, or
terminated, including whether a move to a different room or sharing a room would be
required in the event that the tenant can no longer pay the current rent;

(10) a description of the establishment's complaint resolution process available to residents
including the toll-free complaint line for the Office of Ombudsman for Long-Term Care;

(11) the resident's designated representative, if any;

(12) the establishment's referral procedures if the contract is terminated;

(13) requirements of residency used by the establishment to determine who may reside
or continue to reside in the housing with services establishment;

(14) billing and payment procedures and requirements;

(15) a statement regarding the ability of a resident to receive services from service
providers with whom the establishment does not have an arrangement;

(16) a statement regarding the availability of public funds for payment for residence or
services in the establishment; and

(17) a statement regarding the availability of and contact information for long-term care
consultation services under section 256B.0911 in the county in which the establishment is
located.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2022.
 new text end

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 144D.01, subdivisions 2a, 3a, and 6; 144D.04,
subdivision 2a; 144D.045; 144D.06; 144D.09; and 144D.10, new text end new text begin are repealed effective July 1,
2022.
 new text end

ARTICLE 18

HOME CARE CHANGES

Section 1.

Minnesota Statutes 2018, section 144A.43, subdivision 6, is amended to read:


Subd. 6.

License.

"License" means a basic or comprehensive home care license issued
by the commissioner to a home care providernew text begin and effective July 1, 2022, providing services
outside of assisted living settings licensed under chapter 144Inew text end .

Sec. 2.

new text begin [144A.431] APPLICABILITY OF HOME CARE STATUTES TO ASSISTED
LIVING LICENSE REQUIREMENTS IN CHAPTER 144I.
 new text end

new text begin The provisions in sections 144A.43 to 144A.47 apply to assisted living license
requirements pursuant to section 144I.02. Assisted living license requirements in chapter
144I are effective starting July 1, 2021, for all new assisted living licensees and when home
care licensees have converted their home care license to the assisted living license between
July 1, 2021, and June 30, 2022.
 new text end

Sec. 3.

Minnesota Statutes 2018, section 144A.44, subdivision 1, is amended to read:


Subdivision 1.

Statement of rights.

new text begin (a) new text end A deleted text begin persondeleted text end new text begin client or residentnew text end who receives home
care services new text begin in the community or in an assisted living licensed under chapter 144I new text end has these
rights:

(1) deleted text begin the right todeleted text end receive written informationnew text begin , in plain language,new text end about rights before
receiving services, including what to do if rights are violated;

(2) deleted text begin the right todeleted text end receive care and services according to a suitable and up-to-date plan, and
subject to accepted health care, medical or nursing standardsnew text begin and person-centered carenew text end , to
take an active part in developing, modifying, and evaluating the plan and services;

(3) deleted text begin the right todeleted text end be told before receiving services the type and disciplines of staff who
will be providing the services, the frequency of visits proposed to be furnished, other choices
that are available for addressing home care needs, and the potential consequences of refusing
these services;

(4) deleted text begin the right todeleted text end be told in advance of any recommended changes by the provider in the
service plan and to take an active part in any decisions about changes to the service plan;

(5) deleted text begin the right todeleted text end refuse services or treatment;

(6) deleted text begin the right todeleted text end know, before receiving services or during the initial visit, any limits to
the services available from a home care provider;

(7) deleted text begin the right todeleted text end be told before services are initiated what the provider charges for the
services; to what extent payment may be expected from health insurance, public programs,
or other sources, if known; and what charges the client may be responsible for paying;

(8) deleted text begin the right todeleted text end know that there may be other services available in the community,
including other home care services and providers, and to know where to find information
about these services;

(9) deleted text begin the right todeleted text end choose freely among available providers and to change providers after
services have begun, within the limits of health insurance, long-term care insurance, medical
assistance, deleted text begin ordeleted text end other health programsnew text begin , or public programsnew text end ;

(10) deleted text begin the right todeleted text end have personal, financial, and medical information kept private, and to
be advised of the provider's policies and procedures regarding disclosure of such information;

(11) deleted text begin the right todeleted text end access the client's own records and written information from those
records in accordance with sections 144.291 to 144.298;

(12) deleted text begin the right todeleted text end be served by people who are properly trained and competent to perform
their duties;

(13) deleted text begin the right todeleted text end be treated with courtesy and respect, and to have the client's property
treated with respect;

(14) deleted text begin the right todeleted text end be free from physical and verbal abuse, neglect, financial exploitation,
and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment
of Minors Act;

(15) deleted text begin the right todeleted text end reasonable, advance notice of changes in services or charges;

(16) deleted text begin the right todeleted text end know the provider's reason for termination of services;

(17) deleted text begin the right todeleted text end at least deleted text begin tendeleted text end new text begin 30new text end days' advance notice of the termination of a service new text begin or
housing new text end by a provider, except in cases where:

(i) the client engages in conduct that significantly alters the terms of the service plan
with the home care provider;

(ii) the client, person who lives with the client, or others create an abusive or unsafe
work environment for the person providing home care services; or

(iii) an emergency or a significant change in the client's condition has resulted in service
needs that exceed the current service plan and that cannot be safely met by the home care
provider;

(18) deleted text begin the right todeleted text end a coordinated transfer when there will be a change in the provider of
services;

(19) deleted text begin the right todeleted text end complain new text begin to staff and others of the client's choice new text end about services that
are provided, or fail to be provided, and the lack of courtesy or respect to the client or the
client's propertynew text begin and the right to recommend changes in policies and services, free from
retaliation including the threat of termination of servicesnew text end ;

(20) deleted text begin the right todeleted text end know how to contact an individual associated with the home care provider
who is responsible for handling problems and to have the home care provider investigate
and attempt to resolve the grievance or complaint;

(21) deleted text begin the right todeleted text end know the name and address of the state or county agency to contact for
additional information or assistance; deleted text begin and
deleted text end

(22) deleted text begin the right todeleted text end assert these rights personally, or have them asserted by the client's
representative or by anyone on behalf of the client, without retaliationdeleted text begin .deleted text end new text begin ;
new text end

new text begin (23) internet service at the client's own expense, unless it is provided by the provider;
and
 new text end

new text begin (24) place an electronic monitoring device in the client's or resident's space in compliance
with state requirements.
 new text end

new text begin (b) When providers violate the rights in this section, they are subject to the fines and
license actions in sections 144A.474, subdivision 11, and 144A.475.
 new text end

new text begin (c) Providers must do all of the following:
 new text end

new text begin (1) encourage and assist in the fullest possible exercise of these rights;
 new text end

new text begin (2) provide the names and telephone numbers of individuals and organizations that
provide advocacy and legal services for clients and residents seeking to assert their rights;
 new text end

new text begin (3) make every effort to assist clients or residents in obtaining information regarding
whether Medicare, medical assistance, other health programs, or public programs will pay
for services;
 new text end

new text begin (4) make reasonable accommodations for people who have communication disabilities,
or those who speak a language other than English; and
 new text end

new text begin (5) provide all information and notices in plain language and in terms the client or
resident can understand.
 new text end

Sec. 4.

Minnesota Statutes 2018, section 144A.44, subdivision 2, is amended to read:


Subd. 2.

Interpretation and enforcement of rights.

These rights are established for
the benefit of clients new text begin or residents new text end who receive home care services. All home care providers,
including those exempted under section 144A.471, must comply with this section. The
commissioner shall enforce this section and the home care bill of rights requirement against
home care providers exempt from licensure in the same manner as for licensees. A home
care provider may not request or require a client to surrender any of these rights as a condition
of receiving services. This statement of rights does not replace or diminish other rights and
liberties that may exist relative to clients receiving home care services, persons providing
home care services, or providers licensed under sections 144A.43 to 144A.482.

Sec. 5.

Minnesota Statutes 2018, section 144A.441, is amended to read:


144A.441 ASSISTED LIVING BILL OF RIGHTS ADDENDUM.

Assisted living deleted text begin clientsdeleted text end new text begin residentsnew text end , as defined in section deleted text begin 144G.01, subdivision 3deleted text end new text begin 144I.01new text end ,
shall be provided with the home care bill of rights required by section 144A.44, except that
the home care bill of rights provided to these deleted text begin clientsdeleted text end new text begin residentsnew text end must include the following
provision in place of the provision in section 144A.44, subdivision 1,new text begin paragraph (a),new text end clause
(17):

"(17) the right to reasonable, advance notice of changes in services or charges, including
at least 30 days' advance notice of the termination of a service new text begin or housing new text end by a provider,
except in cases where:

(i) the recipient of services engages in conduct that alters the conditions of employment
as specified in the employment contract between the home care provider and the individual
providing home care services, or creates an abusive or unsafe work environment for the
individual providing home care services;

(ii) an emergency for the informal caregiver or a significant change in the recipient's
condition has resulted in service needs that exceed the current service provider agreement
and that cannot be safely met by the home care provider; or

(iii) the provider has not received payment for servicesdeleted text begin , for which at least ten days'
advance notice of the termination of a service shall be provideddeleted text end ."

Sec. 6.

Minnesota Statutes 2018, section 144A.442, is amended to read:


144A.442 ASSISTED LIVING deleted text begin CLIENTSdeleted text end new text begin RESIDENTSnew text end ; SERVICE
TERMINATION.

new text begin (a) new text end If an arranged home care provider, as defined in section 144D.01, subdivision 2a,
who is not also Medicare certified terminates a service agreement or service plan with an
assisted living client, as defined in section 144G.01, subdivision 3, the home care provider
shall provide the assisted living client and the legal or designated representatives of the
client, if any, with a written notice of termination which includes the following information:

(1) the effective date of termination;

(2) the reason for termination;

(3) without extending the termination notice period, an affirmative offer to meet with
the assisted living client or client representatives within no more than five business days of
the date of the termination notice to discuss the termination;

(4) contact information for a reasonable number of other home care providers in the
geographic area of the assisted living client, as required by section 144A.4791, subdivision
10;

(5) a statement that the provider will participate in a coordinated transfer of the care of
the client to another provider or caregiver, as required by section 144A.44, subdivision 1,
clause (18);

(6) the name and contact information of a representative of the home care provider with
whom the client may discuss the notice of termination;

(7) a copy of the home care bill of rights; and

(8) a statement that the notice of termination of home care services by the home care
provider does not constitute notice of termination of the housing with services contract with
a housing with services establishment.

new text begin (b) Effective July 1, 2021, all assisted living settings must comply with the provisions
in chapter 144I relating to termination of services and housing.
 new text end

Sec. 7.

Minnesota Statutes 2018, section 144A.471, subdivision 1, is amended to read:


Subdivision 1.

License required.

new text begin (a) new text end A home care provider may not open, operate,
manage, conduct, maintain, or advertise itself as a home care provider or provide home care
services in Minnesota without a temporary or current home care provider license issued by
the commissioner of health.

new text begin (b) Effective July 1, 2021, all assisted living providers licensed pursuant to chapter 144I
shall comply with this chapter for the provision of basic and comprehensive home care
services.
 new text end

Sec. 8.

Minnesota Statutes 2018, section 144A.471, subdivision 5, is amended to read:


Subd. 5.

Basic and comprehensive levels of licensure.

new text begin (a) new text end An applicant seeking to
become a home care provider must apply for either a basic or comprehensive home care
license.

new text begin (b) Effective July 1, 2021, all home care providers who also provide housing, must apply
for an assisted living license pursuant to chapter 144I according to the process set out by
the commissioner. Home care providers providing services in the community without
providing housing must apply for a license under this chapter.
 new text end

Sec. 9.

Minnesota Statutes 2018, section 144A.471, subdivision 9, is amended to read:


Subd. 9.

Exclusions from home care licensure.

The following are excluded from home
care licensure and are not required to provide the home care bill of rights:

(1) an individual or business entity providing only coordination of home care that includes
one or more of the following:

(i) determination of whether a client needs home care services, or assisting a client in
determining what services are needed;

(ii) referral of clients to a home care provider;

(iii) administration of payments for home care services; or

(iv) administration of a health care home established under section 256B.0751;

(2) an individual who is not an employee of a licensed home care provider if the
individual:

(i) only provides services as an independent contractor to one or more licensed home
care providers;

(ii) provides no services under direct agreements or contracts with clients; and

(iii) is contractually bound to perform services in compliance with the contracting home
care provider's policies and service plans;

(3) a business that provides staff to home care providers, such as a temporary employment
agency, if the business:

(i) only provides staff under contract to licensed or exempt providers;

(ii) provides no services under direct agreements with clients; and

(iii) is contractually bound to perform services under the contracting home care provider's
direction and supervision;

(4) any home care services conducted by and for the adherents of any recognized church
or religious denomination for its members through spiritual means, or by prayer for healing;

(5) an individual who only provides home care services to a relative;

(6) an individual not connected with a home care provider that provides assistance with
basic home care needs if the assistance is provided primarily as a contribution and not as a
business;

(7) an individual not connected with a home care provider that shares housing with and
provides primarily housekeeping or homemaking services to an elderly or disabled person
in return for free or reduced-cost housing;

(8) an individual or provider providing home-delivered meal services;

(9) an individual providing senior companion services and other older American volunteer
programs (OAVP) established under the Domestic Volunteer Service Act of 1973, United
States Code, title 42, chapter 66;

deleted text begin (10) an employee of a nursing home or home care provider licensed under this chapter
or an employee of a boarding care home licensed under sections 144.50 to 144.56 when
responding to occasional emergency calls from individuals residing in a residential setting
that is attached to or located on property contiguous to the nursing home, boarding care
home, or location where home care services are also provided;
 deleted text end

deleted text begin (11) an employee of a nursing home or home care provider licensed under this chapter
or an employee of a boarding care home licensed under sections 144.50 to 144.56 when
providing occasional minor services free of charge to individuals residing in a residential
setting that is attached to or located on property contiguous to the nursing home, boarding
care home, or location where home care services are also provided;
 deleted text end

(12) a member of a professional corporation organized under chapter 319B that does
not regularly offer or provide home care services as defined in section 144A.43, subdivision
3;

(13) the following organizations established to provide medical or surgical services that
do not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
corporation organized under chapter 317A, a partnership organized under chapter 323, or
any other entity determined by the commissioner;

(14) an individual or agency that provides medical supplies or durable medical equipment,
except when the provision of supplies or equipment is accompanied by a home care service;

(15) a physician licensed under chapter 147;

(16) an individual who provides home care services to a person with a developmental
disability who lives in a place of residence with a family, foster family, or primary caregiver;

(17) a business that only provides services that are primarily instructional and not medical
services or health-related support services;

(18) an individual who performs basic home care services for no more than 14 hours
each calendar week to no more than one client;

(19) an individual or business licensed as hospice as defined in sections 144A.75 to
144A.755 who is not providing home care services independent of hospice service;

(20) activities conducted by the commissioner of health or a community health board
as defined in section 145A.02, subdivision 5, including communicable disease investigations
or testing; or

(21) administering or monitoring a prescribed therapy necessary to control or prevent a
communicable disease, or the monitoring of an individual's compliance with a health directive
as defined in section 144.4172, subdivision 6.

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to clauses (10) and (11) are effective July 1,
2021.
 new text end

Sec. 10.

Minnesota Statutes 2018, section 144A.472, subdivision 7, is amended to read:


Subd. 7.

Fees; application, change of ownership, and renewal.

(a) An initial applicant
seeking temporary home care licensure must submit the following application fee to the
commissioner along with a completed application:

(1) for a basic home care provider, $2,100; or

(2) for a comprehensive home care provider, $4,200.

(b) A home care provider who is filing a change of ownership as required under
subdivision 5 must submit the following application fee to the commissioner, along with
the documentation required for the change of ownership:

(1) for a basic home care provider, $2,100; or

(2) for a comprehensive home care provider, $4,200.

(c) For the period ending June 30, 2018, a home care provider who is seeking to renew
the provider's license shall pay a fee to the commissioner based on revenues derived from
the provision of home care services during the calendar year prior to the year in which the
application is submitted, according to the following schedule:

License Renewal Fee

Provider Annual Revenue
 		Fee
greater than $1,500,000
 $6,625
greater than $1,275,000 and no more than
$1,500,000
 $5,797
greater than $1,100,000 and no more than
$1,275,000
 $4,969
greater than $950,000 and no more than
$1,100,000
 $4,141
greater than $850,000 and no more than $950,000
 $3,727
greater than $750,000 and no more than $850,000
 $3,313
greater than $650,000 and no more than $750,000
 $2,898
greater than $550,000 and no more than $650,000
 $2,485
greater than $450,000 and no more than $550,000
 $2,070
greater than $350,000 and no more than $450,000
 $1,656
greater than $250,000 and no more than $350,000
 $1,242
greater than $100,000 and no more than $250,000
 $828
greater than $50,000 and no more than $100,000
 $500
greater than $25,000 and no more than $50,000
 $400
no more than $25,000
 $200

(d) For the period between July 1, 2018, and June 30, 2020, a home care provider who
is seeking to renew the provider's license shall pay a fee to the commissioner in an amount
that is ten percent higher than the applicable fee in paragraph (c). A home care provider's
fee shall be based on revenues derived from the provision of home care services during the
calendar year prior to the year in which the application is submitted.

(e) Beginning July 1, 2020, a home care provider who is seeking to renew the provider's
license shall pay a fee to the commissioner based on revenues derived from the provision
of home care services during the calendar year prior to the year in which the application is
submitted, according to the following schedule:

License Renewal Fee

Provider Annual Revenue
 		Fee
greater than $1,500,000
 $7,651
greater than $1,275,000 and no more than
$1,500,000
 $6,695
greater than $1,100,000 and no more than
$1,275,000
 $5,739
greater than $950,000 and no more than
$1,100,000
 $4,783
greater than $850,000 and no more than $950,000
 $4,304
greater than $750,000 and no more than $850,000
 $3,826
greater than $650,000 and no more than $750,000
 $3,347
greater than $550,000 and no more than $650,000
 $2,870
greater than $450,000 and no more than $550,000
 $2,391
greater than $350,000 and no more than $450,000
 $1,913
greater than $250,000 and no more than $350,000
 $1,434
greater than $100,000 and no more than $250,000
 $957
greater than $50,000 and no more than $100,000
 $577
greater than $25,000 and no more than $50,000
 $462
no more than $25,000
 $231

(f) If requested, the home care provider shall provide the commissioner information to
verify the provider's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.

(g) At each annual renewal, a home care provider may elect to pay the highest renewal
fee for its license category, and not provide annual revenue information to the commissioner.

(h) A temporary license or license applicant, or temporary licensee or licensee that
knowingly provides the commissioner incorrect revenue amounts for the purpose of paying
a lower license fee, shall be subject to a civil penalty in the amount of double the fee the
provider should have paid.

new text begin (i) The fee for failure to comply with the notification requirements in section 144A.473,
subdivision 2, paragraph (c), is $1,000.
 new text end

deleted text begin (i)deleted text end new text begin (j)new text end Fees deleted text begin and penaltiesdeleted text end collected under this section shall be deposited in the state
treasury and credited to the state government special revenue fund. All fees are
nonrefundable. Fees collected under paragraphs (c), (d), and (e) are nonrefundable even if
received before July 1, 2017, for temporary licenses or licenses being issued effective July
1, 2017, or later.

new text begin (k) Fines collected under this subdivision shall be deposited in a dedicated special revenue
account. On an annual basis, the balance in the special revenue account will be appropriated
to the commissioner to implement the recommendations of the advisory council established
in section 144A.4799. Fines collected in state fiscal years 2018 and 2019 shall be deposited
in the dedicated special revenue account as described in 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. 11.

Minnesota Statutes 2018, section 144A.474, subdivision 9, is amended to read:


Subd. 9.

Follow-up surveys.

For providers that have Level 3 or Level 4 violations under
subdivision 11, or any violations determined to be widespread, the department shall conduct
a follow-up survey within 90 calendar days of the survey. When conducting a follow-up
survey, the surveyor will focus on whether the previous violations have been corrected and
may also address any new violations that are observed while evaluating the corrections that
have been made. deleted text begin If a new violation is identified on a follow-up survey, no fine will be
imposed unless it is not corrected on the next follow-up survey.
deleted text end

Sec. 12.

Minnesota Statutes 2018, section 144A.474, subdivision 11, is amended to read:


Subd. 11.

Fines.

(a) Fines and enforcement actions under this subdivision may be assessed
based on the level and scope of the violations described in paragraph deleted text begin (c)deleted text end new text begin (b) and imposed
immediately with no opportunity to correct the violation firstnew text end as follows:

(1) Level 1, no fines or enforcement;

(2) Level 2, deleted text begin fines ranging from $0 todeleted text end new text begin a fine ofnew text end $500new text begin per violationnew text end , in addition to any of
the enforcement mechanisms authorized in section 144A.475 for widespread violations;

(3) Level 3, deleted text begin fines ranging from $500 to $1,000deleted text end new text begin a fine of $3,000 per incident plus $100
for each resident affected by the violationnew text end , in addition to any of the enforcement mechanisms
authorized in section 144A.475; deleted text begin and
deleted text end

(4) Level 4, deleted text begin fines ranging from $1,000 todeleted text end new text begin a fine ofnew text end $5,000new text begin per incident plus $200 for
each resident affected by the violationnew text end , in addition to any of the enforcement mechanisms
authorized in section 144A.475deleted text begin .deleted text end new text begin ;
new text end

new text begin (5) for maltreatment violations as defined in section 626.557 including abuse, neglect,
financial exploitation, and drug diversion, that are determined against the provider, an
immediate fine shall be imposed of $5,000 per incident plus $200 for each resident affected
by the violation; and
 new text end

new text begin (6) the fines in clauses (1) to (4) are increased and immediate fine imposition is authorized
for both surveys and investigations conducted.
 new text end

(b) Correction orders for violations are categorized by both level and scope and fines
shall be assessed as follows:

(1) level of violation:

(i) Level 1 is a violation that has no potential to cause more than a minimal impact on
the client and does not affect health or safety;

(ii) Level 2 is a violation that did not harm a client's health or safety but had the potential
to have harmed a client's health or safety, but was not likely to cause serious injury,
impairment, or death;

(iii) Level 3 is a violation that harmed a client's health or safety, not including serious
injury, impairment, or death, or a violation that has the potential to lead to serious injury,
impairment, or death; and

(iv) Level 4 is a violation that results in serious injury, impairment, or death;

(2) scope of violation:

(i) isolated, when one or a limited number of clients are affected or one or a limited
number of staff are involved or the situation has occurred only occasionally;

(ii) pattern, when more than a limited number of clients are affected, more than a limited
number of staff are involved, or the situation has occurred repeatedly but is not found to be
pervasive; and

(iii) widespread, when problems are pervasive or represent a systemic failure that has
affected or has the potential to affect a large portion or all of the clients.

(c) If the commissioner finds that the applicant or a home care provider deleted text begin required to be
licensed under sections 144A.43 to 144A.482deleted text end has not corrected violations by the date
specified in the correction order or conditional license resulting from a survey or complaint
investigation, the commissioner deleted text begin may impose a fine. Adeleted text end new text begin shall provide anew text end notice of
noncompliance with a correction order deleted text begin must be maileddeleted text end new text begin by e-mailnew text end to the applicant's or
provider's last known new text begin e-mail new text end address. The noncompliance notice must list the violations not
corrected.

new text begin (d) For every violation identified by the commissioner, the commissioner shall issue an
immediate fine pursuant to paragraph (a), clause (6). The license holder must still correct
the violation in the time specified. The issuance of an immediate fine can occur in addition
to any enforcement mechanism authorized under section 144A.475. The immediate fine
may be appealed as allowed under this subdivision.
 new text end

deleted text begin (d)deleted text end new text begin (e)new text end The license holder must pay the fines assessed on or before the payment date
specified. If the license holder fails to fully comply with the order, the commissioner may
issue a second fine or suspend the license until the license holder complies by paying the
fine. A timely appeal shall stay payment of the fine until the commissioner issues a final
order.

deleted text begin (e)deleted text end new text begin (f)new text end A license holder shall promptly notify the commissioner in writing when a violation
specified in the order is corrected. If upon reinspection the commissioner determines that
a violation has not been corrected as indicated by the order, the commissioner may issue a
second fine. The commissioner shall notify the license holder by mail to the last known
address in the licensing record that a second fine has been assessed. The license holder may
appeal the second fine as provided under this subdivision.

deleted text begin (f)deleted text end new text begin (g)new text end A home care provider that has been assessed a fine under this subdivision has a
right to a reconsideration or a hearing under this section and chapter 14.

deleted text begin (g)deleted text end new text begin (h)new text end When a fine has been assessed, the license holder may not avoid payment by
closing, selling, or otherwise transferring the licensed program to a third party. In such an
event, the license holder shall be liable for payment of the fine.

deleted text begin (h)deleted text end new text begin (i)new text end In addition to any fine imposed under this section, the commissioner may assess
new text begin a penalty amount based on new text end costs related to an investigation that results in a final order
assessing a fine or other enforcement action authorized by this chapter.

deleted text begin (i)deleted text end new text begin (j)new text end Fines collected under this subdivision shall be deposited in deleted text begin the state governmentdeleted text end new text begin
a dedicatednew text end special revenue deleted text begin fund and credited to an account separate from the revenue
collected under section 144A.472. Subject to an appropriation by the legislature, the revenue
from the fines collected must be used by the commissioner for special projects to improve
home care in Minnesota as recommended bydeleted text end new text begin account. On an annual basis, the balance in
the special revenue account shall be appropriated to the commissioner to implement the
recommendations ofnew text end the advisory council established in section 144A.4799.new text begin Fines collected
in state fiscal years 2018 and 2019 shall be deposited in the dedicated special revenue
account as described in this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
 new text end

Sec. 13.

Minnesota Statutes 2018, section 144A.475, subdivision 3b, is amended to read:


Subd. 3b.

Expedited hearing.

(a) Within five business days of receipt of the license
holder's timely appeal of a temporary suspension or issuance of a conditional license, the
commissioner shall request assignment of an administrative law judge. The request must
include a proposed date, time, and place of a hearing. A hearing must be conducted by an
administrative law judgenew text begin pursuant to Minnesota Rules, parts 1400.8505 to 1400.8612,new text end within
30 calendar days of the request for assignment, unless an extension is requested by either
party and granted by the administrative law judge for good cause. The commissioner shall
issue a notice of hearing by certified mail or personal service at least ten business days
before the hearing. Certified mail to the last known address is sufficient. The scope of the
hearing shall be limited solely to the issue of whether the temporary suspension or issuance
of a conditional license should remain in effect and whether there is sufficient evidence to
conclude that the licensee's actions or failure to comply with applicable laws are level 3 or
4 violations as defined in section 144A.474, subdivision 11, paragraph (b), or that there
were violations that posed an imminent risk of harm to the health and safety of persons in
the provider's care.

(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten business days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The record
shall close at the end of the ten-day period for submission of exceptions. The commissioner's
final order shall be issued within ten business days from the close of the record. When an
appeal of a temporary immediate suspension or conditional license is withdrawn or dismissed,
the commissioner shall issue a final order affirming the temporary immediate suspension
or conditional license within ten calendar days of the commissioner's receipt of the
withdrawal or dismissal. The license holder is prohibited from operation during the temporary
suspension period.

(c) When the final order under paragraph (b) affirms an immediate suspension, and a
final licensing sanction is issued under subdivisions 1 and 2 and the licensee appeals that
sanction, the licensee is prohibited from operation pending a final commissioner's order
after the contested case hearing conducted under chapter 14.

(d) A licensee whose license is temporarily suspended must comply with the requirements
for notification and transfer of clients in subdivision 5. These requirements remain if an
appeal is requested.

Sec. 14.

Minnesota Statutes 2018, section 144A.475, subdivision 5, is amended to read:


Subd. 5.

Plan required.

(a) The process of suspending deleted text begin ordeleted text end new text begin ,new text end revokingnew text begin , or refusing to renewnew text end
a license must include a plan for transferring affected deleted text begin clientsdeleted text end new text begin clients' carenew text end to other providers
by the home care provider, which will be monitored by the commissioner. Within three
deleted text begin businessdeleted text end new text begin calendarnew text end days of being notified of the deleted text begin finaldeleted text end revocationnew text begin , refusal to renew,new text end or
suspension deleted text begin actiondeleted text end , the home care provider shall provide the commissioner, the lead agencies
as defined in section 256B.0911, new text begin county adult protection and case managers, new text end and the
ombudsman for long-term care with the following information:

(1) a list of all clients, including full names and all contact information on file;

(2) a list of each client's representative or emergency contact person, including full names
and all contact information on file;

(3) the location or current residence of each client;

(4) the payor sources for each client, including payor source identification numbers; and

(5) for each client, a copy of the client's service plan, and a list of the types of services
being provided.

(b) The revocationnew text begin , refusal to renew,new text end or suspension notification requirement is satisfied
by mailing the notice to the address in the license record. The home care provider shall
cooperate with the commissioner and the lead agenciesnew text begin , county adult protection and county
managers, and the ombudsman for long term carenew text end during the process of transferring care of
clients to qualified providers. Within three deleted text begin businessdeleted text end new text begin calendarnew text end days of being notified of the
final revocationnew text begin , refusal to renew,new text end or suspension action, the home care provider must notify
and disclose to each of the home care provider's clients, or the client's representative or
emergency contact persons, that the commissioner is taking action against the home care
provider's license by providing a copy of the revocationnew text begin , refusal to renew,new text end or suspension
notice issued by the commissioner.new text begin If the provider does not comply with the disclosure
requirements in this section, the commissioner, lead agencies, county adult protection and
county managers and ombudsman for long-term care shall notify the clients, client
representatives, or emergency contact persons, about the action being taken. The revocation,
refusal to renew, or suspension notice is public data except for any private data contained
therein.
new text end

new text begin (c) A home care provider subject to this subdivision may continue operating during the
period of time home care clients are being transferred to other providers.
 new text end

Sec. 15.

Minnesota Statutes 2018, section 144A.476, subdivision 1, is amended to read:


Subdivision 1.

Prior criminal convictions; owner and managerial officials.

(a) Before
the commissioner issues a temporary licensenew text begin , issues a license as a result of an approved
change in ownership,new text end or renews a license, an owner or managerial official is required to
complete a background study under section 144.057. No person may be involved in the
management, operation, or control of a home care provider if the person has been disqualified
under chapter 245C. If an individual is disqualified under section 144.057 or chapter 245C,
the individual may request reconsideration of the disqualification. If the individual requests
reconsideration and the commissioner sets aside or rescinds the disqualification, the individual
is eligible to be involved in the management, operation, or control of the provider. If an
individual has a disqualification under section 245C.15, subdivision 1, and the disqualification
is affirmed, the individual's disqualification is barred from a set aside, and the individual
must not be involved in the management, operation, or control of the provider.

