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Capital IconMinnesota Legislature

HF 2614

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 05/03/2010 06:59pm

KEY: stricken = removed, old language.
underscored = added, new language.
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 1.39 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 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 3.33 3.34 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20
4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 4.35 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 5.31 5.32 5.33 5.34 5.35 5.36 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32
6.33 6.34 6.35 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 7.34 7.35 7.36 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 8.34 8.35 8.36 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 9.33 9.34 9.35 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 10.33 10.34 10.35 10.36 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 11.34 11.35 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 12.31 12.32 12.33 12.34 12.35 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 13.35 13.36
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 14.34 14.35 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 15.34 15.35 15.36 16.1 16.2 16.3
16.4
16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 16.35 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22
18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 18.34 18.35 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15
19.16 19.17 19.18 19.19 19.20
19.21 19.22
19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 19.34 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8
20.9 20.10
20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21
20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34
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 21.33 21.34 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 22.33 22.34
23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 23.35 23.36 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31
24.32 24.33
24.34 24.35 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15
25.16
25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27
25.28 25.29 25.30 25.31 25.32 25.33 25.34 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 26.31 26.32 26.33 26.34 26.35 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 28.34 28.35 28.36 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 29.34 29.35 30.1 30.2
30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 30.35 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 31.35 31.36 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 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10
34.11 34.12 34.13
34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21
34.22
34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32
34.33
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 35.35 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 36.33 36.34 36.35 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
37.33 37.34 37.35 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
38.33 38.34 38.35 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 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 40.33 40.34 40.35 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14
41.15
41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30
41.31 41.32 41.33 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 42.32 42.33 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 43.34 43.35 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15
44.16 44.17
44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 44.34
45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33
45.34 45.35
46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10
46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24
46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 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 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 49.1 49.2 49.3
49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21
49.22 49.23 49.24
49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 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 50.33 50.34 50.35 50.36 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33
52.34 52.35 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
53.32 53.33 53.34 53.35 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 54.31 54.32 54.33 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 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12
56.13
56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33
57.1
57.2 57.3 57.4 57.5
57.6 57.7
57.8 57.9 57.10 57.11 57.12 57.13
57.14 57.15 57.16 57.17 57.18 57.19
57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27
57.28 57.29
57.30 57.31 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 58.35 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 59.34 59.35 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 60.33 60.34 60.35 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 61.33 61.34 61.35 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 62.34 62.35 62.36 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 63.34 63.35 64.1 64.2 64.3 64.4
64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 64.35 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 65.33 65.34 65.35 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 66.35 66.36 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 67.33 67.34 67.35 67.36 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 68.33 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 69.33 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31
70.32
70.33 70.34 70.35 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 71.32 71.33 71.34 71.35 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 73.35 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 75.35 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 76.34 76.35 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 78.33 78.34 78.35 78.36 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 79.34 79.35 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 80.34 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 81.33 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 82.35 82.36 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 84.31 84.32 84.33 84.34 84.35 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 85.30 85.31 85.32 85.33 85.34 85.35 85.36 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
86.31 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 87.30 87.31 87.32 87.33 87.34 87.35 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 88.32 88.33 88.34 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 90.32 90.33 90.34 90.35 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 91.33 91.34 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 92.32 92.33 92.34 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 93.30 93.31 93.32 93.33 93.34 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 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18
95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 95.34 95.35 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 96.32 96.33 96.34 97.1 97.2
97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13
97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 98.34 98.35 98.36 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 99.32 99.33 99.34 99.35 99.36 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31
100.32 100.33 100.34 100.35 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 101.34 101.35 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 102.34 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 103.33 103.34 103.35 103.36 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 104.33 104.34 104.35 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 105.34 105.35 105.36 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32
106.33 106.34 106.35 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 107.34 107.35 107.36 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 108.33 108.34 108.35 108.36 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 109.34 109.35 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 110.35 110.36
111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 111.34 111.35 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9
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
112.27 112.28 112.29 112.30 112.31 112.32 112.33 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 113.35 113.36 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 114.34 114.35 114.36 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12
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
115.31 115.32 115.33 115.34 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8
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
118.1 118.2
118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 118.35 119.1 119.2 119.3 119.4
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
119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 120.35 120.36 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14
121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22
121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 122.34 122.35 122.36 123.1 123.2 123.3 123.4 123.5 123.6
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
123.31 123.32 123.33 123.34 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 124.34
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
125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 126.33 126.34 126.35 126.36 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 127.34 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 128.35 128.36 128.37 128.38 128.39 128.40 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18
129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 129.35 129.36 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24
130.25 130.26 130.27 130.28 130.29 130.30 130.31
131.1 131.2
131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17
131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 131.34 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26
132.27 132.28
132.29 132.30
132.31 133.1 133.2 133.3 133.4 133.5 133.6
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
133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13
134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16
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
136.33 136.34 136.35 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20
137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 137.35 138.1 138.2 138.3 138.4
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
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
139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34
140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 140.35 140.36 140.37 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 143.34 143.35 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 144.33 144.34 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 145.34 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 146.34 146.35 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 147.33 147.34 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33 148.34 148.35 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33 149.34 149.35 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 150.34 150.35 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 151.34 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 152.34 152.35 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34
154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 154.33 154.34 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 155.35 155.36 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 156.34 156.35 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29
157.30 157.31 157.32 157.33 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28
158.29 158.30 158.31 158.32 158.33 158.34 158.35 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12
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
159.30 159.31 159.32 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 160.35 160.36 160.37 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 162.33 162.34 162.35 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 163.33 163.34 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 164.33 164.34 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 165.34 165.35 165.36 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28
166.29 166.30 166.31 166.32 166.33 166.34 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17
167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 168.34 168.35 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 169.34 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 170.33 170.34 170.35 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 171.34 171.35 171.36 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 172.34 172.35 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33 173.34 173.35 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 174.34 174.35 174.36 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 175.34 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 176.34 176.35 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 177.34 177.35 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 178.35 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 179.34 179.35 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29
180.30 180.31 180.32 180.33 180.34 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 181.34 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 182.35 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 183.35 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 184.35 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 185.35 186.1 186.2 186.3 186.4 186.5 186.6
186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25
187.26 187.27 187.28
187.29 187.30 187.31 187.32
188.1 188.2 188.3
188.4 188.5 188.6
188.7 188.8 188.9

A bill for an act
relating to state government; licensing; state health care programs; continuing
care; children and family services; health reform; Department of Health;
public health; assessing administrative penalties; requiring reports; making
supplemental and contingent appropriations and reductions for the Departments
of Health and Human Services and other health-related boards and councils;
amending Minnesota Statutes 2008, sections 62D.08, by adding a subdivision;
62J.07, subdivision 2, by adding a subdivision; 62J.38; 62Q.19, subdivision 1;
62Q.76, subdivision 1; 62U.05; 119B.025, subdivision 1; 119B.09, subdivision
4; 119B.11, subdivision 1; 144.226, subdivision 3; 144.291, subdivision 2;
144.651, subdivision 2; 144.9504, by adding a subdivision; 144A.51, subdivision
5; 144E.37; 214.40, subdivision 7; 245C.27, subdivision 2; 245C.28, subdivision
3; 254B.01, subdivision 2; 254B.02, subdivisions 1, 5; 254B.03, subdivision
4, by adding a subdivision; 254B.05, subdivision 4; 254B.06, subdivision 2;
254B.09, subdivision 8; 256.01, by adding a subdivision; 256.9657, subdivision
3; 256B.04, subdivision 14; 256B.055, by adding a subdivision; 256B.056,
subdivision 4; 256B.057, subdivision 9; 256B.0625, subdivisions 8, 8a, 8b, 18a,
22, 31, by adding subdivisions; 256B.0631, subdivisions 1, 3; 256B.0644, as
amended; 256B.0754, by adding a subdivision; 256B.0915, subdivision 3b;
256B.19, subdivision 1c; 256B.69, subdivisions 20, as amended, 27, by adding
subdivisions; 256B.692, subdivision 1; 256B.75; 256B.76, subdivisions 2, 4, by
adding a subdivision; 256D.0515; 256J.20, subdivision 3; 256J.24, subdivision
10; 256J.37, subdivision 3a; 256L.02, subdivision 3; 256L.03, subdivision
3, by adding a subdivision; 256L.05, by adding a subdivision; 256L.07, by
adding a subdivision; 256L.12, subdivisions 5, 6, 9; 256L.15, subdivision 1;
626.556, subdivision 10i; 626.557, subdivision 9d; Minnesota Statutes 2009
Supplement, sections 62J.495, subdivisions 1a, 3, by adding a subdivision;
144.0724, subdivision 11; 157.16, subdivision 3; 245C.27, subdivision 1;
252.025, subdivision 7; 252.27, subdivision 2a; 256.045, subdivision 3; 256.969,
subdivision 3a; 256B.0625, subdivisions 9, 13e; 256B.0653, subdivision 5;
256B.0911, subdivision 1a; 256B.0915, subdivision 3a; 256B.69, subdivision
23; 256B.76, subdivision 1; 256B.766; 256D.03, subdivision 3, as amended;
256J.425, subdivision 3; 256L.03, subdivision 5; 256L.11, subdivision 1; 327.15,
subdivision 3; Laws 2005, First Special Session chapter 4, article 8, section 66,
as amended; Laws 2009, chapter 79, article 3, section 18; article 5, sections 17;
18; 22; 75, subdivision 1; 78, subdivision 5; article 13, sections 3, subdivisions
1, as amended, 3, as amended, 4, as amended, 8, as amended; 5, subdivision
8, as amended; Laws 2009, chapter 173, article 1, section 17; Laws 2010,
chapter 200, article 1, sections 12; 16; 21; article 2, section 2, subdivisions 1,
8; proposing coding for new law in Minnesota Statutes, chapters 62A; 62D;
62E; 62J; 62Q; 144; 245; 254B; 256; 256B; repealing Minnesota Statutes 2008,
sections 254B.02, subdivisions 2, 3, 4; 254B.09, subdivisions 4, 5, 7; 256D.03,
subdivisions 3a, 3b, 5, 6, 7, 8; Minnesota Statutes 2009 Supplement, section
256D.03, subdivision 3; Laws 2009, chapter 79, article 7, section 26, subdivision
3; Laws 2010, chapter 200, article 1, sections 12, subdivisions 1, 2, 3, 4, 5, 6, 7,
8, 9; 18; 19.

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

ARTICLE 1

DHS LICENSING

Section 1.

Minnesota Statutes 2009 Supplement, section 245C.27, subdivision 1, is
amended to read:


Subdivision 1.

Fair hearing when disqualification is not deleted text beginset asidedeleted text endnew text begin rescindednew text end.

(a)
If the commissioner does not deleted text beginset asidedeleted text endnew text begin rescindnew text end a disqualification of an individual under
section 245C.22 who is disqualified on the basis of a preponderance of evidence that the
individual committed an act or acts that meet the definition of any of the crimes listed in
section 245C.15; for a determination under section 626.556 or 626.557 of substantiated
maltreatment that was serious or recurring under section 245C.15; or for failure to make
required reports under section 626.556, subdivision 3; or 626.557, subdivision 3, pursuant
to section 245C.15, subdivision 4, paragraph (b), clause (1), the individual may request
a fair hearing under section 256.045, unless the disqualification is deemed conclusive
under section 245C.29.

(b) The fair hearing is the only administrative appeal of the final agency
determination for purposes of appeal by the disqualified individual. The disqualified
individual does not have the right to challenge the accuracy and completeness of data
under section 13.04.

(c) Except as provided under paragraph (e), if the individual was disqualified based
on a conviction of, admission to, or Alford Plea to any crimes listed in section 245C.15,
subdivisions 1 to 4
, or for a disqualification under section 256.98, subdivision 8, the
reconsideration decision under section 245C.22 is the final agency determination for
purposes of appeal by the disqualified individual and is not subject to a hearing under
section 256.045. If the individual was disqualified based on a judicial determination, that
determination is treated the same as a conviction for purposes of appeal.

(d) This subdivision does not apply to a public employee's appeal of a disqualification
under section 245C.28, subdivision 3.

(e) Notwithstanding paragraph (c), if the commissioner does not set aside a
disqualification of an individual who was disqualified based on both a preponderance
of evidence and a conviction or admission, the individual may request a fair hearing
under section 256.045, unless the disqualifications are deemed conclusive under section
245C.29. The scope of the hearing conducted under section 256.045 with regard to the
disqualification based on a conviction or admission shall be limited solely to whether the
individual poses a risk of harm, according to section 256.045, subdivision 3b. In this case,
the reconsideration decision under section 245C.22 is not the final agency decision for
purposes of appeal by the disqualified individual.

Sec. 2.

Minnesota Statutes 2008, section 245C.27, subdivision 2, is amended to read:


Subd. 2.

Consolidated fair hearing.

(a) If an individual who is disqualified on the
bases of serious or recurring maltreatment requests a fair hearing on the maltreatment
determination under section 626.556, subdivision 10i, or 626.557, subdivision 9d, and
requests a fair hearing under this section on the disqualification, which has not been
deleted text begin set asidedeleted text endnew text begin rescindednew text end, the scope of the fair hearing under section 256.045 shall include the
maltreatment determination and the disqualification.

(b) A fair hearing is the only administrative appeal of the final agency determination.
The disqualified individual does not have the right to challenge the accuracy and
completeness of data under section 13.04.

(c) This subdivision does not apply to a public employee's appeal of a disqualification
under section 245C.28, subdivision 3.

Sec. 3.

Minnesota Statutes 2008, section 245C.28, subdivision 3, is amended to read:


Subd. 3.

Employees of public employer.

(a) If the commissioner does not deleted text beginset
aside
deleted text endnew text begin rescindnew text end the disqualification of an individual who is an employee of an employer, as
defined in section 179A.03, subdivision 15, the individual may request a contested case
hearing under chapter 14new text begin, unless the disqualification is deemed conclusive under section
245C.29
new text end. The request for a contested case hearing must be made in writing and must be
postmarked and sent within 30 calendar days after the employee receives notice that the
disqualification has not been deleted text beginset asidedeleted text endnew text begin rescindednew text end. If the individual was disqualified based
on a conviction or admission to any crimes listed in section 245C.15, the scope of the
contested case hearing shall be limited solely to whether the individual poses a risk of
harm pursuant to section 245C.22.

(b) If the commissioner does not deleted text beginset asidedeleted text endnew text begin rescindnew text end a disqualification that is based on
a maltreatment determination, the scope of the contested case hearing must include the
maltreatment determination and the disqualification. In such cases, a fair hearing must
not be conducted under section 256.045.

new text begin (c) If the commissioner does not rescind a disqualification that is based on a
preponderance of evidence that the individual committed an act or acts that meet the
definition of any of the crimes listed in section 245C.15, the scope of the contested case
hearing must include the disqualification decision. In such cases, a fair hearing must
not be conducted under section 256.045.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end Rules adopted under this chapter may not preclude an employee in a contested
case hearing for a disqualification from submitting evidence concerning information
gathered under this chapter.

deleted text begin (d)deleted text endnew text begin (e)new text end When an individual has been disqualified from multiple licensed programs
and the disqualifications have not been deleted text beginset asidedeleted text endnew text begin rescindednew text end under section 245C.22, if at
least one of the disqualifications entitles the person to a contested case hearing under this
subdivision, the scope of the contested case hearing shall include all disqualifications from
licensed programs which were not deleted text beginset asidedeleted text endnew text begin rescindednew text end.

deleted text begin (e)deleted text endnew text begin (f)new text end In determining whether the disqualification should be set aside, the
administrative law judge shall consider all of the characteristics that cause the individual
to be disqualified in order to determine whether the individual poses a risk of harm. The
administrative law judge's recommendation and the commissioner's order to set aside
a disqualification that is the subject of the hearing constitutes a determination that the
individual does not pose a risk of harm and that the individual may provide direct contact
services in the individual program specified in the set aside.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256.045, subdivision 3, is
amended to read:


Subd. 3.

State agency hearings.

(a) State agency hearings are available for the
following:

(1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or
the federal Food Stamp Act whose application for assistance is denied, not acted upon
with reasonable promptness, or whose assistance is suspended, reduced, terminated, or
claimed to have been incorrectly paid;

(2) any patient or relative aggrieved by an order of the commissioner under section
252.27;

(3) a party aggrieved by a ruling of a prepaid health plan;

(4) except as provided under chapter 245C, any individual or facility determined by
a lead agency to have maltreated a vulnerable adult under section 626.557 after they have
exercised their right to administrative reconsideration under section 626.557;

(5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under section 626.556 is denied or not
acted upon with reasonable promptness, regardless of funding source;

(6) any person to whom a right of appeal according to this section is given by other
provision of law;

(7) an applicant aggrieved by an adverse decision to an application for a hardship
waiver under section 256B.15;

(8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;

(9) except as provided under chapter 245A, an individual or facility determined
to have maltreated a minor under section 626.556, after the individual or facility has
exercised the right to administrative reconsideration under section 626.556;

(10) except as provided under chapter 245C, an individual disqualified under
sections 245C.14 and 245C.15, which has not been deleted text beginset asidedeleted text endnew text begin rescindednew text end under sections
245C.22 and 245C.23, on the basis of serious or recurring maltreatment; a preponderance
of the evidence that the individual has committed an act or acts that meet the definition
of any of the crimes listed in section 245C.15, subdivisions 1 to 4; or for failing to make
reports required under section 626.556, subdivision 3, or 626.557, subdivision 3. Hearings
regarding a maltreatment determination under clause (4) or (9) and a disqualification under
this clause in which the basis for a disqualification is serious or recurring maltreatment,
which has not been deleted text beginset asidedeleted text endnew text begin rescindednew text end under sections 245C.22 and 245C.23, shall be
consolidated into a single fair hearing. In such cases, the scope of review by the human
services referee shall include both the maltreatment determination and the disqualification.
The failure to exercise the right to an administrative reconsideration shall not be a bar to a
hearing under this section if federal law provides an individual the right to a hearing to
dispute a finding of maltreatment. Individuals and organizations specified in this section
may contest the specified action, decision, or final disposition before the state agency by
submitting a written request for a hearing to the state agency within 30 days after receiving
written notice of the action, decision, or final disposition, or within 90 days of such written
notice if the applicant, recipient, patient, or relative shows good cause why the request
was not submitted within the 30-day time limit; or

(11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food Stamp Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A
against the debt.

(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or
(10), is the only administrative appeal to the final agency determination specifically,
including a challenge to the accuracy and completeness of data under section 13.04.
Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment
that occur on or after October 1, 1995. Hearings requested by nursing assistants in nursing
homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a
contested case proceeding under the provisions of chapter 14. Hearings requested under
paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after
July 1, 1997. A hearing for an individual or facility under paragraph (a), clause (9), is
only available when there is no juvenile court or adult criminal action pending. If such
action is filed in either court while an administrative review is pending, the administrative
review must be suspended until the judicial actions are completed. If the juvenile court
action or criminal charge is dismissed or the criminal action overturned, the matter may be
considered in an administrative hearing.

(c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.

(d) The scope of hearings involving claims to foster care payments under paragraph
(a), clause (5), shall be limited to the issue of whether the county is legally responsible
for a child's placement under court order or voluntary placement agreement and, if so,
the correct amount of foster care payment to be made on the child's behalf and shall not
include review of the propriety of the county's child protection determination or child
placement decision.

(e) A vendor of medical care as defined in section 256B.02, subdivision 7, or a
vendor under contract with a county agency to provide social services is not a party and
may not request a hearing under this section, except if assisting a recipient as provided in
subdivision 4.

(f) An applicant or recipient is not entitled to receive social services beyond the
services prescribed under chapter 256M or other social services the person is eligible
for under state law.

(g) The commissioner may summarily affirm the county or state agency's proposed
action without a hearing when the sole issue is an automatic change due to a change in
state or federal law.

Sec. 5.

Minnesota Statutes 2008, section 626.556, subdivision 10i, is amended to read:


Subd. 10i.

Administrative reconsideration; review panel.

(a) Administrative
reconsideration is not applicable in family assessments since no determination concerning
maltreatment is made. For investigations, except as provided under paragraph (e), an
individual or facility that the commissioner of human services, a local social service
agency, or the commissioner of education determines has maltreated a child, an interested
person acting on behalf of the child, regardless of the determination, who contests
the investigating agency's final determination regarding maltreatment, may request the
investigating agency to reconsider its final determination regarding maltreatment. The
request for reconsideration must be submitted in writing to the investigating agency within
15 calendar days after receipt of notice of the final determination regarding maltreatment
or, if the request is made by an interested person who is not entitled to notice, within
15 days after receipt of the notice by the parent or guardian of the child. If mailed, the
request for reconsideration must be postmarked and sent to the investigating agency
within 15 calendar days of the individual's or facility's receipt of the final determination. If
the request for reconsideration is made by personal service, it must be received by the
investigating agency within 15 calendar days after the individual's or facility's receipt of the
final determination. Effective January 1, 2002, an individual who was determined to have
maltreated a child under this section and who was disqualified on the basis of serious or
recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration
of the maltreatment determination and the disqualification. The request for reconsideration
of the maltreatment determination and the disqualification must be submitted within 30
calendar days of the individual's receipt of the notice of disqualification under sections
245C.16 and 245C.17. If mailed, the request for reconsideration of the maltreatment
determination and the disqualification must be postmarked and sent to the investigating
agency within 30 calendar days of the individual's receipt of the maltreatment
determination and notice of disqualification. If the request for reconsideration is made by
personal service, it must be received by the investigating agency within 30 calendar days
after the individual's receipt of the notice of disqualification.

(b) Except as provided under paragraphs (e) and (f), if the investigating agency
denies the request or fails to act upon the request within 15 working days after receiving
the request for reconsideration, the person or facility entitled to a fair hearing under section
256.045 may submit to the commissioner of human services or the commissioner of
education a written request for a hearing under that section. Section 256.045 also governs
hearings requested to contest a final determination of the commissioner of education. For
reports involving maltreatment of a child in a facility, an interested person acting on behalf
of the child may request a review by the Child Maltreatment Review Panel under section
256.022 if the investigating agency denies the request or fails to act upon the request or
if the interested person contests a reconsidered determination. The investigating agency
shall notify persons who request reconsideration of their rights under this paragraph.
The request must be submitted in writing to the review panel and a copy sent to the
investigating agency within 30 calendar days of receipt of notice of a denial of a request
for reconsideration or of a reconsidered determination. The request must specifically
identify the aspects of the agency determination with which the person is dissatisfied.

(c) If, as a result of a reconsideration or review, the investigating agency changes
the final determination of maltreatment, that agency shall notify the parties specified in
subdivisions 10b, 10d, and 10f.

(d) Except as provided under paragraph (f), if an individual or facility contests the
investigating agency's final determination regarding maltreatment by requesting a fair
hearing under section 256.045, the commissioner of human services shall assure that the
hearing is conducted and a decision is reached within 90 days of receipt of the request for
a hearing. The time for action on the decision may be extended for as many days as the
hearing is postponed or the record is held open for the benefit of either party.

(e) deleted text beginEffective January 1, 2002,deleted text end If an individual was disqualified under sections
245C.14 and 245C.15, on the basis of a determination of maltreatment, which was
serious or recurring, and the individual has requested reconsideration of the maltreatment
determination under paragraph (a) and requested reconsideration of the disqualification
under sections 245C.21 to 245C.27, reconsideration of the maltreatment determination and
reconsideration of the disqualification shall be consolidated into a single reconsideration.
If reconsideration of the maltreatment determination is denied or the disqualification is not
deleted text begin set asidedeleted text endnew text begin rescindednew text end under sections 245C.21 to 245C.27, the individual may request a fair
hearing under section 256.045. If an individual requests a fair hearing on the maltreatment
determination and the disqualification, the scope of the fair hearing shall include both the
maltreatment determination and the disqualification.

(f) deleted text beginEffective January 1, 2002,deleted text end If a maltreatment determination or a disqualification
based on serious or recurring maltreatment is the basis for a denial of a license under
section 245A.05 or a licensing sanction under section 245A.07, the license holder has the
right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505
to 1400.8612. As provided for under section 245A.08, subdivision 2a, the scope of the
contested case hearing shall include the maltreatment determination, disqualification,
and licensing sanction or denial of a license. In such cases, a fair hearing regarding
the maltreatment determination and disqualification shall not be conducted under
section 256.045. Except for family child care and child foster care, reconsideration of a
maltreatment determination as provided under this subdivision, and reconsideration of a
disqualification as provided under section 245C.22, shall also not be conducted when:

(1) a denial of a license under section 245A.05 or a licensing sanction under section
245A.07, is based on a determination that the license holder is responsible for maltreatment
or the disqualification of a license holder based on serious or recurring maltreatment;

(2) the denial of a license or licensing sanction is issued at the same time as the
maltreatment determination or disqualification; and

(3) the license holder appeals the maltreatment determination or disqualification, and
denial of a license or licensing sanction.

Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
determination or disqualification, but does not appeal the denial of a license or a licensing
sanction, reconsideration of the maltreatment determination shall be conducted under
sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
626.557, subdivision 9d.

If the disqualified subject is an individual other than the license holder and upon
whom a background study must be conducted under chapter 245C, the hearings of all
parties may be consolidated into a single contested case hearing upon consent of all parties
and the administrative law judge.

(g) For purposes of this subdivision, "interested person acting on behalf of the
child" means a parent or legal guardian; stepparent; grandparent; guardian ad litem; adult
stepbrother, stepsister, or sibling; or adult aunt or uncle; unless the person has been
determined to be the perpetrator of the maltreatment.

Sec. 6.

Minnesota Statutes 2008, section 626.557, subdivision 9d, is amended to read:


Subd. 9d.

Administrative reconsideration; review panel.

(a) Except as provided
under paragraph (e), any individual or facility which a lead agency determines has
maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on
behalf of the vulnerable adult, regardless of the lead agency's determination, who contests
the lead agency's final disposition of an allegation of maltreatment, may request the
lead agency to reconsider its final disposition. The request for reconsideration must be
submitted in writing to the lead agency within 15 calendar days after receipt of notice of
final disposition or, if the request is made by an interested person who is not entitled to
notice, within 15 days after receipt of the notice by the vulnerable adult or the vulnerable
adult's legal guardian. If mailed, the request for reconsideration must be postmarked and
sent to the lead agency within 15 calendar days of the individual's or facility's receipt of
the final disposition. If the request for reconsideration is made by personal service, it must
be received by the lead agency within 15 calendar days of the individual's or facility's
receipt of the final disposition. An individual who was determined to have maltreated a
vulnerable adult under this section and who was disqualified on the basis of serious or
recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration
of the maltreatment determination and the disqualification. The request for reconsideration
of the maltreatment determination and the disqualification must be submitted in writing
within 30 calendar days of the individual's receipt of the notice of disqualification
under sections 245C.16 and 245C.17. If mailed, the request for reconsideration of
the maltreatment determination and the disqualification must be postmarked and sent
to the lead agency within 30 calendar days of the individual's receipt of the notice of
disqualification. If the request for reconsideration is made by personal service, it must be
received by the lead agency within 30 calendar days after the individual's receipt of the
notice of disqualification.

(b) Except as provided under paragraphs (e) and (f), if the lead agency denies the
request or fails to act upon the request within 15 working days after receiving the request
for reconsideration, the person or facility entitled to a fair hearing under section 256.045,
may submit to the commissioner of human services a written request for a hearing
under that statute. The vulnerable adult, or an interested person acting on behalf of the
vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review
Panel under section 256.021 if the lead agency denies the request or fails to act upon the
request, or if the vulnerable adult or interested person contests a reconsidered disposition.
The lead agency shall notify persons who request reconsideration of their rights under this
paragraph. The request must be submitted in writing to the review panel and a copy sent
to the lead agency within 30 calendar days of receipt of notice of a denial of a request for
reconsideration or of a reconsidered disposition. The request must specifically identify the
aspects of the agency determination with which the person is dissatisfied.

(c) If, as a result of a reconsideration or review, the lead agency changes the final
disposition, it shall notify the parties specified in subdivision 9c, paragraph (d).

(d) For purposes of this subdivision, "interested person acting on behalf of the
vulnerable adult" means a person designated in writing by the vulnerable adult to act
on behalf of the vulnerable adult, or a legal guardian or conservator or other legal
representative, a proxy or health care agent appointed under chapter 145B or 145C,
or an individual who is related to the vulnerable adult, as defined in section 245A.02,
subdivision 13
.

(e) If an individual was disqualified under sections 245C.14 and 245C.15, on
the basis of a determination of maltreatment, which was serious or recurring, and
the individual has requested reconsideration of the maltreatment determination under
paragraph (a) and reconsideration of the disqualification under sections 245C.21 to
245C.27, reconsideration of the maltreatment determination and requested reconsideration
of the disqualification shall be consolidated into a single reconsideration. If reconsideration
of the maltreatment determination is denied or if the disqualification is not deleted text beginset asidedeleted text endnew text begin
rescinded
new text end under sections 245C.21 to 245C.27, the individual may request a fair hearing
under section 256.045. If an individual requests a fair hearing on the maltreatment
determination and the disqualification, the scope of the fair hearing shall include both the
maltreatment determination and the disqualification.

(f) If a maltreatment determination or a disqualification based on serious or recurring
maltreatment is the basis for a denial of a license under section 245A.05 or a licensing
sanction under section 245A.07, the license holder has the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided
for under section 245A.08, the scope of the contested case hearing must include the
maltreatment determination, disqualification, and licensing sanction or denial of a license.
In such cases, a fair hearing must not be conducted under section 256.045. Except for
family child care and child foster care, reconsideration of a maltreatment determination
under this subdivision, and reconsideration of a disqualification under section 245C.22,
must not be conducted when:

(1) a denial of a license under section 245A.05, or a licensing sanction under section
245A.07, is based on a determination that the license holder is responsible for maltreatment
or the disqualification of a license holder based on serious or recurring maltreatment;

(2) the denial of a license or licensing sanction is issued at the same time as the
maltreatment determination or disqualification; and

(3) the license holder appeals the maltreatment determination or disqualification, and
denial of a license or licensing sanction.

Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
determination or disqualification, but does not appeal the denial of a license or a licensing
sanction, reconsideration of the maltreatment determination shall be conducted under
sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
626.557, subdivision 9d.

If the disqualified subject is an individual other than the license holder and upon
whom a background study must be conducted under chapter 245C, the hearings of all
parties may be consolidated into a single contested case hearing upon consent of all parties
and the administrative law judge.

(g) Until August 1, 2002, an individual or facility that was determined by the
commissioner of human services or the commissioner of health to be responsible for
neglect under section 626.5572, subdivision 17, after October 1, 1995, and before August
1, 2001, that believes that the finding of neglect does not meet an amended definition of
neglect may request a reconsideration of the determination of neglect. The commissioner
of human services or the commissioner of health shall mail a notice to the last known
address of individuals who are eligible to seek this reconsideration. The request for
reconsideration must state how the established findings no longer meet the elements of
the definition of neglect. The commissioner shall review the request for reconsideration
and make a determination within 15 calendar days. The commissioner's decision on this
reconsideration is the final agency action.

(1) For purposes of compliance with the data destruction schedule under subdivision
12b, paragraph (d), when a finding of substantiated maltreatment has been changed as
a result of a reconsideration under this paragraph, the date of the original finding of a
substantiated maltreatment must be used to calculate the destruction date.

(2) For purposes of any background studies under chapter 245C, when a
determination of substantiated maltreatment has been changed as a result of a
reconsideration under this paragraph, any prior disqualification of the individual under
chapter 245C that was based on this determination of maltreatment shall be rescinded,
and for future background studies under chapter 245C the commissioner must not use the
previous determination of substantiated maltreatment as a basis for disqualification or as a
basis for referring the individual's maltreatment history to a health-related licensing board
under section 245C.31.

ARTICLE 2

HEALTH CARE

Section 1.

Minnesota Statutes 2008, section 144.291, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For the purposes of sections 144.291 to 144.298, the following
terms have the meanings given.

(a) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.

(b) "Health information exchange" means a legal arrangement between health care
providers and group purchasers to enable and oversee the business and legal issues
involved in the electronic exchange of health records between the entities for the delivery
of patient care.

(c) "Health record" means any information, whether oral or recorded in any form or
medium, that relates to the past, present, or future physical or mental health or condition of
a patient; the provision of health care to a patient; or the past, present, or future payment
for the provision of health care to a patient.

(d) "Identifying information" means the patient's name, address, date of birth,
gender, parent's or guardian's name regardless of the age of the patient, and other
nonclinical data which can be used to uniquely identify a patient.

(e) "Individually identifiable form" means a form in which the patient is or can be
identified as the subject of the health records.

(f) "Medical emergency" means medically necessary care which is immediately
needed to preserve life, prevent serious impairment to bodily functions, organs, or parts,
or prevent placing the physical or mental health of the patient in serious jeopardy.

(g) "Patient" means a natural person who has received health care services from a
provider for treatment or examination of a medical, psychiatric, or mental condition, the
surviving spouse and parents of a deceased patient, or a person the patient appoints in
writing as a representative, including a health care agent acting according to chapter 145C,
unless the authority of the agent has been limited by the principal in the principal's health
care directive. Except for minors who have received health care services under sections
144.341 to 144.347, in the case of a minor, patient includes a parent or guardian, or a
person acting as a parent or guardian in the absence of a parent or guardian.

(h) "Provider" means:

(1) any person who furnishes health care services and is regulated to furnish the
services under chapter 147, 147A, 147B, 147C, 147D, 148, 148B, 148C, 148D, 150A,
151, 153, or 153A;

(2) a home care provider licensed under section 144A.46;

(3) a health care facility licensed under this chapter or chapter 144A;

(4) a physician assistant registered under chapter 147A; and

(5) an unlicensed mental health practitioner regulated under sections 148B.60 to
148B.71.

(i) "Record locator service" means an electronic index of patient identifying
information that directs providers in a health information exchange to the location of
patient health records held by providers and group purchasers.

(j) "Related health care entity" means an affiliate, as defined in section 144.6521,
subdivision 3
, paragraph (b), of the provider releasing the health recordsnew text begin, including, but
not limited to, affiliates of providers participating in a coordinated care delivery system
established under section 256D.031, subdivision 6
new text end.

Sec. 2.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:


new text begin Subd. 30. new text end

new text begin Review and evaluation of studies. new text end

new text begin The commissioner shall review
all published studies, reports, and program evaluations completed by the Department
of Human Services, and those requested by the legislature but not completed, for state
fiscal years 2000 through 2010. For each item, the commissioner shall report the
legislature's original appropriation for that work, if any, and the actual reported cost of the
completed work by the Department of Human Services. The commissioner shall make
recommendations to the legislature about which studies, reports, and program evaluations
required by law are duplicative, unnecessary, or obsolete. The commissioner shall repeat
this review every five fiscal years.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256.9657, subdivision 3, is amended to read:


Subd. 3.

Surcharge on HMOs and community integrated service networks.

(a)
Effective October 1, 1992, each health maintenance organization with a certificate of
authority issued by the commissioner of health under chapter 62D and each community
integrated service network licensed by the commissioner under chapter 62N shall pay to
the commissioner of human services a surcharge equal to six-tenths of one percent of the
total premium revenues of the health maintenance organization or community integrated
service network as reported to the commissioner of health according to the schedule in
subdivision 4.

(b) new text beginEffective June 1, 2010: (1) the surcharge under paragraph (a) is increased to 2.5
percent; and (2) each county-based purchasing plan authorized under section 256B.692
shall pay to the commissioner a surcharge equal to 2.5 percent of the total premium
revenues of the plan, as reported to the commissioner of health, according to the payment
schedule in subdivision 4.
new text end

new text begin (c) new text endFor purposes of this subdivision, total premium revenue means:

(1) premium revenue recognized on a prepaid basis from individuals and groups
for provision of a specified range of health services over a defined period of time which
is normally one month, excluding premiums paid to a health maintenance organization
or community integrated service network from the Federal Employees Health Benefit
Program;

(2) premiums from Medicare wrap-around subscribers for health benefits which
supplement Medicare coverage;

(3) Medicare revenue, as a result of an arrangement between a health maintenance
organization or a community integrated service network and the Centers for Medicare
and Medicaid Services of the federal Department of Health and Human Services, for
services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
1395w-24, respectively, as they may be amended from time to time; and

(4) medical assistance revenue, as a result of an arrangement between a health
maintenance organization or community integrated service network and a Medicaid state
agency, for services to a medical assistance beneficiary.

If advance payments are made under clause (1) or (2) to the health maintenance
organization or community integrated service network for more than one reporting period,
the portion of the payment that has not yet been earned must be treated as a liability.

deleted text begin (c)deleted text endnew text begin (d)new text end When a health maintenance organization or community integrated service
network merges or consolidates with or is acquired by another health maintenance
organization or community integrated service network, the surviving corporation or the
new corporation shall be responsible for the annual surcharge originally imposed on
each of the entities or corporations subject to the merger, consolidation, or acquisition,
regardless of whether one of the entities or corporations does not retain a certificate of
authority under chapter 62D or a license under chapter 62N.

deleted text begin (d)deleted text endnew text begin (e)new text end Effective July 1 of each year, the surviving corporation's or the new
corporation's surcharge shall be based on the revenues earned in the second previous
calendar year by all of the entities or corporations subject to the merger, consolidation,
or acquisition regardless of whether one of the entities or corporations does not retain a
certificate of authority under chapter 62D or a license under chapter 62N until the total
premium revenues of the surviving corporation include the total premium revenues of all
the merged entities as reported to the commissioner of health.

deleted text begin (e)deleted text endnew text begin (f)new text end When a health maintenance organization or community integrated service
network, which is subject to liability for the surcharge under this chapter, transfers,
assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
of the health maintenance organization or community integrated service network.

deleted text begin (f)deleted text endnew text begin (g)new text end In the event a health maintenance organization or community integrated
service network converts its licensure to a different type of entity subject to liability
for the surcharge under this chapter, but survives in the same or substantially similar
form, the surviving entity remains liable for the surcharge regardless of whether one of
the entities or corporations does not retain a certificate of authority under chapter 62D
or a license under chapter 62N.

deleted text begin (g)deleted text endnew text begin (h)new text end The surcharge assessed to a health maintenance organization or community
integrated service network ends when the entity ceases providing services for premiums
and the cessation is not connected with a merger, consolidation, acquisition, or conversion.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2010.
new text end

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is
amended to read:


Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.

(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
1.9 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2009, through June 30, 2010, to reflect this reduction.

(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2010, to reflect this reduction.

(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

new text begin (i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
payment for fee-for-service admissions occurring on or after July 1, 2011, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
7.5 percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced
for services provided on or after January 1, 2012, to reflect this reduction. Hospitals that,
prior to December 31, 2007, received payment to support the training of residents from an
approved graduate medical residency training program pursuant to United States Code,
title 42, section 256e, are not subject to the provisions of this paragraph.
new text end

Sec. 5.

Minnesota Statutes 2008, section 256B.04, subdivision 14, is amended to read:


Subd. 14.

Competitive bidding.