(b) For purposes of this section, owners of a home care provider subject to the background
check requirement are those individuals whose ownership interest provides sufficient
authority or control to affect or change decisions related to the operation of the home care
provider. An owner includes a sole proprietor, a general partner, or any other individual
whose individual ownership interest can affect the management and direction of the policies
of the home care provider.

(c) For the purposes of this section, managerial officials subject to the background check
requirement are individuals who provide direct contact as defined in section 245C.02,
subdivision 11, or individuals who have the responsibility for the ongoing management or
direction of the policies, services, or employees of the home care provider. Data collected
under this subdivision shall be classified as private data on individuals under section 13.02,
subdivision 12.

(d) The department shall not issue any license if the applicant or owner or managerial
official has been unsuccessful in having a background study disqualification set aside under
section 144.057 and chapter 245C; if the owner or managerial official, as an owner or
managerial official of another home care provider, was substantially responsible for the
other home care provider's failure to substantially comply with sections 144A.43 to
144A.482; or if an owner that has ceased doing business, either individually or as an owner
of a home care provider, was issued a correction order for failing to assist clients in violation
of this chapter.

new text begin (e) Effective July 1, 2021, this section applies to controlling persons as defined in section
144I.01.
 new text end

Sec. 16.

Minnesota Statutes 2018, section 144A.4791, subdivision 10, is amended to read:


Subd. 10.

Termination of service plan.

(a) If a home care provider terminates a service
plan with a client, and the client continues to need home care services, the home care provider
shall provide the client and the client's representative, if any, with a new text begin 30-day new text end written notice
of termination which includes the following information:

(1) the effective date of termination;

(2) the reason for termination;

(3) a list of known licensed home care providers in the client's immediate geographic
area;

(4) a statement that the home care provider will participate in a coordinated transfer of
care of the client to another home care provider, health care provider, or caregiver, as
required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);

(5) the name and contact information of a person employed by the home care provider
with whom the client may discuss the notice of termination; and

(6) if applicable, a statement that the notice of termination of home care services does
not constitute notice of termination of the housing with services contract with a housing
with services establishment.

(b) When the home care provider voluntarily discontinues services to all clients, the
home care provider must notify the commissioner, lead agencies, and ombudsman for
long-term care about its clients and comply with the requirements in this subdivision.

Sec. 17.

Minnesota Statutes 2018, section 144A.4799, is amended to read:


144A.4799 DEPARTMENT OF HEALTH LICENSED HOME CARE new text begin AND
ASSISTED LIVING new text end PROVIDER ADVISORY COUNCIL.

Subdivision 1.

Membership.

The commissioner of health shall appoint eight persons
to a home care and assisted living program advisory council consisting of the following:

(1) three public members as defined in section 214.02 who shall be deleted text begin eitherdeleted text end persons who
are currently receiving home care services deleted text begin ordeleted text end new text begin , persons who have received home care within
five years of the application date, persons whonew text end have family members receiving home care
services, or persons who have family members who have received home care services within
five years of the application date;

(2) three Minnesota home care licensees representing basic and comprehensive levels
of licensure who may be a managerial official, an administrator, a supervising registered
nurse, or an unlicensed personnel performing home care tasks;

(3) one member representing the Minnesota Board of Nursing; deleted text begin and
deleted text end

(4) one member representing the new text begin office of new text end ombudsman for long-term caredeleted text begin .deleted text end new text begin ;
new text end

new text begin (5) beginning July 1, 2021, three members representing providers who are eligible to
be assisted living licensees pursuant to chapter 144I; and
 new text end

new text begin (6) beginning July 1, 2021, a member of a county health and human services or county
adult protection office.
 new text end

Subd. 2.

Organizations and meetings.

The advisory council shall be organized and
administered under section 15.059 with per diems and costs paid within the limits of available
appropriations. Meetings will be held quarterly and hosted by the department. Subcommittees
may be developed as necessary by the commissioner. Advisory council meetings are subject
to the Open Meeting Law under chapter 13D.

Subd. 3.

Duties.

(a) At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed home care providers in this
chapter, including advice on the following:

(1) community standards for home care practicesnew text begin and assisted living settingsnew text end ;

(2) enforcement of licensing standards and whether certain disciplinary actions are
appropriate;

(3) ways of distributing information to licensees and consumers of home care;

(4) training standards;

(5) identifying emerging issues and opportunities in deleted text begin thedeleted text end home care deleted text begin field, includingdeleted text end new text begin and
assisted living;
new text end

new text begin (6)new text end new text begin identifyingnew text end the use of technology in home and telehealth capabilities;

deleted text begin (6)deleted text end new text begin (7)new text end allowable home care licensing modifications and exemptions, including a method
for an integrated license with an existing license for rural licensed nursing homes to provide
limited home care services in an adjacent independent living apartment building owned by
the licensed nursing home; deleted text begin and
deleted text end

deleted text begin (7)deleted text end new text begin (8)new text end recommendations for studies using the data in section 62U.04, subdivision 4,
including but not limited to studies concerning costs related to dementia and chronic disease
among an elderly population over 60 and additional long-term care costs, as described in
section 62U.10, subdivision 6deleted text begin .deleted text end new text begin ; and
new text end

new text begin (9) the single unified assisted living resident bill of rights to be used by July 1, 2021,
for all new assisted living licensees and by assisted living licensees for the benefit of the
assisted living residents.
 new text end

(b) The advisory council shall perform other duties as directed by the commissioner.

(c) The advisory council shall annually deleted text begin review the balance of the account in the state
government special revenue fund described in section 144A.474, subdivision 11, paragraph
(i), anddeleted text end make deleted text begin annualdeleted text end recommendationsdeleted text begin by January 15 directly to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services regarding appropriationsdeleted text end to the commissioner for the purposes in section 144A.474,
subdivision 11, paragraph (i).new text begin The recommendations shall address ways the commissioner
may improve protection of the public under existing statutes and laws and include but are
not limited to projects that create and administer training of licensees and their employees
to improve residents lives, supporting ways that licensees can improve and enhance quality
care, ways to provide technical assistance to licensees to improve compliance; information
technology and data projects that analyze and communicate information about trends of
violations or lead to ways of improving resident care; communications strategies to licensees
and the public; and other projects or pilots that benefit residents, families, and the public.
new text end

Sec. 18. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, section 144A.472, subdivision 4, new text end new text begin is repealed.
 new text end

ARTICLE 19

HUMAN SERVICES FORECAST ADJUSTMENTS

Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
new text end

new text begin The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2017, First Special
Session chapter 6, article 18, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2019" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2019.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2019
 new text end

Sec. 2. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin (318,423,000)
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2019
 new text end
new text begin General
 new text end 		new text begin (317,538,000)
 new text end
new text begin Health Care Access
 new text end 		new text begin 8,410,000
 new text end
new text begin Federal TANF
 new text end 		new text begin (9,295,000)
 new text end

new text begin Subd. 2. new text end

new text begin Forecasted Programs
 new text end

new text begin (a) Minnesota Family
Investment Program
(MFIP)/Diversionary Work
Program (DWP)
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin (19,361,000)
 new text end
new text begin Federal TANF
 new text end 		new text begin (8,893,000)
 new text end
new text begin (b) MFIP Child Care Assistance
 new text end 		new text begin (16,789,000)
 new text end
new text begin (c) General Assistance
 new text end 		new text begin (7,928,000)
 new text end
new text begin (d) Minnesota Supplemental Aid
 new text end 		new text begin (549,000)
 new text end
new text begin (e) Housing Support
 new text end 		new text begin (13,836,000)
 new text end
new text begin (f) Northstar Care for Children
 new text end 		new text begin (19,027,000)
 new text end
new text begin (g) MinnesotaCare
 new text end 		new text begin 8,410,000
 new text end

new text begin This appropriation is from the health care
access fund.
 new text end

new text begin (h) Medical Assistance
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin (222,176,000)
 new text end
new text begin Health Care Access
 new text end 		new text begin -0-
 new text end
new text begin (i) Alternative Care
 new text end 		new text begin -0-
 new text end
new text begin (j) Consolidated Chemical Dependency
Treatment Fund (CCDTF) Entitlement
 new text end 		new text begin (17,872,000)
 new text end

new text begin Subd. 3. new text end

new text begin Technical Activities
 new text end

new text begin (402,000)
 new text end

new text begin This appropriation is from the federal TANF
fund.
 new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following final enactment.
 new text end

ARTICLE 20

APPROPRIATIONS

Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
new text end

new text begin The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2020" and "2021" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2020, or June 30, 2021, respectively.
"The first year" is fiscal year 2020. "The second year" is fiscal year 2021. "The biennium"
is fiscal years 2020 and 2021.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2020
 new text end 		new text begin 2021
 new text end

Sec. 2. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 8,258,513,000
 new text end 		new text begin $
 new text end 		new text begin 8,377,920,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2020
 new text end 		new text begin 2021
 new text end
new text begin General
 new text end 		new text begin 7,442,146,000
 new text end 		new text begin 7,531,758,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 5,575,000
 new text end 		new text begin 5,566,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 527,628,000
 new text end 		new text begin 551,705,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 274,650,000
 new text end 		new text begin 276,245,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 1,896,000
 new text end 		new text begin 1,896,000
 new text end
new text begin Opioid Stewardship
 new text end 		new text begin 6,618,000
 new text end 		new text begin 10,750,000
 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin TANF Maintenance of Effort
 new text end

new text begin (a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
 new text end

new text begin (1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
 new text end

new text begin (2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
 new text end

new text begin (3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
 new text end

new text begin (4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
 new text end

new text begin (5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
 new text end

new text begin (6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
 new text end

new text begin (7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
 new text end

new text begin (8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
 new text end

new text begin (b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
 new text end

new text begin (c) Certain Expenditures Required. The
commissioner shall ensure that the MOE used
by the commissioner of management and
budget for the February and November
forecasts required under Minnesota Statutes,
section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 16
percent of the total required under Code of
Federal Regulations, title 45, section 263.1.
 new text end

new text begin (d) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
 new text end

new text begin (1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
 new text end

new text begin (2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
 new text end

new text begin (3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).
 new text end

new text begin (e) Supplemental Expenditures. For the
purposes of paragraph (d), the commissioner
may supplement the MOE claim with working
family credit expenditures or other qualified
expenditures to the extent such expenditures
are otherwise available after considering the
expenditures allowed in this subdivision.
 new text end

new text begin (f) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
 new text end

new text begin (g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
 new text end

new text begin (h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
 new text end

new text begin (i) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2020 and 2021 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
 new text end

new text begin Subd. 3. new text end

new text begin Working Family Credit as TANF/MOE.
 new text end

new text begin The commissioner may claim as TANF/MOE
up to $6,707,000 per year of working family
credit expenditures in each fiscal year.
 new text end

new text begin Subd. 4. new text end

new text begin Central Office; Operations
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 153,377,000
 new text end 		new text begin 151,082,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 5,450,000
 new text end 		new text begin 5,441,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 20,709,000
 new text end 		new text begin 22,459,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 100,000
 new text end 		new text begin 100,000
 new text end

new text begin (a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
 new text end

new text begin (1) Minnesota Statutes, section 125A.744,
subdivision 3;
 new text end

new text begin (2) Minnesota Statutes, section 245.495,
paragraph (b);
 new text end

new text begin (3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
 new text end

new text begin (4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
 new text end

new text begin (5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
 new text end

new text begin (6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $143,583,000 in fiscal year 2022 and
$146,013,000 in fiscal year 2023. The health
care access fund base is $20,709,000 in fiscal
year 2023. The state government special
revenue fund base is $5,442,000 in fiscal year
2023.
 new text end

new text begin Subd. 5. new text end

new text begin Central Office; Children and Families
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 13,353,000
 new text end 		new text begin 14,204,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 2,582,000
 new text end 		new text begin 2,582,000
 new text end

new text begin (a) Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 each
year in fiscal year 2020 and fiscal year 2021
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $14,440,000 in fiscal year 2022 and
$14,693,000 in fiscal year 2023.
 new text end

new text begin Subd. 6. new text end

new text begin Central Office; Health Care
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 22,612,000
 new text end 		new text begin 23,633,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 25,358,000
 new text end 		new text begin 25,056,000
 new text end

new text begin (a) Nonemergency Medical Transportation
Program Audits. $557,000 in fiscal year 2020
and $1,119,000 in fiscal year 2021 are from
the general fund to conduct audits of the
nonemergency medical transportation
program.
 new text end

new text begin (b) new text begin Base Level Adjustment.new text end The general fund
base is $26,780,000 in fiscal year 2022 and
$29,180,000 in fiscal year 2023. The health
care access fund base is $26,340,000 in fiscal
year 2022 and $27,088,000 in fiscal year 2023.
 new text end

new text begin Subd. 7. new text end

new text begin Central Office; Continuing Care for
Older Adults
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 20,330,000
 new text end 		new text begin 17,991,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 125,000
 new text end 		new text begin 125,000
 new text end

new text begin new text begin Base Level Adjustment.new text end The general fund
base is $20,486,000 in fiscal year 2022 and
$18,006,000 in fiscal year 2023.
 new text end

new text begin Subd. 8. new text end

new text begin Central Office; Community Supports
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 35,081,000
 new text end 		new text begin 34,979,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 163,000
 new text end 		new text begin 163,000
 new text end
new text begin Opioid Stewardship
 new text end 		new text begin 218,000
 new text end 		new text begin 350,000
 new text end

new text begin (a) Assisted Living Survey. Beginning in
fiscal year 2020, $2,500,000 is appropriated
in the even numbered year of each biennium
to fund a resident experience survey and
family survey for all housing with services
sites. This paragraph does not expire.
 new text end

new text begin (b) Information and Assistance Grant
Transfer. $1,000,000 in fiscal year 2020 and
$1,000,000 in fiscal year 2021 are transferred
to the Continuing Care for Older Adults
administration from the Aging and Adult
Services grants for developing the Home and
Community Based Report Card for assisted
living. This transfer is ongoing.
 new text end

new text begin (c) Certified Community Behavioral Health
Center (CCBHC) Expansion. $310,000 in
fiscal year 2020 and $285,000 in fiscal year
2021 are from the general fund to support
CCBHC expansion.
 new text end

new text begin (d) new text begin Base Level Adjustment. new text end The general fund
base is $34,434,000 in fiscal year 2022 and
$34,134,000 in fiscal year 2023. The opioid
stewardship fund base is $336,000 in fiscal
year 2022 and $336,000 in fiscal year 2023.
 new text end

new text begin Subd. 9. new text end

new text begin Forecasted Programs; MFIP/DWP
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 93,888,000
 new text end 		new text begin 112,508,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 78,135,000
 new text end 		new text begin 79,404,000
 new text end

new text begin MFIP Rate Increase. Effective February 1,
2020, the amount of the MFIP cash assistance
portion of the transitional standard is increased
$100 per month per household. This increase
shall be reflected in the MFIP cash assistance
portion of the transitional standard published
annually by the Department of Human
Services. This paragraph does not expire.
 new text end

new text begin Subd. 10. new text end

new text begin Forecasted Programs; MFIP Child
Care Assistance
 new text end

new text begin 109,270,000
 new text end 		new text begin 123,202,000
 new text end

new text begin Subd. 11. new text end

new text begin Forecasted Programs; General
Assistance
 new text end

new text begin 50,563,000
 new text end 		new text begin 51,200,000
 new text end

new text begin (a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
 new text end

new text begin (b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2020 and $6,729,812
in fiscal year 2021. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
 new text end

new text begin Subd. 12. new text end

new text begin Forecasted Programs; Minnesota
Supplemental Aid
 new text end

new text begin 41,834,000
 new text end 		new text begin 45,866,000
 new text end

new text begin Subd. 13. new text end

new text begin Forecasted Programs; Housing
Support
 new text end

new text begin 169,757,000
 new text end 		new text begin 173,586,000
 new text end

new text begin Subd. 14. new text end

new text begin Forecasted Programs; Northstar Care
for Children
 new text end

new text begin 86,921,000
 new text end 		new text begin 94,528,000
 new text end

new text begin Subd. 15. new text end

new text begin Forecasted Programs; MinnesotaCare
 new text end

new text begin 26,772,000
 new text end 		new text begin 29,526,000
 new text end

new text begin (a) Generally. This appropriation is from the
health care access fund.
 new text end

new text begin (b) OneCare Buy-In Option. The fiscal year
2023 base for MinnesotaCare is increased by
$112,000,000 to serve as a reserve for the
Department of Human Services to
operationalize the OneCare Buy-In Option
under Minnesota Statutes, chapter 256T. This
is a onetime increase.
 new text end

new text begin Subd. 16. new text end

new text begin Forecasted Programs; Medical
Assistance
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 5,664,289,000
 new text end 		new text begin 5,682,365,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 450,574,000
 new text end 		new text begin 470,449,000
 new text end

new text begin Behavioral Health Services. $1,000,000 in
fiscal year 2020 and $1,000,000 in fiscal year
2021 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
 new text end

new text begin Subd. 17. new text end

new text begin Forecasted Programs; Alternative
Care
 new text end

new text begin 45,243,000
 new text end 		new text begin 45,245,000
 new text end

new text begin new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
 new text end

new text begin Subd. 18. new text end

new text begin Forecasted Programs; Chemical
Dependency Treatment Fund
 new text end

new text begin 156,941,000
 new text end 		new text begin 158,166,000
 new text end

new text begin Subd. 19. new text end

new text begin Grant Programs; Support Services
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 8,715,000
 new text end 		new text begin 8,715,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 96,213,000
 new text end 		new text begin 96,311,000
 new text end

new text begin Subd. 20. new text end

new text begin Grant Programs; Basic Sliding Fee
Child Care Assistance Grants
 new text end

new text begin 63,227,000
 new text end 		new text begin 74,847,000
 new text end

new text begin (a) Basic Sliding Fee Waiting List
Allocation. Notwithstanding Minnesota
Statutes, section 119B.03, $8,676,000 in fiscal
year 2020 and $17,701,000 in fiscal year 2021
are to reduce the basic sliding fee program
waiting list as follows:
 new text end

new text begin (1) the calendar year 2020 allocation shall be
increased to serve families on the waiting list.
To receive funds appropriated for this purpose,
a county must have a waiting list in the most
recent published waiting list month;
 new text end

new text begin (2) funds shall be distributed proportionately
based on the average of the most recent six
months of published waiting lists to counties
that meet the criteria in clause (1);
 new text end

new text begin (3) allocations in calendar years 2021 and
beyond shall be calculated using the allocation
formula in Minnesota Statutes, section
119B.03; and
 new text end

new text begin (4) the guaranteed floor for calendar year 2021
shall be based on the revised calendar year
2020 allocation.
 new text end

new text begin (b) new text begin Base Level Adjustment.new text end The general fund
base is $87,802,000 in fiscal year 2022 and
$95,282,000 in fiscal year 2023.
 new text end

new text begin Subd. 21. new text end

new text begin Grant Programs; Child Care
Development Grants
 new text end

new text begin 1,737,000
 new text end 		new text begin 1,737,000
 new text end

new text begin Subd. 22. new text end

new text begin Grant Programs; Child Support
Enforcement Grants
 new text end

new text begin 50,000
 new text end 		new text begin 50,000
 new text end

new text begin Subd. 23. new text end

new text begin Grant Programs; Children's Services
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 40,857,000
 new text end 		new text begin 45,345,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 140,000
 new text end 		new text begin 140,000
 new text end

new text begin (a) new text begin Title IV-E Adoption Assistance.new text end (1) The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
 new text end

new text begin (2) Additional federal reimbursement to the
state as a result of the Fostering Connections
to Success and Increasing Adoptions Act's
expanded eligibility for title IV-E adoption
assistance is for postadoption, foster care,
adoption, and kinship services, including a
parent-to-parent support network.
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $48,283,000 in fiscal year 2022 and
$47,998,000 in fiscal year 2023.
 new text end

new text begin Subd. 24. new text end

new text begin Grant Programs; Children and
Community Service Grants
 new text end

new text begin 59,201,000
 new text end 		new text begin 59,701,000
 new text end

new text begin (a) Adult Protection Grants. $1,000,000 in
fiscal year 2020 and $1,500,000 in fiscal year
2021 are for grant funding for adult abuse
maltreatment investigations and adult
protective services to counties and tribes as
allocated and specified under Minnesota
Statutes, section 256M.42.
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $60,251,000 in fiscal year 2022 and
$60,856,000 in fiscal year 2023.
 new text end

new text begin Subd. 25. new text end

new text begin Grant Programs; Children and
Economic Support Grants
 new text end

new text begin 22,065,000
 new text end 		new text begin 22,065,000
 new text end

new text begin Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2020 do not
cancel but are available for this purpose in
fiscal year 2021.
 new text end

new text begin Subd. 26. new text end

new text begin Grant Programs; Health Care Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 3,711,000
 new text end 		new text begin 3,711,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 3,465,000
 new text end 		new text begin 3,465,000
 new text end

new text begin Subd. 27. new text end

new text begin Grant Programs; Other Long-Term
Care Grants
 new text end

new text begin 1,925,000
 new text end 		new text begin 1,925,000
 new text end

new text begin Subd. 28. new text end

new text begin Grant Programs; Aging and Adult
Services Grants
 new text end

new text begin 31,811,000
 new text end 		new text begin 31,995,000
 new text end

new text begin Subd. 29. new text end

new text begin Grant Programs; Deaf and
Hard-of-Hearing Grants
 new text end

new text begin 2,886,000
 new text end 		new text begin 2,886,000
 new text end

new text begin Subd. 30. new text end

new text begin Grant Programs; Disabilities Grants
 new text end

new text begin 22,231,000
 new text end 		new text begin 22,944,000
 new text end

new text begin (a) Training of Direct Support Services
Providers. $375,000 in fiscal year 2020 and
$375,000 in fiscal year 2021 are for stipends
to pay for training of individual providers of
direct support services as defined in Minnesota
Statutes, section 256B.0711, subdivision 1.
This training is available to individual
providers who have completed designated
voluntary trainings made available through
the State Service Employees International
Union Healthcare Minnesota Committee. This
is a onetime appropriation. This appropriation
is available only if the labor agreement
between the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
 new text end

new text begin (b) Training for New Worker Orientation.
$125,000 in fiscal year 2020 and $125,000 in
fiscal year 2021 are for new worker orientation
training and is allocated to the Minnesota State
Service Employees International Union
Healthcare Minnesota Committee. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
 new text end

new text begin (c) Benefits Planning Grants. $600,000 in
fiscal year 2020 and $600,000 in fiscal year
2021 are to provide grant funding to the
Disability Hub for benefits planning to people
with disabilities.
 new text end

new text begin (d) Regional Support for Person-Centered
Practices Grants. $374,000 in fiscal year
2020 and $486,000 in fiscal year 2021 are to
extend and expand regional capacity for
person-centered planning. This grant funding
must be allocated to regional cohorts for
training, coaching, and mentoring for
person-centered and collaborative safety
practices benefiting people with disabilities,
and employees, organizations, and
communities serving people with disabilities.
 new text end

new text begin (e) Disability Hub for Families Grants.
$100,000 in fiscal year 2020 and $200,000 in
fiscal year 2021 are for grants to connect
families through innovation grants, life
planning tools, and website information as
they support a child or family member with
disabilities.
 new text end

new text begin (f) Electronic Visit Verification. $500,000
in fiscal year 2021 is for grants to providers
who use a different vendor than the contract
with the State of Minnesota for electronic visit
verification.
 new text end

new text begin (g) Base Level Adjustment. The general fund
base is $22,556,000 in fiscal year 2022 and
$22,168,000 in fiscal year 2023.
 new text end

new text begin Subd. 31. new text end

new text begin Grant Programs; Housing Support
Grants
 new text end

new text begin 10,264,000
 new text end 		new text begin 11,364,000
 new text end

new text begin Subd. 32. new text end

new text begin Grant Programs; Adult Mental Health
Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 78,708,000
 new text end 		new text begin 78,377,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 750,000
 new text end 		new text begin 750,000
 new text end
new text begin Opioid Stewardship
 new text end 		new text begin 6,400,000
 new text end 		new text begin 10,400,000
 new text end

new text begin (a) Certified Community Behavioral Health
Center (CCBHC) Expansion. $200,000 in
fiscal year 2021 is from the general fund for
grants for planning, staff training, and other
quality improvements that are required to
comply with federal CCBHC criteria for three
expansion sites.
 new text end

new text begin (b) Traditional Healing. $2,400,000 in fiscal
year 2020 and $2,400,000 in fiscal year 2021
are from the opioid stewardship fund
appropriation to provide grant funding to
Tribal Nations and five urban Indian
communities for traditional healing practices
to American Indians and increase the capacity
of culturally specific providers in the
behavioral health workforce.
 new text end

new text begin (c) Opioid Stewardship Fee Distribution to
Counties and Tribes. $4,000,000 in fiscal
year 2020 and $4,000,000 in fiscal year 2021
are from the opioid stewardship fund for
allocation to county and tribal social service
agencies by a formula determined by the
commissioner of human services in
consultation with counties and tribes.
 new text end

new text begin (d) Opioid Stewardship Fund Initiatives.
$4,000,000 in fiscal year 2021 is from the
opioid stewardship fund for initiatives related
to prevention, education, treatment, and
services that promote innovation and capacity
building to address the opioid addiction and
overdose epidemic.
 new text end

new text begin (e) Base Level Adjustment. The general fund
base is $78,277,000 in fiscal year 2022 and
$78,177,000 in fiscal year 2023.
 new text end

new text begin Subd. 33. new text end

new text begin Grant Programs; Child Mental Health
Grants
 new text end

new text begin 25,726,000
 new text end 		new text begin 25,726,000
 new text end

new text begin (a) Children's Intensive Services Reform.
$400,000 in fiscal year 2020 and $400,000 in
fiscal year 2021 are appropriated from the
general fund for start-up grants to prospective
psychiatric residential treatment facility sites
for administrative expenses, consulting
services, Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
compliance, therapeutic resources including
evidence-based, culturally appropriate
curriculums, and training programs for staff
and clients as well as allowable physical
renovations to the property.
 new text end

new text begin (b) Base Level Adjustment. The general fund
base is $26,226,000 in fiscal year 2022 and
$26,226,000 in fiscal year 2023.
 new text end

new text begin Subd. 34. new text end

new text begin Grant Programs; Chemical
Dependency Treatment Support Grants
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 2,136,000
 new text end 		new text begin 2,136,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 1,733,000
 new text end 		new text begin 1,733,000
 new text end

new text begin Problem Gambling. $225,000 in fiscal year
2020 and $225,000 in fiscal year 2021 are
from the lottery prize fund for a grant to the
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services 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 related to problem gambling.
 new text end

new text begin Subd. 35. new text end

new text begin Direct Care and Treatment -
Generally
 new text end

new text begin (a) new text begin Transfer Authority. new text end Money appropriated
to budget activities under this subdivision and
subdivisions 36, 37, 38, and 39 may be
transferred between budget activities and
between years of the biennium with the
approval of the commissioner of management
and budget.
 new text end

new text begin (b) State Operated Services Account. Any
balance remaining in the state operated
services account at the end of fiscal year 2019
shall be transferred to the general fund.
 new text end

new text begin Subd. 36. new text end

new text begin Direct Care and Treatment - Mental
Health and Substance Abuse
 new text end

new text begin 129,186,000
 new text end 		new text begin 130,543,000
 new text end

new text begin (a) Transfer Authority. Money previously
appropriated to support the continued
operations of the Community Addiction
Enterprise (C.A.R.E.) program may be
transferred to the enterprise fund for C.A.R.E.
 new text end

new text begin (b) new text begin Base Level Adjustment. new text end The general fund
base is $130,539,000 in fiscal year 2022 and
$130,539,000 in fiscal year 2023.
 new text end

new text begin Subd. 37. new text end

new text begin Direct Care and Treatment -
Community-Based Services
 new text end

new text begin 16,630,000
 new text end 		new text begin 17,177,000
 new text end

new text begin (a) Transfer Authority. Money previously
appropriated to support the continued
operations of the Minnesota State Operated
Community Services (MSOCS) program may
be transferred to the enterprise fund for
MSOCS.
 new text end

new text begin (b) MSOCS Operating Adjustment.
$1,594,000 in fiscal year 2020 and $3,729,000
in fiscal year 2021 are from the general fund
for the Minnesota State Operated Community
Services program. The commissioner shall
transfer $1,594,000 in fiscal year 2020 and
$3,729,000 in fiscal year 2021 to the enterprise
fund for MSOCS.
 new text end

new text begin (c) Base Level Adjustment. The general fund
base is $17,176,000 in fiscal year 2022 and
$17,176,000 in fiscal year 2023.
 new text end

new text begin Subd. 38. new text end

new text begin Direct Care and Treatment - Forensic
Services
 new text end

new text begin 112,126,000
 new text end 		new text begin 115,342,000
 new text end

new text begin Base Level Adjustment. The general fund
base is $115,944,000 in fiscal year 2022 and
$115,944,000 in fiscal year 2023.
 new text end

new text begin Subd. 39. new text end

new text begin Direct Care and Treatment - Sex
Offender Program
 new text end

new text begin 97,243,000
 new text end 		new text begin 98,689,000
 new text end

new text begin (a) new text begin Transfer Authority. new text end Money appropriated
for the Minnesota sex offender program may
be transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
 new text end

new text begin (b) new text begin Base Level Adjustment.new text end The general fund
base is $99,234,000 in fiscal year 2022 and
$99,234,000 in fiscal year 2023.
 new text end

new text begin Subd. 40. new text end

new text begin Direct Care and Treatment -
Operations
 new text end

new text begin 48,252,000
 new text end 		new text begin 47,838,000
 new text end

new text begin Base Level Adjustment. The general fund
base is $47,837,000 in fiscal year 2022 and
$47,837,000 in fiscal year 2023.
 new text end

new text begin Subd. 41. new text end

new text begin Technical Activities
 new text end

new text begin 97,381,000
 new text end 		new text begin 97,708,000
 new text end

new text begin (a) Generally. This appropriation is from the
federal TANF fund.
 new text end

new text begin (b) Base Level Adjustment. The TANF fund
base is $97,760,000 in fiscal year 2022 and
$97,820,000 in fiscal year 2023.
 new text end

Sec. 3. new text begin COMMISSIONER OF HEALTH
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 253,084,000
 new text end 		new text begin $
 new text end 		new text begin 260,743,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2020
 new text end 		new text begin 2021
 new text end
new text begin General
 new text end 		new text begin 138,199,000
 new text end 		new text begin 141,258,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 59,662,000
 new text end 		new text begin 61,914,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 37,510,000
 new text end 		new text begin 36,607,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 11,713,000
 new text end 		new text begin 11,713,000
 new text end
new text begin Opioid Stewardship
Fund
 new text end 		new text begin 6,000,000
 new text end 		new text begin 9,251,000
 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin Health Improvement
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 98,345,000
 new text end 		new text begin 97,775,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 7,232,000
 new text end 		new text begin 7,162,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 37,510,000
 new text end 		new text begin 36,607,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 11,713,000
 new text end 		new text begin 11,713,000
 new text end

new text begin (a) TANF Appropriations. (1) $3,579,000
of the TANF fund each year is for home
visiting and nutritional services listed under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
 new text end

new text begin (2) $2,000,000 of the TANF fund each year
is for decreasing racial and ethnic disparities
in infant mortality rates under Minnesota
Statutes, section 145.928, subdivision 7;
 new text end

new text begin (3) $4,978,000 of the TANF fund each year
is for the family home visiting grant program
according to Minnesota Statutes, section
145A.17. $4,000,000 of the funding must be
distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1. $978,000 of the
funding must be distributed to tribal
governments according to Minnesota Statutes,
section 145A.14, subdivision 2a;
 new text end

new text begin (4) $1,156,000 of the TANF fund each year
is for family planning grants under Minnesota
Statutes, section 145.925; and
 new text end

new text begin (5) The commissioner may use up to 6.23
percent of the funds appropriated each year to
conduct the ongoing evaluations required
under Minnesota Statutes, section 145A.17,
subdivision 7, and training and technical
assistance as required under Minnesota
Statutes, section 145A.17, subdivisions 4 and
5.
 new text end

new text begin (b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
 new text end

new text begin (c) new text begin Opioid and Other Drug Abuse
Prevention.new text end $6,000,000 in fiscal year 2020
and $9,251,000 in fiscal year 2021 are
appropriated from the opioid stewardship fund
to the commissioner of health to support a
comprehensive, community-based opioid and
other drug abuse prevention program. The
commissioner may use up to 19 percent in
fiscal year 2020 and up to 14 percent in fiscal
year 2021 for administration. The remaining
funds are allocated as follows:
 new text end

new text begin (1) $1,000,000 each fiscal year is for grants
to regional emergency medical services and
law enforcement agencies and organizations
to purchase opioid antagonists, including
Narcan or Naloxone, and to train first
responders across Minnesota;
 new text end

new text begin (2) $1,000,000 in fiscal year 2020 and
$2,000,000 in fiscal year 2021 are for
community grants authorized in Minnesota
Statutes, section 145.9275, subdivision 1;
 new text end

new text begin (3) $2,000,000 in fiscal year 2020 and
$4,000,000 in fiscal year 2021 are for tribal
government grants in Minnesota Statutes,
section 145.9275, subdivision 2; and
 new text end

new text begin (4) $875,000 in fiscal year 2020 and
$1,000,000 in fiscal year 2021 are for
overdose fatality review grants across
Minnesota.
 new text end

new text begin (d) Comprehensive Suicide Prevention.
$3,929,000 each fiscal year from the general
fund appropriations is to support a
comprehensive, community-based suicide
prevention strategy. The funds are allocated
as follows:
 new text end

new text begin (1) $1,291,000 each fiscal year is for
community-based suicide prevention grants
authorized in Minnesota Statutes, section
145.56, subdivision 2. Specific emphasis must
be placed on those communities with the
greatest disparities;
 new text end

new text begin (2) $913,000 each fiscal year is to support
evidence-based training for educators and
school staff and purchase suicide prevention
curriculum for student use statewide, as
authorized in Minnesota Statutes, section
145.56, subdivision 2;
 new text end

new text begin (3) $205,000 each fiscal year is to implement
the Zero Suicide framework with up to 20
behavioral and health care organizations each
year to treat individuals at risk for suicide and
support those individuals across systems of
care upon discharge;
 new text end

new text begin (4) $1,322,000 each fiscal year is to develop
and fund a Minnesota-based network of
National Suicide Prevention Lifeline,
providing statewide coverage;
 new text end

new text begin (5) $198,000 each fiscal year is to conduct
suicide fatality reviews to identify the scope
of the suicide problem, identify high-risk
groups, set priority prevention activities, and
monitor the effects of suicide prevention
programs; and
 new text end

new text begin (6) the commissioner may retain up to 22.4
percent of the appropriation under this
subdivision to administer the comprehensive
suicide prevention strategy.
 new text end

new text begin (e) Statewide Tobacco Cessation. $1,663,000
in fiscal year 2020 and $2,878,000 in fiscal
year 2021 are from the general fund to the
commissioner of health for statewide tobacco
cessation services under Minnesota Statutes,
section 144.397.
 new text end

new text begin (f) Health Care Access Survey. $450,000 in
fiscal year 2020 is from the health care access
fund for the commissioner to continue and
improve the Minnesota Health Care Access
Survey. This appropriation is added to the
department's base budget for even-numbered
fiscal years.
 new text end

new text begin (g) Community Solutions for Healthy Child
Development Grant Program. $2,000,000
in fiscal year 2020 is for the community
solutions for healthy child development grant
program to promote health and racial equity
for young children and their families under
Minnesota Statutes, section 145.9285. The
commissioner may use up to 23.5 percent of
the total appropriation for administration. This
is a onetime appropriation and is available
until June 30, 2023.
 new text end

new text begin (h) Base Level Adjustments. The health care
access fund base is $37,657,000 in fiscal year
2022 and $36,607,000 in fiscal year 2023.
 new text end

new text begin Subd. 3. new text end

new text begin Health Protection
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 28,904,000
 new text end 		new text begin 32,421,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 52,430,000
 new text end 		new text begin 54,752,000
 new text end

new text begin (a) Vulnerable Adults Program
Improvements. $7,438,000 in fiscal year 2020
and $4,302,000 in fiscal year 2021 are from
the general fund for the commissioner to
continue necessary current operations
improvements to the regulatory activities,
systems, analysis, reporting, and
communications that contribute to the health,
safety, care quality, and abuse prevention for
vulnerable adults in Minnesota. $1,103,000 in
fiscal year 2020 and $1,103,000 in fiscal year
2021 are from the state government special
revenue fund to improve the frequency of
home care provider inspections. The state
government special revenue appropriations
under this paragraph are onetime
appropriations.
 new text end

new text begin (b) Vulnerable Adults Regulatory Reform.
$2,432,000 in fiscal year 2020 and $8,114,000
in fiscal year 2021 are from the general fund
for the commissioner to establish the assisted
living licensure under Minnesota Statutes,
section 144I.01. This is a onetime
appropriation. The commissioner shall transfer
fine revenue previously deposited to the state
government special revenue fund under
Minnesota Statutes, section 144A.474,
subdivision 11, which is estimated to be
$632,000, to a dedicated account in the state
treasury.
 new text end

new text begin (c) Laboratory Equipment. $840,000 in
fiscal year 2020 and $655,000 in fiscal year
2021 are from the general fund for the
commissioner to purchase equipment for the
public health laboratory. These appropriations
are onetime appropriations and available until
June 30, 2023.
 new text end

new text begin (d) Provider Network Adequacy Reviews.
$231,000 in fiscal year 2020 and $231,000 in
fiscal year 2021 are from the general fund for
health plan product reviews and licensing of
health maintenance organizations. The
$77,000 annual transfer from the state
government special revenue fund to the
general fund required by Laws 2008, chapter
364, section 17, paragraph (b), shall end in
fiscal year 2019.
 new text end

new text begin (e) Base Level Adjustment. The general fund
base is $25,150,000 in fiscal year 2022 and
$24,719,000 in fiscal year 2023. The state
government special revenue fund base is
$67,107,000 in fiscal year 2022 and
$67,067,000 in fiscal year 2023.
 new text end

new text begin Subd. 4. new text end

new text begin Health Operations
 new text end

new text begin 10,950,000
 new text end 		new text begin 11,062,000
 new text end

Sec. 4. new text begin HEALTH-RELATED BOARDS
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 26,498,000
 new text end 		new text begin $
 new text end 		new text begin 25,888,000
 new text end

new text begin This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin Board of Chiropractic Examiners
 new text end

new text begin 629,000
 new text end 		new text begin 641,000
 new text end

new text begin Subd. 3. new text end

new text begin Board of Dentistry
 new text end

new text begin 1,503,000
 new text end 		new text begin 1,450,000
 new text end

new text begin Subd. 4. new text end

new text begin Board of Dietetics and Nutrition
Practice
 new text end

new text begin 147,000
 new text end 		new text begin 149,000
 new text end

new text begin Subd. 5. new text end

new text begin Board of Marriage and Family Therapy
 new text end

new text begin 384,000
 new text end 		new text begin 389,000
 new text end

new text begin Base Level Adjustment. The base is $384,000
in fiscal year 2022 and $384,000 in fiscal year
2023.
 new text end

new text begin Subd. 6. new text end

new text begin Board of Medical Practice
 new text end

new text begin 6,013,000
 new text end 		new text begin 5,996,000
 new text end

new text begin (a) Health Professional Services Program.
This appropriation includes $1,023,000 in
fiscal year 2020 and $1,002,000 in fiscal year
2021 for the health professional services
program.
 new text end

new text begin (b) Base Level Adjustment. The base is
$5,912,000 in fiscal year 2022 and $5,868,000
in fiscal year 2023.
 new text end

new text begin Subd. 7. new text end

new text begin Board of Nursing
 new text end

new text begin 4,993,000
 new text end 		new text begin 4,993,000
 new text end

new text begin Subd. 8. new text end

new text begin Board of Nursing Home Administrators
 new text end

new text begin 3,733,000
 new text end 		new text begin 3,201,000
 new text end

new text begin (a) Administrative Services Unit - Operating
Costs. Of this appropriation, $3,445,000 in
fiscal year 2020 and $2,910,000 in fiscal year
2021 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
 new text end

new text begin (b) Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2020
and $150,000 in fiscal year 2021 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
 new text end

new text begin (c) Administrative Services Unit -
Retirement Costs. Of this appropriation,
$558,000 in fiscal year 2020 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.
 new text end

new text begin (d) Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2020
and $200,000 in fiscal year 2021 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
 new text end

new text begin Subd. 9. new text end

new text begin Board of Optometry
 new text end

new text begin 200,000
 new text end 		new text begin 201,000
 new text end

new text begin Subd. 10. new text end

new text begin Board of Pharmacy
 new text end

new text begin 3,599,000
 new text end 		new text begin 3,629,000
 new text end

new text begin $1,643,000 in fiscal year 2020 and $1,285,000
in fiscal year 2021 are from the opioid
stewardship fund.
 new text end

new text begin Subd. 11. new text end

new text begin Board of Physical Therapy
 new text end

new text begin 547,000
 new text end 		new text begin 549,000
 new text end

new text begin Subd. 12. new text end

new text begin Board of Podiatric Medicine
 new text end

new text begin 199,000
 new text end 		new text begin 199,000
 new text end

new text begin Subd. 13. new text end

new text begin Board of Psychology
 new text end

new text begin 1,357,000
 new text end 		new text begin 1,395,000
 new text end

new text begin Base Level Adjustment. The base is
$1,355,000 in fiscal year 2022 and $1,355,000
in fiscal year 2023.
 new text end

new text begin Subd. 14. new text end

new text begin Board of Social Work
 new text end

new text begin 1,437,000
 new text end 		new text begin 1,404,000
 new text end

new text begin Subd. 15. new text end

new text begin Board of Veterinary Medicine
 new text end

new text begin 345,000
 new text end 		new text begin 353,000
 new text end

new text begin Subd. 16. new text end

new text begin Board of Behavioral Health and
Therapy
 new text end

new text begin 937,000
 new text end 		new text begin 858,000
 new text end

new text begin new text begin Base Level Adjustment.new text end The base is $833,000
in fiscal year 2022 and $833,000 in fiscal year
2023.
 new text end

new text begin Subd. 17. new text end

new text begin Board of Occupational Therapy
Practice
 new text end

new text begin 450,000
 new text end 		new text begin 456,000
 new text end

Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
REGULATORY BOARD
new text end

new text begin $
 new text end 		new text begin 3,747,000
 new text end 		new text begin $
 new text end 		new text begin 3,809,000
 new text end

new text begin (a) Cooper/Sams Volunteer Ambulance
Program. $950,000 in fiscal year 2020 and
$950,000 in fiscal year 2021 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
 new text end

new text begin (1) Of this amount, $861,000 in fiscal year
2020 and $861,000 in fiscal year 2021 are for
the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40.
 new text end

new text begin (2) Of this amount, $89,000 in fiscal year 2020
and $89,000 in fiscal year 2021 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
 new text end

new text begin (b) EMSRB Operations. $1,851,000 in fiscal
year 2020 and $1,913,000 in fiscal year 2021
are for board operations. The base for this
program is $1,880,000 in fiscal year 2022 and
$1,880,000 in fiscal year 2023.
 new text end

new text begin (c) Regional Grants. $585,000 in fiscal year
2020 and $585,000 in fiscal year 2021 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.
 new text end

new text begin (d) Ambulance Training Grant. $585,000
in fiscal year 2020 and $585,000 in fiscal year
2021 are for training grants under Minnesota
Statutes, section 144E.35.
 new text end

new text begin (e) Base Level Adjustment. The base is
$3,776,000 in fiscal year 2022 and $3,776,000
in fiscal year 2023.
 new text end

Sec. 6. new text begin COUNCIL ON DISABILITY
new text end

new text begin $
 new text end 		new text begin 1,014,000
 new text end 		new text begin $
 new text end 		new text begin 1,006,000
 new text end

Sec. 7. new text begin OMBUDSMAN FOR MENTAL
HEALTH AND DEVELOPMENTAL
DISABILITIES
new text end

new text begin $
 new text end 		new text begin 2,438,000
 new text end 		new text begin $
 new text end 		new text begin 2,438,000
 new text end

new text begin Department of Psychiatry Monitoring.
$100,000 in fiscal year 2020 and $100,000 in
fiscal year 2021 are for monitoring the
Department of Psychiatry at the University of
Minnesota.
 new text end

Sec. 8. new text begin OMBUDSPERSONS FOR FAMILIES
new text end

new text begin $
 new text end 		new text begin 714,000
 new text end 		new text begin $
 new text end 		new text begin 723,000
 new text end

Sec. 9.

Laws 2017, First Special Session chapter 6, article 18, section 2, subdivision 1, is
amended to read:


Subdivision 1.

Total Appropriation

 $
 		7,548,395,000
 		$
 		deleted text begin 7,654,331,000
 deleted text end new text begin 7,654,596,000
 new text end
Appropriations by Fund
2018
 2019
General
 6,819,523,000
 deleted text begin 6,880,153,000
 deleted text end new text begin 6,880,418,000
 new text end
State Government
Special Revenue
 4,274,000
 4,274,000
Health Care Access
 446,453,000
 501,104,000
Federal TANF
 276,249,000
 266,904,000
Lottery Prize
 1,896,000
 1,896,000

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019.
 new text end

Sec. 10.

Laws 2017, First Special Session chapter 6, article 18, section 2, subdivision 3,
is amended to read:


Subd. 3.

Central Office; Operations
Appropriations by Fund
General
 136,778,000
 deleted text begin 121,009,000
 deleted text end new text begin 121,024,000
 new text end
State Government
Special Revenue
 4,149,000
 4,149,000
Health Care Access
 21,019,000
 21,019,000
Federal TANF
 100,000
 100,000

(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:

(1) Minnesota Statutes, section 125A.744,
subdivision 3;

(2) Minnesota Statutes, section 245.495,
paragraph (b);

(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);

(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);

(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and

(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).

(b) Transfer to Office of Legislative
Auditor. $600,000 in fiscal year 2018 and
$600,000 in fiscal year 2019 are for transfer
to the Office of the Legislative Auditor for
audit activities under Minnesota Statutes,
section 3.972, subdivision 2b.

(c) Base Level Adjustment. The general fund
base is $133,378,000 in fiscal year 2020 and
$133,418,000 in fiscal year 2021.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019.
 new text end

Sec. 11.

Laws 2017, First Special Session chapter 6, article 18, section 2, subdivision 5,
is amended to read:


Subd. 5.

Central Office; Health Care
Appropriations by Fund
General
 20,719,000
 deleted text begin 21,249,000
 deleted text end new text begin 21,336,000
 new text end
Health Care Access
 23,697,000
 23,804,000

(a) Integrated Health Partnership Health
Information Exchange. $125,000 in fiscal
year 2018 and $250,000 in fiscal year 2019
are from the general fund to contract with
state-certified health information exchange
vendors to support providers participating in
an integrated health partnership under
Minnesota Statutes, section 256B.0755, to
connect enrollees with community supports
and social services and improve collaboration
among participating and authorized providers.

(b) Transfer to Legislative Auditor. 153,000
in fiscal year 2018 and $153,000 in fiscal year
2019 are from the general fund for transfer to
the Office of the Legislative Auditor for the
auditor to establish and maintain a team of
auditors with the training and experience
necessary to fulfill the requirements in
Minnesota Statutes, section 3.972, subdivision
2a.

(c) Base Level Adjustment. The general fund
base is $21,257,000 in fiscal year 2020 and
$21,302,000 in fiscal year 2021.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019.
 new text end

Sec. 12.

Laws 2017, First Special Session chapter 6, article 18, section 2, subdivision 15,
is amended to read:


Subd. 15.

Forecasted Programs; Medical
Assistance
Appropriations by Fund
General
 5,174,139,000
 deleted text begin 5,172,292,000
deleted text end new text begin 5,172,455,000
new text end
Health Care Access
 385,159,000
 438,848,000

(a) Behavioral Health Services. $1,000,000
in fiscal year 2018 and $1,000,000 in fiscal
year 2019 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).

(b) Self-Directed Workforce Collective
Bargaining Agreement. (1) This
appropriation includes money to implement a
collective bargaining agreement between the
state and the Service Employees International
Union Healthcare Minnesota (SEIU). This
appropriation is not available until the
collective bargaining agreement between the
state of Minnesota and the Service Employees
International Union Healthcare Minnesota
under Minnesota Statutes, section 179A.54,
is approved as provided in clause (3).

(2) The commissioner of management and
budget is authorized to negotiate and enter
into a collective bargaining agreement with
SEIU under Minnesota Statutes, section
179A.54, subject to clause (1), and subdivision
7, paragraph (f). The economic terms of the
collective bargaining agreement may include
wage floor increases for direct support
workers, paid time off, holiday pay, wage
increases for workers serving people with
complex needs, training stipends, and training
for direct support workers and for
implementation of the registry as outlined in
the collective bargaining agreement.

(3) Notwithstanding Minnesota Statutes,
sections 3.855, 179A.22, subdivision 4, and
179A.54, subdivision 5, upon approval of a
negotiated collective bargaining agreement by
the SEIU and the commissioner of
management and budget, the commissioner
of human services is authorized to implement
the negotiated collective bargaining
agreement.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective April 1, 2019.
 new text end

Sec. 13. new text begin TRANSFER; OPIOID STEWARDSHIP FUND.
new text end

new text begin In fiscal year 2020, the commissioner of management and budget shall transfer
$13,000,000 from the health care access fund to the opioid stewardship fund. This is a
onetime transfer.
 new text end

Sec. 14. new text begin TRANSFERS; HUMAN SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Grants. new text end

new text begin The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2021, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid program, group residential housing
program, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health and Human Services Finance Committee quarterly
about transfers made under this subdivision.
 new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin Positions, salary money, and nonsalary administrative money
may be transferred within the Departments of Health and Human Services as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioner shall inform the chairs and ranking minority
members of the senate Health and Human Services Finance Division and the house of
representatives Health and Human Services Finance Committee quarterly about transfers
made under this subdivision.
 new text end

Sec. 15. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end

new text begin The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
 new text end

Sec. 16. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2021, unless a
different expiration date is explicit.
 new text end

Sec. 17. new text begin EFFECTIVE DATE.
new text end

new text begin This article is effective July 1, 2019, unless a different effective date is specified.
 new text end

APPENDIX

Repealed Minnesota Statutes: 19-0023

119B.16 FAIR HEARING PROCESS.

Subd. 2.

Informal conference.

The county agency shall offer an informal conference to applicants and recipients adversely affected by an agency action to attempt to resolve the dispute. The county agency shall offer an informal conference to providers to whom the county agency has assigned responsibility for an overpayment in an attempt to resolve the dispute. The county agency or the provider may ask the family in whose case the overpayment arose to participate in the informal conference, but the family may refuse to do so. The county agency shall advise adversely affected applicants, recipients, and providers that a request for a conference with the agency is optional and does not delay or replace the right to a fair hearing.

144A.071 MORATORIUM ON CERTIFICATION OF NURSING HOME BEDS.

Subd. 4d.

Consolidation of nursing facilities.

(a) The commissioner of health, in consultation with the commissioner of human services, may approve a request for consolidation of nursing facilities which includes the closure of one or more facilities and the upgrading of the physical plant of the remaining nursing facility or facilities, the costs of which exceed the threshold project limit under subdivision 2, clause (a). The commissioners shall consider the criteria in this section, section 144A.073, and section 256R.40, in approving or rejecting a consolidation proposal. In the event the commissioners approve the request, the commissioner of human services shall calculate an external fixed costs rate adjustment according to clauses (1) to (3):

(1) the closure of beds shall not be eligible for a planned closure rate adjustment under section 256R.40, subdivision 5;

(2) the construction project permitted in this clause shall not be eligible for a threshold project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception adjustment under section 144A.073; and

(3) the payment rate for external fixed costs for a remaining facility or facilities shall be increased by an amount equal to 65 percent of the projected net cost savings to the state calculated in paragraph (b), divided by the state's medical assistance percentage of medical assistance dollars, and then divided by estimated medical assistance resident days, as determined in paragraph (c), of the remaining nursing facility or facilities in the request in this paragraph. The rate adjustment is effective on the first day of the month of January or July, whichever date occurs first following both the completion of the construction upgrades in the consolidation plan and the complete closure of the facility or facilities designated for closure in the consolidation plan. If more than one facility is receiving upgrades in the consolidation plan, each facility's date of construction completion must be evaluated separately.

(b) For purposes of calculating the net cost savings to the state, the commissioner shall consider clauses (1) to (7):

(1) the annual savings from estimated medical assistance payments from the net number of beds closed taking into consideration only beds that are in active service on the date of the request and that have been in active service for at least three years;

(2) the estimated annual cost of increased case load of individuals receiving services under the elderly waiver;

(3) the estimated annual cost of elderly waiver recipients receiving support under housing support under chapter 256I;

(4) the estimated annual cost of increased case load of individuals receiving services under the alternative care program;

(5) the annual loss of license surcharge payments on closed beds;

(6) the savings from not paying planned closure rate adjustments that the facilities would otherwise be eligible for under section 256R.40; and

(7) the savings from not paying external fixed costs payment rate adjustments from submission of renovation costs that would otherwise be eligible as threshold projects under section 256B.434, subdivision 4f.

(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical assistance resident days of the remaining facility or facilities shall be computed assuming 95 percent occupancy multiplied by the historical percentage of medical assistance resident days of the remaining facility or facilities, as reported on the facility's or facilities' most recent nursing facility statistical and cost report filed before the plan of closure is submitted, multiplied by 365.

(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy percentages will be those reported on the facility's or facilities' most recent nursing facility statistical and cost report filed before the plan of closure is submitted, and the average payment rates shall be calculated based on the approved payment rates in effect at the time the consolidation request is submitted.

(e) To qualify for the external fixed costs payment rate adjustment under this subdivision, the closing facilities shall:

(1) submit an application for closure according to section 256R.40, subdivision 2; and

(2) follow the resident relocation provisions of section 144A.161.

(f) The county or counties in which a facility or facilities are closed under this subdivision shall not be eligible for designation as a hardship area under subdivision 3 for five years from the date of the approval of the proposed consolidation. The applicant shall notify the county of this limitation and the county shall acknowledge this in a letter of support.

144A.472 HOME CARE PROVIDER LICENSE; APPLICATION AND RENEWAL.

Subd. 4.

Multiple units.

Multiple units or branches of a licensee must be separately licensed if the commissioner determines that the units cannot adequately share supervision and administration of services from the main office.

144D.01 DEFINITIONS.

Subd. 2a.

Arranged home care provider.

"Arranged home care provider" means a home care provider licensed under chapter 144A that provides services to some or all of the residents of a housing with services establishment and that is either the establishment itself or another entity with which the establishment has an arrangement.

Subd. 3a.

Direct-care staff.

"Direct-care staff" means staff and employees who provide home care services listed in section 144A.471, subdivisions 6 and 7.

Subd. 6.

Health-related services.

"Health-related services" include professional nursing services, home health aide tasks, or the central storage of medication for residents.

144D.04 HOUSING WITH SERVICES CONTRACTS.

Subd. 2a.

Additional contract requirements.

(a) For a resident receiving one or more health-related services from the establishment's arranged home care provider, as defined in section 144D.01, subdivision 6, the contract must include the requirements in paragraph (b). A restriction of a resident's rights under this subdivision is allowed only if determined necessary for health and safety reasons identified by the home care provider's registered nurse in an initial assessment or reassessment, as defined under section 144A.4791, subdivision 8, and documented in the written service plan under section 144A.4791, subdivision 9. Any restrictions of those rights for people served under sections 256B.0915 and 256B.49 must be documented in the resident's coordinated service and support plan (CSSP), as defined under sections 256B.0915, subdivision 6 and 256B.49, subdivision 15.

(b) The contract must include a statement:

(1) regarding the ability of a resident to furnish and decorate the resident's unit within the terms of the lease;

(2) regarding the resident's right to access food at any time;

(3) regarding a resident's right to choose the resident's visitors and times of visits;

(4) regarding the resident's right to choose a roommate if sharing a unit; and

(5) notifying the resident of the resident's right to have and use a lockable door to the resident's unit. The landlord shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible.

144D.045 INFORMATION CONCERNING ARRANGED HOME CARE PROVIDERS.

If a housing with services establishment has one or more arranged home care providers, the establishment shall arrange to have that arranged home care provider deliver the following information in writing to a prospective resident, prior to the date on which the prospective resident executes a contract with the establishment or the prospective resident's move-in date, whichever is earlier:

(1) the name, mailing address, and telephone number of the arranged home care provider;

(2) the name and mailing address of at least one natural person who is authorized to accept service of process on behalf of the entity described in clause (1);

(3) a description of the process through which a home care service agreement or service plan between a resident and the arranged home care provider, if any, may be modified, amended, or terminated;

(4) the arranged home care provider's billing and payment procedures and requirements; and

(5) any limits to the services available from the arranged provider.

144D.06 OTHER LAWS.

In addition to registration under this chapter, a housing with services establishment must comply with chapter 504B and the provisions of section 325F.72, and shall obtain and maintain all other licenses, permits, registrations, or other governmental approvals required of it. A housing with services establishment is not required to obtain a lodging license under chapter 157 and related rules.

144D.09 TERMINATION OF LEASE.

The housing with services establishment shall include with notice of termination of lease information about how to contact the ombudsman for long-term care, including the address and telephone number along with a statement of how to request problem-solving assistance.

144D.10 MANAGER REQUIREMENTS.

(a) The person primarily responsible for oversight and management of a housing with services establishment, as designated by the owner of the housing with services establishment, must obtain at least 30 hours of continuing education every two years of employment as the manager in topics relevant to the operations of the housing with services establishment and the needs of its tenants. Continuing education earned to maintain a professional license, such as nursing home administrator license, nursing license, social worker license, and real estate license, can be used to complete this requirement.

(b) For managers of establishments identified in section 325F.72, this continuing education must include at least eight hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter.

(c) For managers of establishments not covered by section 325F.72, but who provide assisted living services under chapter 144G, this continuing education must include at least four hours of documented training on the topics identified in section 144D.065, paragraph (b), within 160 working hours of hire, and two hours of training on these topics for each 12 months of employment thereafter.

(d) A statement verifying compliance with the continuing education requirement must be included in the housing with services establishment's annual registration to the commissioner of health. The establishment must maintain records for at least three years demonstrating that the person primarily responsible for oversight and management of the establishment has attended educational programs as required by this section.

(e) New managers may satisfy the initial dementia training requirements by producing written proof of previously completed required training within the past 18 months.

(f) This section does not apply to an establishment registered under section 144D.025 serving the homeless.

144G.01 DEFINITIONS.

Subdivision 1.

Scope; other definitions.

For purposes of sections 144G.01 to 144G.05, the following definitions apply. In addition, the definitions provided in section 144D.01 also apply to sections 144G.01 to 144G.05.

Subd. 2.

Assisted living.

"Assisted living" means a service or package of services advertised, marketed, or otherwise described, offered, or promoted using the phrase "assisted living" either alone or in combination with other words, whether orally or in writing, and which is subject to the requirements of this chapter.

Subd. 3.

Assisted living client; client.

"Assisted living client" or "client" means a housing with services resident who receives assisted living that is subject to the requirements of this chapter.

Subd. 4.

Commissioner.

"Commissioner" means the commissioner of health.

144G.02 ASSISTED LIVING; PROTECTED TITLE; REGULATORY FUNCTION.

Subdivision 1.

Protected title; restriction on use.

No person or entity may use the phrase "assisted living," whether alone or in combination with other words and whether orally or in writing, to advertise, market, or otherwise describe, offer, or promote itself, or any housing, service, service package, or program that it provides within this state, unless the person or entity is a housing with services establishment that meets the requirements of this chapter, or is a person or entity that provides some or all components of assisted living that meet the requirements of this chapter. A person or entity entitled to use the phrase "assisted living" shall use the phrase only in the context of its participation in assisted living that meets the requirements of this chapter. A housing with services establishment offering or providing assisted living that is not made available to residents in all of its housing units shall identify the number or location of the units in which assisted living is available, and may not use the term "assisted living" in the name of the establishment registered with the commissioner under chapter 144D, or in the name the establishment uses to identify itself to residents or the public.