(a) When determined to be effective, economical,
and feasible, the commissioner may utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C, to provide items under the medical
assistance program including but not limited to the following:

(1) eyeglasses;

(2) oxygen. The commissioner shall provide for oxygen needed in an emergency
situation on a short-term basis, until the vendor can obtain the necessary supply from
the contract dealer;

(3) hearing aids and supplies; deleted text beginand
deleted text end

(4) durable medical equipment, including but not limited to:

(i) hospital beds;

(ii) commodes;

(iii) glide-about chairs;

(iv) patient lift apparatus;

(v) wheelchairs and accessories;

(vi) oxygen administration equipment;

(vii) respiratory therapy equipment;

(viii) electronic diagnostic, therapeutic and life-support systems;

(5) nonemergency medical transportation level of need determinations, disbursement
of public transportation passes and tokens, and volunteer and recipient mileage and
parking reimbursements; deleted text beginand
deleted text end

(6) drugsnew text begin; and
new text end

new text begin (7) medical suppliesnew text end.

(b) Rate changes under this chapter and chapters 256D and 256L do not affect
contract payments under this subdivision unless specifically identified.

(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation for special transportation services under the provisions of chapter 16C.

Sec. 6.

Minnesota Statutes 2008, section 256B.055, is amended by adding a
subdivision to read:


new text begin Subd. 15. new text end

new text begin Adults without children. new text end

new text begin Medical assistance may be paid for a person
who is over age 21 and under age 65, who is not pregnant, and who is not described in
subdivision 4, 7, or another subdivision of this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval and is
retroactive from April 1, 2010.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256B.056, subdivision 4, is amended to read:


Subd. 4.

Income.

(a) To be eligible for medical assistance, a person eligible under
section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
the federal poverty guidelines. Effective January 1, 2000, and each successive January,
recipients of supplemental security income may have an income up to the supplemental
security income standard in effect on that date.

(b) To be eligible for medical assistance, families and children may have an income
up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
1996, shall be increased by three percent.

(c) Effective July 1, 2002, to be eligible for medical assistance, families and children
may have an income up to 100 percent of the federal poverty guidelines for the family size.

(d) In computing income to determine eligibility of persons under paragraphs (a)
to (c)new text begin and (e)new text end who are not residents of long-term care facilities, the commissioner shall
disregard increases in income as required by Public Law Numbers 94-566, section 503;
99-272; and 99-509. Veterans aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.

new text begin (e) To be eligible for medical assistance, a person eligible under section 256B.055,
subdivision 15, may have income up to 75 percent of the federal poverty guidelines for
family size.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval and is
retroactive from April 1, 2010.
new text end

Sec. 8.

Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to read:


Subd. 8.

Physical therapy.

Medical assistance covers physical therapy and related
servicesdeleted text begin, including specialized maintenance therapydeleted text end. new text beginAuthorization by the commissioner
is required to provide services to a recipient beyond any of the following onetime service
thresholds: (1) 80 units of any approved CPT code other than modalities; (2) 20 modality
sessions; and (3) three evaluations or reevaluations.
new text endServices provided by a physical
therapy assistant shall be reimbursed at the same rate as services performed by a physical
therapist when the services of the physical therapy assistant are provided under the
direction of a physical therapist who is on the premises. Services provided by a physical
therapy assistant that are provided under the direction of a physical therapist who is not on
the premises shall be reimbursed at 65 percent of the physical therapist rate.

Sec. 9.

Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to
read:


Subd. 8a.

Occupational therapy.

Medical assistance covers occupational therapy
and related servicesdeleted text begin, including specialized maintenance therapydeleted text end. new text beginAuthorization by the
commissioner is required to provide services to a recipient beyond any of the following
onetime service thresholds: (1) 120 units of any combination of approved CPT codes;
and (2) two evaluations or reevaluations.
new text endServices provided by an occupational therapy
assistant shall be reimbursed at the same rate as services performed by an occupational
therapist when the services of the occupational therapy assistant are provided under the
direction of the occupational therapist who is on the premises. Services provided by an
occupational therapy assistant that are provided under the direction of an occupational
therapist who is not on the premises shall be reimbursed at 65 percent of the occupational
therapist rate.

Sec. 10.

Minnesota Statutes 2008, section 256B.0625, subdivision 8b, is amended to
read:


Subd. 8b.

Speech language pathology and audiology services.

Medical assistance
covers speech language pathology and related servicesdeleted text begin, including specialized maintenance
therapy
deleted text end. new text beginAuthorization by the commissioner is required to provide services to a recipient
beyond any of the following onetime service thresholds: (1) 50 treatment sessions with
any combination of approved CPT codes; and (2) one evaluation.
new text endMedical assistance
covers audiology services and related services. Services provided by a person who has
been issued a temporary registration under section 148.5161 shall be reimbursed at the
same rate as services performed by a speech language pathologist or audiologist as long as
the requirements of section 148.5161, subdivision 3, are met.

Sec. 11.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 8d. new text end

new text begin Chiropractic services. new text end

new text begin Payment for chiropractic services is limited to
one annual evaluation and 12 visits per year unless prior authorization of a greater number
of visits is obtained.
new text end

Sec. 12.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9,
is amended to read:


Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

(b) Medical assistance dental coverage for nonpregnant adults is limited to the
following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one new text beginsetnew text end per year;

(5) periapical x-rays;

(6) panoramic x-raysnew text begin or full-mouth radiographsnew text end, limited to one every five years,
and only if provided in conjunction with a posterior extraction or scheduled outpatient
facility procedure, or as medically necessary for the diagnosis and follow-up of oral and
maxillofacial pathology and trauma. Panoramic x-rays may be taken once every two years
for patients who cannot cooperate for intraoral film due to a developmental disability or
medical condition that does not allow for intraoral film placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars onlynew text begin, and
molar root canal therapy as deemed medically necessary for patients that are at high risk
of osteonecrosis from molar extractions
new text end;

(12) removable prostheses, each dental arch limited to one every six yearsdeleted text begin;deleted text endnew text begin including:
new text end

new text begin (i) relines of full dentures once every six years per dental arch;
new text end

new text begin (ii) repair of acrylic bases of full dentures and acrylic partial dentures, limited to one
per year; and
new text end

new text begin (iii) adding a maximum of two denture teeth and two wrought wire clasps per year to
partial dentures per dental arch;
new text end

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; deleted text beginand
deleted text end

(15) full-mouth deleted text begindebridementdeleted text endnew text begin periodontal scaling and root planingnew text end, limited to one
every five yearsnew text begin; and
new text end

new text begin (16) moderate sedation, deep sedation, and general anesthesia, limited to when
provided by an oral maxillofacial surgeon who is board-certified, or actively participating
in the American Board of Oral and Maxillofacial Surgery certification process, when
medically necessary to allow the surgical management of acute oral and maxillofacial
pathology which cannot be accomplished safely with local anesthesia alone and would
otherwise require operating room services
new text end.

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two
years;

(2) general anesthesia; and

(3) full-mouth survey once every deleted text beginfivedeleted text endnew text begin twonew text end years.

(d) Medical assistance covers dental services for children that are medically
necessary. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants once every five years per permanent molar; and

(3) application of fluoride varnish once every six months.

Sec. 13.

Minnesota Statutes 2009 Supplement, 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 actual acquisition costs of the drugs plus a fixed dispensing fee;
the maximum allowable cost set by the federal government or by the commissioner plus
the fixed dispensing fee; or the usual and customary price charged to the public. The
amount of payment basis must be reduced to reflect all discount amounts applied to the
charge by any 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 pharmacy dispensing fee shall be $3.65, except that the dispensing fee
for intravenous solutions which must be compounded by the pharmacist shall be $8 per
bag, $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 liter. Actual acquisition cost
includes quantity and other special discounts except time and cash discounts. Effective
deleted text begin July 1, 2009deleted text endnew text begin July 1, 2010new text end, the actual acquisition cost of a drug shall be estimated by the
commissioner, at average wholesale price minus deleted text begin15deleted text endnew text begin 12.5new text end percentnew text begin or wholesale acquisition
cost plus 5.0 percent, whichever is lower
new text end. The actual acquisition cost of antihemophilic
factor drugs shall be estimated at the average wholesale price minus deleted text begin30deleted text endnew text begin 28.12new text end percentnew text begin or
wholesale acquisition cost minus 13.76 percent, whichever is lower
new text end. new text beginAverage wholesale
price is defined as the price for a drug product listed as the average wholesale price in the
commissioner's primary reference source. 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.
new text endThe maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to,
but no higher than, the maximum amount paid by other third-party payors in this state who
have maximum allowable cost programs. Establishment of the amount of payment for
drugs shall not be subject to the requirements of the Administrative Procedure Act.

(b) 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. The pharmacy provider
will be required to credit the department for the actual acquisition cost of all unused
drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
manufacturer's unopened package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available, payment shall be on the
basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost
established by the commissioner.

(d) 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 or the amount established for Medicare by the United States Department of
Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
Security Act.

(e) The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates 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, 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 this paragraph. 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 reimbursement rate to prevent access to care issues.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 14.

Minnesota Statutes 2008, section 256B.0625, subdivision 18a, is amended to
read:


Subd. 18a.

Access to medical services.

(a) Medical assistance reimbursement for
meals for persons traveling to receive medical care may not exceed $5.50 for breakfast,
$6.50 for lunch, or $8 for dinner.

(b) Medical assistance reimbursement for lodging for persons traveling to receive
medical care may not exceed $50 per day unless prior authorized by the local agency.

(c) Medical assistance direct mileage reimbursement to the eligible person or the
eligible person's driver may not exceed 20 cents per mile.

(d) Regardless of the number of employees that an enrolled health care provider
may have, medical assistance covers sign and oral language interpreter services when
provided by an enrolled health care provider during the course of providing a direct,
person-to-person covered health care service to an enrolled recipient with limited English
proficiency or who has a hearing loss and uses interpreting services.new text begin Coverage for oral
language interpreter services shall be provided only if the oral language interpreter used
by the enrolled health care provider is listed in the registry or roster established under
section 144.058.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 15.

Minnesota Statutes 2008, section 256B.0625, subdivision 31, is amended to
read:


Subd. 31.

Medical supplies and equipment.

Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall
be made for wheelchairs and wheelchair accessories for recipients who are residents
of intermediate care facilities for the developmentally disabled. Reimbursement for
wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
conditions and limitations as coverage for recipients who do not reside in institutions. A
wheelchair purchased outside of the facility's payment rate is the property of the recipient.new text begin
The commissioner may set reimbursement rates for specified categories of medical
supplies at levels below the Medicare payment rate.
new text end

Sec. 16.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 54. new text end

new text begin Services provided in birth centers. new text end

new text begin (a) Medical assistance covers
services provided in a birth center licensed under section 144.615 by a licensed health
professional if the service would otherwise be covered if provided in a hospital.
new text end

new text begin (b) Facility services provided by a birth center shall be paid at the lower of billed
charges or 70 percent of the statewide average for a facility payment rate made to a
hospital for an uncomplicated vaginal birth as determined using the most recent calendar
year for which complete claims data is available. If a recipient is transported from a birth
center to a hospital prior to the delivery, the payment for facility services to the birth center
shall be the lower of billed charges or 15 percent of the average facility payment made to a
hospital for the services provided for an uncomplicated vaginal delivery as determined
using the most recent calendar year for which complete claims data is available.
new text end

new text begin (c) Professional services provided by traditional midwives licensed under chapter
147D shall be paid at the lower of billed charges or 100 percent of the rate paid to a
physician performing the same services. If a recipient is transported from a birth center to
a hospital prior to the delivery, a licensed traditional midwife who does not perform the
delivery may not bill for any delivery services. Services are not covered if provided by an
unlicensed traditional midwife.
new text end

new text begin (d) The commissioner shall apply for any necessary waivers from the Centers for
Medicare and Medicaid Services to allow birth centers and birth center providers to be
reimbursed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256B.0631, subdivision 1, is amended to
read:


Subdivision 1.

Co-payments.

(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following co-payments for all recipients, effective
for services provided on or after October 1, 2003, and before January 1, 2009:

(1) $3 per nonpreventive visit. For purposes of this subdivision, a visit means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;

(2) $3 for eyeglasses;

(3) $6 for nonemergency visits to a hospital-based emergency room; and

(4) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness.

(b) Except as provided in subdivision 2, the medical assistance benefit plan shall
include the following co-payments for all recipients, effective for services provided on
or after January 1, 2009:

(1) deleted text begin$6deleted text endnew text begin $3.50new text end for nonemergency visits to a hospital-based emergency room;

(2) $3 per brand-name drug prescription and $1 per generic drug prescription, subject
to a deleted text begin$7deleted text endnew text begin $12new text end per month maximum for prescription drug co-payments. No co-payments shall
apply to antipsychotic drugs when used for the treatment of mental illness; and

(3) for individuals identified by the commissioner with income at or below 100
percent of the federal poverty guidelines, total monthly co-payments must not exceed five
percent of family income. For purposes of this paragraph, family income is the total
earned and unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on co-payments.

(c) Recipients of medical assistance are responsible for all co-payments in this
subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to paragraph (b), clause (1), related to the
co-payment for nonemergency visits is effective January 1, 2011, and the amendment
to paragraph (b), clause (2), related to the per month maximum for prescription drug
co-payments is effective July 1, 2010.
new text end

Sec. 18.

Minnesota Statutes 2008, section 256B.0631, subdivision 3, is amended to
read:


Subd. 3.

Collection.

(a) The medical assistance reimbursement to the provider
shall be reduced by the amount of the co-payment, except that reimbursements shall
not be reduced:

(1) once a recipient has reached the $12 per month maximum deleted text beginor the $7 per month
maximum effective January 1, 2009,
deleted text end for prescription drug co-payments; or

(2) for a recipient identified by the commissioner under 100 percent of the federal
poverty guidelines who has met their monthly five percent co-payment limit.

(b) The provider collects the co-payment from the recipient. Providers may not deny
services to recipients who are unable to pay the co-payment.

(c) Medical assistance reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the removal of deleted text beginthedeleted text end co-payments
effective new text beginon or after new text endJanuary 1, 2009.

Sec. 19.

Minnesota Statutes 2008, section 256B.0644, as amended by Laws 2010,
chapter 200, article 1, section 6, 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, general assistance medical care 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.

(b) For providers other than health maintenance organizations, participation in the
medical assistance program means that:

(1) the provider accepts new medical assistance, general assistance medical care,
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, general assistance medical care,
and MinnesotaCare as their primary source of coverage; or

(3) for dental service providers, at least ten percent of the provider's patients are
covered by medical assistance, general assistance medical care, 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.

deleted text begin (d) Any hospital or other provider that is participating in a coordinated care
delivery system under section 256D.031, subdivision 6, or receives payments from the
uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to
provide services to any patient enrolled in general assistance medical care regardless of
the availability or the amount of payment.
deleted text end

deleted text begin (e)deleted text endnew text begin (d)new text end For purposes of paragraphs (a) and (b), participation in the general assistance
medical care program applies only to pharmacy providersnew text begin dispensing prescription drugs
according to section 256D.03, subdivision 3
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin The amendment striking the existing paragraph (d) is effective
30 days after federal approval of the amendments in this article to Minnesota Statutes,
sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011,
whichever is later. The amendment to the new paragraph (d) is effective June 1, 2010.
new text end

Sec. 20.

Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 5,
is amended to read:


Subd. 5.

Home care therapies.

(a) Home care therapies include the following:
physical therapy, occupational therapy, respiratory therapy, and speech and language
pathology therapy services.

(b) Home care therapies must be:

(1) provided in the recipient's residence after it has been determined the recipient is
unable to access outpatient therapy;

(2) prescribed, ordered, or referred by a physician and documented in a plan of care
and reviewed, according to Minnesota Rules, part 9505.0390;

(3) assessed by an appropriate therapist; and

(4) provided by a Medicare-certified home health agency enrolled as a Medicaid
provider agency.

(c) Restorative deleted text beginand specialized maintenancedeleted text end therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be
used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.

(d) For both physical and occupational therapies, the therapist and the therapist's
assistant may not both bill for services provided to a recipient on the same day.

Sec. 21.

new text begin [256B.0755] PAYMENT REFORM DEMONSTRATION PROJECT FOR
SPECIAL PATIENT POPULATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Demonstration project. new text end

new text begin (a) The commissioner of human services,
in consultation with the commissioner of health, shall establish a payment reform
demonstration project implementing an alternative payment system for health care
providers serving an identified group of patients who are enrolled in a state health
care program, and are either high utilizers of high-cost health care services or have
characteristics that put them at high risk of becoming high utilizers. The purpose of the
demonstration project is to implement and evaluate methods of reducing hospitalizations,
emergency room use, high-cost medications and specialty services, admissions to nursing
facilities, or use of long-term home and community-based services, in order to reduce the
total cost of care and services for the patients.
new text end

new text begin (b) The commissioner shall give the highest priority to projects that will serve
patients who have chronic medical conditions or complex medical needs that are
complicated by a physical disability, serious mental illness, or serious socioeconomic
factors such as poverty, homelessness, or language or cultural barriers. The commissioner
shall also give the highest priority to providers or groups of providers who have the
highest concentrations of patients with these characteristics.
new text end

new text begin (c) The commissioner must implement this payment reform demonstration project
in a manner consistent with the payment reform initiative provided in sections 62U.02
to 62U.04.
new text end

new text begin (d) For purposes of this section, "state health care program" means the medical
assistance, MinnesotaCare, and general assistance medical care programs.
new text end

new text begin Subd. 2. new text end

new text begin Participation. new text end

new text begin (a) The commissioner shall request eligible providers or
groups of providers to submit a proposal to participate in the demonstration project by
September 1, 2010. The providers who are interested in participating shall negotiate with
the commissioner to determine:
new text end

new text begin (1) the identified group of patients who are to be enrolled in the program;
new text end

new text begin (2) the services that are to be included in the total cost of care calculation;
new text end

new text begin (3) the methodology for calculating the total cost of care, which may take into
consideration the impact on costs to other state or local government programs including,
but not limited to, social services and income maintenance programs;
new text end

new text begin (4) the time period to be covered under the bid;
new text end

new text begin (5) the implementation of a risk adjustment mechanism to adjust for factors that are
beyond the control of the provider including nonclinical factors that will affect the cost
or outcomes of treatment;
new text end

new text begin (6) the payment reforms and payment methods to be used under the project, which
may include but are not limited to adjustments in fee-for-service payments, payment of
care coordination fees, payments for start-up and implementation costs to be recovered or
repaid later in the project, payments adjusted based on a provider's proportion of patients
who are enrolled in state health care programs; payments adjusted for the clinical or
socioeconomic complexity of the patients served, payment incentives tied to use of
inpatient and emergency room services, and periodic settle-up adjustments;
new text end

new text begin (7) methods of sharing financial risk and benefit between the commissioner and
the provider or groups of providers, which may include but are not limited to stop-loss
arrangements to cover high-cost outlier cases or costs that are beyond the control of the
provider, and risk-sharing and benefit-sharing corridors; and
new text end

new text begin (8) performance and outcome benchmarks to be used to measure performance,
achievement of cost-savings targets, and quality of care provided.
new text end

new text begin (b) A provider or group of providers may submit a proposal for a demonstration
project in partnership with a health maintenance organization or county-based purchasing
plan for the purposes of sharing risk, claims processing, or administration of the project,
or to extend participation in the project to persons who are enrolled in prepaid health
care programs.
new text end

new text begin Subd. 3. new text end

new text begin Total cost of care agreement. new text end

new text begin Based on negotiations, the commissioner
must enter into an agreement with interested and eligible providers or groups of providers
to implement projects that are designed to reduce the total cost of care for the identified
patients. To the extent possible, the projects shall begin implementation on January 1,
2011, or upon federal approval, whichever is later.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility. new text end

new text begin To be eligible to participate, providers or groups of providers
must meet certification standards for health care homes established by the Department of
Health and the Department of Human Services under section 256B.0751.
new text end

new text begin Subd. 5. new text end

new text begin Alternative payments. new text end

new text begin The commissioner shall seek all federal waivers
and approvals necessary to implement this section and to obtain federal matching funds. To
the extent authorized by federal law, the commissioner may waive existing fee-for-service
payment rates, provider contract or performance requirements, consumer incentive
policies, or other requirements in statute or rule in order to allow the providers or groups
of providers to utilize alternative payment and financing methods that will appropriately
fund necessary and cost-effective primary care and care coordination services; establish
appropriate incentives for prevention, health promotion, and care coordination; and
mitigate financial harm to participating providers caused by the successful reduction in
preventable hospitalization, emergency room use, and other costly services.
new text end

new text begin Subd. 6. new text end

new text begin Cost neutrality. new text end

new text begin The total cost, including administrative costs, of this
demonstration project must not exceed the costs that would otherwise be incurred by
the state had services to the state health care program enrollees participating in the
demonstration project been provided, as applicable for the enrollee, under fee-for-service
or through managed care or county-based purchasing plans.
new text end