Subd. 2.

Authority of commissioner.

(a) The commissioner, upon receipt of information that may indicate the failure of a housing with services establishment, the arranged home care provider, an assisted living client, or an assisted living client's representative to comply with a legal requirement to which one or more of the entities may be subject, shall make appropriate referrals to other governmental agencies and entities having jurisdiction over the subject matter. The commissioner may also make referrals to any public or private agency the commissioner considers available for appropriate assistance to those involved.

(b) In addition to the authority with respect to licensed home care providers under section 144A.45 and with respect to housing with services establishments under chapter 144D, the commissioner shall have standing to bring an action for injunctive relief in the district court in the district in which a housing with services establishment is located to compel the housing with services establishment or the arranged home care provider to meet the requirements of this chapter or other requirements of the state or of any county or local governmental unit to which the establishment or arranged home care provider is otherwise subject. Proceedings for securing an injunction may be brought by the commissioner through the attorney general or through the appropriate county attorney. The sanctions in this section do not restrict the availability of other sanctions.

144G.03 ASSISTED LIVING REQUIREMENTS.

Subdivision 1.

Verification in annual registration.

A registered housing with services establishment using the phrase "assisted living," pursuant to section 144G.02, subdivision 1, shall verify to the commissioner in its annual registration pursuant to chapter 144D that the establishment is complying with sections 144G.01 to 144G.05, as applicable.

Subd. 2.

Minimum requirements for assisted living.

(a) Assisted living shall be provided or made available only to individuals residing in a registered housing with services establishment. Except as expressly stated in this chapter, a person or entity offering assisted living may define the available services and may offer assisted living to all or some of the residents of a housing with services establishment. The services that comprise assisted living may be provided or made available directly by a housing with services establishment or by persons or entities with which the housing with services establishment has made arrangements.

(b) A person or entity entitled to use the phrase "assisted living," according to section 144G.02, subdivision 1, shall do so only with respect to a housing with services establishment, or a service, service package, or program available within a housing with services establishment that, at a minimum:

(1) provides or makes available health-related services under a home care license. At a minimum, health-related services must include:

(i) assistance with self-administration of medication, medication management, or medication administration as defined in section 144A.43; and

(ii) assistance with at least three of the following seven activities of daily living: bathing, dressing, grooming, eating, transferring, continence care, and toileting.

All health-related services shall be provided in a manner that complies with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285;

(2) provides necessary assessments of the physical and cognitive needs of assisted living clients by a registered nurse, as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285;

(3) has and maintains a system for delegation of health care activities to unlicensed personnel by a registered nurse, including supervision and evaluation of the delegated activities as required by applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285;

(4) provides staff access to an on-call registered nurse 24 hours per day, seven days per week;

(5) has and maintains a system to check on each assisted living client at least daily;

(6) provides a means for assisted living clients to request assistance for health and safety needs 24 hours per day, seven days per week, from the establishment or a person or entity with which the establishment has made arrangements;

(7) has a person or persons available 24 hours per day, seven days per week, who is responsible for responding to the requests of assisted living clients for assistance with health or safety needs, who shall be:

(i) awake;

(ii) located in the same building, in an attached building, or on a contiguous campus with the housing with services establishment in order to respond within a reasonable amount of time;

(iii) capable of communicating with assisted living clients;

(iv) capable of recognizing the need for assistance;

(v) capable of providing either the assistance required or summoning the appropriate assistance; and

(vi) capable of following directions;

(8) offers to provide or make available at least the following supportive services to assisted living clients:

(i) two meals per day;

(ii) weekly housekeeping;

(iii) weekly laundry service;

(iv) upon the request of the client, reasonable assistance with arranging for transportation to medical and social services appointments, and the name of or other identifying information about the person or persons responsible for providing this assistance;

(v) upon the request of the client, reasonable assistance with accessing community resources and social services available in the community, and the name of or other identifying information about the person or persons responsible for providing this assistance; and

(vi) periodic opportunities for socialization; and

(9) makes available to all prospective and current assisted living clients information consistent with the uniform format and the required components adopted by the commissioner under section 144G.06. This information must be made available beginning no later than six months after the commissioner makes the uniform format and required components available to providers according to section 144G.06.

Subd. 3.

Exemption from awake-staff requirement.

A housing with services establishment that offers or provides assisted living is exempt from the requirement in subdivision 2, paragraph (b), clause (7), item (i), that the person or persons available and responsible for responding to requests for assistance must be awake, if the establishment meets the following requirements:

(1) the establishment has a maximum capacity to serve 12 or fewer assisted living clients;

(2) the person or persons available and responsible for responding to requests for assistance are physically present within the housing with services establishment in which the assisted living clients reside;

(3) the establishment has a system in place that is compatible with the health, safety, and welfare of the establishment's assisted living clients;

(4) the establishment's housing with services contract, as required by section 144D.04, includes a statement disclosing the establishment's qualification for, and intention to rely upon, this exemption;

(5) the establishment files with the commissioner, for purposes of public information but not review or approval by the commissioner, a statement describing how the establishment meets the conditions in clauses (1) to (4), and makes a copy of this statement available to actual and prospective assisted living clients; and

(6) the establishment indicates on its housing with services registration, under section 144D.02 or 144D.03, as applicable, that it qualifies for and intends to rely upon the exemption under this subdivision.

Subd. 4.

Nursing assessment.

(a) A housing with services establishment offering or providing assisted living shall:

(1) offer to have the arranged home care provider conduct a nursing assessment by a registered nurse of the physical and cognitive needs of the prospective resident and propose a service plan prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier; and

(2) inform the prospective resident of the availability of and contact information for long-term care consultation services under section 256B.0911, prior to the date on which a prospective resident executes a contract with a housing with services establishment or the date on which a prospective resident moves in, whichever is earlier.

(b) An arranged home care provider is not obligated to conduct a nursing assessment by a registered nurse when requested by a prospective resident if either the geographic distance between the prospective resident and the provider, or urgent or unexpected circumstances, do not permit the assessment to be conducted prior to the date on which the prospective resident executes a contract or moves in, whichever is earlier. When such circumstances occur, the arranged home care provider shall offer to conduct a telephone conference whenever reasonably possible.

(c) The arranged home care provider shall comply with applicable home care licensure requirements in chapter 144A and sections 148.171 to 148.285, with respect to the provision of a nursing assessment prior to the delivery of nursing services and the execution of a home care service plan or service agreement.

Subd. 5.

Assistance with arranged home care provider.

The housing with services establishment shall provide each assisted living client with identifying information about a person or persons reasonably available to assist the client with concerns the client may have with respect to the services provided by the arranged home care provider. The establishment shall keep each assisted living client reasonably informed of any changes in the personnel referenced in this subdivision. Upon request of the assisted living client, such personnel or designee shall provide reasonable assistance to the assisted living client in addressing concerns regarding services provided by the arranged home care provider.

Subd. 6.

Termination of housing with services contract.

If a housing with services establishment terminates a housing with services contract with an assisted living client, the establishment shall provide the assisted living client, and the legal or designated representative of the assisted living client, if any, with a written notice of termination which includes the following information:

(1) the effective date of termination;

(2) the section of the contract that authorizes the termination;

(3) without extending the termination notice period, an affirmative offer to meet with the assisted living client and, if applicable, client representatives, within no more than five business days of the date of the termination notice to discuss the termination;

(4) an explanation that:

(i) the assisted living client must vacate the apartment, along with all personal possessions, on or before the effective date of termination;

(ii) failure to vacate the apartment by the date of termination may result in the filing of an eviction action in court by the establishment, and that the assisted living client may present a defense, if any, to the court at that time; and

(iii) the assisted living client may seek legal counsel in connection with the notice of termination;

(5) a statement that, with respect to the notice of termination, reasonable accommodation is available for the disability of the assisted living client, if any; and

(6) the name and contact information of the representative of the establishment with whom the assisted living client or client representatives may discuss the notice of termination.

144G.04 RESERVATION OF RIGHTS.

Subdivision 1.

Use of services.

Nothing in this chapter requires an assisted living client to utilize any service provided or made available in assisted living.

Subd. 2.

Housing with services contracts.

Nothing in this chapter requires a housing with services establishment to execute or refrain from terminating a housing with services contract with a prospective or current resident who is unable or unwilling to meet the requirements of residency, with or without assistance.

Subd. 3.

Provision of services.

Nothing in this chapter requires the arranged home care provider to offer or continue to provide services under a service agreement or service plan to a prospective or current resident of the establishment whose needs cannot be met by the arranged home care provider.

Subd. 4.

Altering operations; service packages.

Nothing in this chapter requires a housing with services establishment or arranged home care provider offering assisted living to fundamentally alter the nature of the operations of the establishment or the provider in order to accommodate the request or need for facilities or services by any assisted living client, or to refrain from requiring, as a condition of residency, that an assisted living client pay for a package of assisted living services even if the client does not choose to utilize all or some of the services in the package.

144G.05 REIMBURSEMENT UNDER ASSISTED LIVING SERVICE PACKAGES.

Notwithstanding the provisions of this chapter, the requirements for the elderly waiver program's assisted living payment rates under section 256B.0915, subdivision 3e, shall continue to be effective and providers who do not meet the requirements of this chapter may continue to receive payment under section 256B.0915, subdivision 3e, as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved Elderly Home and Community Based Services Waiver Program (Control Number 0025.91). Providers of assisted living for the community access for disability inclusion (CADI) and Brain Injury (BI) waivers shall continue to receive payment as long as they continue to meet the definitions and standards for assisted living and assisted living plus set forth in the federally approved CADI and BI waiver plans.

144G.06 UNIFORM CONSUMER INFORMATION GUIDE.

The commissioner shall adopt a uniform format for the guide to be used by individual providers, and the required components of materials to be used by providers to inform assisted living clients of their legal rights, and shall make the uniform format and the required components available to assisted living providers.

214.17 HIV, HBV, AND HCV PREVENTION PROGRAM; PURPOSE AND SCOPE.

Sections 214.17 to 214.25 are intended to promote the health and safety of patients and regulated persons by reducing the risk of infection in the provision of health care.

214.18 DEFINITIONS.

Subdivision 1.

Board.

"Board" means the Boards of Dentistry, Medical Practice, Nursing, and Podiatric Medicine. For purposes of sections 214.19, subdivisions 4 and 5; 214.20, paragraph (1); and 214.24, board also includes the Board of Chiropractic Examiners.

Subd. 2.

Commissioner.

"Commissioner" means the commissioner of health.

Subd. 3.

HBV.

"HBV" means the hepatitis B virus with the e antigen present in the most recent blood test.

Subd. 3a.

HCV.

"HCV" means the hepatitis C virus.

Subd. 4.

HIV.

"HIV" means the human immunodeficiency virus.

Subd. 5.

Regulated person.

"Regulated person" means a licensed dental hygienist, dentist, physician, nurse who is currently registered as a registered nurse or licensed practical nurse, podiatrist, a registered dental assistant, a physician assistant, and for purposes of sections 214.19, subdivisions 4 and 5; 214.20, paragraph (a); and 214.24, a chiropractor.

214.19 REPORTING OBLIGATIONS.

Subdivision 1.

Permission to report.

A person with actual knowledge that a regulated person has been diagnosed as infected with HIV, HBV, or HCV may file a report with the commissioner.

Subd. 2.

Self-reporting.

A regulated person who is diagnosed as infected with HIV, HBV, or HCV shall report that information to the commissioner promptly, and as soon as medically necessary for disease control purposes but no more than 30 days after learning of the diagnosis or 30 days after becoming licensed or registered by the state.

Subd. 3.

Mandatory reporting.

A person or institution required to report HIV, HBV, or HCV status to the commissioner under Minnesota Rules, parts 4605.7030, subparts 1 to 4 and 6, and 4605.7040, shall, at the same time, notify the commissioner if the person or institution knows that the reported person is a regulated person.

Subd. 4.

Infection control reporting.

A regulated person shall, within ten days, report to the appropriate board personal knowledge of a serious failure or a pattern of failure by another regulated person to comply with accepted and prevailing infection control procedures related to the prevention of HIV, HBV, and HCV transmission. In lieu of reporting to the board, the regulated person may make the report to a designated official of the hospital, nursing home, clinic, or other institution or agency where the failure to comply with accepted and prevailing infection control procedures occurred. The designated official shall report to the appropriate board within 30 days of receiving a report under this subdivision. The report shall include specific information about the response by the institution or agency to the report. A regulated person shall not be discharged or discriminated against for filing a complaint in good faith under this subdivision.

Subd. 5.

Immunity.

A person is immune from civil liability or criminal prosecution for submitting a report in good faith to the commissioner or to a board under this section.

214.20 GROUNDS FOR DISCIPLINARY OR RESTRICTIVE ACTION.

A board may refuse to grant a license or registration or may impose disciplinary or restrictive action against a regulated person who:

(1) fails to follow accepted and prevailing infection control procedures, including a failure to conform to current recommendations of the Centers for Disease Control for preventing the transmission of HIV, HBV, and HCV, or fails to comply with infection control rules promulgated by the board. Injury to a patient need not be established;

(2) fails to comply with any requirement of sections 214.17 to 214.24; or

(3) fails to comply with any monitoring or reporting requirement.

214.21 TEMPORARY SUSPENSION.

The board may, without hearing, temporarily suspend the right to practice of a regulated person if the board finds that the regulated person has refused to submit to or comply with monitoring under section 214.23. The suspension shall take effect upon written notice to the regulated person specifying the statute or rule violated. The suspension shall remain in effect until the board issues a final order based on a stipulation or after a hearing. At the time the board issues the suspension notice, the board shall schedule a disciplinary hearing to be held under chapter 14. The regulated person shall be provided with at least 20 days' notice of a hearing held under this section. The hearing shall be scheduled to begin no later than 30 days after the issuance of the suspension order.

214.22 NOTICE; ACTION.

If the board has reasonable grounds to believe a regulated person infected with HIV, HBV, or HCV has done or omitted doing any act that would be grounds for disciplinary action under section 214.20, the board may take action after giving notice three business days before the action, or a lesser time if deemed necessary by the board. The board may:

(1) temporarily suspend the regulated person's right to practice under section 214.21;

(2) require the regulated person to appear personally at a conference with representatives of the board and to provide information relating to the regulated person's health or professional practice; and

(3) take any other lesser action deemed necessary by the board for the protection of the public.

214.23 MONITORING.

Subdivision 1.

Commissioner of health.

The board shall enter into a contract with the commissioner to perform the functions in subdivisions 2 and 3. The contract shall provide that:

(1) unless requested to do otherwise by a regulated person, a board shall refer all regulated persons infected with HIV, HBV, or HCV to the commissioner;

(2) the commissioner may choose to refer any regulated person who is infected with HIV, HBV, or HCV as well as all information related thereto to the person's board at any time for any reason, including but not limited to: the degree of cooperation and compliance by the regulated person; the inability to secure information or the medical records of the regulated person; or when the facts may present other possible violations of the regulated persons practices act. Upon request of the regulated person who is infected with HIV, HBV, or HCV the commissioner shall refer the regulated person and all information related thereto to the person's board. Once the commissioner has referred a regulated person to a board, the board may not thereafter submit it to the commissioner to establish a monitoring plan unless the commissioner of health consents in writing;

(3) a board shall not take action on grounds relating solely to the HIV, HBV, or HCV status of a regulated person until after referral by the commissioner; and

(4) notwithstanding sections 13.39 and 13.41 and chapters 147, 147A, 148, 150A, 153, and 214, a board shall forward to the commissioner any information on a regulated person who is infected with HIV, HBV, or HCV that the Department of Health requests.

Subd. 2.

Monitoring plan.

After receiving a report that a regulated person is infected with HIV, HBV, or HCV, the board or the commissioner acting on behalf of the board shall evaluate the past and current professional practice of the regulated person to determine whether there has been a violation under section 214.20. After evaluation of the regulated person's past and current professional practice, the board or the commissioner, acting on behalf of the board, shall establish a monitoring plan for the regulated person. The monitoring plan may:

(1) address the scope of a regulated person's professional practice when the board or the commissioner, acting on behalf of the board, determines that the practice constitutes an identifiable risk of transmission of HIV, HBV, or HCV from the regulated person to the patient;

(2) include the submission of regular reports at a frequency determined by the board or the commissioner, acting on behalf of the board, regarding the regulated person's health status; and

(3) include any other provisions deemed reasonable by the board or the commissioner of health, acting on behalf of the board.

The board or commissioner, acting on behalf of the board, may enter into agreements with qualified persons to perform monitoring on its behalf. The regulated person shall comply with any monitoring plan established under this subdivision.

Subd. 3.

Expert review panel.

The board or the commissioner acting on behalf of the board may appoint an expert review panel to assist in the performance of the responsibilities under this section. In consultations with the expert review panel, the commissioner or board shall, to the extent possible, protect the identity of the regulated person. When an expert review panel is appointed, it must contain at least one member appointed by the commissioner and one professional member appointed by the board. The panel shall provide expert assistance to the board, or to the commissioner acting on behalf of the board, in the subjects of infectious diseases, epidemiology, practice techniques used by regulated persons, and other subjects determined by the board or by the commissioner acting on behalf of the board. Members of the expert review panel are subject to those provisions of chapter 13 that restrict the commissioner or the board under Laws 1992, chapter 559, article 1.

Subd. 4.

Immunity.

Members of the board or the commissioner acting on behalf of the board, and persons who participate on an expert review panel or who assist the board or the commissioner in monitoring the practice of a regulated person, are immune from civil liability or criminal prosecution for any actions, transactions, or publications made in good faith and in execution of, or relating to, their duties under sections 214.17 to 214.24, except that no immunity shall be available for persons who have knowingly violated any provision of chapter 13.

214.24 INSPECTION OF PRACTICE.

Subdivision 1.

Authority.

The board is authorized to conduct inspections of the clinical practice of a regulated person to determine whether the regulated person is following accepted and prevailing infection control procedures. The board shall provide at least three business days' notice to the clinical practice prior to the inspection. The clinical practice of a regulated person includes any location where the regulated person practices that is not an institution licensed and subject to inspection by the commissioner of health. During the course of inspections the privacy and confidentiality of patients and regulated persons shall be maintained. The board may require on license renewal forms that regulated persons inform the board of all locations where they practice.

Subd. 2.

Access; records.

An inspector from the board shall have access, during reasonable business hours for purposes of inspection, to all areas of the practice setting where patient care is rendered or drugs or instruments are held that come into contact with a patient. An inspector is authorized to interview employees and regulated persons in the performance of an inspection, to observe infection control procedures, test equipment used to sterilize instruments, and to review and copy all relevant records, excluding patient health records. In performing these responsibilities, inspectors shall make reasonable efforts to respect and preserve patient privacy and the privacy of the regulated person. Boards are authorized to conduct joint inspections and to share information obtained under this section. The boards shall contract with the commissioner to perform the duties under this subdivision.

Subd. 3.

Board action.

If accepted and prevailing infection control techniques are not being followed, the board may educate the regulated person or take other actions. The board and the inspector shall maintain patient confidentiality in any action resulting from the inspection.

Subd. 4.

Rulemaking.

A board is authorized to adopt rules setting standards for infection control procedures. Boards shall engage in joint rulemaking. Boards must seek and consider the advice of the commissioner of health before adopting rules. No inspections shall be conducted under this section until after infection control rules have been adopted. Each board is authorized to provide educational information and training to regulated persons regarding infection control. All regulated persons who are employers shall make infection control rules available to employees who engage in functions related to infection control.

245.462 DEFINITIONS.

Subd. 4a.

Clinical supervision.

"Clinical supervision" means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager. Clinical supervision must be accomplished by full or part-time employment of or contracts with mental health professionals. Clinical supervision must be documented by the mental health professional cosigning individual treatment plans and by entries in the client's record regarding supervisory activities.

245E.06 ADMINISTRATIVE SANCTIONS.

Subd. 2.

Written notice of department sanction; sanction effective date; informal meeting.

(a) The department shall give notice in writing to a person of an administrative sanction that is to be imposed. The notice shall be sent by mail as defined in section 245E.01, subdivision 11.

(b) The notice shall state:

(1) the factual basis for the department's determination;

(2) the sanction the department intends to take;

(3) the dollar amount of the monetary recovery or recoupment, if any;

(4) how the dollar amount was computed;

(5) the right to dispute the department's determination and to provide evidence;

(6) the right to appeal the department's proposed sanction; and

(7) the option to meet informally with department staff, and to bring additional documentation or information, to resolve the issues.

(c) In cases of determinations resulting in denial or termination of payments, in addition to the requirements of paragraph (b), the notice must state:

(1) the length of the denial or termination;

(2) the requirements and procedures for reinstatement; and

(3) the provider's right to submit documents and written arguments against the denial or termination of payments for review by the department before the effective date of denial or termination.

(d) The submission of documents and written argument for review by the department under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the deadline for filing an appeal.

(e) Notwithstanding section 245E.03, subdivision 4, the effective date of the proposed sanction shall be 30 days after the license holder's, provider's, controlling individual's, or recipient's receipt of the notice, unless timely appealed. If a timely appeal is made, the proposed sanction shall be delayed pending the final outcome of the appeal. Implementation of a proposed sanction following the resolution of a timely appeal may be postponed if, in the opinion of the department, the delay of sanction is necessary to protect the health or safety of children in care. The department may consider the economic hardship of a person in implementing the proposed sanction, but economic hardship shall not be a determinative factor in implementing the proposed sanction.

(f) Requests for an informal meeting to attempt to resolve issues and requests for appeals must be sent or delivered to the department's Office of Inspector General, Financial Fraud and Abuse Division.

Subd. 4.

Consolidated hearings with licensing sanction.

If a financial misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing sanction exists for which there is an appeal hearing right and the sanction is timely appealed, and the overpayment recovery action and licensing sanction involve the same set of facts, the overpayment recovery action and licensing sanction must be consolidated in the contested case hearing related to the licensing sanction.

Subd. 5.

Effect of department's administrative determination or sanction.

Unless a timely and proper appeal is received by the department, the department's administrative determination or sanction shall be considered a final department determination.

246.18 DISPOSAL OF FUNDS.

Subd. 8.

State-operated services account.

(a) The state-operated services account is established in the special revenue fund. Revenue generated by new state-operated services listed under this section established after July 1, 2010, that are not enterprise activities must be deposited into the state-operated services account, unless otherwise specified in law:

(1) intensive residential treatment services;

(2) foster care services; and

(3) psychiatric extensive recovery treatment services.

(b) Funds deposited in the state-operated services account are appropriated to the commissioner of human services for the purposes of:

(1) providing services needed to transition individuals from institutional settings within state-operated services to the community when those services have no other adequate funding source; and

(2) funding the operation of the intensive residential treatment service program in Willmar.

Subd. 9.

Transfers.

The commissioner may transfer state mental health grant funds to the account in subdivision 8 for noncovered allowable costs of a provider certified and licensed under section 256B.0622 and operating under section 246.014.

252.41 DEFINITIONS.

Subd. 8.

Supported employment.

"Supported employment" means employment of a person with a disability so severe that the person needs ongoing training and support to get and keep a job in which:

(1) the person engages in paid work at a work site where individuals without disabilities who do not require public subsidies also may be employed;

(2) public funds are necessary to provide ongoing training and support services throughout the period of the person's employment; and

(3) the person has the opportunity for social interaction with individuals who do not have disabilities and who are not paid caregivers.

252.431 SUPPORTED EMPLOYMENT SERVICES; DEPARTMENTAL DUTIES; COORDINATION.

The commissioners of employment and economic development, human services, and education shall ensure that supported employment services provided as part of a comprehensive service system will:

(1) provide the necessary supports to assist persons with severe disabilities to obtain and maintain employment in normalized work settings available to the general work force that:

(i) maximize community and social integration; and

(ii) provide job opportunities that meet the individual's career potential and interests;

(2) allow persons with severe disabilities to actively participate in the planning and delivery of community-based employment services at the individual, local, and state level; and

(3) be coordinated among the Departments of Human Services, Employment and Economic Development, and Education to:

(i) promote the most efficient and effective funding;

(ii) avoid duplication of services; and

(iii) improve access and transition to employability services.

The commissioners of employment and economic development, human services, and education shall report to the legislature by January 1993 on the steps taken to implement this section.

252.451 BUSINESS AGREEMENTS; SUPPORT AND SUPERVISION OF PERSONS WITH DISABILITIES.

Subdivision 1.

Definition.

For the purposes of this section, "qualified business" means a business that employs primarily nondisabled persons and will employ persons with developmental disabilities. For purposes of this section, licensed providers of residential services for persons with developmental disabilities are not a qualified business. A qualified business and its employees are exempt from Minnesota Rules, parts 9525.1800 to 9525.1930.

Subd. 2.

Vendor participation and reimbursement.

Notwithstanding requirements in chapters 245A and 245D, and sections 252.28, 252.41 to 252.46, and 256B.501, vendors of day training and habilitation services may enter into written agreements with qualified businesses to provide additional training and supervision needed by individuals to maintain their employment.

Subd. 3.

Agreement specifications.

Agreements must include the following:

(1) the type and amount of supervision and support to be provided by the business to the individual in accordance with their needs as identified in their individual service plan;

(2) the methods used to periodically assess the individual's satisfaction with their work, training, and support;

(3) the measures taken by the qualified business and the vendor to ensure the health, safety, and protection of the individual during working hours, including the reporting of abuse and neglect under state law and rules;

(4) the training and support services the vendor will provide to the qualified business, including the frequency of on-site supervision and support; and

(5) any payment to be made to the qualified business by the vendor. Payment to the business must be limited to:

(i) additional costs of training coworkers and managers that exceed ordinary and customary training costs and are a direct result of employing a person with a developmental disability; and

(ii) additional costs for training, supervising, and assisting the person with a developmental disability that exceed normal and customary costs required for performing similar tasks or duties.

Payments made to a qualified business under this section must not include incentive payments to the qualified business or salary supplementation for the person with a developmental disability.

Subd. 4.

Client protection.

Persons receiving training and support under this section may not be denied their rights or procedural protections under section 256.045, subdivision 4a, or 256B.092, including the county agency's responsibility to arrange for appropriate services, as necessary, in the event that persons lose their job or the contract with the qualified business is terminated.

Subd. 5.

Vendor payment.

(a) For purposes of this section, the vendor shall bill and the commissioner shall reimburse the vendor for full-day or partial-day services to a client that would otherwise have been paid to the vendor for providing direct services, provided that both of the following criteria are met:

(1) the vendor provides services and payments to the qualified business that enable the business to perform support and supervision services for the client that the vendor would otherwise need to perform; and

(2) the client for whom a rate will be billed will receive full-day or partial-day services from the vendor and the rate to be paid the vendor will allow the client to work with this support and supervision at the qualified business instead of receiving these services from the vendor.

(b) Medical assistance reimbursement of services provided to persons receiving day training and habilitation services under this section is subject to the limitations on reimbursement for vocational services under federal law and regulation.

254B.03 RESPONSIBILITY TO PROVIDE CHEMICAL DEPENDENCY TREATMENT.

Subd. 4a.

Division of costs for medical assistance services.

Notwithstanding subdivision 4, for chemical dependency services provided on or after October 1, 2008, and reimbursed by medical assistance, the county share is 30 percent of the nonfederal share.

256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.

Subd. 2.

Establishment.

The commissioner of human services shall establish a certified peer specialist program model, which:

(1) provides nonclinical peer support counseling by certified peer specialists;

(2) provides a part of a wraparound continuum of services in conjunction with other community mental health services;

(3) is individualized to the consumer; and

(4) promotes socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.

Subd. 4.

Peer support specialist program providers.

The commissioner shall develop a process to certify peer support specialist programs, in accordance with the federal guidelines, in order for the program to bill for reimbursable services. Peer support programs may be freestanding or within existing mental health community provider centers.

Subd. 5.

Certified peer specialist training and certification.

The commissioner of human services shall develop a training and certification process for certified peer specialists, who must be at least 21 years of age. The candidates must have had a primary diagnosis of mental illness, be a current or former consumer of mental health services, and must demonstrate leadership and advocacy skills and a strong dedication to recovery. The training curriculum must teach participating consumers specific skills relevant to providing peer support to other consumers. In addition to initial training and certification, the commissioner shall develop ongoing continuing educational workshops on pertinent issues related to peer support counseling.

256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.

Subd. 2.

Establishment.

The commissioner of human services shall establish a certified family peer specialists program model which:

(1) provides nonclinical family peer support counseling, building on the strengths of families and helping them achieve desired outcomes;

(2) collaborates with others providing care or support to the family;

(3) provides nonadversarial advocacy;

(4) promotes the individual family culture in the treatment milieu;

(5) links parents to other parents in the community;

(6) offers support and encouragement;

(7) assists parents in developing coping mechanisms and problem-solving skills;

(8) promotes resiliency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services;

(9) establishes and provides peer-led parent support groups; and

(10) increases the child's ability to function better within the child's home, school, and community by educating parents on community resources, assisting with problem solving, and educating parents on mental illnesses.

Subd. 4.

Peer support specialist program providers.

The commissioner shall develop a process to certify family peer support specialist programs, in accordance with the federal guidelines, in order for the program to bill for reimbursable services. Family peer support programs must operate within an existing mental health community provider or center.

Subd. 5.

Certified family peer specialist training and certification.

The commissioner shall develop a training and certification process for certified family peer specialists who must be at least 21 years of age. The candidates must have raised or be currently raising a child with a mental illness, have had experience navigating the children's mental health system, and must demonstrate leadership and advocacy skills and a strong dedication to family-driven and family-focused services. The training curriculum must teach participating family peer specialists specific skills relevant to providing peer support to other parents. In addition to initial training and certification, the commissioner shall develop ongoing continuing educational workshops on pertinent issues related to family peer support counseling.

256B.0659 PERSONAL CARE ASSISTANCE PROGRAM.

Subd. 22.

Annual review for personal care providers.

(a) All personal care assistance provider agencies shall resubmit, on an annual basis, the information specified in subdivision 21, in a format determined by the commissioner, and provide a copy of the personal care assistance provider agency's most current version of its grievance policies and procedures along with a written record of grievances and resolutions of the grievances that the personal care assistance provider agency has received in the previous year and any other information requested by the commissioner.