Sec. 22.

new text begin [256B.0757] INTENSIVE CARE MANAGEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Report. new text end

new text begin The commissioner shall review medical assistance
enrollment and by July 1, 2011, present a report to the legislature that describes the
common characteristics and costs of those enrollees age 18 and over whose annual medical
costs are greater than 95 percent of all other enrollees, using deidentified data.
new text end

new text begin Subd. 2. new text end

new text begin Intensive care management system established. new text end

new text begin The commissioner shall
implement, by January 1, 2012, or upon federal approval, whichever is later, a program
to provide intensive care management to medical assistance enrollees age 18 and over
currently served under fee-for-service, managed care, or county-based purchasing, whose
annual medical care costs are in the top five percent of all medical assistance enrollees.
The intensive care management program must reduce these enrollees' medical assistance
costs by at least 20 percent on average, improve quality of care through care coordination,
and provide financial incentives for providers to deliver care efficiently. The commissioner
may require medical assistance enrollees meeting the criteria specified in this subdivision
to participate in the intensive care management program, and may reassign enrollees
from existing managed care and county-based purchasing plans to those plans that are
participating in the demonstration program. The commissioner shall seek all federal
approvals and waivers necessary to implement the intensive care management program.
new text end

new text begin Subd. 3. new text end

new text begin Request for proposals. new text end

new text begin The commissioner of human services shall
request proposals by September 1, 2011, or upon federal approval, whichever is later,
from health care providers, managed care plans, and county-based purchasing plans to
provide intensive care management services under the requirements of subdivision 1.
Proposals submitted must:
new text end

new text begin (1) designate the medical assistance population and geographic area of the state
to be served;
new text end

new text begin (2) describe in detail the proposed intensive care management program;
new text end

new text begin (3) provide estimates of cost savings to the state and the evidence supporting these
estimates;
new text end

new text begin (4) describe the extent to which the intensive care management program is consistent
with and builds upon current state health care home, care coordination, and payment
reform initiatives; and
new text end

new text begin (5) meet quality assurance, data reporting, and other criteria specified by the
commissioner in the request for proposals.
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. 23.

Minnesota Statutes 2008, section 256B.69, is amended by adding a
subdivision to read:


new text begin Subd. 5k. new text end

new text begin Payment rate modification. new text end

new text begin For services rendered on or after August
1, 2010, the total payment made to managed care and county-based purchasing plans
under the medical assistance program and under MinnesotaCare for families with children
shall be increased by 1.4 percent.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010.
new text end

Sec. 24.

Minnesota Statutes 2008, section 256B.69, is amended by adding a
subdivision to read:


new text begin Subd. 5l. new text end

new text begin Payment reduction. new text end

new text begin For services rendered on or after January 1, 2011,
the total payment made to managed care plans for providing covered services under
the medical assistance, general assistance medical care, and MinnesotaCare programs
is reduced by one percent from their current statutory rates. This provision excludes
payments for nursing home services, home and community-based waivers, home care
services covered under section 256B.0651, subdivision 2, payments to demonstration
projects for persons with disabilities, and mental health services added as covered benefits
after December 31, 2007.
new text end

Sec. 25.

Minnesota Statutes 2008, section 256B.69, subdivision 20, as amended by
Laws 2010, chapter 200, article 1, section 10, is amended to read:


Subd. 20.

Ombudsperson.

deleted text begin(a)deleted text end The commissioner shall designate an ombudsperson
to advocate for persons required to enroll in prepaid health plans under this section. The
ombudsperson shall advocate for recipients enrolled in prepaid health plans through
complaint and appeal procedures and ensure that necessary medical services are provided
either by the prepaid health plan directly or by referral to appropriate social services. At
the time of enrollment in a prepaid health plan, the local agency shall inform recipients
about the ombudsperson program and their right to a resolution of a complaint by the
prepaid health plan if they experience a problem with the plan or its providers.

deleted text begin (b) The commissioner shall designate an ombudsperson to advocate for persons
enrolled in a care coordination delivery system under section 256D.031. The
ombudsperson shall advocate for recipients enrolled in a care coordination delivery
system through the state appeal process and assist enrollees in accessing necessary
medical services through the care coordination delivery systems directly or by referral to
appropriate services. At the time of enrollment in a care coordination delivery system, the
local agency shall inform recipients about the ombudsperson program.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 30 days after federal approval of the
amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and
256B.056, subdivision 4, or January 1, 2011, whichever is later.
new text end

Sec. 26.

Minnesota Statutes 2008, section 256B.69, subdivision 27, is amended to read:


Subd. 27.

Information for persons with limited English-language proficiency.

Managed care contracts entered into under this section and deleted text beginsections 256D.03, subdivision
4
, paragraph (c), and
deleted text end new text beginsection new text end256L.12 must require demonstration providers to provide
language assistance to enrollees that ensures meaningful access to its programs and
services according to Title VI of the Civil Rights Act and federal regulations adopted
under that law or any guidance from the United States Department of Health and Human
Services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 27.

Minnesota Statutes 2008, section 256B.692, subdivision 1, is amended to read:


Subdivision 1.

In general.

County boards or groups of county boards may elect
to purchase or provide health care services on behalf of persons eligible for medical
assistance deleted text beginand general assistance medical caredeleted text end who would otherwise be required to or may
elect to participate in the prepaid medical assistance deleted text beginor prepaid general assistance medical
care programs
deleted text end according to deleted text beginsectionsdeleted text end new text beginsection new text end256B.69 deleted text beginand 256D.03deleted text end. Counties that elect to
purchase or provide health care under this section must provide all services included in
prepaid managed care programs according to deleted text beginsectionsdeleted text end new text beginsection new text end256B.69, subdivisions 1
to 22
deleted text begin, and 256D.03deleted text end. County-based purchasing under this section is governed by section
256B.69, unless otherwise provided for under this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 28.

Minnesota Statutes 2008, section 256B.75, is amended to read:


256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.

(a) For outpatient hospital facility fee payments for services rendered on or after
October 1, 1992, the commissioner of human services shall pay the lower of (1) submitted
charge, or (2) 32 percent above the rate in effect on June 30, 1992, except for those
services for which there is a federal maximum allowable payment. Effective for services
rendered on or after January 1, 2000, payment rates for nonsurgical outpatient hospital
facility fees and emergency room facility fees shall be increased by eight percent over the
rates in effect on December 31, 1999, except for those services for which there is a federal
maximum allowable payment. Services for which there is a federal maximum allowable
payment shall be paid at the lower of (1) submitted charge, or (2) the federal maximum
allowable payment. Total aggregate payment for outpatient hospital facility fee services
shall not exceed the Medicare upper limit. If it is determined that a provision of this
section conflicts with existing or future requirements of the United States government with
respect to federal financial participation in medical assistance, the federal requirements
prevail. The commissioner may, in the aggregate, prospectively reduce payment rates to
avoid reduced federal financial participation resulting from rates that are in excess of
the Medicare upper limitations.

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and
ambulatory surgery hospital facility fee services for critical access hospitals designated
under section 144.1483, clause (10), shall be paid on a cost-based payment system that is
based on the cost-finding methods and allowable costs of the Medicare program.

(c) Effective for services provided on or after July 1, 2003, rates that are based
on the Medicare outpatient prospective payment system shall be replaced by a budget
neutral prospective payment system that is derived using medical assistance data. The
commissioner shall provide a proposal to the 2003 legislature to define and implement
this provision.

(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital
facility services is reduced by .5 percent from the current statutory rate.

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital
facility services before third-party liability and spenddown, is reduced five percent from
the current statutory rates. Facilities defined under section 256.969, subdivision 16, are
excluded from this paragraph.

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three
percent from the current statutory rates. Mental health services and facilities defined under
section 256.969, subdivision 16, are excluded from this paragraph.

new text begin (g) Notwithstanding any contrary provision in this section, payment for all outpatient
and emergency services provided by any hospital that, prior to December 31, 2007, has
received payment to support the training of residents from an approved graduate medical
residency training program under United States Code, title 42, section 256e, must be paid
for fiscal years 2012 and 2013 an additional $7,000,000. Payment rates for subsequent
fiscal years are as follows:
new text end

new text begin (1) 2014: 50 percent of costs;
new text end

new text begin (2) 2015: 60 percent of costs;
new text end

new text begin (3) 2016: 70 percent of costs;
new text end

new text begin (4) 2017: 80 percent of costs;
new text end

new text begin (5) 2018: 90 percent of costs; and
new text end

new text begin (6) 2019 and thereafter: 100 percent of costs.
new text end

Sec. 29.

Minnesota Statutes 2009 Supplement, section 256B.76, subdivision 1, is
amended to read:


Subdivision 1.

Physician reimbursement.

(a) Effective for services rendered on
or after October 1, 1992, the commissioner shall make payments for physician services
as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and

(3) all physician 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
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992.

(b) Effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates
in effect on December 31, 1999, except for home health agency and family planning
agency services. The increases in this paragraph shall be implemented January 1, 2000,
for managed care.

(c) Effective for services rendered on or after July 1, 2009, payment rates for
physician and professional services shall be reduced by five percent over the rates in
effect on June 30, 2009. This reduction does not apply to office or other outpatient visits,
preventive medicine visits and family planning visits billed by physicians, advanced
practice nurses, or physician assistants in a family planning agency or in one of the
following primary care practices: general practice, general internal medicine, general
pediatrics, general geriatrics, and family medicine. This reduction does not apply to
federally qualified health centers, rural health centers, and Indian health services.new text begin This
reduction does not apply to physical therapy services, occupational therapy services,
and speech pathology and related services provided on or after July 1, 2010.
new text end Effective
October 1, 2009, payments made to managed care plans and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction
described in this paragraph.

new text begin (d) Effective for services rendered on or after July 1, 2010, payment rates for
physician and professional services shall be reduced by three percent over the rates in
effect on June 30, 2010. This reduction does not apply to those providers and entities
exempt from the reduction in paragraph (c). Effective October 1, 2010, payments made
to managed care plans and county-based purchasing plans under sections 256B.69,
256B.692, and 256L.12 shall reflect the payment reductions in this paragraph.
new text end

new text begin (e) Effective for services rendered on or after June 1, 2010, payment rates for
physician and professional services billed by physicians employed by and clinics that are
owned by a nonprofit health maintenance organization shall be increased by 15 percent.
Effective October 1, 2010, payments to managed care and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
described in this paragraph.
new text end

Sec. 30.

Minnesota Statutes 2008, 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.

new text begin (f) Effective for dental services rendered on or after October 1, 2010, by a
state-operated dental clinic, payment shall be paid on a cost-based payment system that
is based on the cost-finding methods and allowable costs of the Medicare program. For
services performed by a state-operated dental clinic pursuant to a contract between the
clinic and a managed care plan or a county-based purchasing plan, a supplemental payment
shall be made to the clinic by the commissioner that is equal to the amount by which the
amount determined under this paragraph exceeds the amount of the payments provided
under the contract. Managed care plans and county-based purchasing plans participating
in medical assistance must provide to the commissioner any expenditure, cost, and
revenue information deemed necessary by the commissioner for purposes of obtaining
federal Medicaid matching funds for cost-based reimbursement for state-operated dental
clinics. Cost-based reimbursement shall be implemented in managed care contracts
beginning January 1, 2011.
new text end

new text begin (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.
new text end

Sec. 31.

Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:


Subd. 4.

Critical access dental providers.

Effective for dental services rendered
on or after January 1, 2002, 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, 2007, the commissioner shall increase
reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to
the critical access dental provider. The commissioner shall pay the health plan companies
in amounts sufficient to reflect increased reimbursements to critical access dental providers
as approved by the commissioner. In determining which dentists and dental clinics shall
be deemed critical access dental providers, the commissioner shall review:

(1) the utilization rate in the service area in which the dentist or dental clinic operates
for dental services to patients covered by medical assistance, general assistance medical
care, or MinnesotaCare as their primary source of coverage;

(2) the level of services provided by the dentist or dental clinic to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare as their primary
source of coveragedeleted text begin; anddeleted text endnew text begin. The commissioner shall pay critical access dental provider
payments to a dentist or dental clinic that meets any one of the following criteria:
new text end

new text begin (i) at least 40 percent of patient encounters are with patients who are uninsured or
covered by medical assistance, general assistance medical care, or MinnesotaCare;
new text end

new text begin (ii) the dental clinic or dental group is owned and operated by a nonprofit operation
under chapter 317A with more than 10,000 patient encounters per year with patients
who are uninsured or covered by medical assistance, general assistance medical care,
or MinnesotaCare;
new text end

new text begin (iii) the dental clinic is associated with an oral health or dental education program
operated by the University of Minnesota or an institution within the Minnesota State
Colleges and Universities system; or
new text end

new text begin (iv) the dental clinic is a state-operated dental clinic;
new text end

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within deleted text beginthedeleted text endnew text begin a geographicnew text end service areanew text begin, and
to ensure that the maximum travel distance or travel time is the lesser of 60 miles or 60
minutes;
new text end

new text begin (4) whether the provider has completed the application for critical access dental
provider designation by the due date, and has provided correct information;
new text end

new text begin (5) whether the dentist or dental clinic meets the quality and continuity of care
criteria recommended by the dental services advisory committee and adopted by the
department; and
new text end

new text begin (6) whether the dentist or dental clinic serves people in all Minnesota health care
programs
new text end.

In the absence of a critical access dental provider in a service area, the commissioner may
designate a dentist or dental clinic as a critical access dental provider if the dentist or
dental clinic is willing to provide care to patients covered by medical assistance, general
assistance medical care, or MinnesotaCare at a level which significantly increases access
to dental care in the service area.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 32.

Minnesota Statutes 2008, section 256B.76, is amended by adding a
subdivision to read:


new text begin Subd. 4a. new text end

new text begin Designation and termination of critical access dental providers. new text end

new text begin (a)
Notwithstanding the provisions in subdivision 4, the commissioner may review and not
designate an individual dentist or dental clinic as a critical access dental provider under
subdivision 4 or section 256L.11, subdivision 7, when the dentist or clinic:
new text end

new text begin (1) has been subject to a corrective or disciplinary action by the Board of Dentistry
related to fraud or direct patient care. Designation shall not be made until the provider is no
longer subject to a corrective or disciplinary action related to fraud or direct patient care; or
new text end

new text begin (2) has been subject, within the past three years, to a postinvestigation action by the
commissioner of human services or issuance of a warning as specified in Minnesota Rules,
parts 9505.2160 to 9505.2245. The provider shall not be considered for critical access
dental designation until the January following the year in which the action has ended.
new text end

new text begin (b) The commissioner may terminate a critical access designation of an individual
dentist or clinic if the dentist or clinic:
new text end

new text begin (1) becomes subject to a disciplinary or corrective action by the Board of Dentistry
related to fraud or direct patient care. The provider shall not be considered for critical
access designation until the January following the year in which the action has ended;
new text end

new text begin (2) becomes subject to a postinvestigation action by the commissioner of human
services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160
to 9505.2245;
new text end

new text begin (3) does not meet the quality and continuity of care criteria that have been
recommended by the Dental Services Advisory Committee and adopted by the department;
or
new text end

new text begin (4) does not serve people in all Minnesota public health care programs.
new text end

new text begin (c) Any termination is effective on the date of notification of the:
new text end

new text begin (1) postinvestigative action;
new text end

new text begin (2) disciplinary or corrective action by the Minnesota Board of Dentistry; or
new text end

new text begin (3) determination of not meeting quality and continuity of care criteria.
new text end

new text begin The commissioner may review postinvestigative actions taken by a health plan
under contract to provide dental services to Minnesota health care program enrollees.
After an investigation conducted by the Department of Human Services surveillance unit,
the findings of the health plan may be incorporated to determine if a provider will be
designated or terminated from the program.
new text end

new text begin (d) A provider who has been terminated or not designated under this section may
appeal only through the contested hearing process as defined in section 14.02, subdivision
3, by filing with the commissioner a written request of appeal. The appeal request must
be received by the commissioner no later than 30 days after notification of termination
or nondesignation.
new text end

new text begin (e) The commissioner may make an exception to paragraphs (a) and (b) if an action
taken by the Board of Dentistry or the commissioner is the result of events not directly
related to patient care or that will not affect direct patient care to Minnesota health care
program enrollees.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 33.

Minnesota Statutes 2009 Supplement, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for
basic care services, shall be reduced by three percent, prior to third-party liability and
spenddown calculation.new text begin This reduction applies to physical therapy services, occupational
therapy services, and speech language pathology and related services provided on or after
July 1, 2010. 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.
new text end 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 this reduction.

(b) This section 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.

Sec. 34.

new text begin [256B.767] MEDICARE PAYMENT LIMIT.
new text end

new text begin 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.
new text end

Sec. 35.

new text begin [256B.768] FEE-FOR-SERVICE PAYMENT INCREASE.
new text end

new text begin Effective for services rendered on or after January 1, 2011, the commissioner shall
increase fee-for-service payment rates by seven percent 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.
new text end

Sec. 36.

Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, as
amended by Laws 2010, chapter 200, article 1, section 11, is amended to read:


Subd. 3.

General assistance medical care; eligibility.

(a) Beginning April 1, 2010,
the general assistance medical care program shall be administered according to section
256D.031, unless otherwise stated, except for outpatient prescription drug coverage,
which shall continue to be administered under this section and funded under section
256D.031, subdivision 9, beginning June 1, 2010.

(b) Outpatient prescription drug coverage under general assistance medical care is
limited to prescription drugs that:

(1) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and

(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with the agreements.
Outpatient prescription drug coverage under general assistance medical care must conform
to coverage under the medical assistance program according to section 256B.0625,
subdivisions 13
to deleted text begin13gdeleted text endnew text begin 13hnew text end.

(c) Outpatient prescription drug coverage does not include drugs administered in a
clinic or other outpatient setting.

new text begin (d) For the period beginning April 1, 2010, to May 31, 2010, general assistance
medical care covers the services listed in subdivision 4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 37.

Minnesota Statutes 2008, section 256L.02, subdivision 3, is amended to read:


Subd. 3.

Financial management.

(a) The commissioner shall manage spending for
the MinnesotaCare program in a manner that maintains a minimum reserve. As part of
each state revenue and expenditure forecast, the commissioner must make an assessment
of the expected expenditures for the covered services for the remainder of the current
biennium and for the following biennium. The estimated expenditure, including the
reserve, shall be compared to an estimate of the revenues that will be available in the health
care access fund. Based on this comparison, and after consulting with the chairs of the
house of representatives Ways and Means Committee and the senate Finance Committee,
and the Legislative Commission on Health Care Access, the commissioner shall, as
necessary, make the adjustments specified in paragraph (b) to ensure that expenditures
remain within the limits of available revenues for the remainder of the current biennium
and for the following biennium. The commissioner shall not hire additional staff using
appropriations from the health care access fund until the commissioner of management
and budget makes a determination that the adjustments implemented under paragraph (b)
are sufficient to allow MinnesotaCare expenditures to remain within the limits of available
revenues for the remainder of the current biennium and for the following biennium.