(b) The commissioner shall send annual review notification to personal care assistance provider agencies 30 days prior to renewal. The notification must:

(1) list the materials and information the personal care assistance provider agency is required to submit;

(2) provide instructions on submitting information to the commissioner; and

(3) provide a due date by which the commissioner must receive the requested information.

Personal care assistance provider agencies shall submit required documentation for annual review within 30 days of notification from the commissioner. If no documentation is submitted, the personal care assistance provider agency enrollment number must be terminated or suspended.

(c) Personal care assistance provider agencies also currently licensed under section 144A.471, subdivision 6 or 7, or currently certified for participation in Medicare as a home health agency are deemed in compliance with the personal care assistance requirements for enrollment, annual review process, and documentation.

256B.0705 PERSONAL CARE ASSISTANCE SERVICES; MANDATED SERVICE VERIFICATION.

Subdivision 1.

Definitions.

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

(b) "Personal care assistance services" or "PCA services" means services provided according to section 256B.0659.

(c) "Personal care assistant" or "PCA" has the meaning given in section 256B.0659, subdivision 1.

(d) "Service verification" means a random, unscheduled telephone call made for the purpose of verifying that the individual personal care assistant is present at the location where personal care assistance services are being provided and is providing services as scheduled.

Subd. 2.

Verification schedule.

An agency that submits claims for reimbursement for PCA services under this chapter must develop and implement administrative policies and procedures by which the agency verifies the services provided by a PCA. For each service recipient, the agency must conduct at least one service verification every 90 days. If more than one PCA provides services to a single service recipient, the agency must conduct a service verification for each PCA providing services before conducting a service verification for a PCA whose services were previously verified by the agency. Service verification must occur on an ongoing basis while the agency provides PCA services to the recipient. During service verification, the agency must speak with both the PCA and the service recipient or recipient's authorized representative. Only qualified professional service verifications are eligible for reimbursement. An agency may substitute a visit by a qualified professional that is eligible for reimbursement under section 256B.0659, subdivision 14 or 19.

Subd. 3.

Documentation of verification.

An agency must fully document service verifications in a legible manner and must maintain the documentation on site for at least five years from the date of documentation. For each service verification, documentation must include:

(1) the names and signatures of the service recipient or recipient's authorized representative, the PCA and any other agency staff present with the PCA during the service verification, and the staff person conducting the service verification; and

(2) the start and end time, day, month, and year of the service verification, and the corresponding PCA time sheet.

Subd. 4.

Variance.

The Office of Inspector General at the Department of Human Services may grant a variance to the service verification requirements in this section if an agency uses an electronic monitoring system or other methods that verify a PCA is present at the location where services are provided and is providing services according to the prescribed schedule. A decision to grant or deny a variance request is final and not subject to appeal under chapter 14.

256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.

Subd. 10.

Service authorization.

Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.

256B.0944 CHILDREN'S MENTAL HEALTH CRISIS RESPONSE SERVICES.

Subd. 10.

Client record.

The provider must maintain a file for each client that complies with the requirements under section 256B.0943, subdivision 11, and contains the following information:

(1) individual crisis treatment plans signed by the recipient, mental health professional, and mental health practitioner who developed the crisis treatment plan, or if the recipient refused to sign the plan, the date and reason stated by the recipient for not signing the plan;

(2) signed release of information forms;

(3) recipient health information and current medications;

(4) emergency contacts for the recipient;

(5) case records that document the date of service, place of service delivery, signature of the person providing the service, and the nature, extent, and units of service. Direct or telephone contact with the recipient's family or others should be documented;

(6) required clinical supervision by mental health professionals;

(7) summary of the recipient's case reviews by staff; and

(8) any written information by the recipient that the recipient wants in the file.

256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.

Subd. 5.

Service authorization.

The commissioner will administer authorizations for services under this section in compliance with section 256B.0625, subdivision 25.

256B.0947 INTENSIVE REHABILITATIVE MENTAL HEALTH SERVICES.

Subd. 9.

Service authorization.

The commissioner shall publish prior authorization criteria and standards to be used for intensive nonresidential rehabilitative mental health services, as provided in section 256B.0625, subdivision 25.

256B.431 RATE DETERMINATION.

Subd. 3a.

Property-related costs after July 1, 1985.

(a) For rate years beginning on or after July 1, 1985, the commissioner, by permanent rule, shall reimburse nursing facility providers that are vendors in the medical assistance program for the rental use of real estate and depreciable equipment. "Real estate" means land improvements, buildings, and attached fixtures used directly for resident care. "Depreciable equipment" means the standard movable resident care equipment and support service equipment generally used in long-term care facilities.

(b) In developing the method for determining payment rates for the rental use of nursing facilities, the commissioner shall consider factors designed to:

(1) simplify the administrative procedures for determining payment rates for property-related costs;

(2) minimize discretionary or appealable decisions;

(3) eliminate any incentives to sell nursing facilities;

(4) recognize legitimate costs of preserving and replacing property;

(5) recognize the existing costs of outstanding indebtedness allowable under the statutes and rules in effect on May 1, 1983;

(6) address the current value of, if used directly for patient care, land improvements, buildings, attached fixtures, and equipment;

(7) establish an investment per bed limitation;

(8) reward efficient management of capital assets;

(9) provide equitable treatment of facilities;

(10) consider a variable rate; and

(11) phase-in implementation of the rental reimbursement method.

(c) For rate years beginning on or after July 1, 1987, a nursing facility which has reduced licensed bed capacity after January 1, 1986, shall be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds licensed prior to the reduction; and

(2) establish capacity days for each rate year following the licensure reduction based on the number of beds licensed on the previous April 1 if the commissioner is notified of the change by April 4. The notification must include a copy of the delicensure request that has been submitted to the commissioner of health.

(d) For rate years beginning on or after July 1, 1989, the interest expense that results from a refinancing of a nursing facility's demand call loan, when the loan that must be refinanced was incurred before May 22, 1983, is an allowable interest expense if:

(1) the demand call loan or any part of it was in the form of a loan that was callable at the demand of the lender;

(2) the demand call loan or any part of it was called by the lender through no fault of the nursing facility;

(3) the demand call loan or any part of it was made by a government agency operating under a statutory or regulatory loan program;

(4) the refinanced debt does not exceed the sum of the allowable remaining balance of the demand call loan at the time of payment on the demand call loan and refinancing costs;

(5) the term of the refinanced debt does not exceed the remaining term of the demand call loan, had the debt not been subject to an on-call payment demand; and

(6) the refinanced debt is not a debt between related organizations as defined in Minnesota Rules, part 9549.0020, subpart 38.

Subd. 3f.

Property costs after July 1, 1988.

(a) For the rate year beginning July 1, 1988, the replacement-cost-new per bed limit must be $32,571 per licensed bed in multiple bedrooms and $48,857 per licensed bed in a single bedroom. For the rate year beginning July 1, 1989, the replacement-cost-new per bed limit for a single bedroom must be $49,907 adjusted according to Minnesota Rules, part 9549.0060, subpart 4, item A, subitem (1). Beginning January 1, 1990, the replacement-cost-new per bed limits must be adjusted annually as specified in Minnesota Rules, part 9549.0060, subpart 4, item A, subitem (1). Beginning January 1, 1991, the replacement-cost-new per bed limits will be adjusted annually as specified in Minnesota Rules, part 9549.0060, subpart 4, item A, subitem (1), except that the index utilized will be the Bureau of Economic Analysis: Price Indexes for Private Fixed Investments in Structures; Special Care.

(b) For the rate year beginning July 1, 1988, the commissioner shall increase the rental factor as established in Minnesota Rules, part 9549.0060, subpart 8, item A, by 6.2 percent rounded to the nearest 100th percent for the purpose of reimbursing nursing facilities for soft costs and entrepreneurial profits not included in the cost valuation services used by the state's contracted appraisers. For rate years beginning on or after July 1, 1989, the rental factor is the amount determined under this paragraph for the rate year beginning July 1, 1988.

(c) For rate years beginning on or after July 1, 1988, in order to determine property-related payment rates under Minnesota Rules, part 9549.0060, for all nursing facilities except those whose average length of stay in a skilled level of care within a nursing facility is 180 days or less, the commissioner shall use 95 percent of capacity days. For a nursing facility whose average length of stay in a skilled level of care within a nursing facility is 180 days or less, the commissioner shall use the greater of resident days or 80 percent of capacity days but in no event shall the divisor exceed 95 percent of capacity days.

(d) For rate years beginning on July 1, 1988, and July 1, 1989, the commissioner shall add ten cents per resident per day to each nursing facility's property-related payment rate. The ten-cent property-related payment rate increase is not cumulative from rate year to rate year. For the rate year beginning July 1, 1990, the commissioner shall increase each nursing facility's equipment allowance as established in Minnesota Rules, part 9549.0060, subpart 10, by ten cents per resident per day. For rate years beginning on or after July 1, 1991, the adjusted equipment allowance must be adjusted annually for inflation as in Minnesota Rules, part 9549.0060, subpart 10, item E. For the rate period beginning October 1, 1992, the equipment allowance for each nursing facility shall be increased by 28 percent. For rate years beginning after June 30, 1993, the allowance must be adjusted annually for inflation.

(e) For rate years beginning on or after July 1, 1990, Minnesota Rules, part 9549.0060, subpart 5, item E, shall not apply to outstanding related organization debt incurred prior to May 23, 1983, provided that the debt was an allowable debt under Minnesota Rules, parts 9510.0010 to 9510.0480, the debt is subject to repayment through annual principal payments, and the nursing facility demonstrates to the commissioner's satisfaction that the interest rate on the debt was less than market interest rates for similar arm's-length transactions at the time the debt was incurred. If the debt was incurred due to a sale between family members, the nursing facility must also demonstrate that the seller no longer participates in the management or operation of the nursing facility. Debts meeting the conditions of this paragraph are subject to all other provisions of Minnesota Rules, parts 9549.0010 to 9549.0080.

(f) For rate years beginning on or after July 1, 1990, a nursing facility with operating lease costs incurred for the nursing facility's buildings shall receive its building capital allowance computed in accordance with Minnesota Rules, part 9549.0060, subpart 8. If an operating lease provides that the lessee's rent is adjusted to recognize improvements made by the lessor and related debt, the costs for capital improvements and related debt shall be allowed in the computation of the lessee's building capital allowance, provided that reimbursement for these costs under an operating lease shall not exceed the rate otherwise paid.

Subd. 3g.

Property costs after July 1, 1990, for certain facilities.

(a) For rate years beginning on or after July 1, 1990, nursing facilities that, on or after January 1, 1976, but prior to January 1, 1987, were newly licensed after new construction, or increased their licensed beds by a minimum of 35 percent through new construction, and whose building capital allowance is less than their allowable annual principal and interest on allowable debt prior to the application of the replacement-cost-new per bed limit and whose remaining weighted average debt amortization schedule as of January 1, 1988, exceeded 15 years, must receive a property-related payment rate equal to the greater of their rental per diem or their annual allowable principal and allowable interest without application of the replacement-cost-new per bed limit, divided by their capacity days as determined under Minnesota Rules, part 9549.0060, subpart 11, as modified by subdivision 3f, paragraph (c), for the preceding reporting year, plus their equipment allowance. A nursing facility that is eligible for a property-related payment rate under this subdivision and whose property-related payment rate in a subsequent rate year is its rental per diem must continue to have its property-related payment rates established for all future rate years based on the rental reimbursement method in Minnesota Rules, part 9549.0060.

The commissioner may require the nursing facility to apply for refinancing as a condition of receiving special rate treatment under this subdivision.

(b) If a nursing facility is eligible for a property-related payment rate under this subdivision, and the nursing facility's debt is refinanced after October 1, 1988, the provisions in paragraphs (1) to (7) also apply to the property-related payment rate for rate years beginning on or after July 1, 1990.

(1) A nursing facility's refinancing must not include debts with balloon payments.

(2) If the issuance costs, including issuance costs on the debt refinanced, are financed as part of the refinancing, the historical cost of capital assets limit in Minnesota Rules, part 9549.0060, subpart 5, item A, subitem (6), includes issuance costs that do not exceed seven percent of the debt refinanced, plus the related issuance costs. For purposes of this paragraph, issuance costs means the fees charged by the underwriter, issuer, attorneys, bond raters, appraisers, and trustees, and includes the cost of printing, title insurance, registration tax, and a feasibility study for the refinancing of a nursing facility's debt. Issuance costs do not include bond premiums or discounts when bonds are sold at other than their par value, points, or a bond reserve fund. To the extent otherwise allowed under this paragraph, the straight-line amortization of the refinancing issuance costs is not an allowable cost.

(3) The annual principal and interest expense payments and any required annual municipal fees on the nursing facility's refinancing replace those of the refinanced debt and, together with annual principal and interest payments on other allowable debts, are allowable costs subject to the limitation on historical cost of capital assets plus issuance costs as limited in paragraph (2), if any.

(4) If the nursing facility's refinancing includes zero coupon bonds, the commissioner shall establish a monthly debt service payment schedule based on an annuity that will produce an amount equal to the zero coupon bonds at maturity. The term and interest rate is the term and interest rate of the zero coupon bonds. Any refinancing to repay the zero coupon bonds is not an allowable cost.

(5) The annual amount of annuity payments is added to the nursing facility's allowable annual principal and interest payment computed in paragraph (3).

(6) The property-related payment rate is equal to the amount in paragraph (5), divided by the nursing facility's capacity days as determined under Minnesota Rules, part 9549.0060, subpart 11, as modified by subdivision 3f, paragraph (c), for the preceding reporting year plus an equipment allowance.

(7) Except as provided in this subdivision, the provisions of Minnesota Rules, part 9549.0060 apply.

Subd. 3i.

Property costs for the rate year beginning July 1, 1990.

Notwithstanding Minnesota Rules, part 9549.0060, subpart 13, item H, the commissioner shall determine property-related payment rates for nursing facilities for the rate year beginning July 1, 1990, as follows:

(a) The property-related payment rate for a nursing facility that qualifies under subdivision 3g is the greater of the rate determined under that subdivision or the rate determined under paragraph (c), (d), or (e), whichever is applicable.

(b) Nursing facilities shall be grouped according to the type of property-related payment rate the commissioner determined for the rate year beginning July 1, 1989. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item A (full rental reimbursement), shall be considered group A. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item B (phase-down to full rental reimbursement), shall be considered group B. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item C or D (phase-up to full rental reimbursement), shall be considered group C.

(c) For the rate year beginning July 1, 1990, a group A nursing facility shall receive its property-related payment rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.

(d) For the rate year beginning July 1, 1990, a Group B nursing facility shall receive the greater of 87 percent of the property-related payment rate in effect on July 1, 1989; or the rental per diem rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section in effect on July 1, 1990; or the sum of 100 percent of the nursing facility's allowable principal and interest expense, plus its equipment allowance multiplied by the resident days for the reporting year ending September 30, 1989, divided by the nursing facility's capacity days as determined under Minnesota Rules, part 9549.0060, subpart 11, as modified by subdivision 3f, paragraph (c); except that the nursing facility's property-related payment rate must not exceed its property-related payment rate in effect on July 1, 1989.

(e) For the rate year beginning July 1, 1990, a group C nursing facility shall receive its property-related payment rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section, except the rate must not exceed the lesser of its property-related payment rate determined for the rate year beginning July 1, 1989, multiplied by 116 percent or its rental per diem rate determined effective July 1, 1990.

(f) The property-related payment rate for a nursing facility that qualifies for a rate adjustment under Minnesota Rules, part 9549.0060, subpart 13, item G (special reappraisals), shall have the property-related payment rate determined in paragraphs (a) to (e) adjusted according to the provisions in that rule.

(g) Except as provided in subdivision 4, paragraph (f), and subdivision 11, a nursing facility that has a change in ownership or a reorganization of provider entity is subject to the provisions of Minnesota Rules, part 9549.0060, subpart 13, item F.

Subd. 13.

Hold-harmless property-related rates.

(a) Terms used in subdivisions 13 to 21 shall be as defined in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.

(b) Except as provided in this subdivision, for rate periods beginning on October 1, 1992, and for rate years beginning after June 30, 1993, the property-related rate for a nursing facility shall be the greater of $4 or the property-related payment rate in effect on September 30, 1992. In addition, the incremental increase in the nursing facility's rental rate will be determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.

(c) Notwithstanding Minnesota Rules, part 9549.0060, subpart 13, item F, a nursing facility that has a sale permitted under subdivision 14 after June 30, 1992, shall receive the property-related payment rate in effect at the time of the sale or reorganization. For rate periods beginning after October 1, 1992, and for rate years beginning after June 30, 1993, a nursing facility shall receive, in addition to its property-related payment rate in effect at the time of the sale, the incremental increase allowed under subdivision 14.

(d) For rate years beginning after June 30, 1993, the property-related rate for a nursing facility licensed after July 1, 1989, after relocating its beds from a separate nursing home to a building formerly used as a hospital and sold during the cost reporting year ending September 30, 1991, shall be its property-related rate prior to the sale in addition to the incremental increases provided under this section effective on October 1, 1992, of 29 cents per day, and any incremental increases after October 1, 1992, calculated by using its rental rate under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section, recognizing the current appraised value of the facility at the new location, and including as allowable debt otherwise allowable debt incurred to remodel the facility in the new location prior to the relocation of beds.

Subd. 15.

Capital repair and replacement cost reporting and rate calculation.

For rate years beginning after June 30, 1993, a nursing facility's capital repair and replacement payment rate shall be established annually as provided in paragraphs (a) to (e).

(a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 12, the costs of any of the following items not included in the equity incentive computations under subdivision 16 or reported as a capital asset addition under subdivision 18, paragraph (b), including cash payment for equity investment and principal and interest expense for debt financing, must be reported in the capital repair and replacement cost category:

(1) wall coverings;

(2) paint;

(3) floor coverings;

(4) window coverings;

(5) roof repair; and

(6) window repair or replacement.

(b) Notwithstanding Minnesota Rules, part 9549.0060, subpart 12, the repair or replacement of a capital asset not included in the equity incentive computations under subdivision 16 or reported as a capital asset addition under subdivision 18, paragraph (b), must be reported under this subdivision when the cost of the item exceeds $500, or in the plant operations and maintenance cost category when the cost of the item is equal to or less than $500.

(c) To compute the capital repair and replacement payment rate, the allowable annual repair and replacement costs for the reporting year must be divided by actual resident days for the reporting year. The annual allowable capital repair and replacement costs shall not exceed $150 per licensed bed. The excess of the allowed capital repair and replacement costs over the capital repair and replacement limit shall be a cost carryover to succeeding cost reporting periods, except that sale of a facility, under subdivision 14, shall terminate the carryover of all costs except those incurred in the most recent cost reporting year. The termination of the carryover shall have effect on the capital repair and replacement rate on the same date as provided in subdivision 14, paragraph (f), for the sale. For rate years beginning after June 30, 1994, the capital repair and replacement limit shall be subject to the index provided in subdivision 3f, paragraph (a). For purposes of this subdivision, the number of licensed beds shall be the number used to calculate the nursing facility's capacity days. The capital repair and replacement rate must be added to the nursing facility's total payment rate.

(d) Capital repair and replacement costs under this subdivision shall not be counted as either care-related or other operating costs, nor subject to care-related or other operating limits.

(e) If costs otherwise allowable under this subdivision are incurred as the result of a project approved under the moratorium exception process in section 144A.073, or in connection with an addition to or replacement of buildings, attached fixtures, or land improvements for which the total historical cost of these assets exceeds the lesser of $150,000 or ten percent of the nursing facility's appraised value, these costs must be claimed under subdivision 16 or 17, as appropriate.

Subd. 17.

Special provisions for moratorium exceptions.

Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, for rate periods beginning on October 1, 1992, and for rate years beginning after June 30, 1993, a nursing facility that (1) has completed a construction project approved under section 144A.071, subdivision 4a, clause (m); (2) has completed a construction project approved under section 144A.071, subdivision 4a, and effective after June 30, 1995; (3) has completed a construction project approved under section 144A.071, subdivision 4c; or (4) has completed a renovation, replacement, or upgrading project approved under the moratorium exception process in section 144A.073 shall be reimbursed for costs directly identified to that project as provided in subdivision 16 and subdivisions 17 to 17f.

Subd. 17a.

Allowable interest expense.

(a) Notwithstanding Minnesota Rules, part 9549.0060, subparts 5, item A, subitems (1) and (3), and 7, item D, allowable interest expense on debt shall include:

(1) interest expense on debt related to the cost of purchasing or replacing depreciable equipment, excluding vehicles, not to exceed ten percent of the total historical cost of the project; and

(2) interest expense on debt related to financing or refinancing costs, including costs related to points, loan origination fees, financing charges, legal fees, and title searches; and issuance costs including bond discounts, bond counsel, underwriter's counsel, corporate counsel, printing, and financial forecasts. Allowable debt related to items in this clause shall not exceed seven percent of the total historical cost of the project. To the extent these costs are financed, the straight-line amortization of the costs in this clause is not an allowable cost; and

(3) interest on debt incurred for the establishment of a debt reserve fund, net of the interest earned on the debt reserve fund.

(b) Debt incurred for costs under paragraph (a) is not subject to Minnesota Rules, part 9549.0060, subpart 5, item A, subitem (5) or (6).

Subd. 17c.

Replacement-costs-new per bed limit.

Notwithstanding subdivision 3f, paragraph (a), for rate periods beginning on October 1, 1992, and for rate years beginning after June 30, 1993, the replacement-costs-new per bed limit to be used in Minnesota Rules, part 9549.0060, subpart 4, item B, for a nursing facility that has completed a renovation, replacement, or upgrading project that has been approved under the moratorium exception process in section 144A.073, or that has completed an addition to or replacement of buildings, attached fixtures, or land improvements for which the total historical cost exceeds the lesser of $150,000 or ten percent of the most recent appraised value, must be $47,500 per licensed bed in multiple-bed rooms and $71,250 per licensed bed in a single-bed room. These amounts must be adjusted annually as specified in subdivision 3f, paragraph (a), beginning January 1, 1993.

Subd. 17d.

Determination of rental per diem for total replacement projects.

(a) For purposes of this subdivision, a total replacement means the complete replacement of the nursing facility's physical plant through the construction of a new physical plant, the transfer of the nursing facility's license from one physical plant location to another, or a new building addition to relocate beds from three- and four-bed wards. For total replacement projects completed on or after July 1, 1992, the commissioner shall compute the incremental change in the nursing facility's rental per diem, for rate years beginning on or after July 1, 1995, by replacing its appraised value, including the historical capital asset costs, and the capital debt and interest costs with the new nursing facility's allowable capital asset costs and the related allowable capital debt and interest costs. If the new nursing facility has decreased its licensed capacity, the aggregate investment per bed limit in subdivision 3a, paragraph (c), shall apply.

(b) If the new nursing facility has retained a portion of the original physical plant for nursing facility usage, then a portion of the appraised value prior to the replacement must be retained and included in the calculation of the incremental change in the nursing facility's rental per diem. For purposes of this subdivision, the original nursing facility means the nursing facility prior to the total replacement project. The portion of the appraised value to be retained shall be calculated according to clauses (1) to (3):

(1) The numerator of the allocation ratio shall be the square footage of the area in the original physical plant which is being retained for nursing facility usage.

(2) The denominator of the allocation ratio shall be the total square footage of the original nursing facility physical plant.

(3) Each component of the nursing facility's allowable appraised value prior to the total replacement project shall be multiplied by the allocation ratio developed by dividing clause (1) by clause (2).

(c) In the case of either type of total replacement as authorized under section 144A.071 or 144A.073, the provisions of subdivisions 17 to 17f shall also apply.

(d) For purposes of the moratorium exception authorized under section 144A.071, subdivision 4a, paragraph (s), if the total replacement involves the renovation and use of an existing health care facility physical plant, the new allowable capital asset costs and related debt and interest costs shall include first the allowable capital asset costs and related debt and interest costs of the renovation, to which shall be added the allowable capital asset costs of the existing physical plant prior to the renovation, and if reported by the facility, the related allowable capital debt and interest costs.

Subd. 17e.

Replacement-costs-new per bed limit effective October 1, 2007.

Notwithstanding Minnesota Rules, part 9549.0060, subpart 11, item C, subitem (2), for a total replacement, as defined in subdivision 17d, authorized under section 144A.071 or 144A.073 after July 1, 1999, any building project that is a relocation, renovation, upgrading, or conversion completed on or after July 1, 2001, or any building project eligible for reimbursement under section 256B.434, subdivision 4f, the replacement-costs-new per bed limit shall be $74,280 per licensed bed in multiple-bed rooms, $92,850 per licensed bed in semiprivate rooms with a fixed partition separating the resident beds, and $111,420 per licensed bed in single rooms. Minnesota Rules, part 9549.0060, subpart 11, item C, subitem (2), does not apply. These amounts must be adjusted annually as specified in subdivision 3f, paragraph (a), beginning January 1, 2000. These amounts must be increased annually as specified in subdivision 3f, paragraph (a), beginning October 1, 2012.

Subd. 18.

Updating appraisals, additions, and replacements.

(a) Notwithstanding Minnesota Rules, part 9549.0060, subparts 1 to 3, the appraised value, routine updating of the appraised value, and special reappraisals are subject to this subdivision.

For all rate years after June 30, 1993, the commissioner shall no longer conduct any appraisals under Minnesota Rules, part 9549.0060, for the purpose of determining property-related payment rates.

(b) Notwithstanding Minnesota Rules, part 9549.0060, subpart 2, for rate years beginning after June 30, 1993, the commissioner shall routinely update the appraised value of each nursing facility by adding the cost of capital asset acquisitions to its allowable appraised value.

The commissioner shall also annually index each nursing facility's allowable appraised value by the inflation index referenced in subdivision 3f, paragraph (a), for the purpose of computing the nursing facility's annual rental rate. In annually adjusting the nursing facility's appraised value, the commissioner must not include the historical cost of capital assets acquired during the reporting year in the nursing facility's appraised value.

In addition, the nursing facility's appraised value must be reduced by the historical cost of capital asset disposals or applicable credits such as public grants and insurance proceeds. Capital asset additions and disposals must be reported on the nursing facility's annual cost report in the reporting year of acquisition or disposal. The incremental increase in the nursing facility's rental rate resulting from this annual adjustment as determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section shall be added to the nursing facility's property-related payment rate for the rate year following the reporting year.

Subd. 21.

Indexing thresholds.

Beginning January 1, 1993, and each January 1 thereafter, the commissioner shall annually update the dollar thresholds in subdivisions 15, paragraph (e), 16, and 17, and in section 144A.071, subdivisions 2 and 4a, clauses (b) and (e), by the inflation index referenced in subdivision 3f, paragraph (a).

Subd. 22.

Changes to nursing facility reimbursement.

In the determination of incremental increases in the nursing facility's rental rate as required in subdivisions 14 to 21, except for a refinancing permitted under subdivision 19, the commissioner must adjust the nursing facility's property-related payment rate for both incremental increases and decreases in recomputations of its rental rate.

Subd. 30.

Bed layaway and delicensure.

(a) For rate years beginning on or after July 1, 2000, a nursing facility reimbursed under this section which has placed beds on layaway shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph (c), and calculation of the rental per diem, have those beds given the same effect as if the beds had been delicensed so long as the beds remain on layaway. At the time of a layaway, a facility may change its single bed election for use in calculating capacity days under Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be effective the first day of the month of January or July, whichever occurs first following the date on which the layaway of the beds becomes effective under section 144A.071, subdivision 4b.

(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to the contrary under section 256B.434 or chapter 256R, a nursing facility reimbursed under that section or chapter that has placed beds on layaway shall, for so long as the beds remain on layaway, be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the layaway and the number of beds after the layaway.

The commissioner shall increase the facility's property payment rate by the incremental increase in the rental per diem resulting from the recalculation of the facility's rental per diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and (3). If a facility reimbursed under section 256B.434 or chapter 256R completes a moratorium exception project after its base year, the base year property rate shall be the moratorium project property rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4, paragraph (c). The property payment rate increase shall be effective the first day of the month of January or July, whichever occurs first following the date on which the layaway of the beds becomes effective.

(c) If a nursing facility removes a bed from layaway status in accordance with section 144A.071, subdivision 4b, the commissioner shall establish capacity days based on the number of licensed and certified beds in the facility not on layaway and shall reduce the nursing facility's property payment rate in accordance with paragraph (b).

(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision to the contrary under section 256B.434 or chapter 256R, a nursing facility reimbursed under that section or chapter that has delicensed beds after July 1, 2000, by giving notice of the delicensure to the commissioner of health according to the notice requirements in section 144A.071, subdivision 4b, shall be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the delicensure and the number of beds after the delicensure.

The commissioner shall increase the facility's property payment rate by the incremental increase in the rental per diem resulting from the recalculation of the facility's rental per diem applying only the changes resulting from the delicensure of beds and clauses (1), (2), and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception project after its base year, the base year property rate shall be the moratorium project property rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4, paragraph (c). The property payment rate increase shall be effective the first day of the month of January or July, whichever occurs first following the date on which the delicensure of the beds becomes effective.

(e) For nursing facilities reimbursed under this section, section 256B.434, or chapter 256R, any beds placed on layaway shall not be included in calculating facility occupancy as it pertains to leave days defined in Minnesota Rules, part 9505.0415.

(f) For nursing facilities reimbursed under this section, section 256B.434, or chapter 256R, the rental rate calculated after placing beds on layaway may not be less than the rental rate prior to placing beds on layaway.

(g) A nursing facility receiving a rate adjustment as a result of this section shall comply with section 256R.06, subdivision 5.

(h) A facility that does not utilize the space made available as a result of bed layaway or delicensure under this subdivision to reduce the number of beds per room or provide more common space for nursing facility uses or perform other activities related to the operation of the nursing facility shall have its property rate increase calculated under this subdivision reduced by the ratio of the square footage made available that is not used for these purposes to the total square footage made available as a result of bed layaway or delicensure.

Subd. 45.

Rate adjustments for some moratorium exception projects.

Notwithstanding any other law to the contrary, money available for moratorium exception projects under section 144A.073, subdivisions 2 and 11, shall be used to fund the incremental rate increases resulting from this section for any nursing facility with a moratorium exception project approved under section 144A.073, and completed after August 30, 2010, where the replacement-costs-new limits under subdivision 17e were higher at any time after project approval than at the time of project completion. The commissioner shall calculate the property rate increase for these facilities using the highest set of limits; however, any rate increase under this section shall not be effective until on or after the effective date of this section, contingent upon federal approval. No property rate decrease shall result from this section.