(b) The adjustments the commissioner shall use must be implemented in this ordernew text begin,
but shall not be implemented before July 1, 2014
new text end: first, stop enrollment of single adults
and households without children;new text begin andnew text end second, upon 45 days' notice, stop coverage of
single adults and households without children already enrolled in the MinnesotaCare
programdeleted text begin; third, upon 90 days' notice, decrease the premium subsidy amounts by ten
percent for families with gross annual income above 200 percent of the federal poverty
guidelines; fourth, upon 90 days' notice, decrease the premium subsidy amounts by ten
percent for families with gross annual income at or below 200 percent; and fifth, require
applicants to be uninsured for at least six months prior to eligibility in the MinnesotaCare
program
deleted text end. If these measures are insufficient to limit the expenditures to the estimated
amount of revenue, the commissioner shall deleted text beginfurther limit enrollment or decrease premium
subsidies
deleted text endnew text begin notify the chairs of the house of representatives Ways and Means Committee and
the senate Finance Committee, and the Legislative Commission on Health Care Access,
and present recommendations to the chairs and commission for limiting expenditures to
the estimated amount of revenue
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the
amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and
256B.056, subdivision 4.
new text end

Sec. 38.

Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:


Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2
, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of $10,000new text begin, unless supplemental hospital coverage
has been purchased under subdivision 3c
new text end.

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 39.

Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision
to read:


new text begin Subd. 3c. new text end

new text begin Supplemental hospital coverage. new text end

new text begin (a) Effective January 1, 2011, or upon
federal approval, whichever is later, the commissioner shall offer all MinnesotaCare
applicants, and all enrollees during the open enrollment periods specified in paragraph
(b), the opportunity to purchase at full cost, supplemental hospital coverage to cover
inpatient hospital expenses in excess of the inpatient hospital annual limit established
under subdivision 3. Premiums for this coverage may vary only for age and shall be
collected by the commissioner using the procedures established for the sliding scale
premium determined under section 256L.15.
new text end

new text begin (b) The commissioner shall notify all persons submitting applications of the option to
purchase this coverage at the time of application. The commissioner shall provide persons
enrolled in MinnesotaCare on the effective date of this subdivision with the opportunity to
purchase this supplemental coverage during an initial open enrollment period. Following
this initial open enrollment period, the commissioner shall provide all enrollees with the
opportunity to purchase this supplemental coverage during an annual open enrollment
period during the month of November with coverage to take effect the following January 1.
new text end

Sec. 40.

Minnesota Statutes 2009 Supplement, section 256L.03, subdivision 5, is
amended to read:


Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency roomnew text begin for services
provided through December 31, 2010, and $3.50 effective January 1, 2011
new text end.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

(d) Paragraph (a), clause (4), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
and who are not pregnant shall be financially responsible for the coinsurance amount, if
applicable, andnew text begin if supplemental coverage has not been purchased under subdivision 3c,new text end
amounts which exceed the $10,000 inpatient hospital benefit limit.

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
or changes from one prepaid health plan to another during a calendar year, any charges
submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
expenses incurred by the enrollee for inpatient services, that were submitted or incurred
prior to enrollment, or prior to the change in health plans, shall be disregarded.

new text begin (g) MinnesotaCare reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the reduction of the co-payments
in paragraph (a), clause (5), effective January 1, 2011.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to paragraph (e) is effective January 1, 2011,
or upon federal approval, whichever is later.
new text end

Sec. 41.

Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Disclosure statement for inpatient hospital limit. new text end

new text begin The commissioner
shall develop, and include with MinnesotaCare application and renewal materials, a
disclosure statement that contains the following or similar language: "For adults without
children, and for parents and relative caretakers with family gross income that exceeds
215 percent of the federal poverty guidelines, who are not pregnant, coverage of inpatient
hospital services under MinnesotaCare is subject to an annual limit of $10,000. Enrollees
subject to the limit may be responsible for inpatient hospital costs that exceed the $10,000
annual limit."
new text end

Sec. 42.

Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Firefighters; volunteer ambulance attendants. new text end

new text begin (a) For purposes of this
subdivision, "qualified individual" means:
new text end

new text begin (1) a volunteer firefighter with a department as defined in section 299N.01,
subdivision 2, who has passed the probationary period; and
new text end

new text begin (2) a volunteer ambulance attendant as defined in section 144E.001, subdivision 15.
new text end

new text begin (b) A qualified individual who documents to the satisfaction of the commissioner
status as a qualified individual by completing and submitting a one-page form developed
by the commissioner is eligible for MinnesotaCare without meeting other eligibility
requirements of this chapter, but must pay premiums equal to the average expected
capitation rate for adults with no children paid under section 256L.12. Individuals eligible
under this subdivision shall receive coverage for the benefit set provided to adults with no
children.
new text end

Sec. 43.

Minnesota Statutes 2009 Supplement, section 256L.11, subdivision 1, is
amended to read:


Subdivision 1.

Medical assistance rate to be used.

(a) Payment to providers under
sections 256L.01 to 256L.11 shall be at the same rates and conditions established for
medical assistance, except as provided in subdivisions 2 to 6.

(b) Effective for services provided on or after July 1, 2009, total payments for basic
care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care and county-based purchasing plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

(c) Effective for services provided on or after July 1, 2009, payment rates for
physician and professional services shall be reduced as described under section 256B.76,
subdivision 1, paragraph (c). Payments made to managed care and county-based
purchasing plans shall be reduced for services provided on or after October 1, 2009,
to reflect this reduction.

new text begin (d) Effective for services provided on or after July 1, 2010, payment rates for
physician and professional services shall be reduced as described under section 256B.76,
subdivision 1, paragraph (d). Payments made to managed care plans and county-based
purchasing plans shall be reduced for services provided on or after October 1, 2010,
to reflect this reduction.
new text end

Sec. 44.

Minnesota Statutes 2008, section 256L.12, subdivision 5, is amended to read:


Subd. 5.

Eligibility for other state programs.

MinnesotaCare enrollees who
become eligible for medical assistance deleted text beginor general assistance medical caredeleted text end will remain in
the same managed care plan if the managed care plan has a contract for that population.
deleted text begin Effective January 1, 1998,deleted text end MinnesotaCare enrollees who were formerly eligible for
general assistance medical care pursuant to section 256D.03, subdivision 3, within six
months of MinnesotaCare enrollment and were enrolled in a prepaid health plan pursuant
to section 256D.03, subdivision 4, paragraph (c), must remain in the same managed care
plan if the managed care plan has a contract for that population. Managed care plans must
participate in the MinnesotaCare deleted text beginand general assistance medical care programsdeleted text end new text beginprogram
new text endunder a contract with the Department of Human Services in service areas where they
participate in the medical assistance program.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 45.

Minnesota Statutes 2008, section 256L.12, subdivision 6, is amended to read:


Subd. 6.

Co-payments and benefit limits.

Enrollees are responsible for all
co-payments in sections 256L.03, subdivision 5, and 256L.035, and shall pay co-payments
to the managed care plan or to its participating providers. The enrollee is also responsible
for payment of inpatient hospital charges which exceed the MinnesotaCare benefit limitnew text begin,
unless supplemental hospital coverage has been purchased under subdivision 3c
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 46.

Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:


Subd. 9.

Rate setting; performance withholds.

(a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.

(b) For services rendered on or after January 1, 2003, to December 31, 2003, the
commissioner shall withhold .5 percent of managed care plan payments under this section
pending completion of performance targets. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year if performance targets
in the contract are achieved. A managed care plan may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably expected
to be returned.

(c) For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments under this section pending
completion of performance targets. Each performance target must be quantifiable,
objective, measurable, and reasonably attainable, except in the case of a performance target
based on a federal or state law or rule. Criteria for assessment of each performance target
must be outlined in writing prior to the contract effective date. The managed care plan
must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
attainment of the performance target is accurate. The commissioner shall periodically
change the administrative measures used as performance targets in order to improve plan
performance across a broader range of administrative services. The performance targets
must include measurement of plan efforts to contain spending on health care services and
administrative activities. The commissioner may adopt plan-specific performance targets
that take into account factors affecting only one plan, such as characteristics of the plan's
enrollee population. The withheld funds must be returned no sooner than July 1 and no
later than July 31 of the following calendar year if performance targets in the contract are
achieved. deleted text beginA managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
paragraph that is reasonably expected to be returned.
deleted text end

new text begin (d) For services rendered on or after January 1, 2011, the commissioner shall
withhold an additional three percent of managed care plan payments under this section.
The withheld funds must be returned no sooner than July 1, and no later than July 31 of
the following calendar year. The return of the withhold under this paragraph is not subject
to the requirements of paragraph (b) or (c).
new text end

new text begin (e) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section.
new text end

Sec. 47.

Laws 2009, chapter 79, article 5, section 75, subdivision 1, is amended to read:


Subdivision 1.

Medical assistance coverage.

The commissioner of human services
shall establish a demonstration project to provide additional medical assistance coverage
for a maximum of 200 American Indian children in Minneapolis, St. Paul, and Duluth
who are burdened by health disparities associated with the cumulative health impact
of toxic environmental exposures. Under this demonstration project, the additional
medical assistance coverage for this population must include, but is not limited to,new text begin home
environmental assessments for triggers of asthma, in-home asthma education on the proper
medical management of asthma by a certified asthma educator or public health nurse with
asthma management training limited to two visits per child. Coverage also includes
new text end the
following durable medical equipment: high efficiency particulate air (HEPA) cleaners,
HEPA vacuum cleaners, allergy bed and pillow encasements, high filtration filters for
forced air gas furnaces, and dehumidifiers with medical tubing to connect the appliance to
a floor drain, if the listed item is medically deleted text beginnecessarydeleted text endnew text begin usefulnew text end to reduce asthma symptoms.
Provision of these itemsnew text begin of durable medical equipmentnew text end must be preceded by a home
environmental assessment for triggers of asthma and in-home asthma education on the
proper medical management of asthma by a Certified Asthma Educator or public health
nurse with asthma management training.

Sec. 48.

Laws 2009, chapter 79, article 5, section 78, subdivision 5, is amended to read:


Subd. 5.

Expiration.

This sectionnew text begin, with the exception of subdivision 4,new text end expires
deleted text begin December 31, 2010deleted text endnew text begin June 30, 2011. Subdivision 4 expires December 31, 2011new text end.

Sec. 49.

Laws 2010, chapter 200, article 1, section 12, subdivision 6, is amended to
read:


Subd. 6.

Coordinated care delivery systems.

(a) Effective June 1, 2010, the
commissioner shall contract with hospitals or groups of hospitals that qualify under
paragraph (b) and agree to deliver services according to this subdivision. Contracting
hospitals shall develop and implement a coordinated care delivery system to provide health
care services to individuals who are eligible for general assistance medical care under this
section and who either choose to receive services through the coordinated care delivery
system or who are enrolled by the commissioner under paragraph (c). new text beginA contracting
hospital may negotiate a limit to the number of general assistance medical care enrollees it
serves, but must comply with the emergency care requirements of United States Code, title
42, 1395dd (EMTALA).
new text end The health care services provided by the system must include:
(1) the services described in subdivision 4 with the exception of outpatient prescription
drug coverage but shall include drugs administered in a clinic or other outpatient setting;
or (2) a set of comprehensive and medically necessary health services that the recipients
might reasonably require to be maintained in good health and that has been approved by
the commissioner, including at a minimum, but not limited to, emergency care, medical
transportation services, inpatient hospital and physician care, outpatient health services,
preventive health services, mental health services, and prescription drugs administered
in a clinic or other outpatient setting. Outpatient prescription drug coverage is covered
on a fee-for-service basis in accordance with section 256D.03, subdivision 3, and funded
under subdivision 9. A hospital establishing a coordinated care delivery system under this
subdivision must ensure that the requirements of this subdivision are met.

(b) A hospital or group of hospitals may contract with the commissioner to develop
and implement a coordinated care delivery system as follows:

(1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during
calendar year 2008, it received fee-for-service payments for services to general assistance
medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater
than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to
provide geographic access or to ensure that at least 80 percent of enrollees have access to
a coordinated care delivery system; and

(2) effective December 1, 2010, a Minnesota hospital not qualified under clause
(1) may contract with the commissioner under this subdivision if it agrees to satisfy the
requirements of this subdivision.

deleted text begin Participation by hospitals shall become effective quarterly on June 1, September 1,
December 1, or March 1. Hospital participation is effective for a period of 12 months and
may be renewed for successive 12-month periods.
deleted text end

new text begin Coordinated care delivery system contracts are in effect from June 1, 2010, to
December 31, 2010, or upon the effective date of the expansion of medical assistance
coverage to include adults without children, whichever is later.
new text end

(c) Applicants and recipients may enroll in any available coordinated care delivery
system statewide. If more than one coordinated care delivery system is available, the
applicant or recipient shall be allowed to choose among the systemsnew text begin that provide services
within 25 miles of the individual's community of residence
new text end. The commissioner may assign
an applicant or recipient to a coordinated care delivery systemnew text begin that provides services
within 25 miles of the individual's community of residence,
new text end if no choice is made by the
applicant or recipient. The commissioner shall consider a recipient's zip code, city of
residence, county of residence, or distance from a participating coordinated care delivery
system when determining default assignment. An applicant or recipient may decline
enrollment in a coordinated care delivery system. Upon enrollment into a coordinated care
delivery system, the recipient must agree to receive all nonemergency services through the
coordinated care delivery system. Enrollment in a coordinated care delivery system is
for six months and may be renewed for additional six-month periods, except that initial
enrollment is for six months or until the end of a recipient's period of general assistance
medical care eligibility, whichever occurs first. A recipient who continues to meet the
eligibility requirements of this section is not eligible to enroll in MinnesotaCare during
a period of enrollment in a coordinated care delivery system. From June 1, 2010, to
November 30, 2010, applicants and recipients not enrolled in a coordinated care delivery
system may seek services from a hospital eligible for reimbursement under the temporary
uncompensated care pool established under subdivision 8. After November 30, 2010,
services are available only through a coordinated care delivery system.

(d)new text begin A hospital must provide access to cost-effective outpatient services available
in its service area.
new text end The hospital may contract and coordinate with providers and clinics
for the delivery of services and shall contract withnew text begin federally qualified health centers andnew text end
essential community providers as defined under section 62Q.19, subdivision 1, paragraph
(a), clauses (1) and (2), to the extent practicable. If a provider or clinic contracts with a
hospital to provide services through the coordinated care delivery system, the provider
may not refuse to provide services to any recipient enrolled in the system, and payment for
services shall be negotiated with the hospital and paid by the hospital from the system's
allocation under subdivision 7.

(e) A coordinated care delivery system must:

(1) provide the covered services required under paragraph (a) to recipients enrolled
in the coordinated care delivery system, and comply with the requirements of subdivision
4, paragraphs (b) to (g);

(2) establish a process to monitor enrollment and ensure the quality of care provided;
and

(3) in cooperation with counties, coordinate the delivery of health care services with
existing homeless prevention, supportive housing, and rent subsidy programs and funding
administered by the Minnesota Housing Finance Agency under chapter 462A; and

(4) adopt innovative and cost-effective methods of care delivery and coordination,
which may include the use of allied health professionals, telemedicine, patient educators,
care coordinators, and community health workers.

(f) The hospital may require a recipient to designate a primary care provider or
a primary care clinic. The hospital may limit the delivery of services to a network of
providers who have contracted with the hospital to deliver services in accordance with
this subdivision, and require a recipient to seek services only within this network. The
hospital may also require a referral to a provider before the service is eligible for payment.
A coordinated care delivery system is not required to provide payment to a provider who
is not employed by or under contract with the system for services provided to a recipient
enrolled in the system, except in cases of an emergency. For purposes of this section,
emergency services are defined in accordance with Code of Federal Regulations, title
42, section 438.114 (a).

(g) A recipient enrolled in a coordinated care delivery system has the right to appeal
to the commissioner according to section 256.045.

(h) The state shall not be liable for the payment of any cost or obligation incurred
by the coordinated care delivery system.

(i) The hospital must provide the commissioner with data necessary for assessing
enrollment, quality of care, cost, and utilization of services. Each hospital must provide,
on a quarterly basis on a form prescribed by the commissioner for each recipient served by
the coordinated care delivery system, the services provided, the cost of services provided,
and the actual payment amount for the services provided and any other information the
commissioner deems necessary to claim federal Medicaid match. The commissioner must
provide this data to the legislature on a quarterly basis.

(j) Effective June 1, 2010, the provisions of section 256.9695, subdivision 2,
paragraph (b), do not apply to general assistance medical care provided under this section.

new text begin (k) If a recipient is transferred from a hospital that is not participating in a
coordinated care delivery system to a hospital participating in a coordinated care delivery
system, in order to receive a higher level of care, the transferring hospital remains eligible
to receive any available funding through the temporary uncompensated care pool for the
care initially provided at that hospital. The hospital participating in the coordinated care
delivery system shall be responsible only for care provided at that hospital, and is not
financially liable for the initial care provided by the transferring hospital.
new text end

Sec. 50.

Laws 2010, chapter 200, article 1, section 12, subdivision 7, is amended to
read:


Subd. 7.

Payments; rate setting for the hospital coordinated care delivery
system.

(a) Effective for general assistance medical care services, with the exception
of outpatient prescription drug coverage, provided on or after June 1, 2010, through a
coordinated care delivery system, the commissioner shall allocate the annual appropriation
for the coordinated care delivery system to hospitals participating under subdivision
6 in quarterly payments, beginning on the first scheduled warrant on or after June 1,
2010. The payment shall be allocated among all hospitals qualified to participate on the
allocation date. Each hospital or group of hospitals shall receive a pro rata share of the
allocation based on the hospital's or group of hospitals' calendar year 2008 payments for
general assistance medical care services, new text beginadjusted for any limits on the number of general
assistance medical care enrollees accepted by a hospital,
new text end provided that, for the purposes of
this allocation, payments to Hennepin County Medical Center, Regions Hospital, Saint
Mary's Medical Center, and University of Minnesota Medical Center, Fairview, shall be
weighted at 110 percent of the actual amount. The commissioner may prospectively
reallocate payments to participating hospitals on a biannual basis to ensure that final
allocations reflect actual coordinated care delivery system enrollment. The 2008 base year
shall be updated by one calendar year each June 1, beginning June 1, 2011.

new text begin (b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the
commissioner shall make one-third of the quarterly payment in June and the remaining
two-thirds of the quarterly payment in July to each participating hospital or group of
hospitals.
new text end

deleted text begin (b)deleted text endnew text begin (c)new text end In order to be reimbursed under this section, nonhospital providers of health
care services shall contract with one or more hospitals described in paragraph (a) to
provide services to general assistance medical care recipients through the coordinated care
delivery system established by the hospital. The hospital shall reimburse bills submitted
by nonhospital providers participating under this paragraph at a rate negotiated between
the hospital and the nonhospital provider.

deleted text begin (c)deleted text endnew text begin (d)new text end The commissioner shall apply for federal matching funds under section
256B.199, paragraphs (a) to (d), for expenditures under this subdivision.

deleted text begin (d)deleted text endnew text begin (e)new text end Outpatient prescription drug coverage is provided in accordance with section
256D.03, subdivision 3, and paid on a fee-for-service basis under subdivision 9.

Sec. 51.