256B.434 ALTERNATIVE PAYMENT DEMONSTRATION PROJECT.

Subd. 4.

Alternate rates for nursing facilities.

Effective for the rate years beginning on and after January 1, 2019, a nursing facility's property payment rate for the second and subsequent years of a facility's contract under this section are the previous rate year's property payment rate plus an inflation adjustment. The index for the inflation adjustment must be based on the change in the Consumer Price Index-All Items (United States City average) (CPI-U) forecasted by the Reports and Forecasts Division of the Department of Human Services, as forecasted in the fourth quarter of the calendar year preceding the rate year. The inflation adjustment must be based on the 12-month period from the midpoint of the previous rate year to the midpoint of the rate year for which the rate is being determined.

Subd. 4f.

Construction project rate adjustments effective October 1, 2006.

(a) Effective October 1, 2006, facilities reimbursed under this section may receive a property rate adjustment for construction projects exceeding the threshold in section 256B.431, subdivision 16, and below the threshold in section 144A.071, subdivision 2, clause (a). For these projects, capital assets purchased shall be counted as construction project costs for a rate adjustment request made by a facility if they are: (1) purchased within 24 months of the completion of the construction project; (2) purchased after the completion date of any prior construction project; and (3) are not purchased prior to July 14, 2005. Except as otherwise provided in this subdivision, the definitions, rate calculation methods, and principles in sections 144A.071 and 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, shall be used to calculate rate adjustments for allowable construction projects under this subdivision and section 144A.073. Facilities completing construction projects between October 1, 2005, and October 1, 2006, are eligible to have a property rate adjustment effective October 1, 2006. Facilities completing projects after October 1, 2006, are eligible for a property rate adjustment effective on the first day of the month following the completion date. Facilities completing projects after January 1, 2018, are eligible for a property rate adjustment effective on the first day of the month of January or July, whichever occurs immediately following the completion date.

(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a construction project on or after October 1, 2004, and do not have a contract under subdivision 3 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431, subdivision 10, through September 30, 2006. If the request results in the commissioner determining a rate adjustment is allowable, the rate adjustment is effective on the first of the month following project completion. These facilities shall be allowed to accumulate construction project costs for the period October 1, 2004, to September 30, 2006.

(c) Facilities shall be allowed construction project rate adjustments no sooner than 12 months after completing a previous construction project. Facilities must request the rate adjustment according to section 256B.431, subdivision 10.

(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060, subpart 11. For rate calculations under this section, the number of licensed beds in the nursing facility shall be the number existing after the construction project is completed and the number of days in the nursing facility's reporting period shall be 365.

(e) The value of assets to be recognized for a total replacement project as defined in section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value of assets to be recognized for all other projects shall be computed as described in clause (2).

(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the maximum amount of assets allowable in a facility's property rate calculation. If a facility's current request for a rate adjustment results from the completion of a construction project that was previously approved under section 144A.073, the assets to be used in the rate calculation cannot exceed the lesser of the amount determined under sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction project. A current request that is not the result of a project under section 144A.073 cannot exceed the limit under section 144A.071, subdivision 2, paragraph (a). Applicable credits must be deducted from the cost of the construction project.

(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be used to compute the maximum amount of assets allowable in a facility's property rate calculation.

(ii) The value of a facility's assets to be compared to the amount in item (i) begins with the total appraised value from the last rate notice a facility received when its rates were set under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each rate year the facility received an inflation factor on its property-related rate when its rates were set under this section. The value of assets listed as previous capital additions, capital additions, and special projects on the facility's base year rate notice and the value of assets related to a construction project for which the facility received a rate adjustment when its rates were determined under this section shall be added to the indexed appraised value.

(iii) The maximum amount of assets to be recognized in computing a facility's rate adjustment after a project is completed is the lesser of the aggregate replacement-cost-new limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the construction project.

(iv) If a facility's current request for a rate adjustment results from the completion of a construction project that was previously approved under section 144A.073, the assets to be added to the rate calculation cannot exceed the lesser of the amount determined under sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction project. A current request that is not the result of a project under section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2, paragraph (a). Assets disposed of as a result of a construction project and applicable credits must be deducted from the cost of the construction project.

(f) For construction projects approved under section 144A.073, allowable debt may never exceed the lesser of the cost of the assets purchased, the threshold limit in section 144A.071, subdivision 2, or the replacement-cost-new limit less previously existing capital debt.

(g) For construction projects that were not approved under section 144A.073, allowable debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously existing capital debt. Amounts of debt taken out that exceed the costs of a construction project shall not be allowed regardless of the use of the funds.

For all construction projects being recognized, interest expense and average debt shall be computed based on the first 12 months following project completion. "Previously existing capital debt" means capital debt recognized on the last rate determined under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt recognized for a construction project for which the facility received a rate adjustment when its rates were determined under this section.

For a total replacement project as defined in section 256B.431, subdivision 17d, the value of previously existing capital debt shall be zero.

(h) In addition to the interest expense allowed from the application of paragraph (f), the amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and (3), will be added to interest expense.

(i) The equity portion of the construction project shall be computed as the allowable assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added. This sum must be divided by 95 percent of capacity days to compute the construction project rate adjustment.

(j) For projects that are not a total replacement of a nursing facility, the amount in paragraph (i) is adjusted for nonreimbursable areas and then added to the current property payment rate of the facility.

(k) For projects that are a total replacement of a nursing facility, the amount in paragraph (i) becomes the new property payment rate after being adjusted for nonreimbursable areas. Any amounts existing in a facility's rate before the effective date of the construction project for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431, subdivision 19, shall be removed from the facility's rates.

(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060, subpart 10, as the result of construction projects under this section. Allowable equipment shall be included in the construction project costs.

(m) Capital assets purchased after the completion date of a construction project shall be counted as construction project costs for any future rate adjustment request made by a facility under section 144A.071, subdivision 2, clause (a), if they are purchased within 24 months of the completion of the future construction project.

(n) In subsequent rate years, the property payment rate for a facility that results from the application of this subdivision shall be the amount inflated in subdivision 4.

(o) Construction projects are eligible for an equity incentive under section 256B.431, subdivision 16. When computing the equity incentive for a construction project under this subdivision, only the allowable costs and allowable debt related to the construction project shall be used. The equity incentive shall not be a part of the property payment rate and not inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing facilities reimbursed under this section shall be allowed for a duration determined under section 256B.431, subdivision 16, paragraph (c).

Subd. 4i.

Construction project rate adjustments for certain nursing facilities.

(a) This subdivision applies to nursing facilities with at least 120 active beds as of January 1, 2015, that have projects approved in 2015 under the nursing facility moratorium exception process in section 144A.073. When each facility's moratorium exception construction project is completed, the facility must receive the rate adjustment allowed under subdivision 4f. In addition to that rate adjustment, facilities with at least 120 active beds, but not more than 149 active beds, as of January 1, 2015, must have their construction project rate adjustment increased by an additional $4; and facilities with at least 150 active beds, but not more than 160 active beds, as of January 1, 2015, must have their construction project rate adjustment increased by an additional $12.50.

(b) Notwithstanding any other law to the contrary, money available under section 144A.073, subdivision 11, after the completion of the moratorium exception approval process in 2015 under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the medical assistance budget for the increases allowed in this subdivision.

Subd. 4j.

Construction project rate increase for certain nursing facilities.

(a) This subdivision applies to nursing facilities:

(1) located in Ramsey County;

(2) with at least 130 active beds as of September 30, 2017;

(3) with a portion of beds dually certified for Medicare and Medicaid and a portion of beds certified for Medicaid only; and

(4) with debt service payments that are not being covered by the existing property payment rate on September 30, 2017.

(b) The commissioner shall increase the property rate of each facility meeting the qualifications of this subdivision by $7.55.

(c) Notwithstanding any other law to the contrary, money available under section 144A.073, subdivision 15, after the completion of the 2018 moratorium exception approval process under section 144A.073, subdivision 3, shall be used to pay the medical assistance cost for the property rate increase in this subdivision.

256L.11 PROVIDER PAYMENT.

Subd. 6a.

Dental providers.

Effective for dental services provided to MinnesotaCare enrollees on or after January 1, 2018, the commissioner shall increase payment rates to dental providers by 54 percent. Payments made to prepaid health plans under section 256L.12 shall reflect the payment increase described in this subdivision. The prepaid health plans under contract with the commissioner shall provide payments to dental providers that are at least equal to a rate that includes the payment rate specified in this subdivision, and if applicable to the provider, the rates described under subdivision 7.

256R.36 HOLD HARMLESS.

No nursing facility's operating payment rate, plus its employer health insurance costs portion of the external fixed costs payment rate, will be less than its prior system operating cost payment rate.

256R.40 NURSING FACILITY VOLUNTARY CLOSURE; ALTERNATIVES.

Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Closure" means the cessation of operations of a nursing facility and delicensure and decertification of all beds within the facility.

(c) "Closure plan" means a plan to close a nursing facility and reallocate a portion of the resulting savings to provide planned closure rate adjustments at other facilities.

(d) "Commencement of closure" means the date on which residents and designated representatives are notified of a planned closure as provided in section 144A.161, subdivision 5a, as part of an approved closure plan.

(e) "Completion of closure" means the date on which the final resident of the nursing facility designated for closure in an approved closure plan is discharged from the facility or the date that beds from a partial closure are delicensed and decertified.

(f) "Partial closure" means the delicensure and decertification of a portion of the beds within the facility.

(g) "Planned closure rate adjustment" means an increase in a nursing facility's operating rates resulting from a planned closure or a planned partial closure of another facility.

Subd. 2.

Applications for planned closure rate.

(a) To be considered for approval of a planned closure, an application must include:

(1) a description of the proposed closure plan, which must include identification of the facility or facilities to receive a planned closure rate adjustment;

(2) the proposed timetable for any proposed closure, including the proposed dates for announcement to residents, commencement of closure, and completion of closure;

(3) if available, the proposed relocation plan for current residents of any facility designated for closure. If a relocation plan is not available, the application must include a statement agreeing to develop a relocation plan designed to comply with section 144A.161;

(4) a description of the relationship between the nursing facility that is proposed for closure and the nursing facility or facilities proposed to receive the planned closure rate adjustment. If these facilities are not under common ownership, copies of any contracts, purchase agreements, or other documents establishing a relationship or proposed relationship must be provided; and

(5) documentation, in a format approved by the commissioner, that all the nursing facilities receiving a planned closure rate adjustment under the plan have accepted joint and several liability for recovery of overpayments under section 256B.0641, subdivision 2, for the facilities designated for closure under the plan.

(b) The application must also address the criteria listed in subdivision 3.

Subd. 3.

Criteria for review of application.

In reviewing and approving closure proposals, the commissioner shall consider, but not be limited to, the following criteria:

(1) improved quality of care and quality of life for consumers;

(2) closure of a nursing facility that has a poor physical plant;

(3) the existence of excess nursing facility beds, measured in terms of beds per thousand persons aged 85 or older. The excess must be measured in reference to:

(i) the county in which the facility is located. A facility in a county that is in the lowest quartile of counties with reference to beds per thousand persons aged 85 or older is not in an area of excess capacity;

(ii) the county and all contiguous counties;

(iii) the region in which the facility is located; or

(iv) the facility's service area. The facility shall indicate in its application the service area it believes is appropriate for this measurement;

(4) low-occupancy rates, provided that the unoccupied beds are not the result of a personnel shortage. In analyzing occupancy rates, the commissioner shall examine waiting lists in the applicant facility and at facilities in the surrounding area, as determined under clause (3);

(5) evidence of coordination between the community planning process and the facility application. If the planning group does not support a level of nursing facility closures that the commissioner considers to be reasonable, the commissioner may approve a planned closure proposal without its support;

(6) proposed usage of funds available from a planned closure rate adjustment for care-related purposes;

(7) innovative use planned for the closed facility's physical plant;

(8) evidence that the proposal serves the interests of the state; and

(9) evidence of other factors that affect the viability of the facility, including excessive nursing pool costs.

Subd. 4.

Review and approval of applications.

(a) The commissioner, in consultation with the commissioner of health, shall approve or deny an application within 30 days after receiving it. The commissioner may appoint an advisory review panel composed of representatives of counties, consumers, and providers to review proposals and provide comments and recommendations to the committee. The commissioners of human services and health shall provide staff and technical assistance to the committee for the review and analysis of proposals.

(b) Approval of a planned closure expires 18 months after approval by the commissioner unless commencement of closure has begun.

(c) The commissioner may change any provision of the application to which the applicant, the regional planning group, and the commissioner agree.

Subd. 5.

Planned closure rate adjustment.

(a) The commissioner shall calculate the amount of the planned closure rate adjustment available under subdivision 6 according to clauses (1) to (4):

(1) the amount available is the net reduction of nursing facility beds multiplied by $2,080;

(2) the total number of beds in the nursing facility or facilities receiving the planned closure rate adjustment must be identified;

(3) capacity days are determined by multiplying the number determined under clause (2) by 365; and

(4) the planned closure rate adjustment is the amount available in clause (1), divided by capacity days determined under clause (3).

(b) A planned closure rate adjustment under this section is effective on the first day of the month of January or July, whichever occurs immediately following completion of closure of the facility designated for closure in the application and becomes part of the nursing facility's external fixed payment rate.

(c) Upon the request of a closing facility, the commissioner must allow the facility a closure rate adjustment as provided under section 144A.161, subdivision 10.

(d) A facility that has received a planned closure rate adjustment may reassign it to another facility that is under the same ownership at any time within three years of its effective date. The amount of the adjustment is computed according to paragraph (a).

(e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, the commissioner shall recalculate planned closure rate adjustments for facilities that delicense beds under this section on or after July 1, 2001, to reflect the increase in the per bed dollar amount. The recalculated planned closure rate adjustment is effective from the date the per bed dollar amount is increased.

Subd. 6.

Assignment of closure rate to another facility.

A facility or facilities reimbursed under this chapter with a closure plan approved by the commissioner under subdivision 4 may assign a planned closure rate adjustment to another facility or facilities that are not closing or in the case of a partial closure, to the facility undertaking the partial closure. A facility may also elect to have a planned closure rate adjustment shared equally by the five nursing facilities with the lowest total operating payment rates in the state development region designated under section 462.385, in which the facility that is closing is located. The planned closure rate adjustment must be calculated under subdivision 5. Facilities that delicense beds without a closure plan, or whose closure plan is not approved by the commissioner, are not eligible to assign a planned closure rate adjustment under subdivision 5, unless they: (1) are delicensing five or fewer beds, or less than six percent of their total licensed bed capacity, whichever is greater; (2) are located in a county in the top three quartiles of beds per 1,000 persons aged 65 or older; and (3) have not delicensed beds in the prior three months. Facilities meeting these criteria are eligible to assign the amount calculated under subdivision 5 to themselves. If a facility is delicensing the greater of six or more beds, or six percent or more of its total licensed bed capacity, and does not have an approved closure plan or is not eligible for the adjustment under subdivision 5, the commissioner shall calculate the amount the facility would have been eligible to assign under subdivision 5, and shall use this amount to provide equal rate adjustments to the five nursing facilities with the lowest total operating payment rates in the state development region designated under section 462.385, in which the facility that delicensed beds is located.

Subd. 7.

Other rate adjustments.

Facilities receiving planned closure rate adjustments remain eligible for any applicable rate adjustments provided under this chapter.

256R.41 SINGLE-BED ROOM INCENTIVE.

(a) Beginning July 1, 2005, the operating payment rate for nursing facilities reimbursed under this chapter shall be increased by 20 percent multiplied by the ratio of the number of new single-bed rooms created divided by the number of active beds on July 1, 2005, for each bed closure that results in the creation of a single-bed room after July 1, 2005. The commissioner may implement rate adjustments for up to 3,000 new single-bed rooms each year. For eligible bed closures for which the commissioner receives a notice from a facility that a bed has been delicensed and a new single-bed room has been established, the rate adjustment in this paragraph shall be effective on either the first day of the month of January or July, whichever occurs first following the date of the bed delicensure.

(b) A nursing facility is prohibited from discharging residents for purposes of establishing single-bed rooms. A nursing facility must submit documentation to the commissioner in a form prescribed by the commissioner, certifying the occupancy status of beds closed to create single-bed rooms. In the event that the commissioner determines that a facility has discharged a resident for purposes of establishing a single-bed room, the commissioner shall not provide a rate adjustment under paragraph (a).

Repealed Minnesota Session Laws: 19-0023

Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 10

Sec. 3. new text begin COMMISSIONER OF HUMAN SERVICESnew text end

new text begin Subd. 10. new text end

new text begin State-Operated Services new text end

new text begin new text begin Obsolete Laundry Depreciation Account.new text end $669,000, or the balance, whichever is greater, must be transferred from the state-operated services laundry depreciation account in the special revenue fund and deposited into the general fund by June 30, 2010. This paragraph is effective the day following final enactment. new text end

new text begin new text begin Operating Budget Reductions.new text end No operating budget reductions enacted in Laws 2010, chapter 200, or in this act shall be allocated to state-operated services. new text end

new text begin new text begin Prohibition on Transferring Funds.new text end The commissioner shall not transfer mental health grants to state-operated services without specific legislative approval. Notwithstanding any contrary provision in this article, this paragraph shall not expire. new text end

new text begin (a) Adult Mental Health Services new text end new text begin -0- new text end new text begin 6,888,000 new text end

new text begin Base Adjustment. The general fund base is decreased by $12,286,000 in fiscal year 2012 and $12,394,000 in fiscal year 2013. new text end

new text begin new text begin Appropriation Requirements. new text end (a) The general fund appropriation to the commissioner includes funding for the following: new text end

new text begin (1) to a community collaborative to begin providing crisis center services in the Mankato area that are comparable to the crisis services provided prior to the closure of the Mankato Crisis Center. The commissioner shall recruit former employees of the Mankato Crisis Center who were recently laid off to staff the new crisis services. The commissioner shall obtain legislative approval prior to discontinuing this funding; new text end

new text begin (2) to maintain the building in Eveleth that currently houses community transition services and to establish a psychiatric intensive therapeutic foster home as an enterprise activity. The commissioner shall request a waiver amendment to allow CADI funding for psychiatric intensive therapeutic foster care services provided in the same location and building as the community transition services. If the federal government does not approve the waiver amendment, the commissioner shall continue to pay the lease for the building out of the state-operated services budget until the commissioner of administration subleases the space or until the lease expires, and shall establish the psychiatric intensive therapeutic foster home at a different site. The commissioner shall make diligent efforts to sublease the space; new text end

new text begin (3) to convert the community behavioral health hospitals in Wadena and Willmar to facilities that provide more suitable services based on the needs of the community, which may include, but are not limited to, psychiatric extensive recovery treatment services. The commissioner may also establish other community-based services in the Willmar and Wadena areas that deliver the appropriate level of care in response to the express needs of the communities. The services established under this provision must be staffed by state employees. new text end

new text begin (4) to continue the operation of the dental clinics in Brainerd, Cambridge, Faribault, Fergus Falls, and Willmar at the same level of care and staffing that was in effect on March 1, 2010. The commissioner shall not proceed with the planned closure of the dental clinics, and shall not discontinue services or downsize any of the state-operated dental clinics without specific legislative approval. The commissioner shall continue to bill for services provided to obtain medical assistance critical access dental payments and cost-based payment rates as provided in Minnesota Statutes, section 256B.76, subdivision 2, and shall bill for services provided three months retroactively from the date of this act. This appropriation is onetime; new text end

new text begin (5) to convert the Minnesota Neurorehabilitation Hospital in Brainerd to a neurocognitive psychiatric extensive recovery treatment service; and new text end

new text begin (6) to convert the Minnesota extended treatment options (METO) program to the following community-based services provided by state employees: (i) psychiatric extensive recovery treatment services; (ii) intensive transitional foster homes as enterprise activities; and (iii) other community-based support services. The provisions under Minnesota Statutes, section 252.025, subdivision 7, are applicable to the METO services established under this clause. Notwithstanding Minnesota Statutes, section 246.18, subdivision 8, any revenue lost to the general fund by the conversion of METO to new services must be replaced by revenue from the new services to offset the lost revenue to the general fund until June 30, 2013. Any revenue generated in excess of this amount shall be deposited into the special revenue fund under Minnesota Statutes, section 246.18, subdivision 8. new text end

new text begin (b) The commissioner shall not move beds from the Anoka-Metro Regional Treatment Center to the psychiatric nursing facility at St. Peter without specific legislative approval. new text end

new text begin (c) The commissioner shall implement changes, including the following, to save a minimum of $6,006,000 beginning in fiscal year 2011, and report to the legislature the specific initiatives implemented and the savings allocated to each one, including: new text end

new text begin (1) maximizing budget savings through strategic employee staffing; and new text end

new text begin (2) identifying and implementing cost reductions in cooperation with state-operated services employees. new text end

new text begin Base level funding is reduced by $6,006,000 effective fiscal year 2011. new text end

new text begin (d) The commissioner shall seek certification or approval from the federal government for the new services under paragraph (a) that are eligible for federal financial participation and deposit the revenue associated with these new services in the account established under Minnesota Statutes, section 246.18, subdivision 8, unless otherwise specified. new text end

new text begin (e) Notwithstanding any contrary provision in this article, this rider shall not expire. new text end

new text begin (b) Minnesota Sex Offender Services new text end new text begin -0- new text end new text begin (145,000) new text end

new text begin Sex Offender Services. Base level funding for Minnesota sex offender services is reduced by $418,000 in fiscal year 2012 and $419,000 in fiscal year 2013 for the 50-bed sex offender treatment program within the Moose Lake correctional facility in which Department of Human Services staff from Minnesota sex offender services provide clinical treatment to incarcerated offenders. This reduction shall become part of the base for the Department of Human Services. new text end

new text begin Interagency Agreements. The commissioner of human services may enter into interagency agreements with the commissioner of corrections to continue sex offender treatment and chemical dependency treatment on a cost-sharing basis, in which each department pays 50 percent of the costs of these services. new text end

new text begin Base Adjustment. The general fund base is increased by $418,000 in fiscal year 2012 and $419,000 in fiscal year 2013. new text end

Repealed Minnesota Rule: 19-0023

2960.3030 CAPACITY LIMITS.

Subp. 3.

Exceptions to capacity limits.

A variance may be granted to allow up to eight foster children in addition to the license holder's own children if the conditions in items A to E are met:

A.

placement is necessary to keep a sibling group together, to keep a child in the child's home community, or is necessary because the foster child was formerly living in the home and it would be in the child's best interest to be placed there again;

B.

there is no risk of harm to the children currently in the home;

C.

the structural characteristics of the home, including sleeping space, can accommodate the additional foster children;

D.

the home remains in compliance with applicable zoning, health, fire, and building codes; and

E.

the statement of intended use states the conditions for the exception to capacity limits and explains how the license holder will maintain a ratio of adults to children which ensures the safety and appropriate supervision of all the children in the foster home.

A foster home licensed by the Department of Corrections need not meet the requirement in item A.

3400.0185 TERMINATION AND ADVERSE ACTIONS; NOTICE REQUIRED.

Subp. 5.

Notice to providers of actions adverse to the provider.

The county must give a provider written notice of the following actions adverse to the provider: a denial of authorization, a termination of authorization, a reduction in the number of hours of care with that provider, and a determination that the provider has an overpayment. The notice must include the following information:

A.

a description of the adverse action;

B.

the effective date of the adverse action; and

C.

a statement that unless a family appeals the adverse action before the effective date or the provider appeals the overpayment determination, the adverse action will occur on the effective date. The notice must be mailed to the provider at least 15 calendar days before the effective date of the adverse action.

6400.6970 FEES.

Subpart 1.

Payment types and nonrefundability.

The fees imposed in this part shall be paid by cash, personal check, bank draft, cashier's check, or money order made payable to the Board of Examiners for Nursing Home Administrators. All fees are nonrefundable.

Subp. 2.

Amounts.

The amount of fees may be set by the board with the approval of the Department of Management and Budget up to the limits provided in this part depending upon the total amount required to sustain board operations under Minnesota Statutes, section 16A.1285, subdivision 2. Information about fees in effect at any time is available from the board office. The maximum amounts of fees are:

A.

application for licensure, $150;

B.

for a prospective applicant for a review of education and experience advisory to the license application, $50, to be applied to the fee for application for licensure if the latter is submitted within one year of the request for review of education and experience;

C.

state examination, $75;

D.

initial license, $200 if issued between July 1 and December 31, $100 if issued between January 1 and June 30;

E.

acting administrator permit, $250;

F.

renewal license, $200;

G.

duplicate license, $10;

H.

fee to a sponsor for review of individual continuing education seminars, institutes, workshops, or home study courses:

(1)

for less than seven clock hours, $30; and

(2)

for seven or more clock hours, $50;

I.

fee to a licensee for review of continuing education seminars, institutes, workshops, or home study courses not previously approved for a sponsor and submitted with an application for license renewal:

(1)

for less than seven clock hours total, $30; and

(2)

for seven or more clock hours total, $50;

J.

late renewal fee, $50;

K.

fee to a licensee for verification of licensure status and examination scores, $30; and

L.

registration as a registered continuing education sponsor, $1,000.

7200.6100 FEES.

The nonrefundable fees for licensure payable to the board are as follows:

A.

application for admission to national standardized examination, $150;

B.

application for professional responsibility examination, $150;

C.

application for licensure as a licensed psychologist, $500;

D.

renewal of license for a licensed psychologist, $500;

E.

late renewal of license for a licensed psychologist, $250;

F.

application for converting from master's to doctoral level licensure, $150; and

G.

application for guest licensure, $150.

7200.6105 CONTINUING EDUCATION SPONSOR FEE.

A sponsor applying for approval of a continuing education activity pursuant to part 7200.3830, subpart 2, shall submit with the application a fee of $80 for each activity.

9502.0425 PHYSICAL ENVIRONMENT.

Subp. 4.

Means of escape.

From each room of the residence used by children, there must be two means of escape. One means of escape must be a stairway or door leading to the floor of exit discharge. The other must be a door or window leading directly outside. The window must be openable without special knowledge. It must have a clear opening of not less than 5.7 square feet and have a minimum clear opening dimension of 20 inches wide and 24 inches high. The window must be within 48 inches from the floor.

Subp. 16.

Extinguishers.

A portable, operational, multipurpose, dry chemical fire extinguisher with a minimum 2 A 10 BC rating must be maintained in the kitchen and cooking areas of the residence at all times. All caregivers shall know how to use the fire extinguisher.

Subp. 17.

Smoke detection systems.

Smoke detectors that have been listed by the Underwriter Laboratory must be properly installed and maintained on all levels.

9503.0155 FACILITY.

Subp. 8.

Telephone; posted numbers.

A telephone that is not coin operated must be located within the center. A list of emergency numbers must be posted next to the telephone. If a 911 emergency number is not available, the numbers listed must be those of the local fire department, police department, emergency transportation, and poison control center.

9505.0370 DEFINITIONS.

Subpart 1.

Scope.

For parts 9505.0370 to 9505.0372, the following terms have the meanings given them.

Subp. 2.

Adult day treatment.

"Adult day treatment" or "adult day treatment program" means a structured program of treatment and care.

Subp. 3.

Child.

"Child" means a person under 18 years of age.

Subp. 4.

Client.

"Client" means an eligible recipient who is determined to have or who is being assessed for a mental illness as specified in part 9505.0371.

Subp. 5.

Clinical summary.

"Clinical summary" means a written description of a clinician's formulation of the cause of the client's mental health symptoms, the client's prognosis, and the likely consequences of the symptoms; how the client meets the criteria for the diagnosis by describing the client's symptoms, the duration of symptoms, and functional impairment; an analysis of the client's other symptoms, strengths, relationships, life situations, cultural influences, and health concerns and their potential interaction with the diagnosis and formulation of the client's mental health condition; and alternative diagnoses that were considered and ruled out.

Subp. 6.

Clinical supervision.

"Clinical supervision" means the documented time a clinical supervisor and supervisee spend together to discuss the supervisee's work, to review individual client cases, and for the supervisee's professional development. It includes the documented oversight and supervision responsibility for planning, implementation, and evaluation of services for a client's mental health treatment.

Subp. 7.

Clinical supervisor.

"Clinical supervisor" means the mental health professional who is responsible for clinical supervision.

Subp. 8.

Cultural competence or culturally competent.

"Cultural competence" or "culturally competent" means the mental health provider's:

A.

awareness of the provider's own cultural background, and the related assumptions, values, biases, and preferences that influence assessment and intervention processes;

B.

ability and will to respond to the unique needs of an individual client that arise from the client's culture;

C.

ability to utilize the client's culture as a resource and as a means to optimize mental health care; and

D.

willingness to seek educational, consultative, and learning experiences to expand knowledge of and increase effectiveness with culturally diverse populations.

Subp. 9.

Cultural influences.

"Cultural influences" means historical, geographical, and familial factors that affect assessment and intervention processes. Cultural influences that are relevant to the client may include the client's:

A.

racial or ethnic self-identification;

B.

experience of cultural bias as a stressor;

C.

immigration history and status;

D.

level of acculturation;

E.

time orientation;

F.

social orientation;

G.

verbal communication style;

H.

locus of control;

I.

spiritual beliefs; and

J.

health beliefs and the endorsement of or engagement in culturally specific healing practices.

Subp. 10.

Culture.

"Culture" means the distinct ways of living and understanding the world that are used by a group of people and are transmitted from one generation to another or adopted by an individual.

Subp. 11.

Diagnostic assessment.

"Diagnostic assessment" means a written assessment that documents a clinical and functional face-to-face evaluation of the client's mental health, including the nature, severity and impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies the client's strengths and resources.

Subp. 12.

Dialectical behavior therapy.

"Dialectical behavior therapy" means an evidence-based treatment approach provided in an intensive outpatient treatment program using a combination of individualized rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program is certified by the commissioner and involves the following service components: individual dialectical behavior therapy, group skills training, telephone coaching, and team consultation meetings.

Subp. 13.

Explanation of findings.

"Explanation of findings" means the explanation of a client's diagnostic assessment, psychological testing, treatment program, and consultation with culturally informed mental health consultants as required under parts 9520.0900 to 9520.0926, or other accumulated data and recommendations to the client, client's family, primary caregiver, or other responsible persons.

Subp. 14.

Family.

"Family" means a person who is identified by the client or the client's parent or guardian as being important to the client's mental health treatment. Family may include, but is not limited to, parents, children, spouse, committed partners, former spouses, persons related by blood or adoption, or persons who are presently residing together as a family unit.

Subp. 15.

Individual treatment plan.

"Individual treatment plan" means a written plan that outlines and defines the course of treatment. It delineates the goals, measurable objectives, target dates for achieving specific goals, main participants in treatment process, and recommended services that are based on the client's diagnostic assessment and other meaningful data that are needed to aid the client's recovery and enhance resiliency.

Subp. 16.

Medication management.

"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.

Subp. 17.

Mental health practitioner.

"Mental health practitioner" means a person who is qualified according to part 9505.0371, subpart 5, items B and C, and provides mental health services to a client with a mental illness under the clinical supervision of a mental health professional.

Subp. 18.

Mental health professional.

"Mental health professional" means a person who is enrolled to provide medical assistance services and is qualified according to part 9505.0371, subpart 5, item A.

Subp. 19.

Mental health telemedicine.

"Mental health telemedicine" has the meaning given in Minnesota Statutes, section 256B.0625, subdivision 46.

Subp. 20.

Mental illness.

"Mental illness" has the meaning given in Minnesota Statutes, section 245.462, subdivision 20. "Mental illness" includes "emotional disturbance" as defined in Minnesota Statutes, section 245.4871, subdivision 15.

Subp. 21.

Multidisciplinary staff.

"Multidisciplinary staff" means a group of individuals from diverse disciplines who come together to provide services to clients under part 9505.0372, subparts 8, 9, and 10.

Subp. 22.

Neuropsychological assessment.

"Neuropsychological assessment" means a specialized clinical assessment of the client's underlying cognitive abilities related to thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist.

Subp. 23.

Neuropsychological testing.

"Neuropsychological testing" means administering standardized tests and measures designed to evaluate the client's ability to attend to, process, interpret, comprehend, communicate, learn and recall information; and use problem-solving and judgment.

Subp. 24.

Partial hospitalization program.

"Partial hospitalization program" means a provider's time-limited, structured program of psychotherapy and other therapeutic services, as defined in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x, (ff), that is provided in an outpatient hospital facility or community mental health center that meets Medicare requirements to provide partial hospitalization services.

Subp. 25.

Primary caregiver.

"Primary caregiver" means a person, other than the facility staff, who has primary legal responsibility for providing the client with food, clothing, shelter, direction, guidance, and nurturance.

Subp. 26.

Psychological testing.

"Psychological testing" means the use of tests or other psychometric instruments to determine the status of the recipient's mental, intellectual, and emotional functioning.

Subp. 27.

Psychotherapy.

"Psychotherapy" means treatment of a client with mental illness that applies the most appropriate psychological, psychiatric, psychosocial, or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the client.

Subp. 28.

Supervisee.

"Supervisee" means an individual who requires clinical supervision because the individual does not meet mental health professional standards in part 9505.0371, subpart 5, item A.

9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.

Subpart 1.

Purpose.

This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.

Subp. 2.

Client eligibility for mental health services.

The following requirements apply to mental health services:

A.

The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:

(1)

prior to completion of a client's initial diagnostic assessment, a client is eligible for:

(a)

one explanation of findings;

(b)

one psychological testing; and

(c)

either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and

(2)

for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.

B.

A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:

(1)

may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:

(a)

a new client; or

(b)

an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and

(2)

may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and

(3)

must not be used for:

(a)

a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or

(b)

more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.

C.

For a child, a new standard or extended diagnostic assessment must be completed:

(1)

when the child does not meet the criteria for a brief diagnostic assessment;

(2)

at least annually following the initial diagnostic assessment, if:

(a)

additional services are needed; and

(b)

the child does not meet criteria for brief assessment;

(3)

when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or

(4)

when the child's current mental health condition does not meet criteria of the child's current diagnosis.

D.

For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:

(1)

when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;

(2)

at least every three years following the initial diagnostic assessment for an adult who receives mental health services;

(3)

when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or

(4)

when the adult's current mental health condition does not meet criteria of the current diagnosis.

E.

An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.

Subp. 3.

Authorization for mental health services.

Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.

Subp. 4.

Clinical supervision.

A.

Clinical supervision must be based on each supervisee's written supervision plan and must:

(1)

promote professional knowledge, skills, and values development;

(2)

model ethical standards of practice;

(3)

promote cultural competency by:

(a)

developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;

(b)

addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;

(c)

developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and

(d)

emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;

(4)

recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and

(5)

monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.

B.

Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.

(1)

Individual supervision means one or more designated clinical supervisors and one supervisee.

(2)

Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.

C.

The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:

(1)

the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;

(2)

the name, licensure, and qualifications of the supervisor;

(3)

the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;

(4)

the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;

(5)

procedures that the supervisee must use to respond to client emergencies; and

(6)

authorized scope of practices, including:

(a)

description of the supervisee's service responsibilities;

(b)

description of client population; and

(c)

treatment methods and modalities.

D.

Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:

(1)

date and duration of supervision;

(2)

identification of supervision type as individual or group supervision;

(3)

name of the clinical supervisor;

(4)

subsequent actions that the supervisee must take; and

(5)

date and signature of the clinical supervisor.

E.

Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.

Subp. 5.

Qualified providers.

Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.

A.

A mental health professional must be qualified in one of the following ways:

(1)

in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;

(2)

in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;

(3)

in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;

(4)

in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;

(5)

in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;

(6)

a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or

(7)

in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:

(a)

is certified as a clinical nurse specialist;

(b)

for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or

(c)

for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.

B.

A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be qualified in at least one of the following ways:

(1)

holds a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university; and

(a)

has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or

(b)

is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioner's clients belong, completes 40 hours of training in the delivery of services to clients with mental illness, and receives clinical supervision from a mental health professional at least once a week until the requirements of 2,000 hours of supervised experience are met;

(2)

has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;

(3)

is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;

(4)

holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or

(5)

is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.

C.

Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:

(1)

the mental health practitioner is:

(a)

complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or

(b)

a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional defined in item A; and

(2)

the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:

(a)

direct practice;

(b)

treatment team collaboration;

(c)

continued professional learning; and

(d)

job management.

D.

A clinical supervisor must:

(1)

be a mental health professional licensed as specified in item A;

(2)

hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;

(3)

be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;

(4)

be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;

(5)

not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;

(6)

have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:

(a)

capacity to provide services that incorporate best practice;

(b)

ability to recognize and evaluate competencies in supervisees;

(c)

ability to review assessments and treatment plans for accuracy and appropriateness;

(d)

ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and

(e)

ability to coach, teach, and practice skills with supervisees;

(7)

accept full professional liability for a supervisee's direction of a client's mental health services;

(8)

instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;

(9)

review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;

(10)

review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;

(11)

apply evidence-based practices and research-informed models to treat clients;

(12)

be employed by or under contract with the same agency as the supervisee;

(13)

develop a clinical supervision plan for each supervisee;

(14)

ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;

(15)

establish an evaluation process that identifies the performance and competence of each supervisee; and

(16)

document clinical supervision of each supervisee and securely maintain the documentation record.

Subp. 6.

Release of information.

Providers who receive a request for client information and providers who request client information must:

A.

comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and

B.

subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.

Subp. 7.

Individual treatment plan.

Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:

A.

based on the client's current diagnostic assessment;

B.

developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and

C.

reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.

Subp. 8.

Documentation.

To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:

A.

in the client's mental health record:

(1)

each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and

(2)

all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;

B.

the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and

C.

dates that treatment begins and ends and reason for the discontinuation of the mental health service.

Subp. 9.

Service coordination.

The provider must coordinate client services as authorized by the client as follows:

A.

When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.

B.

The mental health provider must coordinate mental health care with the client's physical health provider.

Subp. 10.

Telemedicine services.

Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telemedicine.

9505.0372 COVERED SERVICES.

Subpart 1.

Diagnostic assessment.

Medical assistance covers four types of diagnostic assessments when they are provided in accordance with the requirements in this subpart.

A.

To be eligible for medical assistance payment, a diagnostic assessment must:

(1)

identify a mental health diagnosis and recommended mental health services, which are the factual basis to develop the recipient's mental health services and treatment plan; or

(2)

include a finding that the client does not meet the criteria for a mental health disorder.

B.

A standard diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The standard diagnostic assessment must be done within the cultural context of the client and must include relevant information about:

(1)

the client's current life situation, including the client's:

(a)

age;

(b)

current living situation, including household membership and housing status;

(c)

basic needs status including economic status;

(d)

education level and employment status;

(e)

significant personal relationships, including the client's evaluation of relationship quality;

(f)

strengths and resources, including the extent and quality of social networks;

(g)

belief systems;

(h)

contextual nonpersonal factors contributing to the client's presenting concerns;

(i)

general physical health and relationship to client's culture; and

(j)

current medications;

(2)

the reason for the assessment, including the client's:

(a)

perceptions of the client's condition;

(b)

description of symptoms, including reason for referral;

(c)

history of mental health treatment, including review of the client's records;

(d)

important developmental incidents;

(e)

maltreatment, trauma, or abuse issues;

(f)

history of alcohol and drug usage and treatment;

(g)

health history and family health history, including physical, chemical, and mental health history; and

(h)

cultural influences and their impact on the client;

(3)

the client's mental status examination;

(4)

the assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;

(5)

the screenings used to determine the client's substance use, abuse, or dependency and other standardized screening instruments determined by the commissioner;

(6)

assessment methods and use of standardized assessment tools by the provider as determined and periodically updated by the commissioner;

(7)

the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and

(8)

the client data that is adequate to support the findings on all axes of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and any differential diagnosis.

C.

An extended diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The face-to-face interview is conducted over three or more assessment appointments because the client's complex needs necessitate significant additional assessment time. Complex needs are those caused by acuity of psychotic disorder; cognitive or neurocognitive impairment; need to consider past diagnoses and determine their current applicability; co-occurring substance abuse use disorder; or disruptive or changing environments, communication barriers, or cultural considerations as documented in the assessment. For child clients, the appointments may be conducted outside the diagnostician's office for face-to-face consultation and information gathering with family members, doctors, caregivers, teachers, and other providers, with or without the child present, and may involve directly observing the child in various settings that the child frequents such as home, school, or care settings. To complete the diagnostic assessment with adult clients, the appointments may be conducted outside of the diagnostician's office for face-to-face assessment with the adult client. The appointment may involve directly observing the adult client in various settings that the adult frequents, such as home, school, job, service settings, or community settings. The appointments may include face-to-face meetings with the adult client and the client's family members, doctors, caregivers, teachers, social support network members, recovery support resource representatives, and other providers for consultation and information gathering for the diagnostic assessment. The components of an extended diagnostic assessment include the following relevant information:

(1)

for children under age 5:

(a)

utilization of the DC:0-3R diagnostic system for young children;

(b)

an early childhood mental status exam that assesses the client's developmental, social, and emotional functioning and style both within the family and with the examiner and includes:

i.

physical appearance including dysmorphic features;

ii.

reaction to new setting and people and adaptation during evaluation;

iii.

self-regulation, including sensory regulation, unusual behaviors, activity level, attention span, and frustration tolerance;

iv.

physical aspects, including motor function, muscle tone, coordination, tics, abnormal movements, and seizure activity;

v.

vocalization and speech production, including expressive and receptive language;

vi.

thought, including fears, nightmares, dissociative states, and hallucinations;

vii.

affect and mood, including modes of expression, range, responsiveness, duration, and intensity;

viii.

play, including structure, content, symbolic functioning, and modulation of aggression;

ix.

cognitive functioning; and

x.

relatedness to parents, other caregivers, and examiner; and

(c)

other assessment tools as determined and periodically revised by the commissioner;

(2)

for children ages 5 to 18, completion of other assessment standards for children as determined and periodically revised by the commissioner; and

(3)

for adults, completion of other assessment standards for adults as determined and periodically revised by the commissioner.

D.

A brief diagnostic assessment must include a face-to-face interview with the client and a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The professional or practitioner must gather initial background information using the components of a standard diagnostic assessment in item B, subitems (1), (2), unit (b), (3), and (5), and draw a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's immediate needs or presenting problem. Treatment sessions conducted under authorization of a brief assessment may be used to gather additional information necessary to complete a standard diagnostic assessment or an extended diagnostic assessment.

E.

Adult diagnostic assessment update includes a face-to-face interview with the client, and contains a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C, who reviews a standard or extended diagnostic assessment. The adult diagnostic assessment update must update the most recent assessment document in writing in the following areas:

(1)

review of the client's life situation, including an interview with the client about the client's current life situation, and a written update of those parts where significant new or changed information exists, and documentation where there has not been significant change;

(2)

review of the client's presenting problems, including an interview with the client about current presenting problems and a written update of those parts where there is significant new or changed information, and note parts where there has not been significant change;

(3)

screenings for substance use, abuse, or dependency and other screenings as determined by the commissioner;

(4)

the client's mental health status examination;

(5)

assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;

(6)

the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary, or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and

(7)

the client's diagnosis on all axes of the current edition of the Diagnostic and Statistical Manual and any differential diagnosis.

Subp. 2.

Neuropsychological assessment.

A neuropsychological assessment must include a face-to-face interview with the client, the interpretation of the test results, and preparation and completion of a report. A client is eligible for a neuropsychological assessment if at least one of the following criteria is met:

A.

There is a known or strongly suspected brain disorder based on medical history or neurological evaluation such as a history of significant head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative disorders, significant exposure to neurotoxins, central nervous system infections, metabolic or toxic encephalopathy, fetal alcohol syndrome, or congenital malformations of the brain; or

B.

In the absence of a medically verified brain disorder based on medical history or neurological evaluation, there are cognitive or behavioral symptoms that suggest that the client has an organic condition that cannot be readily attributed to functional psychopathology, or suspected neuropsychological impairment in addition to functional psychopathology. Examples include:

(1)

poor memory or impaired problem solving;

(2)

change in mental status evidenced by lethargy, confusion, or disorientation;

(3)

deterioration in level of functioning;

(4)

marked behavioral or personality change;

(5)

in children or adolescents, significant delays in academic skill acquisition or poor attention relative to peers;

(6)

in children or adolescents, significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers; and

(7)

in children or adolescents, significant inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.

C.

If neither criterion in item A nor B is fulfilled, neuropsychological evaluation is not indicated.

D.

The neuropsychological assessment must be conducted by a neuropsychologist with competence in the area of neuropsychological assessment as stated to the Minnesota Board of Psychology who:

(1)

was awarded a diploma by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or the American Board of Pediatric Neuropsychology;

(2)

earned a doctoral degree in psychology from an accredited university training program:

(a)

completed an internship, or its equivalent, in a clinically relevant area of professional psychology;

(b)

completed the equivalent of two full-time years of experience and specialized training, at least one which is at the postdoctoral level, in the study and practices of clinical neuropsychology and related neurosciences supervised by a clinical neuropsychologist; and

(c)

holds a current license to practice psychology independently in accordance with Minnesota Statutes, sections 148.88 to 148.98;

(3)

is licensed or credentialed by another state's board of psychology examiners in the specialty of neuropsychology using requirements equivalent to requirements specified by one of the boards named in subitem (1); or

(4)

was approved by the commissioner as an eligible provider of neuropsychological assessment prior to December 31, 2010.

Subp. 3.

Neuropsychological testing.

A.

Medical assistance covers neuropsychological testing when the client has either:

(1)

a significant mental status change that is not a result of a metabolic disorder that has failed to respond to treatment;

(2)

in children or adolescents, a significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers;

(3)

in children or adolescents, significant inability to develop expected knowledge, skills, or abilities, as required to adapt to new or changing cognitive, social, physical, or emotional demands; or

(4)

a significant behavioral change, memory loss, or suspected neuropsychological impairment in addition to functional psychopathology, or other organic brain injury or one of the following:

(a)

traumatic brain injury;

(b)

stroke;

(c)

brain tumor;

(d)

substance abuse or dependence;

(e)

cerebral anoxic or hypoxic episode;

(f)

central nervous system infection or other infectious disease;

(g)

neoplasms or vascular injury of the central nervous system;

(h)

neurodegenerative disorders;

(i)

demyelinating disease;

(j)

extrapyramidal disease;

(k)

exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction;

(l)

systemic medical conditions known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and related hematologic anomalies, and autoimmune disorders such as lupus, erythematosis, or celiac disease;

(m)

congenital genetic or metabolic disorders known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;

(n)

severe or prolonged nutrition or malabsorption syndromes; or

(o)

a condition presenting in a manner making it difficult for a clinician to distinguish between:

i.

the neurocognitive effects of a neurogenic syndrome such as dementia or encephalopathy; and

ii.

a major depressive disorder when adequate treatment for major depressive disorder has not resulted in improvement in neurocognitive function, or another disorder such as autism, selective mutism, anxiety disorder, or reactive attachment disorder.

B.

Neuropsychological testing must be administered or clinically supervised by a neuropsychologist qualified as defined in subpart 2, item D.

C.

Neuropsychological testing is not covered when performed:

(1)

primarily for educational purposes;

(2)

primarily for vocational counseling or training;

(3)

for personnel or employment testing;

(4)

as a routine battery of psychological tests given at inpatient admission or continued stay; or

(5)

for legal or forensic purposes.

Subp. 4.

Psychological testing.

Psychological testing must meet the following requirements:

A.

The psychological testing must:

(1)

be administered or clinically supervised by a licensed psychologist with competence in the area of psychological testing as stated to the Minnesota Board of Psychology; and

(2)

be validated in a face-to-face interview between the client and a licensed psychologist or a mental health practitioner working as a clinical psychology trainee as required by part 9505.0371, subpart 5, item C, under the clinical supervision of a licensed psychologist according to part 9505.0371, subpart 5, item A, subitem (2).

B.

The administration, scoring, and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.

C.

The report resulting from the psychological testing must be:

(1)

signed by the psychologist conducting the face-to-face interview;

(2)

placed in the client's record; and

(3)

released to each person authorized by the client.

Subp. 5.

Explanations of findings.

To be eligible for medical assistance payment, the mental health professional providing the explanation of findings must obtain the authorization of the client or the client's representative to release the information as required in part 9505.0371, subpart 6. Explanation of findings is provided to the client, client's family, and caregivers, or to other providers to help them understand the results of the testing or diagnostic assessment, better understand the client's illness, and provide professional insight needed to carry out a plan of treatment. An explanation of findings is not paid separately when the results of psychological testing or a diagnostic assessment are explained to the client or the client's representative as part of the psychological testing or a diagnostic assessment.

Subp. 6.

Psychotherapy.

Medical assistance covers psychotherapy as conducted by a mental health professional or a mental health practitioner as defined in part 9505.0371, subpart 5, item C, as provided in this subpart.

A.

Individual psychotherapy is psychotherapy designed for one client.

B.

Family psychotherapy is designed for the client and one or more family members or the client's primary caregiver whose participation is necessary to accomplish the client's treatment goals. Family members or primary caregivers participating in a therapy session do not need to be eligible for medical assistance. For purposes of this subpart, the phrase "whose participation is necessary to accomplish the client's treatment goals" does not include shift or facility staff members at the client's residence. Medical assistance payment for family psychotherapy is limited to face-to-face sessions at which the client is present throughout the family psychotherapy session unless the mental health professional believes the client's absence from the family psychotherapy session is necessary to carry out the client's individual treatment plan. If the client is excluded, the mental health professional must document the reason for and the length of time of the exclusion. The mental health professional must also document the reason or reasons why a member of the client's family is excluded.

C.

Group psychotherapy is appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive mutual benefit from treatment in a group setting. For a group of three to eight persons, one mental health professional or practitioner is required to conduct the group. For a group of nine to 12 persons, a team of at least two mental health professionals or two mental health practitioners or one mental health professional and one mental health practitioner is required to co-conduct the group. Medical assistance payment is limited to a group of no more than 12 persons.

D.

A multiple-family group psychotherapy session is eligible for medical assistance payment if the psychotherapy session is designed for at least two but not more than five families. Multiple-family group psychotherapy is clearly directed toward meeting the identified treatment needs of each client as indicated in client's treatment plan. If the client is excluded, the mental health professional or practitioner must document the reason for and the length of the time of the exclusion. The mental health professional or practitioner must document the reasons why a member of the client's family is excluded.

Subp. 7.

Medication management.

The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse, as defined in Minnesota Statutes, sections 148.171 to 148.285, who is qualified in psychiatric nursing.

Subp. 8.

Adult day treatment.

Adult day treatment payment limitations include the following conditions.

A.

Adult day treatment must consist of at least one hour of group psychotherapy, and must include group time focused on rehabilitative interventions, or other therapeutic services that are provided by a multidisciplinary staff. Adult day treatment is an intensive psychotherapeutic treatment. The services must stabilize the client's mental health status, and develop and improve the client's independent living and socialization skills. The goal of adult day treatment is to reduce or relieve the effects of mental illness so that an individual is able to benefit from a lower level of care and to enable the client to live and function more independently in the community. Day treatment services are not a part of inpatient or residential treatment services.

B.

To be eligible for medical assistance payment, a day treatment program must:

(1)

be reviewed by and approved by the commissioner;

(2)

be provided to a group of clients by a multidisciplinary staff under the clinical supervision of a mental health professional;

(3)

be available to the client at least two days a week for at least three consecutive hours per day. The day treatment may be longer than three hours per day, but medical assistance must not reimburse a provider for more than 15 hours per week;

(4)

include group psychotherapy done by a mental health professional, or mental health practitioner qualified according to part 9505.0371, subpart 5, item C, and rehabilitative interventions done by a mental health professional or mental health practitioner daily;

(5)

be included in the client's individual treatment plan as necessary and appropriate. The individual treatment plan must include attainable, measurable goals as they relate to services and must be completed before the first day treatment session. The vendor must review the recipient's progress and update the treatment plan at least every 30 days until the client is discharged and include an available discharge plan for the client in the treatment plan; and

(6)

document the interventions provided and the client's response daily.

C.

To be eligible for adult day treatment, a recipient must:

(1)

be 18 years of age or older;

(2)

not be residing in a nursing facility, hospital, institute of mental disease, or regional treatment center, unless the recipient has an active discharge plan that indicates a move to an independent living arrangement within 180 days;

(3)

have a diagnosis of mental illness as determined by a diagnostic assessment;

(4)

have the capacity to engage in the rehabilitative nature, the structured setting, and the therapeutic parts of psychotherapy and skills activities of a day treatment program and demonstrate measurable improvements in the recipient's functioning related to the recipient's mental illness that would result from participating in the day treatment program;

(5)

have at least three areas of functional impairment as determined by a functional assessment with the domains prescribed by Minnesota Statutes, section 245.462, subdivision 11a;

(6)

have a level of care determination that supports the need for the level of intensity and duration of a day treatment program; and

(7)

be determined to need day treatment by a mental health professional who must deem the day treatment services medically necessary.

D.

The following services are not covered by medical assistance if they are provided by a day treatment program:

(1)

a service that is primarily recreation-oriented or that is provided in a setting that is not medically supervised. This includes: sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;

(2)

a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's mental illness;

(3)

consultation with other providers or service agency staff about the care or progress of a client;

(4)

prevention or education programs provided to the community;

(5)

day treatment for recipients with primary diagnoses of alcohol or other drug abuse;

(6)

day treatment provided in the client's home;

(7)

psychotherapy for more than two hours daily; and

(8)

participation in meal preparation and eating that is not part of a clinical treatment plan to address the client's eating disorder.

Subp. 9.

Partial hospitalization.

Partial hospitalization is a covered service when it is an appropriate alternative to inpatient hospitalization for a client who is experiencing an acute episode of mental illness that meets the criteria for an inpatient hospital admission as specified in part 9505.0520, subpart 1, and who has the family and community resources necessary and appropriate to support the client's residence in the community. Partial hospitalization consists of multiple intensive short-term therapeutic services provided by a multidisciplinary staff to treat the client's mental illness.

Subp. 10.

Dialectical behavior therapy (DBT).

Dialectical behavior therapy (DBT) treatment services must meet the following criteria:

A.

DBT must be provided according to this subpart and Minnesota Statutes, section 256B.0625, subdivision 5l.

B.

DBT is an outpatient service that is determined to be medically necessary by either: (1) a mental health professional qualified according to part 9505.0371, subpart 5, or (2) a mental health practitioner working as a clinical trainee according to part 9505.0371, subpart 5, item C, who is under the clinical supervision of a mental health professional according to part 9505.0371, subpart 5, item D, with specialized skill in dialectical behavior therapy. The treatment recommendation must be based upon a comprehensive evaluation that includes a diagnostic assessment and functional assessment of the client, and review of the client's prior treatment history. Treatment services must be provided pursuant to the client's individual treatment plan and provided to a client who satisfies the criteria in item C.

C.

To be eligible for DBT, a client must:

(1)

be 18 years of age or older;

(2)

have mental health needs that cannot be met with other available community-based services or that must be provided concurrently with other community-based services;

(3)

meet one of the following criteria:

(a)

have a diagnosis of borderline personality disorder; or

(b)

have multiple mental health diagnoses and exhibit behaviors characterized by impulsivity, intentional self-harm behavior, and be at significant risk of death, morbidity, disability, or severe dysfunction across multiple life areas;

(4)

understand and be cognitively capable of participating in DBT as an intensive therapy program and be able and willing to follow program policies and rules assuring safety of self and others; and

(5)

be at significant risk of one or more of the following if DBT is not provided:

(a)

mental health crisis;

(b)

requiring a more restrictive setting such as hospitalization;

(c)

decompensation; or

(d)

engaging in intentional self-harm behavior.

D.

The treatment components of DBT are individual therapy and group skills as follows:

(1)

Individual DBT combines individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and reinforce the use of adaptive skillful behaviors. The therapist must:

(a)

identify, prioritize, and sequence behavioral targets;

(b)

treat behavioral targets;

(c)

generalize DBT skills to the client's natural environment through telephone coaching outside of the treatment session;

(d)

measure the client's progress toward DBT targets;

(e)

help the client manage crisis and life-threatening behaviors; and

(f)

help the client learn and apply effective behaviors when working with other treatment providers.

(2)

Individual DBT therapy is provided by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.

(3)

Group DBT skills training combines individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce the client's suicidal and other dysfunctional coping behaviors and restore function by teaching the client adaptive skills in the following areas:

(a)

mindfulness;

(b)

interpersonal effectiveness;

(c)

emotional regulation; and

(d)

distress tolerance.

(4)

Group DBT skills training is provided by two mental health professionals, or by a mental health professional cofacilitating with a mental health practitioner.

(5)

The need for individual DBT skills training must be determined by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.

E.

A program must be certified by the commissioner as a DBT provider. To qualify for certification, a provider must:

(1)

hold current accreditation as a DBT program from a nationally recognized certification body approved by the commissioner or submit to the commissioner's inspection and provide evidence that the DBT program's policies, procedures, and practices will continuously meet the requirements of this subpart;

(2)

be enrolled as a MHCP provider;

(3)

collect and report client outcomes as specified by the commissioner; and

(4)

have a manual that outlines the DBT program's policies, procedures, and practices which meet the requirements of this subpart.

F.

The DBT treatment team must consist of persons who are trained in DBT treatment. The DBT treatment team may include persons from more than one agency. Professional and clinical affiliations with the DBT team must be delineated:

(1)

A DBT team leader must:

(a)

be a mental health professional employed by, affiliated with, or contracted by a DBT program certified by the commissioner;

(b)

have appropriate competencies and working knowledge of the DBT principles and practices; and

(c)

have knowledge of and ability to apply the principles and DBT practices that are consistent with evidence-based practices.

(2)

DBT team members who provide individual DBT or group skills training must:

(a)

be a mental health professional or be a mental health practitioner, who is employed by, affiliated with, or contracted with a DBT program certified by the commissioner;

(b)

have or obtain appropriate competencies and working knowledge of DBT principles and practices within the first six months of becoming a part of the DBT program;

(c)

have or obtain knowledge of and ability to apply the principles and practices of DBT consistently with evidence-based practices within the first six months of working at the DBT program;

(d)

participate in DBT consultation team meetings; and

(e)

require mental health practitioners to have ongoing clinical supervision by a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices.

Subp. 11.

Noncovered services.

The mental health services in items A to J are not eligible for medical assistance payment under this part:

A.

a mental health service that is not medically necessary;

B.

a neuropsychological assessment carried out by a person other than a neuropsychologist who is qualified according to part 9505.0372, subpart 2, item D;

C.

a service ordered by a court that is solely for legal purposes and not related to the recipient's diagnosis or treatment for mental illness;

D.

services dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health;

E.

a service that is only for a vocational purpose or an educational purpose that is not mental health related;

F.

staff training that is not related to a client's individual treatment plan or plan of care;

G.

child and adult protection services;

H.

fund-raising activities;

I.

community planning; and

J.

client transportation.

9520.0010 STATUTORY AUTHORITY AND PURPOSE.

Parts 9520.0010 to 9520.0230 provide methods and procedures relating to the establishment and operation of area-wide, comprehensive, community-based mental health, developmental disability, and chemical dependency programs under state grant-in-aid as provided under Minnesota Statutes, sections 245.61 to 245.69. Minnesota Statutes, sections 245.61 to 245.69 are entitled The Community Mental Health Services Act. For purposes of these parts, "community mental health services" includes services to persons who have mental or emotional disorders or other psychiatric disabilities, developmental disabilities, and chemical dependency, including drug abuse and alcoholism.

9520.0020 BOARD DUTIES.

The community mental health board has the responsibility for ensuring the planning, development, implementation, coordination, and evaluation of the community comprehensive mental health program for the mentally ill/behaviorally disabled, developmentally disabled, and chemically dependent populations in the geographic area it serves. It also has the responsibility for ensuring delivery of services designated by statute.

9520.0030 DEFINITIONS.

Parts 9520.0040 and 9520.0050 also set forth definitions of community mental health centers and community mental health clinics.

9520.0040 COMMUNITY MENTAL HEALTH CENTER.

A community mental health center means an agency which includes all of the following:

A.

Established under the provision of Minnesota Statutes, sections 245.61 to 245.69.

B.