Laws 2010, chapter 200, article 1, section 12, subdivision 8, is amended to
read:


Subd. 8.

Temporary uncompensated care pool.

(a) The commissioner shall
establish a temporary uncompensated care pool, effective June 1, 2010. Payments from
the pool must be distributed, within the limits of the available appropriation, to hospitals
that are not part of a coordinated care delivery system established under subdivision
6.new text begin Payments from the pool must also be distributed, within the limits of the available
appropriation, to ambulance services licensed under chapter 144E that respond to a request
for an emergency ambulance call or interfacility transfer for a general assistance medical
care enrollee, if the call or transfer originates from a location more than 25 miles from the
health care facility that receives the enrollee.
new text end

(b) Hospitals seeking reimbursement from this pool must submit an invoice to
the commissioner in a form prescribed by the commissioner for payment for services
provided to an applicant or recipient not enrolled in a coordinated care delivery system. A
payment amount, as calculated under current law, must be determined, but not paid, for
each admission of or service provided to a general assistance medical care recipient on
or after June 1, 2010, to deleted text beginNovember 30deleted text endnew text begin December 31new text end, 2010new text begin, or until medical assistance
coverage is expanded to include adults without children, whichever is later
new text end.

(c) The aggregated payment amounts for each hospital must be calculated as a
percentage of the total calculated amount for all hospitals.

(d) Distributions from the uncompensated care pool for each hospital must be
determined by multiplying the factor in paragraph (c) by the amount of money in the
uncompensated care pool that is available for the six-month period.

(e) The commissioner shall apply for federal matching funds under section
256B.199, paragraphs (a) to (d), for expenditures under this subdivision.

(f) Outpatient prescription drugs are not eligible for payment under this subdivision.

Sec. 52.

Laws 2010, chapter 200, article 1, section 12, the effective date, is amended to
read:


EFFECTIVE DATE.

This section is effective for services rendered on or after
April 1, 2010new text begin, except that subdivision 4 is effective June 1, 2010new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 53.

Laws 2010, chapter 200, article 1, section 16, is amended to read:


Sec. 16.

Minnesota Statutes 2008, section 256L.05, subdivision 3c, is amended to
read:


Subd. 3c.

Retroactive coverage.

Notwithstanding subdivision 3, the effective
date of coverage shall be the first day of the month following termination from medical
assistance for families and individuals who are eligible for MinnesotaCare and who
submitted a written request for retroactive MinnesotaCare coverage with a completed
application within 30 days of the mailing of notification of termination from medical
assistance. The applicant must provide all required verifications within 30 days of the
written request for verification. For retroactive coverage, premiums must be paid in full
for any retroactive month, current month, and next month within 30 days of the premium
billing. General assistance medical care recipients may qualify for retroactive coverage
under this subdivision at six-month renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2010.
new text end

Sec. 54.

Laws 2010, chapter 200, article 1, section 21, is amended to read:


Sec. 21. REPEALER.

(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; and 256D.03,
subdivision 9, are repealed effective April 1, 2010.

(b) Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 4, is repealed
effective deleted text beginAprildeleted text end new text beginJune new text end1, 2010.

(c) Minnesota Statutes 2008, section 256B.195, subdivisions 4 and 5, are repealed
effective for federal fiscal year 2010.

(d) Minnesota Statutes 2009 Supplement, section 256B.195, subdivisions 1, 2, and
3, are repealed effective for federal fiscal year 2010.

(e) Minnesota Statutes 2008, sections 256L.07, subdivision 6; 256L.15, subdivision
4; and 256L.17, subdivision 7, are repealed January 1, 2011.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2010.
new text end

Sec. 55.

Laws 2010, chapter 200, article 2, section 2, subdivision 1, is amended to read:


Subdivision 1.

Total Appropriation

$
(7,985,000)
$
(93,128,000)
Appropriations by Fund
2010
2011
General
34,807,000
118,493,000
Health Care Access
(42,792,000)
(211,621,000)

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

new text begin Special Revenue Fund Transfers.
new text end

new text begin (1) The commissioner shall transfer the
following amounts from special revenue
fund balances to the general fund by June
30 of each respective fiscal year: $410,000
for fiscal year 2010, and $412,000 for fiscal
year 2011.
new text end

new text begin (2) Actual transfers made under clause (1)
must be separately identified and reported as
part of the quarterly reporting of transfers
to the chairs of the relevant senate budget
division and house of representatives finance
division.
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. 56.

Laws 2010, chapter 200, article 2, section 2, subdivision 8, is amended to read:


Subd. 8.

Transfers

The commissioner must transfer $29,538,000
in fiscal year 2010 and $18,462,000 in fiscal
year 2011 from the health care access fund to
the general fund. This is a onetime transfer.

The commissioner must transfer $4,800,000
from the consolidated chemical dependency
treatment fund to the general fund by June
30, 2010.

Compulsive Gambling deleted text beginSpecial Revenuedeleted text end
Administration.
new text beginThe lottery prize fund
appropriation for compulsive gambling
administration is reduced by
new text end$6,000 for fiscal
year 2010 and $4,000 for fiscal year 2011deleted text begin
must be transferred from the lottery prize
fund appropriation for compulsive gambling
administration to the general fund by June
30 of each respective fiscal year
deleted text end.new text begin These are
onetime reductions.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 57. new text beginEARLY EXPANSION.
new text end

new text begin All costs related to implementation of Minnesota Statutes, sections 256B.055,
subdivision 15, and 256B.056, subdivision 4, paragraph (e), shall be paid from the health
care access fund.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval and is
retroactive to April 1, 2010.
new text end

Sec. 58. new text beginFISCAL AND ACTUARIAL ANALYSIS.
new text end

new text begin The commissioner of human services shall offer a request for proposal and accept
bids for the completion of a complete fiscal and actuarial analysis of 2010 House File 135
and 2010 Senate File 118. The commissioner shall report this analysis to the chairs of the
health and human services finance and policy divisions in the house of representatives and
senate no later than December 15, 2010.
new text end

Sec. 59. new text begin REPEALER; TRANSFER.
new text end

new text begin (a) new text end new text begin Laws 2010, chapter 200, article 1, section 12, subdivisions 1, 2, 3, 4, 5, 6, 7, 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, chapter 200, article 1, sections 18; and 19, new text end new text begin are repealed.
new text end

new text begin (c) new text end new text begin Minnesota Statutes 2008, section 256D.03, subdivisions 3a, 3b, 5, 6, 7, and 8, new text end new text begin
and
new text end new text begin Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraphs (a) and (b) are effective 30 days after federal
approval of the amendments in this article to Minnesota Statutes, sections 256B.055,
subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later,
and all remaining unspent appropriations for the program established by Laws 2010,
chapter 200, are transferred to the health care access fund. Paragraph (c) is effective
30 days after federal approval of the amendments in this article to Minnesota Statutes,
sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011,
whichever is later.
new text end

ARTICLE 3

CONTINUING CARE

Section 1.

Minnesota Statutes 2009 Supplement, section 252.27, subdivision 2a,
is amended to read:


Subd. 2a.

Contribution amount.

(a) The natural or adoptive parents of a minor
child, including a child determined eligible for medical assistance without consideration of
parental income, must contribute to the cost of services used by making monthly payments
on a sliding scale based on income, unless the child is married or has been married,
parental rights have been terminated, or the child's adoption is subsidized according to
section 259.67 or through title IV-E of the Social Security Act. The parental contribution
is a partial or full payment for medical services provided for diagnostic, therapeutic,
curing, treating, mitigating, rehabilitation, maintenance, and personal care services as
defined in United States Code, title 26, section 213, needed by the child with a chronic
illness or disability.

(b) For households with adjusted gross income equal to or greater than 100 percent
of federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 100 percent of federal
poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
contribution is $4 per month;

(2) if the adjusted gross income is equal to or greater than 175 percent of federal
poverty guidelines and less than or equal to 545 percent of federal poverty guidelines,
the parental contribution shall be determined using a sliding fee scale established by the
commissioner of human services which begins at one percent of adjusted gross income
at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted
gross income for those with adjusted gross income up to 545 percent of federal poverty
guidelines;new text begin and
new text end

(3) if the adjusted gross income is greater than 545 percent of federal poverty
guidelines deleted text beginand less than 675 percent of federal poverty guidelinesdeleted text end, the parental
contribution shall be deleted text begin7.5deleted text end new text begin12.5 new text endpercent of adjusted gross incomedeleted text begin;deleted text endnew text begin.
new text end

deleted text begin (4) if the adjusted gross income is equal to or greater than 675 percent of federal
poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 7.5 percent of adjusted gross income at 675 percent of
federal poverty guidelines and increases to ten percent of adjusted gross income for those
with adjusted gross income up to 975 percent of federal poverty guidelines; and
deleted text end

deleted text begin (5) if the adjusted gross income is equal to or greater than 975 percent of federal
poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross
income.
deleted text end

If the child lives with the parent, the annual adjusted gross income is reduced by
$2,400 prior to calculating the parental contribution. If the child resides in an institution
specified in section 256B.35, the parent is responsible for the personal needs allowance
specified under that section in addition to the parental contribution determined under this
section. The parental contribution is reduced by any amount required to be paid directly to
the child pursuant to a court order, but only if actually paid.

(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes
in the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.

(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis
effective with the first month in which the child receives services. Annually upon
redetermination or at termination of eligibility, if the contribution exceeded the cost of
services provided, the local agency or the state shall reimburse that excess amount to
the parents, either by direct reimbursement if the parent is no longer required to pay a
contribution, or by a reduction in or waiver of parental fees until the excess amount is
exhausted. All reimbursements must include a notice that the amount reimbursed may be
taxable income if the parent paid for the parent's fees through an employer's health care
flexible spending account under the Internal Revenue Code, section 125, and that the
parent is responsible for paying the taxes owed on the amount reimbursed.

(f) The monthly contribution amount must be reviewed at least every 12 months;
when there is a change in household size; and when there is a loss of or gain in income
from one month to another in excess of ten percent. The local agency shall mail a written
notice 30 days in advance of the effective date of a change in the contribution amount.
A decrease in the contribution amount is effective in the month that the parent verifies a
reduction in income or change in household size.

(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be
deducted from the adjusted gross income of the parent making the payment prior to
calculating the parental contribution under paragraph (b).

(h) The contribution under paragraph (b) shall be increased by an additional five
percent if the local agency determines that insurance coverage is available but not
obtained for the child. For purposes of this section, "available" means the insurance is a
benefit of employment for a family member at an annual cost of no more than five percent
of the family's annual income. For purposes of this section, "insurance" means health
and accident insurance coverage, enrollment in a nonprofit health service plan, health
maintenance organization, self-insured plan, or preferred provider organization.

Parents who have more than one child receiving services shall not be required
to pay more than the amount for the child with the highest expenditures. There shall
be no resource contribution from the parents. The parent shall not be required to pay
a contribution in excess of the cost of the services provided to the child, not counting
payments made to school districts for education-related services. Notice of an increase in
fee payment must be given at least 30 days before the increased fee is due.

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
in the 12 months prior to July 1:

(1) the parent applied for insurance for the child;

(2) the insurer denied insurance;

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
a complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

For purposes of this section, "insurance" has the meaning given in paragraph (h).

A parent who has requested a reduction in the contribution amount under this
paragraph shall submit proof in the form and manner prescribed by the commissioner or
county agency, including, but not limited to, the insurer's denial of insurance, the written
letter or complaint of the parents, court documents, and the written response of the insurer
approving insurance. The determinations of the commissioner or county agency under this
paragraph are not rules subject to chapter 14.

Sec. 2.

Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:


Subd. 9.

Employed persons with disabilities.

(a) Medical assistance may be paid
for a person who is employed and who:

(1)new text begin but for excess earnings or assets,new text end meets the definition of disabled under the
supplemental security income program;

(2) is at least 16 but less than 65 years of age;

(3) meets the asset limits in paragraph (c); and

(4) deleted text begineffective November 1, 2003,deleted text end pays a premium and other obligations under
paragraph (e).

Any spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.

(b) After the month of enrollment, a person enrolled in medical assistance under
this subdivision who:

(1) is temporarily unable to work and without receipt of earned income due to a
medical condition, as verified by a physician, may retain eligibility for up to four calendar
months; or

(2) effective January 1, 2004, loses employment for reasons not attributable to the
enrollee, may retain eligibility for up to four consecutive months after the month of job
loss. To receive a four-month extension, enrollees must verify the medical condition or
provide notification of job loss. All other eligibility requirements must be met and the
enrollee must pay all calculated premium costs for continued eligibility.

(c) For purposes of determining eligibility under this subdivision, a person's assets
must not exceed $20,000, excluding:

(1) all assets excluded under section 256B.056;

(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
Keogh plans, and pension plans; and

(3) medical expense accounts set up through the person's employer.

(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65
earned income disregard. To be eligible, a person applying for medical assistance under
this subdivision must have earned income above the disregard level.

(2) Effective January 1, 2004, to be considered earned income, Medicare, Social
Security, and applicable state and federal income taxes must be withheld. To be eligible,
a person must document earned income tax withholding.

(e)(1) A person whose earned and unearned income is equal to or greater than 100
percent of federal poverty guidelines for the applicable family size must pay a premium
to be eligible for medical assistance under this subdivision. The premium shall be based
on the person's gross earned and unearned income and the applicable family size using a
sliding fee scale established by the commissioner, which begins at one percent of income
at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income
for those with incomes at or above 300 percent of the federal poverty guidelines. Annual
adjustments in the premium schedule based upon changes in the federal poverty guidelines
shall be effective for premiums due in July of each year.

(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for
medical assistance under this subdivision. An enrollee shall pay the greater of a deleted text begin$35deleted text endnew text begin $50new text end
premium or the premium calculated in clause (1).

(3) Effective November 1, 2003, all enrollees who receive unearned income must
pay deleted text beginone-half of onedeleted text endnew text begin 2.5new text end percent of unearned income in addition to the premium amount.

(4) Effective November 1, 2003, for enrollees whose income does not exceed 200
percent of the federal poverty guidelines and who are also enrolled in Medicare, the
commissioner must reimburse the enrollee for Medicare Part B premiums under section
256B.0625, subdivision 15, paragraph (a).

(5) Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year.

(f) A person's eligibility and premium shall be determined by the local county
agency. Premiums must be paid to the commissioner. All premiums are dedicated to
the commissioner.

(g) Any required premium shall be determined at application and redetermined at
the enrollee's six-month income review or when a change in income or household size is
reported. Enrollees must report any change in income or household size within ten days
of when the change occurs. A decreased premium resulting from a reported change in
income or household size shall be effective the first day of the next available billing month
after the change is reported. Except for changes occurring from annual cost-of-living
increases, a change resulting in an increased premium shall not affect the premium amount
until the next six-month review.

(h) Premium payment is due upon notification from the commissioner of the
premium amount required. Premiums may be paid in installments at the discretion of
the commissioner.

(i) Nonpayment of the premium shall result in denial or termination of medical
assistance unless the person demonstrates good cause for nonpayment. Good cause exists
if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
D, are met. Except when an installment agreement is accepted by the commissioner,
all persons disenrolled for nonpayment of a premium must pay any past due premiums
as well as current premiums due prior to being reenrolled. Nonpayment shall include
payment with a returned, refused, or dishonored instrument. The commissioner may
require a guaranteed form of payment as the only means to replace a returned, refused,
or dishonored instrument.

new text begin (j) The commissioner shall notify enrollees annually beginning at least 24 months
before the person's 65th birthday of the medical assistance eligibility rules affecting
income, assets, and treatment of a spouse's income and assets that will be applied upon
reaching age 65.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 3.

Minnesota Statutes 2009 Supplement, section 256B.0915, subdivision 3a,
is amended to read:


Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of
waivered services to an individual elderly waiver client except for individuals described
in paragraph (b) shall be the weighted average monthly nursing facility rate of the case
mix resident class to which the elderly waiver client would be assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the first day 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 the first day of the state fiscal year in
which the resident assessment system as described in section 256B.438 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 rate of the case mix resident class to which the waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the
previous state fiscal year, adjusted by deleted text beginthe greater ofdeleted text end any legislatively adopted home and
community-based services percentage rate deleted text beginincrease or the average statewide percentage
increase in nursing facility payment rates
deleted text endnew text begin adjustmentnew text end.

(b) The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with (1) no
dependencies in activities of daily living, (2) only one dependency in bathing, dressing,
grooming, or walking, or (3) a dependency score of less than three if eating is the only
dependency, shall be the lower of the case mix classification amount for case mix A as
determined under paragraph (a) or the case mix classification amount for case mix A
effective on October 1, 2008, per month for all new participants enrolled in the program
on or after July 1, 2009. This monthly limit shall be applied to all other participants who
meet this criteria at reassessment.

(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) or
(b), 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) or (b).

Sec. 4.

Minnesota Statutes 2008, section 256B.0915, subdivision 3b, is amended to
read:


Subd. 3b.

Cost limits for elderly waiver applicants who reside in a nursing
facility.

(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 limit for
the cost of elderly waivered services may be requested. The monthly conversion limit for
the cost of elderly waiver services shall be 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 limit for the cost of elderly waiver services shall
be the per diem nursing facility rate as determined by the resident assessment system as
described in section 256B.438 for deleted text beginthat residentdeleted text end new text beginresidents new text endin the nursing facility where the
resident currently residesnew text begin, but in effect on June 30, 2010, and adjusted annually by any
legislatively adopted percentage change in the elderly waiver services rates. That per
diem shall be
new text end multiplied by 365 deleted text beginanddeleted text endnew text begin,new text end divided by 12, deleted text beginlessdeleted text end new text beginand reduced by new text endthe recipient's
maintenance needs allowance as described in subdivision 1d. The initially approved
conversion rate deleted text beginmaydeleted text end new text beginmust new text endbe adjusted by deleted text beginthe greater ofdeleted text end any subsequent legislatively
adopted home and community-based services percentage rate deleted text beginincrease or the average
statewide percentage increase in nursing facility payment rates
deleted text endnew text begin adjustmentnew text end. The limit
under this subdivision 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 conversion rate limit is equal to the nursing facility rate
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) The following costs must be included in determining the total monthly costs
for the waiver client:

(1) cost of all waivered services, including deleted text beginextended medicaldeleted text end new text beginspecialized new text endsupplies
and equipment and environmental deleted text beginmodifications anddeleted text end new text beginaccessibility new text endadaptations; and

(2) cost of skilled nursing, home health aide, and personal care services reimbursable
by medical assistance.

Sec. 5.

Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, is
amended to read:


Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
services shall be administered according to the terms and conditions of the federal contract
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
items B and C, which do not apply to persons enrolling in demonstrations under this
section. An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until four years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
four years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. deleted text beginThe process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs.
deleted text end A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas of
the state. Until July 1, 2009, expansion for MnDHO projects that include home and
community-based services is limited to the two projects and service areas in effect on
March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. Notwithstanding whether expansion occurs under
this paragraph, in determining MnDHO payment rates and risk adjustment methods for
contract years starting in 2012, the commissioner must consider the methods used to
determine county allocations for home and community-based program participants. If
necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs
for home and community-based services, the commissioner shall achieve the reduction by
maintaining the base rate for contract years 2010 and 2011 for services provided under the
community alternatives for disabled individuals waiver at the same level as for contract
year 2009. The commissioner may apply other reductions to MnDHO rates to implement
decreases in provider payment rates required by state law. In developing program
specifications for expansion of integrated programs, the commissioner shall involve and
consult the state-level stakeholder group established in subdivision 28, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
of the house of representatives and senate committees with jurisdiction over health and
human services policy and finance by February 1, 2007.