Provides as a minimum the following services for individuals with mental or emotional disorders, developmental disabilities, alcoholism, drug abuse, and other psychiatric conditions. The extent of each service to be provided by the center shall be indicated in the program plan, which is to reflect the problems, needs, and resources of the community served:

(1)

collaborative and cooperative services with public health and other groups for programs of prevention of mental illness, developmental disability, alcoholism, drug abuse, and other psychiatric disorders;

(2)

informational and educational services to schools, courts, health and welfare agencies, both public and private;

(3)

informational and educational services to the general public, lay, and professional groups;

(4)

consultative services to schools, courts, and health and welfare agencies, both public and private;

(5)

outpatient diagnostic and treatment services; and

(6)

rehabilitative services, particularly for those who have received prior treatment in an inpatient facility.

C.

Provides or contracts for detoxification, evaluation, and referral for chemical dependency services (Minnesota Statutes, section 254A.08).

D.

Provides specific coordination for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. (Minnesota Statutes, sections 254A.07 and 245.61).

E.

Has a competent multidisciplinary mental health/developmental disability/chemical dependency professional team whose members meet the professional standards in their respective fields.

F.

The professional mental health team is qualified by specific mental health training and experience and shall include as a minimum the services of each of the following:

(1)

a licensed physician, who has completed an approved residency program in psychiatry; and

(2)

a doctoral clinical, counseling, or health care psychologist, who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:

(3)

a clinical social worker with a master's degree in social work from an accredited college or university; and/or

(4)

a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health nursing with mental health major, maternal and child health with mental health major, etc.

G.

The multidisciplinary staff shall be sufficient in number to implement and operate the described program of the center. In addition to the above, this team should include other professionals, paraprofessionals, and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner. If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the center, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and show evidence of how the specialized functions of the required professionals are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.

9520.0050 COMMUNITY MENTAL HEALTH CLINIC.

Subpart 1.

Definitions.

A community mental health clinic is an agency which devotes, as its major service, at least two-thirds of its resources for outpatient mental health diagnosis, treatment, and consultation by a multidisciplinary professional mental health team. The multidisciplinary professional mental health team is qualified by special mental health training and experience and shall include as a minimum the services of each of the following:

A.

a licensed physician, who has completed an approved residency program in psychiatry; and

B.

a doctoral clinical, or counseling or health care psychologist who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:

C.

a clinical social worker with a master's degree in social work from an accredited college or university; and/or

D.

a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health with a mental health major, maternal and child health with a mental health major.

Subp. 2.

Other members of multidisciplinary team.

The multidisciplinary team shall be sufficient in number to implement and operate the described program of the clinic. In addition to the above, this team should include other professionals, paraprofessionals and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner.

Subp. 3.

Efforts to acquire staff.

If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the clinic, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and evidence of how the specialized functions of the required professional positions are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.

9520.0060 ANNUAL PLAN AND BUDGET.

On or before the date designated by the commissioner, each year the chair of the community mental health board or director of the community mental health program, provided for in Minnesota Statutes, section 245.62, shall submit an annual plan identifying program priorities in accordance with state grant-in-aid guidelines, and a budget on prescribed report forms for the next state fiscal year, together with the recommendations of the community mental health board, to the commissioner of human services for approval as provided under Minnesota Statutes, section 245.63.

9520.0070 FISCAL AFFILIATES.

Other providers of community mental health services may affiliate with the community mental health center and may be approved and eligible for state grant-in-aid funds. The state funding for other community mental health services shall be contingent upon appropriate inclusion in the center's community mental health plan for the continuum of community mental health services and conformity with the state's appropriate disability plan for mental health, developmental disability, or chemical dependency. Fiscal affiliates (funded contracting agencies) providing specialized services under contract must meet all rules and standards that apply to the services they are providing.

9520.0080 OTHER REQUIRED REPORTS.

The program director of the community mental health program shall provide the commissioner of human services with such reports of program activities as the commissioner may require.

9520.0090 FUNDING.

All state community mental health funding shall go directly to the community mental health board or to a human service board established pursuant to Laws of Minnesota 1975, chapter 402, which itself provides or contracts with another agency to provide the community mental health program. Such programs must meet the standards and rules for community mental health programs as enunciated in parts 9520.0010 to 9520.0230 in accordance with Laws of Minnesota 1975, chapter 402.

9520.0100 OPERATION OF OTHER PROGRAMS.

When the governing authority of the community mental health program operates other programs, services, or activities, only the community mental health center program shall be subject to these parts.

9520.0110 APPLICATIONS AND AGREEMENTS BY LOCAL COUNTIES.

New applications for state assistance or applications for renewal of support must be accompanied by an agreement executed by designated signatories on behalf of the participating counties that specifies the involved counties, the amount and source of local funds in each case, and the period of support. The local funds to be used to match state grant-in-aid must be assured in writing on Department of Human Services forms by the local funding authority(ies).

9520.0120 USE OF MATCHING FUNDS.

Funds utilized by the director as authorized by the community mental health board to match a state grant-in-aid must be available to that director for expenditures for the same general purpose as the state grant-in-aid funds.

9520.0130 QUARTERLY REPORTS.

The director of the community mental health program shall, within 20 days after the end of the quarter, submit quarterly prescribed reports to the commissioner of human services (controller's office), containing all receipts, expenditures, and cash balance, subject to an annual audit by the commissioner or his/her designee.

9520.0140 PAYMENTS.

Payments on approved grants will be made subsequent to the department's receipt of the program's quarterly reporting forms, unless the commissioner of human services has determined that funds allocated to a program are not needed for that program. Payments shall be in an amount of at least equal to the quarterly allocation minus any unexpended balance from the previous quarter providing this payment does not exceed the program grant award. In the event the program does not report within the prescribed time, the department will withhold the process of the program's payment until the next quarterly cycle.

9520.0150 FEES.

No fees shall be charged until the director with approval of the community mental health board has established fee schedules for the services rendered and they have been submitted to the commissioner of human services at least two months prior to the effective date thereof and have been approved by him/her. All fees shall conform to the approved schedules, which are accessible to the public.

9520.0160 SUPPLEMENTAL AWARDS.

The commissioner of human services may make supplemental awards to the community mental health boards.

9520.0170 WITHDRAWAL OF FUNDS.

The commissioner of human services may withdraw funds from any program that is not administered in accordance with its approved plan and budget. Written notice of such intended action will be provided to the director and community mental health board. Opportunity for hearing before the commissioner or his/her designee shall be provided.

9520.0180 BUDGET TRANSFERS.

Community mental health boards may make budget transfers within specified limits during any fiscal year without prior approval of the department. The specified limit which can be transferred in any fiscal year between program activity budgets shall be up to ten percent or up to $5,000 whichever is less. Transfers within an activity can be made into or out of line items with a specified limit of up to ten percent or up to $5,000 whichever is less. No line item can be increased or decreased by more than $5,000 or ten percent in a fiscal year without prior approval of the commissioner. Transfers above the specified limits can be made with prior approval from the commissioner. All transfers within and into program budget activities and/or line items must have prior approval by the community mental health board and this approval must be reflected in the minutes of its meeting, it must be reported to the commissioner with the reasons therefor, including a statement of how the transfer will affect program objectives.

9520.0190 BUDGET ADJUSTMENTS.

Budget adjustments made necessary by funding limitations shall be made by the commissioner and provided in writing to the director and board of the community mental health center.

9520.0200 CENTER DIRECTOR.

Every community mental health board receiving state funds for a community mental health program shall have a center director, who is the full-time qualified professional staff member who serves as the executive officer. To be considered qualified, the individual must have professional training to at least the level of graduate degree in his/her clinical and/or administrative discipline, which is relevant to MH-DD-CD and a minimum of two years experience in community mental health programs. The center director is responsible for the planning/design, development, coordination, and evaluation of a comprehensive, area-wide program and for the overall administration of services operated by the board.

The center director shall be appointed by the community mental health board and shall be approved by the commissioner of human services.

9520.0210 DEADLINE FOR APPROVAL OR DENIAL OF REQUEST FOR APPROVAL STATUS.

The commissioner shall approve or deny, in whole or in part, an application for state financial assistance within 90 days of receipt of the grant-in-aid application or by the beginning of the state fiscal year, whichever is the later.

9520.0230 ADVISORY COMMITTEE.

Subpart 1.

Purpose.

To assist the community mental health board in meeting its responsibilities as described in Minnesota Statutes, section 245.68 and to provide opportunity for broad community representation necessary for effective comprehensive mental health, developmental disability, and chemical dependency program planning, each community mental health board shall appoint a separate advisory committee in at least the three disability areas of mental health, developmental disability, and chemical dependency.

Subp. 2.

Membership.

The advisory committees shall consist of residents of the geographic area served who are interested and knowledgeable in the area governed by such committee.

Subp. 3.

Nominations for membership.

Nominations for appointments as members of the advisory committees are to be made to the community mental health board from agencies, organizations, groups, and individuals within the area served by the community mental health center. Appointments to the advisory committees are made by the community mental health board.

Subp. 4.

Board member on committee.

One community mental health board member shall serve on each advisory committee.

Subp. 5.

Nonprovider members.

Each advisory committee shall have at least one-half of its membership composed of individuals who are not providers of services to the three disability groups.

Subp. 6.

Representative membership.

Membership of each advisory committee shall generally reflect the population distribution of the service delivery area of the community mental health center.

Subp. 7.

Chairperson appointed.

The community mental health board shall appoint a chairperson for each advisory committee. The chairperson shall not be a community mental health board member nor a staff member. The power to appoint the chairperson may be delegated by the community mental health board to the individual advisory committee.

Subp. 8.

Committee responsibility to board.

Each advisory committee shall be directly responsible to the community mental health board. Direct communication shall be effected and maintained through contact between the chairperson of the particular advisory committee, or his/her designee, and the chairperson of the community mental health board, or his/her designee.

Subp. 9.

Staff.

Staff shall be assigned by the director to serve the staffing needs of each advisory committee.

Subp. 10.

Study groups and task forces.

Each advisory committee may appoint study groups and task forces upon consultation with the community mental health board. It is strongly recommended that specific attention be given to the aging and children and youth populations.

Subp. 11.

Quarterly meetings required.

Each advisory committee shall meet at least quarterly.

Subp. 12.

Annual report required.

Each advisory committee must make a formal written and oral report on its work to the community mental health board at least annually.

Subp. 13.

Minutes.

Each advisory committee shall submit copies of minutes of their meetings to the community mental health board and to the Department of Human Services (respective disability group program divisions).

Subp. 14.

Duties of advisory committee.

The advisory committees shall be charged by the community mental health board with assisting in the identification of the community's needs for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. The advisory committee also assists the community mental health board in determining priorities for the community programs. Based on the priorities, each advisory committee shall recommend to the community mental health board ways in which the limited available community resources (work force, facilities, and finances) can be put to maximum and optimal use.

Subp. 15.

Recommendations.

The advisory committee recommendations made to the community mental health board shall be included as a separate section in the grant-in-aid request submitted to the Department of Human Services by the community mental health board.

Subp. 16.

Assessment of programs.

The advisory committees shall assist the community mental health board in assessing the programs carried on by the community mental health board, and make recommendations regarding the reordering of priorities and modifying of programs where necessary.

9549.0057 DETERMINATION OF INTERIM AND SETTLE UP OPERATING COST PAYMENT RATES.

Subpart 1.

Conditions.

To receive an interim payment rate, a nursing facility must comply with the requirements and is subject to the conditions in part 9549.0060, subpart 14, items A to C. The commissioner shall determine interim and settle up operating cost payment rates for a newly constructed nursing facility, or one with an increase in licensed capacity of 50 percent or more according to subparts 2 and 3.

Subp. 2.

Interim operating cost payment rate.

For the rate year or portion of an interim period beginning on or after July 1, 1986, the interim total operating cost payment rate must be determined according to parts 9549.0050 to 9549.0059 (Temporary) in effect on March 1, 1987. For the rate year or portion of an interim period beginning on or after July 1, 1987, the interim total operating cost payment rate must be determined according to parts 9549.0051 to 9549.0059, except that:

A.

The nursing facility must project its anticipated resident days for each resident class. The anticipated resident days for each resident class must be multiplied by the weight for that resident class as listed in part 9549.0058 to determine the anticipated standardized resident days for the reporting period.

B.

The commissioner shall use anticipated standardized resident days in determining the allowable historical case mix operating cost standardized per diem.

C.

The commissioner shall use the anticipated resident days in determining both the allowable historical other care related operating cost per diem and the allowable historical other operating cost per diem.

D.

The annual adjustment factors determined in part 9549.0055, subpart 1, must not be applied to the nursing facility's allowable historical per diems as provided in part 9549.0056, subparts 2 and 4.

E.

The limits established in part 9549.0055, subpart 2, items C and E, as indexed in part 9549.0055, subpart 3 and in effect at the beginning of the interim period, must be increased by ten percent.

F.

The efficiency incentive in part 9549.0056, subpart 4, item A or B, must not apply.

G.

The phase in provisions in part 9549.0056, subpart 7, must not apply.

Subp. 3.

Settle up operating cost payment rate.

The settle up total operating cost payment rate must be determined according to items A to C.

A.

The settle up operating cost payment rate for interim periods before July 1, 1987, is subject to the rule parts that were in effect during the interim period.

B.

To determine the settle up operating cost payment rate for interim periods or the portion of an interim period occurring after July 1, 1987, subitems (1) to (7) must be applied.

(1)

The standardized resident days as determined in part 9549.0054, subpart 2, must be used for the interim period.

(2)

The commissioner shall use the standardized resident days in subitem (1) in determining the allowable historical case mix operating cost standardized per diem.

(3)

The commissioner shall use the actual resident days in determining both the allowable historical other care related operating cost per diem and the allowable historical other operating cost per diem.

(4)

The annual adjustment factors determined in part 9549.0055, subpart 1, must not be applied to the nursing facility's allowable historical per diems as provided in part 9549.0056, subparts 2 and 4.

(5)

The limits established in part 9549.0055, subpart 2, item E, must be the limits for the settle up reporting periods occurring after July 1, 1987. If the interim period includes more than one July 1 date, the commissioner shall use the limit established in part 9549.0055, subpart 2, items C and E, as indexed in part 9549.0055, subpart 3, increased by ten percent for the second July 1 date.

(6)

The efficiency incentive in part 9549.0056, subpart 4, item A or B, must not apply.

(7)

The phase in provisions in part 9549.0056, subpart 7 must not apply.

C.

For the nine month period following the settle up reporting period, the total operating cost payment rate must be determined according to item B except that the efficiency incentive as computed in part 9549.0056, subpart 4, item A or B, applies.

D.

The total operating cost payment rate for the rate year beginning July 1 following the nine month period in item C must be determined under parts 9549.0050 to 9549.0059.

E.

A newly constructed nursing facility or one with an increase in licensed capacity of 50 percent or more must continue to receive the interim total operating cost payment rate until the settle up total operating cost payment rate is determined under this subpart.

9549.0060 DETERMINATION OF THE PROPERTY-RELATED PAYMENT RATE.

Subp. 4.

Determination of allowable appraised value.

A nursing facility's appraised value must be limited by items A to C.

A.

For rate years beginning after June 30, 1985, the replacement cost new per bed limit for licensed beds in single bedrooms and multiple bedrooms is determined according to subitems (1) to (4):

(1)

Effective January 1, 1984, the replacement cost new per bed limit for licensed beds in single bedrooms is $41,251 and for licensed beds in multiple bedrooms is $27,500. On January 1, 1985, the commissioner shall adjust the replacement cost new per bed limit by the percentage change in the composite cost of construction index published by the Bureau of Economic Analysis of the United States Department of Commerce in the Survey of Current Business Statistics for the two previous Octobers. The index is incorporated by reference and is available at the James J. Hill Reference Library, Saint Paul, Minnesota.

(2)

The average historical cost per bed for depreciable equipment is computed by adding the historical cost of depreciable equipment for each nursing facility as determined in subpart 10, item A, and dividing the sum by the total number of licensed beds in those nursing facilities. The amount is then subtracted from the replacement cost new per bed limits determined in subitem (1).

(3)

The differences computed in subitem (2) are the replacement cost new per bed limits for licensed beds in single bedrooms and multiple bedrooms effective for the rate year beginning on July 1, 1985.

(4)

On January 1, 1986, and each succeeding January 1, the commissioner shall adjust the limit in subitem (3) by the percentage change in the composite cost of construction index published by the Bureau of Economic Analysis of the United States Department of Commerce in the Survey of Current Business Statistics for the two previous Octobers.

B.

Each nursing facility's maximum allowable replacement cost new is determined annually according to subitems (1) to (3):

(1)

The multiple bedroom replacement cost new per bed limit in item A must be multiplied by the number of licensed beds in multiple bedrooms.

(2)

The single bedroom replacement cost new per bed limit in item A must be multiplied by the number of licensed beds in single bedrooms except as provided in subpart 11, item C, subitem (2).

(3)

The nursing facility's maximum allowable replacement cost new is the sum of subitems (1) and (2).

C.

The nursing facility's replacement cost new determined in subparts 1 to 3 must be reduced by the replacement cost new of portions of the nursing facility used for functions whose costs are disallowed under parts 9549.0010 to 9549.0080.

D.

The adjusted replacement cost new is the lesser of item B or C.

E.

The adjusted depreciation is determined by subtracting from the depreciation in subparts 1 to 3 the amount of depreciation, if any, related to the portion of the nursing facility's replacement cost new disallowed in item C or D.

F.

The nursing facility's allowable appraised value is determined by subtracting the amount determined in item E from the amount in item D. If no adjustment to the replacement cost new is required in items C and D, then the nursing facility's allowable appraised value is the appraised value determined in subparts 1 to 3.

Subp. 5.

Allowable debt.

For purposes of determining the property-related payment rate, the commissioner shall allow or disallow debt according to items A to D.

A.

Debt shall be limited as follows:

(1)

Debt incurred for the purchase of land directly used for resident care and the purchase or construction of nursing facility buildings, attached fixtures, or land improvements or the capitalized replacement or capitalized repair of existing buildings, attached fixtures, or land improvements shall be allowed. Debt incurred for any other purpose shall not be allowed.

(2)

Working capital debt shall not be allowed.

(3)

An increase in the amount of a debt as a result of refinancing of capital assets which occurs after May 22, 1983, shall not be allowed except to the extent that the increase in debt is the result of refinancing costs such as points, loan origination fees, or title searches.

(4)

An increase in the amount of total outstanding debt incurred after May 22, 1983, as a result of a change in ownership or reorganization of provider entities, shall not be allowed and the previous owner's allowable debt as of May 22, 1983, shall be allowed under item B.

(5)

Any portion of the total allowable debt exceeding the appraised value as determined in subpart 4 shall not be allowed.

(6)

Any portion of a debt of which the proceeds exceed the historical cost of the capital asset acquired shall not be allowed.

B.

The nursing facility shall apportion debts incurred before October 1, 1984, among land and buildings, attached fixtures, land improvements, depreciable equipment and working capital by direct identification. If direct identification of any part of the debt is not possible, that portion of the debt which cannot be directly identified shall be apportioned to each component, except working capital debt, based on the ratio of the historical cost of the component to the total historical cost of all components. The portion of debt assigned to land and buildings, attached fixtures, and land improvements is allowable debt.

A hospital attached nursing facility that has debts that are not directly identifiable to the hospital or the nursing facility shall allocate the portion of allowable debt computed according to subpart 5, and allowable interest expense computed according to subpart 7 assigned to land and buildings, attached fixtures, and land improvements using the Medicare stepdown method described in subpart 1.

C.

For debts incurred after September 30, 1984, the nursing facility shall directly identify the proceeds of the debt associated with specific land and buildings, attached fixtures, and land improvements, and keep records that separate such debt proceeds from all other debt. Only the debt identified with specific land and buildings, attached fixtures, and land improvement shall be allowed.

D.

For reporting years ending on or after September 30, 1984, the total amount of allowable debt shall be the sum of all allowable debts at the beginning of the reporting year plus all allowable debts at the end of the reporting year divided by two. Nursing facilities which have a debt with a zero balance at the beginning or end of the reporting year must use a monthly average for the reporting year.

E.

Debt incurred as a result of loans between related organizations must not be allowed.

Subp. 6.

Limitations on interest rates.

The commissioner shall limit interest rates according to items A to C.

A.

Except as provided in item B, the effective interest rate of each allowable debt, including points, financing charges, and amortization bond premiums or discounts, entered into after September 30, 1984, is limited to the lesser of:

(1)

the effective interest rate on the debt; or

(2)

16 percent.

B.

Variable or adjustable rates for allowable debt are allowed subject to item A. For each allowable debt with a variable or adjustable rate, the effective interest rate must be computed by dividing the interest expense for the reporting year by the average allowable debt computed under subpart 5, item D.

C.

For rate years beginning on July 1, 1985, and July 1, 1986, the effective interest rate for debts incurred before October 1, 1984, is allowed if the interest rate is not in excess of what the borrower would have had to pay in an arms length transaction in the market in which the debt was incurred. For rate years beginning after June 30, 1987, the effective interest rate for debts incurred before October 1, 1984, is allowed subject to item A.

Subp. 7.

Allowable interest expense.

The commissioner shall allow or disallow interest expense including points, finance charges, and amortization bond premiums or discounts under items A to G.

A.

Interest expense is allowed only on the debt which is allowed under subpart 5 and within the interest rate limits in subpart 6.

B.

A nonprofit nursing facility shall use its restricted funds to purchase or replace capital assets to the extent of the cost of those capital assets before it borrows funds for the purchase or replacement of those capital assets. For purposes of this item and part 9549.0035, subpart 2, a restricted fund is a fund for which use is restricted to the purchase or replacement of capital assets by the donor or by the nonprofit nursing facility's board.

C.

Construction period interest expense must be capitalized as a part of the cost of the building. The period of construction extends to the earlier of either the first day a resident is admitted to the nursing facility, or the date the nursing facility is certified to receive medical assistance recipients.

D.

Interest expense for allowable debts entered into after May 22, 1983, is allowed for the portion of the debt which together with all outstanding allowable debt does not exceed 100 percent of the most recent allowable appraised value as determined in subparts 1 to 4.

E.

Increases in interest expense after May 22, 1983, which are the result of changes in ownership or reorganization of provider entities, are not allowable.

F.

Except as provided in item G, increases in total interest expense which are the result of refinancing of debt after May 22, 1983, are not allowed. The total interest expense must be computed as the sum of the annual interest expense over the remaining term of the debt refinanced.

G.

Increases in total interest expense which result from refinancing a balloon payment on allowable debt after May 22, 1983, shall be allowed according to subitems (1) to (3).

(1)

The interest rate on the refinanced debt shall be limited under subpart 6, item A.

(2)

The refinanced debt shall not exceed the balloon payment.

(3)

The term of the refinanced debt must not exceed the term of the original debt computed as though the balloon payment did not exist.

Subp. 10.

Equipment allowance.

For rate years beginning after June 30, 1985, the equipment allowance must be computed according to items A to E.

A.

The historical cost of depreciable equipment for nursing facilities which do not have costs for operating leases for depreciable equipment in excess of $10,000 during the reporting year ending September 30, 1984, is determined under subitem (1) or (2).

(1)

The total historical cost of depreciable equipment reported on the nursing facility's audited financial statement for the reporting year ending September 30, 1984, must be multiplied by 70 percent. The product is the historical cost of depreciable equipment.

(2)

The nursing facility may submit an analysis which classifies the historical cost of each item of depreciable equipment reported on September 30, 1984. The analysis must include an itemized description of each piece of depreciable equipment and its historical cost. The sum of the historical cost of each piece of equipment is the total historical cost of depreciable equipment for that nursing facility.

For purposes of this item, a hospital attached nursing facility shall use the allocation method in subpart 1 to stepdown the historical cost of depreciable equipment.

B.

The historical cost per bed of depreciable equipment for each nursing facility must be computed by dividing the total historical cost of depreciable equipment determined in item A by the nursing facility's total number of licensed beds on September 30, 1984.

C.

All nursing facilities must be grouped in one of the following:

(1)

nursing facilities with total licensed beds of less than 61 beds;

(2)

nursing facilities with total licensed beds of more than 60 beds and less than 101 beds; or

(3)

nursing facilities with more than 100 total licensed beds.

D.

Within each group determined in item C, the historical cost per bed for each nursing facility determined in item B must be ranked and the median historical cost per bed established.

E.

The median historical cost per bed for each group in item C as determined in item D must be increased by ten percent. For rate years beginning after June 30, 1986, this amount shall be adjusted annually by the percentage change indicated by the urban consumer price index for Minneapolis-Saint Paul, as published by the Bureau of Labor Statistics, new series index (1967=100) for the two previous Decembers. This index is incorporated by reference and available at the James J. Hill Reference Library, Saint Paul, Minnesota.

F.

The equipment allowance for each group in item C shall be the amount computed in item E multiplied by 15 percent and divided by 350.

Subp. 11.

Capacity days.

The number of capacity days is determined under items A to C.

A.

The number of capacity days is determined by multiplying the number of licensed beds in the nursing facility by the number of days in the nursing facility's reporting period.

B.

Except as in item C, nursing facilities shall increase the number of capacity days by multiplying the number of licensed single bedrooms by 0.5 and by the number of days in the nursing facility's reporting period.

C.

The commissioner shall waive the requirements of item B if a nursing facility agrees in writing to subitems (1) to (3).

(1)

The nursing facility shall agree not to request a private room payment in part 9549.0070, subpart 3 for any of its medical assistance residents in licensed single bedrooms.

(2)

The nursing facility shall agree not to use the single bedroom replacement cost new limit for any of its licensed single bedrooms in the computation of the allowable appraised value in subpart 4.

(3)

The nursing facility shall agree not to charge any private paying resident in a single bedroom a payment rate that exceeds the amount calculated under units (a) to (c).

(a)

The nursing facility's average total payment rate shall be determined by multiplying the total payment rate for each case mix resident class by the number of resident days for that class in the nursing facility's reporting year and dividing the sum of the resident class amounts by the total number of resident days in the nursing facility's reporting year.

(b)

The nursing facility's maximum single bedroom adjustment must be determined by multiplying its average total payment rate calculated under unit (a) by ten percent.

(c)

The nursing facility's single bedroom adjustment which must not exceed the amount computed in unit (b) must be added to each total payment rate established in Minnesota Statutes, sections 256B.431, 256B.434, and 256B.441, to determine the nursing facility's single bedroom payment rates.

Subp. 14.

Determination of interim and settle-up payment rates.

The commissioner shall determine interim and settle-up payment rates according to items A to J.

A.

A newly constructed nursing facility, or one with a capacity increase of 50 percent or more, may submit a written application to the commissioner to receive an interim payment rate. The nursing facility shall submit cost reports and other supporting information as required in parts 9549.0010 to 9549.0080 for the reporting year in which the nursing facility plans to begin operation at least 60 days before the first day a resident is admitted to the newly constructed nursing facility bed. The nursing facility shall state the reasons for noncompliance with parts 9549.0010 to 9549.0080. The effective date of the interim payment rate is the earlier of either the first day a resident is admitted to the newly constructed nursing facility or the date the nursing facility bed is certified for medical assistance. The interim payment rate for a newly constructed nursing facility, or a nursing facility with a capacity increase of 50 percent or more, is determined under items B to D.

B.

The interim payment rate must not be in effect more than 17 months. When the interim payment rate begins between May 1 and September 30, the nursing facility shall file settle-up cost reports for the period from the beginning of the interim payment rate through September 30 of the following year. When the interim payment rate begins between October 1 and April 30, the nursing facility shall file settle-up cost reports for the period from the beginning of the interim payment rate to the first September 30 following the beginning of the interim payment rate.

C.

The interim payment rate for a nursing facility which commenced construction prior to July 1, 1985, is determined by 12 MCAR S 2.05014 [Temporary] except that capital assets must be classified under parts 9549.0010 to 9549.0080.

D.

The interim property-related payment rate for a nursing facility which commences construction after June 30, 1985, is determined as follows:

(1)

At least 60 days before the first day a resident is admitted to the newly constructed nursing facility bed and upon receipt of written application from the nursing facility, the commissioner shall establish the nursing facility's appraised value according to subparts 1 and 4.

(2)

The nursing facility shall project the allowable debt and the allowable interest expense according to subparts 5 and 7.

(3)

The interim building capital allowance must be determined under subpart 8 or 9.

(4)

The equipment allowance during the interim period must be the equipment allowance computed in accordance with subpart 10 which is in effect on the effective date of the interim property-related payment rate.

(5)

The interim property-related payment rate must be the sum of subitems (3) and (4).

(6)

Anticipated resident days may be used instead of 96 percent capacity days.

E.

The settle-up property-related payment rate and the property-related payment rate for the nine months following the settle up for a nursing facility which commenced construction before July 1, 1985, is determined under 12 MCAR S 2.05014 [Temporary]. The property-related payment rate for the rate year beginning July 1 following the nine month period is determined under part 9549.0060.

F.

The settle-up property-related payment rate for a nursing facility which commenced construction after June 30, 1985, shall be established as follows:

(1)

The appraised value determined in item D, subitem (1), must be updated in accordance with subpart 2, item B prorated for each rate year, or portion of a rate year, included in the interim payment rate period.

(2)

The nursing facility's allowable debt, allowable interest rate, and allowable interest expense for the interim rate period shall be computed in accordance with subparts 5, 6, and 7.

(3)

The settle-up building capital allowance shall be determined in accordance with subpart 8 or 9.

(4)

The equipment allowance shall be updated in accordance with subpart 10 prorated for each rate year, or portion of a rate year, included in the interim payment rate period.

(5)

The settle-up property-related payment rate must be the sum of subitems (3) and (4).

(6)

Resident days may be used instead of 96 percent capacity days.

G.

The property-related payment rate for the nine months following the settle up for a nursing facility which commenced construction after June 30, 1985, shall be established in accordance with item F except that 96 percent capacity days must be used.

H.

The property-related payment rate for the rate year beginning July 1 following the nine month period in item G must be determined under this part.

I.

A newly constructed nursing facility or one with a capacity increase of 50 percent or more must continue to receive the interim property-related payment rate until the settle-up property-related payment rate is determined under this subpart.

J.

The interim real estate taxes and special assessments payment rate shall be established using the projected real estate taxes and special assessments cost divided by anticipated resident days. The settle-up real estate taxes and special assessments payment rate shall be established using the real estate taxes and special assessments divided by resident days. The real estate and special assessments payment rate for the nine months following the settle up shall be equal to the settle-up real estate taxes and special assessments payment rate.