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

Sec. 6.

new text begin [256.4825] REPORT REGARDING PROGRAMS AND SERVICES FOR
PEOPLE WITH DISABILITIES.
new text end

new text begin The Minnesota State Council on Disability, the Minnesota Consortium for Citizens
with Disabilities, and the Arc of Minnesota may submit an annual report by January 15 of
each year, beginning in 2012, to the chairs and ranking minority members of the legislative
committees with jurisdiction over programs serving people with disabilities as provided in
this section. The report must describe the existing state policies and goals for programs
serving people with disabilities including, but not limited to, programs for employment,
transportation, housing, education, quality assurance, consumer direction, physical and
programmatic access, and health. The report must provide data and measurements to
assess the extent to which the policies and goals are being met. The commissioner of
human services and the commissioners of other state agencies administering programs for
people with disabilities shall cooperate with the Minnesota State Council on Disability,
the Minnesota Consortium for Citizens with Disabilities, and the Arc of Minnesota and
provide those organizations with existing published information and reports that will assist
in the preparation of the report.
new text end

Sec. 7. new text beginCASE MANAGEMENT REFORM.
new text end

new text begin (a) By February 1, 2011, the commissioner of human services shall provide specific
recommendations and language for proposed legislation to:
new text end

new text begin (1) define the administrative and the service functions of case management and make
changes to improve the funding for administrative functions;
new text end

new text begin (2) standardize and simplify processes, standards, and timelines for administrative
functions of case management within the Department of Human Services, Disability
Services Division, including eligibility determinations, resource allocation, management
of dollars, provision for assignment of one case manager at a time per person, waiting lists,
quality assurance, host county concurrence requirements, county of financial responsibility
provisions, and waiver compliance; and
new text end

new text begin (3) increase opportunities for consumer choice of case management functions
involving service coordination.
new text end

new text begin (b) In developing these recommendations, the commissioner shall consider the
recommendations of the 2007 Redesigning Case Management Services for Persons
with Disabilities report and consult with existing stakeholder groups, which include
representatives of counties, disability and senior advocacy groups, service providers, and
representatives of agencies which provide contracted case management.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8. new text beginCOMMISSIONER TO SEEK FEDERAL MATCH.
new text end

new text begin (a) The commissioner of human services shall seek federal financial participation
for eligible activity related to fiscal years 2010 and 2011 grants to Advocating Change
Together to establish a statewide self-advocacy network for persons with developmental
disabilities and for eligible activities under any future grants to the organization.
new text end

new text begin (b) The commissioner shall report to the chairs of the senate Health and Human
Services Budget Division and the house of representatives Health Care and Human
Services Finance Division by December 15, 2010, with the results of the application for
federal matching funds.
new text end

ARTICLE 4

CHILDREN AND FAMILY SERVICES

Section 1.

Minnesota Statutes 2008, section 119B.025, subdivision 1, is amended to
read:


Subdivision 1.

Factors which must be verified.

(a) 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) 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) If a family did not use the universal application or child care addendum to apply
for child care assistance, the family must complete the universal application or child care
addendum at its next eligibility redetermination and the county must verify the factors
listed in paragraph (a) as part of that redetermination. Once a family has completed a
universal application or child care addendum, the county shall use the redetermination
form described in paragraph (c) for that family's subsequent redeterminations. Eligibility
must be redetermined at least every six months. new text beginFor a family where at least one parent is
under the age of 21, does not have a high school or general equivalency diploma, and is a
student in a school district or another similar program that provides or arranges for child
care, as well as parenting, social services, career and employment supports, and academic
support to achieve high school graduation, the redetermination of eligibility shall be
deferred beyond six months, but not to exceed 12 months, to the end of the student's
school year.
new text endIf a family reports a change in an eligibility factor before the family's next
regularly scheduled redetermination, the county must recalculate eligibility without
requiring verification of any eligibility factor that did not change.

(c) The commissioner shall develop a redetermination form to redetermine eligibility
and a change report form to report changes that minimize paperwork for the county and
the participant.

new text begin (d) Families have the primary responsibility to verify information. A county must
consider the family's circumstances and ability to produce verification when initiating a
request for verification. If a family is unable to verify an eligibility factor, the county
must request written consent from the family to obtain verification from other sources. A
county may not request a specific form of verification if another is more readily available.
When verification of an eligibility factor other than income is not available despite the
efforts of the county and the family, the county must accept a signed statement from the
family attesting to the correctness of the information if one is provided. The county must
deny or end assistance to families who refuse or deliberately fail to verify information.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 15, 2010.
new text end

Sec. 2.

Minnesota Statutes 2008, section 119B.09, subdivision 4, is amended to read:


Subd. 4.

Eligibility; annual income; calculation.

Annual income of the applicant
family is the current monthly income of the family multiplied by 12 or the income for
the 12-month period immediately preceding the date of application, or income calculated
by the method which provides the most accurate assessment of income available to the
family. Self-employment income must be calculated based on gross receipts less operating
expenses. Income must be recalculated when the family's income changes, but no less
often than every six months. new text beginFor a family where at least one parent is under the age
of 21, does not have a high school or general equivalency diploma, and is a student in
a school district or another similar program that provides or arranges for child care,
as well as parenting, social services, career and employment supports, and academic
support to achieve high school graduation, income must be recalculated when the family's
income changes, but otherwise shall be deferred beyond six months, but not to exceed 12
months, to the end of the student's school year.
new text endIncome must be verified with documentary
evidence. If the applicant does not have sufficient evidence of income, verification must
be obtained from the source of the income.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 15, 2010.
new text end

Sec. 3.

Minnesota Statutes 2008, section 119B.11, subdivision 1, is amended to read:


Subdivision 1.

County contributions required.

(a) In addition to payments from
basic sliding fee child care program participants, each county shall contribute from county
tax or other sources a deleted text beginfixed local matchdeleted text endnew text begin maintenance of effortnew text end equal to its calendar year
1996 required county contribution reduced by the administrative funding loss that would
have occurred in state fiscal year 1996 under section 119B.15new text begin, except the maintenance of
effort for a county must be equal to at least 1.1 percent of the county's basic sliding fee
direct services allocation for the previous calendar year and no greater than six percent
of the county's basic sliding fee direct services allocation for the previous calendar year
new text end.
The commissioner shall recover funds from the county as necessary to bring county
expenditures into compliance with this subdivision. The commissioner may accept county
contributions, including contributions above the deleted text beginfixed local matchdeleted text endnew text begin county maintenance of
effort
new text end, in order to make state payments.

(b) The commissioner may accept payments from counties to:

(1) fulfill the county contribution as required under subdivision 1;

(2) pay for services authorized under this chapter beyond those paid for with federal
or state funds or with the required county contributions; or

(3) pay for child care services in addition to those authorized under this chapter, as
authorized under other federal, state, or local statutes or regulations.

(c) The county payments must be deposited in an account in the special revenue
fund. Money in this account is appropriated to the commissioner for child care assistance
under this chapter and other applicable statutes and regulations and is in addition to other
state and federal appropriations.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256D.0515, is amended to read:


256D.0515 ASSET LIMITATIONS FOR FOOD STAMP HOUSEHOLDS.

All food stamp households must be determined eligible for the benefit discussed
under section 256.029. Food stamp households must demonstrate thatdeleted text begin:
deleted text end

deleted text begin (1)deleted text end their gross income deleted text beginmeets the federal Food Stamp requirements under United
States Code, title 7, section 2014(c); and
deleted text endnew text begin is equal to or less than 165 percent of the federal
poverty guidelines for the same family size.
new text end

deleted text begin (2) they have financial resources, excluding vehicles, of less than $7,000.
deleted text end

Sec. 5.

Minnesota Statutes 2008, section 256J.20, subdivision 3, is amended to read:


Subd. 3.

Other property limitations.

To be eligible for MFIP, the equity value of
all nonexcluded real and personal property of the assistance unit must not exceed $2,000
for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to
(19) must be excluded when determining the equity value of real and personal property:

(1) a licensed vehicle up to a loan value of less than or equal to deleted text begin$15,000deleted text endnew text begin $7,500new text end. deleted text beginIf the
assistance unit owns more than one licensed vehicle, the county agency shall determine the
loan value of all additional vehicles and exclude the combined loan value of less than or
equal to $7,500.
deleted text end The county agency shall apply any excess loan value as if it were equity
value to the asset limit described in this sectiondeleted text begin,deleted text endnew text begin. If the assistance unit owns more than
one licensed vehicle, the county agency shall determine the vehicle with the highest loan
value and count only the loan value over $7,500,
new text end excluding: (i) the value of one vehicle
per physically disabled person when the vehicle is needed to transport the disabled unit
member; this exclusion does not apply to mentally disabled people; (ii) the value of special
equipment for a disabled member of the assistance unit; and (iii) any vehicle used for
long-distance travel, other than daily commuting, for the employment of a unit member.

new text begin The county agency shall count the loan value of all other vehicles and apply this
amount as if it were equity value to the asset limit described in this section.
new text endTo establish the
loan value of vehicles, a county agency must use the N.A.D.A. Official Used Car Guide,
Midwest Edition, for newer model cars. When a vehicle is not listed in the guidebook,
or when the applicant or participant disputes the loan value listed in the guidebook as
unreasonable given the condition of the particular vehicle, the county agency may require
the applicant or participant document the loan value by securing a written statement from
a motor vehicle dealer licensed under section 168.27, stating the amount that the dealer
would pay to purchase the vehicle. The county agency shall reimburse the applicant or
participant for the cost of a written statement that documents a lower loan value;

(2) the value of life insurance policies for members of the assistance unit;

(3) one burial plot per member of an assistance unit;

(4) the value of personal property needed to produce earned income, including
tools, implements, farm animals, inventory, business loans, business checking and
savings accounts used at least annually and used exclusively for the operation of a
self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use
is to produce income and if the vehicles are essential for the self-employment business;

(5) the value of personal property not otherwise specified which is commonly
used by household members in day-to-day living such as clothing, necessary household
furniture, equipment, and other basic maintenance items essential for daily living;

(6) the value of real and personal property owned by a recipient of Supplemental
Security Income or Minnesota supplemental aid;

(7) the value of corrective payments, but only for the month in which the payment
is received and for the following month;

(8) a mobile home or other vehicle used by an applicant or participant as the
applicant's or participant's home;

(9) money in a separate escrow account that is needed to pay real estate taxes or
insurance and that is used for this purpose;

(10) money held in escrow to cover employee FICA, employee tax withholding,
sales tax withholding, employee worker compensation, business insurance, property rental,
property taxes, and other costs that are paid at least annually, but less often than monthly;

(11) monthly assistance payments for the current month's or short-term emergency
needs under section 256J.626, subdivision 2;

(12) the value of school loans, grants, or scholarships for the period they are
intended to cover;

(13) payments listed in section 256J.21, subdivision 2, clause (9), which are held
in escrow for a period not to exceed three months to replace or repair personal or real
property;

(14) income received in a budget month through the end of the payment month;

(15) savings from earned income of a minor child or a minor parent that are set aside
in a separate account designated specifically for future education or employment costs;

(16) the federal earned income credit, Minnesota working family credit, state and
federal income tax refunds, state homeowners and renters credits under chapter 290A,
property tax rebates and other federal or state tax rebates in the month received and the
following month;

(17) payments excluded under federal law as long as those payments are held in a
separate account from any nonexcluded funds;

(18) the assets of children ineligible to receive MFIP benefits because foster care or
adoption assistance payments are made on their behalf; and

(19) the assets of persons whose income is excluded under section 256J.21,
subdivision 2
, clause (43).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2010.
new text end

Sec. 6.

Minnesota Statutes 2008, section 256J.24, subdivision 10, is amended to read:


Subd. 10.

MFIP exit level.

The commissioner shall adjust the MFIP earned income
disregard to ensure that most participants do not lose eligibility for MFIP until their
income reaches at least deleted text begin115deleted text endnew text begin 110new text end percent of the federal poverty guidelines in effect deleted text beginin
October of each fiscal year
deleted text endnew text begin at the time of the adjustmentnew text end. The adjustment to the disregard
shall be based on a household size of three, and the resulting earned income disregard
percentage must be applied to all household sizes. The adjustment under this subdivision
must be implemented deleted text beginat the same time as the October food stamp ordeleted text endnew text begin whenever there is anew text end
food support deleted text begincost-of-livingdeleted text end adjustment deleted text beginisdeleted text end reflected in the food portion of MFIP transitional
standard as required under subdivision 5a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2010.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256J.37, subdivision 3a, is amended to read:


Subd. 3a.

Rental subsidies; unearned income.

(a) deleted text beginEffective July 1, 2003,deleted text end The
county agency shall count deleted text begin$50deleted text end new text begin$100 new text endof the value of public and assisted rental subsidies
provided through the Department of Housing and Urban Development (HUD) as unearned
income to the cash portion of the MFIP grant. The full amount of the subsidy must be
counted as unearned income when the subsidy is less than deleted text begin$50deleted text endnew text begin $100new text end. The income from
this subsidy shall be budgeted according to section 256J.34.

(b) The provisions of this subdivision shall not apply to an MFIP assistance unit
which includes a participant who is:

(1) age 60 or older;

(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
certified by a qualified professional when the illness, injury, or incapacity is expected
to continue for more than 30 days and prevents the person from obtaining or retaining
employment; or

(3) a caregiver whose presence in the home is required due to the illness or
incapacity of another member in the assistance unit, a relative in the household, or a foster
child in the household when the illness or incapacity and the need for the participant's
presence in the home has been certified by a qualified professional and is expected to
continue for more than 30 days.

(c) The provisions of this subdivision shall not apply to an MFIP assistance unit
where the parental caregiver is an SSI recipient.

(d) Prior to implementing this provision, the commissioner must identify the MFIP
participants subject to this provision and provide written notice to these participants at
least 30 days before the first grant reduction. The notice must inform the participant of the
basis for the potential grant reduction, the exceptions to the provision, if any, and inform
the participant of the steps necessary to claim an exception. A person who is found not to
meet one of the exceptions to the provision must be notified and informed of the right to a
fair hearing under section 256J.40. The notice must also inform the participant that the
participant may be eligible for a rent reduction resulting from a reduction in the MFIP
grant and encourage the participant to contact the local housing authority.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2010.
new text end

Sec. 8.

Minnesota Statutes 2009 Supplement, section 256J.425, subdivision 3, is
amended to read:


Subd. 3.

Hard-to-employ participants.

(a) An assistance unit subject to the time
limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under
a hardship extension if the participant who reached the time limit belongs to any of the
following groups:

(1) a person who is diagnosed by a licensed physician, psychological practitioner, or
other qualified professional, as developmentally disabled or mentally ill, and the condition
severely limits the person's ability to obtain or maintain suitable employment;

(2) a person who:

(i) has been assessed by a vocational specialist or the county agency to be
unemployable for purposes of this subdivision; or

(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county
agency to be employable, but the condition severely limits the person's ability to obtain or
maintain suitable employment. The determination of IQ level must be made by a qualified
professional. In the case of a non-English-speaking person: (A) the determination must
be made by a qualified professional with experience conducting culturally appropriate
assessments, whenever possible; (B) the county may accept reports that identify an
IQ range as opposed to a specific score; (C) these reports must include a statement of
confidence in the results;

(3) a person who is determined by a qualified professional to be learning disabled,
and the condition severely limits the person's ability to obtain or maintain suitable
employment. For purposes of the initial approval of a learning disability extension, the
determination must have been made or confirmed within the previous 12 months. In the
case of a non-English-speaking person: (i) the determination must be made by a qualified
professional with experience conducting culturally appropriate assessments, whenever
possible; and (ii) these reports must include a statement of confidence in the results. If a
rehabilitation plan for a participant extended as learning disabled is developed or approved
by the county agency, the plan must be incorporated into the employment plan. However,
a rehabilitation plan does not replace the requirement to develop and comply with an
employment plan under section 256J.521; or

(4) a person who has been granted a family violence waiver, and who is complying
with an employment plan under section 256J.521, subdivision 3.

(b) For purposes of this deleted text beginsectiondeleted text endnew text begin chapternew text end, "severely limits the person's ability to obtain
or maintain suitable employment" meansnew text begin:
new text end

new text begin (1)new text end that a qualified professional has determined that the person's condition prevents
the person from working 20 or more hours per weeknew text begin; or
new text end

new text begin (2) for a person who meets the requirements of paragraph (a), clause (2), item (ii), or
clause (3), a qualified professional has determined the person's condition:
new text end

new text begin (i) significantly restricts the range of employment that the person is able to perform;
or
new text end

new text begin (ii) significantly interferes with the person's ability to obtain or maintain suitable
employment for 20 or more hours per week
new text end.

Sec. 9. new text beginQUALITY RATING SYSTEM TRAINING, COACHING,
CONSULTATION, AND SUPPORTS.
new text end

new text begin The commissioner of human services shall direct $500,000 in federal child care
development funds used for grants under Minnesota Statutes, section 119B.21, in fiscal
year 2011 for the purpose of providing statewide child care provider training, coaching,
consultation, and supports to prepare for the voluntary Minnesota quality rating system.
This is a onetime appropriation. In addition, to the extent that private funds are made
available, the commissioner shall designate those funds for this purpose.
new text end

Sec. 10. new text beginCHILD CARE ASSISTANCE REDETERMINATION OF ELIGIBILITY
AND INFORMATION VERIFICATION.
new text end

new text begin The commissioner of human services shall use existing resources to implement
the changes in this act related to child care assistance redetermination of eligibility and
information verification under Minnesota Statutes, sections 119B.025, subdivision 1, and
119B.09, subdivision 4.
new text end

ARTICLE 5

MISCELLANEOUS

Section 1.

new text begin [62A.3075] CANCER CHEMOTHERAPY TREATMENT
COVERAGE.
new text end

new text begin (a) A health plan company that provides coverage under a health plan for cancer
chemotherapy treatment shall not require a higher co-payment, deductible, or coinsurance
amount for a prescribed, orally administered anticancer medication that is used to kill or
slow the growth of cancerous cells than what the health plan requires for an intravenously
administered or injected cancer medication that is provided, regardless of formulation or
benefit category determination by the health plan company.
new text end

new text begin (b) A health plan company must not achieve compliance with this section
by imposing an increase in co-payment, deductible, or coinsurance amount for an
intravenously administered or injected cancer chemotherapy agent covered under the
health plan.
new text end

new text begin (c) Nothing in this section shall be interpreted to prohibit a health plan company
from requiring prior authorization or imposing other appropriate utilization controls in
approving coverage for any chemotherapy.
new text end

new text begin (d) A plan offered by the commissioner of management and budget under section
43A.23 is deemed to be at parity and in compliance with this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraphs (a) and (c) are effective August 1, 2010, and apply
to health plans providing coverage to a Minnesota resident offered, issued, sold, renewed,
or continued as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after
that date. Paragraph (b) is effective the day following final enactment.
new text end

Sec. 2.

new text begin [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
paragraphs (b) to (e) have the meanings given.
new text end

new text begin (b) "Autism spectrum disorder" means the following 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:
new text end

new text begin (1) autism or autistic disorder;
new text end

new text begin (2) Asperger's syndrome; or
new text end

new text begin (3) pervasive developmental disorder - not otherwise specified.
new text end

new text begin (c) "Board-certified behavior analyst" means an individual certified by the Behavior
Analyst Certification Board as a board-certified behavior analyst.
new text end

new text begin (d) "Evidence-based," for purposes of this section only, is as described in subdivision
2, paragraph (c), clause (2).
new text end

new text begin (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
new text end

new text begin (f) "Manualized approach" means a self-contained volume, text, or set of
instructional media, which may include videos or compact discs, that codifies in
reasonable detail the procedures for implementing treatment.
new text end

new text begin (g) "Medical necessity" or "medically necessary care" has the meaning given in
section 62Q.53, subdivision 2.
new text end

new text begin (h) "Mental health professional" has the meaning given in section 245.4871,
subdivision 27, clauses (1) to (6).
new text end

new text begin (i) "Qualified mental health behavioral aide" means a mental health behavioral aide
as defined in section 256B.0943, subdivision 7.
new text end

new text begin (j) "Qualified mental health practitioner" means a mental health practitioner as
defined in section 245.4871, subdivision 26.
new text end

new text begin (k) "Statistically superior outcomes" means a research study in which the probability
that the results would be obtained under the null hypothesis is less than five percent.
new text end

new text begin Subd. 2. new text end

new text begin Coverage required. new text end

new text begin (a) For coverage requirements to apply, an individual
must have a diagnosis of autism spectrum disorder made through an evaluation of the
patient, completed within the six months prior to the start of treatment, which includes
all of the following:
new text end

new text begin (1) a complete medical and psychological evaluation performed by a licensed
physician and psychologist using empirically validated tools or tests that incorporate
measures for intellectual functioning, language development, adaptive skills, and
behavioral problems, which must include:
new text end

new text begin (i) a developmental history of the child, focusing on developmental milestones
and delays;
new text end

new text begin (ii) a family history, including whether there are other family members with an
autism spectrum disorder, developmental disability, fragile X syndrome, or tuberous
sclerosis;
new text end

new text begin (iii) a medical history, including signs of deterioration, seizure activity, brain injury,
and head circumference;
new text end

new text begin (iv) a physical examination completed within the past 12 months;
new text end

new text begin (v) an evaluation for intellectual functioning;
new text end

new text begin (vi) a lead screening for those children with a developmental disability; and
new text end

new text begin (vii) other evaluations and testing as indicated by the medical evaluation, which
may include neuropsychological testing, occupational therapy, physical therapy, family
functioning, genetic testing, imaging laboratory tests, and electrophysiological testing;
new text end

new text begin (2) a communication assessment conducted by a speech pathologist; and
new text end

new text begin (3) a comprehensive hearing test conducted by an audiologist with experience in
testing very young children.
new text end

new text begin (b) A health plan must provide coverage for the diagnosis, evaluation, assessment,
and medically necessary care of autism spectrum disorders that is evidence-based,
including but not limited to:
new text end

new text begin (1) neurodevelopmental and behavioral health treatments, instruction, and
management;
new text end

new text begin (2) applied behavior analysis and intensive early intervention services, including
service package models such as intensive early intervention behavior therapy services
and Lovaas therapy;
new text end

new text begin (3) speech therapy;
new text end

new text begin (4) occupational therapy;
new text end

new text begin (5) physical therapy; and
new text end

new text begin (6) prescription medications.
new text end

new text begin (c) Coverage required under this section shall include treatment that is in accordance
with:
new text end

new text begin (1) an individualized treatment plan prescribed by the insured's treating physician or
mental health professional as defined in this section; and
new text end

new text begin (2) medically and scientifically accepted evidence that meets the criteria of a
peer-reviewed, published study that is one of the following:
new text end

new text begin (i) a randomized study with adequate statistical power, including a sample size of
30 or more for each group, that shows statistically superior outcomes to a pill placebo
group, psychological placebo group, another treatment group, or a wait list control group,
or that is equivalent to another evidence-based treatment that meets the above standard
for the specified problem area; or
new text end

new text begin (ii) a series of at least three single-case design experiments with clear specification
of the subjects and with clear specification of the treatment approach that:
new text end

new text begin (A) use robust experimental designs;
new text end

new text begin (B) show statistically superior outcomes to pill placebo, psychological placebo,
or another treatment group; and
new text end

new text begin (C) either use a manualized approach or are conducted by at least two independent
investigators or teams; or
new text end

new text begin (3) where evidence meeting the standards of this subdivision does not exist for
the treatment of a diagnosed condition or for an individual matching the demographic
characteristics for which the evidence is valid, practice guidelines based on consensus
of Minnesota health care professionals knowledgeable in the treatment of individuals
with autism spectrum disorders.
new text end

new text begin (d) Early intensive behavior therapies that meet the criteria set forth in paragraphs
(b) and (c) must also meet the following best practices standards:
new text end

new text begin (1) the services must be prescribed by a mental health professional as an appropriate
treatment option for the individual child;
new text end

new text begin (2) regular reporting of services provided and the child's progress must be submitted
to the prescribing mental health professional;
new text end

new text begin (3) care must include appropriate parent or legal guardian education and
involvement;
new text end

new text begin (4) the medically prescribed treatment and frequency of services should be
coordinated between the school and provider for all children up to age 21; and
new text end

new text begin (5) services must be provided by a mental health professional or, as appropriate, a
board-certified behavior analyst, a qualified mental health practitioner, or a qualified
mental health behavioral aide.
new text end

new text begin (e) Providers under this section must work with the commissioner in implementing
evidence-based practices and, specifically for children under age 21, the Minnesota
Evidence-Based Practice Database of research-informed practice elements and specific
constituent practices.
new text end

new text begin (f) A health plan company may not refuse to renew or reissue, or otherwise terminate
or restrict coverage of an individual solely because the individual is diagnosed with an
autism spectrum disorder.
new text end

new text begin (g) A health plan company may request an updated treatment plan only once every
six months, unless the health plan company and the treating physician or mental health
professional agree that a more frequent review is necessary due to emerging circumstances.
new text end

new text begin Subd. 3. new text end

new text begin Supervision, delegation of duties, and observation of qualified mental
health practitioner, board-certified behavior analyst, or mental health behavioral
aide.
new text end

new text begin A mental health professional who uses the services of a qualified mental health
practitioner, board-certified behavior analyst, or qualified mental health behavioral aide for
the purpose of assisting in the provision of services to patients who have autism spectrum
disorder is responsible for functions performed by these service providers. The qualified
mental health professional must maintain clinical supervision of services they provide
and accept full responsibility for their actions. The services provided must be medically
necessary and identified in the child's individual treatment plan. Service providers must
document their activities in written progress notes that reflect implementation of the
individual treatment plan.
new text end

new text begin Subd. 4. new text end

new text begin State health care programs. new text end

new text begin This section does not affect benefits
available under the medical assistance, MinnesotaCare, and general assistance medical
care programs, and the state employee group insurance plan offered under sections
43A.22 to 43A.30. These programs and the state employee group insurance plan must
maintain current levels of coverage, and section 256B.0644 shall continue to apply.
The commissioner shall monitor these services and report to the chairs of the house
of representatives and senate standing committees that have jurisdiction over health
and human services by February 1, 2011, whether there are gaps in the level of service
provided by these programs and the state employee group insurance plan, and the level of
service provided by private health plans following enactment of this section.
new text end

new text begin Subd. 5. new text end

new text begin No effect on other law. new text end

new text begin Nothing in this section limits in any way the
coverage required under sections 62Q.47 and 62Q.53.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010, and applies to
coverage offered, issued, sold, renewed, or continued as defined in Minnesota Statutes,
section 60A.02, subdivision 2a, on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2008, section 62J.38, is amended to read:


62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.

(a) The commissioner shall require group purchasers to submit detailed data on total
health care spending for each calendar year. Group purchasers shall submit data for the
1993 calendar year by April 1, 1994, and each April 1 thereafter shall submit data for the
preceding calendar year.

(b) The commissioner shall require each group purchaser to submit data on revenue,
expenses, and member months, as applicable. Revenue data must distinguish between
premium revenue and revenue from other sources and must also include information
on the amount of revenue in reserves and changes in reserves. Expenditure data must
distinguish between costs incurred for patient care and administrative costsnew text begin, including
amounts paid to contractors, subcontractors, and other entities for the purpose of managing
provider utilization or distributing provider payments
new text end. Patient care and administrative
costs must include only expenses incurred on behalf of health plan members and must
not include the cost of providing health care services for nonmembers at facilities owned
by the group purchaser or affiliate. Expenditure data must be provided separately
for the following categories and for other categories required by the commissioner:
physician services, dental services, other professional services, inpatient hospital services,
outpatient hospital services, emergency, pharmacy services and other nondurable medical
goods, mental health, and chemical dependency services, other expenditures, subscriber
liability, and administrative costs. Administrative costs must include costs for marketing;
advertising; overhead; salaries and benefits of central office staff who do not provide
direct patient care; underwriting; lobbying; claims processing; provider contracting and
credentialing; detection and prevention of payment for fraudulent or unjustified requests
for reimbursement or services; clinical quality assurance and other types of medical care
quality improvement efforts; concurrent or prospective utilization review as defined in
section 62M.02; costs incurred to acquire a hospital, clinic, or health care facility, or the
assets thereof; capital costs incurred on behalf of a hospital or clinic; lease payments; or
any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation
agreement with a hospital, clinic, or other health care provider. Capital costs and costs
incurred must be recorded according to standard accounting principles. The reports of
this data must also separately identify expenses for local, state, and federal taxes, fees,
and assessments. The commissioner may require each group purchaser to submit any
other data, including data in unaggregated form, for the purposes of developing spending
estimates, setting spending limits, and monitoring actual spending and costs. In addition to
reporting administrative costs incurred to acquire a hospital, clinic, or health care facility,
or the assets thereof; or any other costs incurred pursuant to a partnership, joint venture,
integration, or affiliation agreement with a hospital, clinic, or other health care provider;
reports submitted under this section also must include the payments made during the
calendar year for these purposes. The commissioner shall make public, by group purchaser
data collected under this paragraph in accordance with section 62J.321, subdivision 5.
Workers' compensation insurance plans and automobile insurance plans are exempt from
complying with this paragraph as it relates to the submission of administrative costs.

(c) The commissioner may collect information on:

(1) premiums, benefit levels, managed care procedures, and other features of health
plan companies;

(2) prices, provider experience, and other information for services less commonly
covered by insurance or for which patients commonly face significant out-of-pocket
expenses; and

(3) information on health care services not provided through health plan companies,
including information on prices, costs, expenditures, and utilization.

(d) All group purchasers shall provide the required data using a uniform format and
uniform definitions, as prescribed by the commissioner.

Sec. 4.

new text begin [62Q.545] COVERAGE OF PRIVATE DUTY NURSING SERVICES.
new text end

new text begin (a) A health plan must cover private duty nursing services as provided under section
256B.0625, subdivision 7, for persons who are covered under the health plan and require
private duty nursing services.
new text end

new text begin (b) For purposes of this section, a period of private duty nursing services may
be subject to the co-payment, coinsurance, deductible, or other enrollee cost-sharing
requirements that apply under the health plan. Cost-sharing requirements for private duty
nursing services must not place a greater financial burden on the insured or enrollee than
those requirements applied by the health plan to other similar services or benefits.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 5.

Minnesota Statutes 2008, section 62Q.76, subdivision 1, is amended to read:


Subdivision 1.

Applicability.

For purposes of sections 62Q.76 to deleted text begin62Q.79deleted text endnew text begin 62Q.791new text end,
the terms deleted text begindefined in this sectiondeleted text endnew text begin contract, health care provider, dental plan, dental
organization, dentist, and enrollee
new text end have the meanings given themnew text begin in sections 62Q.733
and 62Q.76
new text end.

Sec. 6.

new text begin [62Q.791] CONTRACTS WITH DENTAL CARE PROVIDERS.
new text end

new text begin (a) Notwithstanding any other provision of law, no contract of any dental
organization licensed under chapter 62C for provision of dental care services may:
new text end

new text begin (1) require, directly or indirectly, that a dentist or health care provider provide dental
care services to its enrollees at a fee set by the dental organization, unless the services
provided are covered dental care services for enrollees under the dental plan or contract; or
new text end

new text begin (2) prohibit, directly or indirectly, the dentist or health care provider from offering or
providing dental care services that are not covered dental care services under the dental
plan or contract, on terms and conditions acceptable to the enrollee and the dentist or
health care provider. For purposes of this section, "covered dental care services" means
dental care services that are expressly covered under the dental plan or contract, including
dental care services that are subject to contractual limitations such as deductibles,
co-payments, annual maximums, and waiting periods.
new text end

new text begin (b) When making payment or otherwise adjudicating any claim for dental care
services provided to an enrollee, a dental organization or dental plan must clearly identify
on an explanation of benefits form or other form of claim resolution the amount, if any,
that is the enrollee's responsibility to pay to the enrollee's dentist or health care provider.
new text end

new text begin (c) This section does not apply to any contract for the provision of dental care
services under any public program sponsored or funded by the state or federal government.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010.
new text end

Sec. 7.

new text begin [245.6971] ADVISORY GROUP ON STATE-OPERATED SERVICES
REDESIGN.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Advisory Group on State-Operated Services
Redesign is established to make recommendations to the commissioner of human services
and the legislature on the continuum of services needed to provide individuals with
complex conditions including mental illness and developmental disabilities access to
quality care and the appropriate level of care across the state to promote wellness, reduce
cost, and improve efficiency.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin The Advisory Group on State-Operated Services Redesign shall
make recommendations to the commissioner and the legislature no later than December
15, 2010, on the following:
new text end

new text begin (1) transformation needed to improve service delivery and provide a continuum of
care, such as transition of current facilities, closure of current facilities, or the development
of new models of care;
new text end

new text begin (2) gaps and barriers to accessing quality care, system inefficiencies, and cost
pressures;
new text end

new text begin (3) services that are best provided by the state and those that are best provided
in the community;
new text end

new text begin (4) an implementation plan to achieve integrated service delivery across the public,
private, and nonprofit sectors;
new text end

new text begin (5) an implementation plan to ensure that individuals with complex chemical and
mental health needs receive the appropriate level of care to achieve recovery and wellness;
and
new text end

new text begin (6) financing mechanisms that include all possible revenue sources to maximize
federal funding and promote cost efficiencies and sustainability.
new text end

new text begin Subd. 3. new text end

new text begin Membership. new text end

new text begin The advisory group shall be composed of the following,
who will serve at the pleasure of their appointing authority:
new text end

new text begin (1) the commissioner of human services or the commissioner's designee, and two
additional representatives from the department;
new text end

new text begin (2) two legislators appointed by the speaker of the house, one from the minority
and one from the majority;
new text end

new text begin (3) two legislators appointed by the senate rules committee, one from the minority
and one from the majority;
new text end

new text begin (4) one representative appointed by AFSCME Council 5;
new text end

new text begin (5) one representative appointed by the ombudsman for mental health and
developmental disabilities;
new text end

new text begin (6) one representative appointed by the Minnesota Association of Professional
Employees;
new text end

new text begin (7) one representative appointed by the Minnesota Hospital Association;
new text end

new text begin (8) one representative appointed by the Minnesota Nurses Association;
new text end

new text begin (9) one representative appointed by NAMI-MN;
new text end

new text begin (10) one representative appointed by the Mental Health Association of Minnesota;
new text end

new text begin (11) one representative appointed by the Minnesota Association Of Community
Mental Health Programs;
new text end

new text begin (12) one representative appointed by the Minnesota Dental Association;
new text end

new text begin (13) three clients or client family members representing different populations
receiving services from state-operated services, who are appointed by the commissioner;
new text end

new text begin (14) one representative appointed by the chair of the state-operated services
governing board; and
new text end

new text begin (15) one representative appointed by the Minnesota Disability Law Center.
new text end

new text begin Subd. 4. new text end

new text begin Administration. new text end

new text begin The commissioner shall convene the first meeting of the
advisory group and shall provide administrative support and staff.
new text end

new text begin Subd. 5. new text end

new text begin Recommendations. new text end

new text begin The advisory group must report its recommendations
to the commissioner and to the legislature no later than December 15, 2010.
new text end

new text begin Subd. 6. new text end

new text begin Expiration. new text end

new text begin This section expires January 31, 2011.
new text end

Sec. 8.

new text begin [245.6972] LEGISLATIVE APPROVAL REQUIRED.
new text end

new text begin The commissioner of human services shall not redesign or move state-operated
services programs without specific legislative approval. The commissioner may proceed
with redesign at the Mankato Crisis Center and the closure of the Community Behavioral
Health Hospital in Cold Spring.
new text end

Sec. 9.

Minnesota Statutes 2009 Supplement, section 252.025, subdivision 7, is
amended to read:


Subd. 7.

Minnesota extended treatment options.

The commissioner shall develop
by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have
developmental disabilities and exhibit severe behaviors which present a risk to public
safety. This program is statewide and must provide specialized residential services in
Cambridge and an array of community-based services with sufficient levels of care and a
sufficient number of specialists to ensure that individuals referred to the program receive
the appropriate care. new text beginThe number of beds at the Cambridge facility may be reorganized
into two 16-bed facilities, one for individuals with developmental disabilities and one
for individuals with developmental disabilities and a co-occurring mental illness, with
the remaining beds converted into transitional intensive treatment foster homes.
new text endThe
individuals working in the community-based services under this section are state
employees supervised by the commissioner of human services. No layoffs shall occur as a
result of restructuring under this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 10.

Minnesota Statutes 2008, section 254B.01, subdivision 2, is amended to read:


Subd. 2.

American Indian.

For purposes of services provided under section
deleted text begin 254B.09, subdivision 7deleted text endnew text begin 254B.09, subdivision 8new text end, "American Indian" means a person who is
a member of an Indian tribe, and the commissioner shall use the definitions of "Indian"
and "Indian tribe" and "Indian organization" provided in Public Law 93-638. For purposes
of services provided under section deleted text begin254B.09, subdivision 4deleted text endnew text begin 254B.09, subdivision 6new text end,
"American Indian" means a resident of federally recognized tribal lands who is recognized
as an Indian person by the federally recognized tribal governing body.

Sec. 11.

Minnesota Statutes 2008, section 254B.02, subdivision 1, is amended to read:


Subdivision 1.

Chemical dependency treatment allocation.

The chemical
dependency deleted text beginfunds appropriated for allocationdeleted text endnew text begin treatment appropriationnew text end shall be placed in
a special revenue account. 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 beginSix percent of the remaining money must
be reserved for tribal allocation under section 254B.09, subdivisions 4 and 5. The
commissioner shall annually divide the money available in the chemical dependency
fund that is not held in reserve by counties from a previous allocation, or allocated to
the American Indian chemical dependency tribal account. Six percent of the remaining
money must be reserved for the nonreservation American Indian chemical dependency
allocation for treatment of American Indians by eligible vendors under section 254B.05,
subdivision 1
.
deleted text end The remainder of the money deleted text beginmust be allocated among the counties
according to the following formula, using state demographer data and other data sources
determined by the commissioner:
deleted text endnew text begin in the special revenue account must be used according
to the requirements in this chapter.
new text end

deleted text begin (a) For purposes of this formula, American Indians and children under age 14 are
subtracted from the population of each county to determine the restricted population.
deleted text end

deleted text begin (b) The amount of chemical dependency fund expenditures for entitled persons for
services not covered by prepaid plans governed by section 256B.69 in the previous year is
divided by the amount of chemical dependency fund expenditures for entitled persons for
all services to determine the proportion of exempt service expenditures for each county.
deleted text end

deleted text begin (c) The prepaid plan months of eligibility is multiplied by the proportion of exempt
service expenditures to determine the adjusted prepaid plan months of eligibility for
each county.
deleted text end

deleted text begin (d) The adjusted prepaid plan months of eligibility is added to the number of
restricted population fee for service months of eligibility for the Minnesota family
investment program, general assistance, and medical assistance and divided by the county
restricted population to determine county per capita months of covered service eligibility.
deleted text end

deleted text begin (e) The number of adjusted prepaid plan months of eligibility for the state is added
to the number of fee for service months of eligibility for the Minnesota family investment
program, general assistance, and medical assistance for the state restricted population and
divided by the state restricted population to determine state per capita months of covered
service eligibility.
deleted text end

deleted text begin (f) The county per capita months of covered service eligibility is divided by the
state per capita months of covered service eligibility to determine the county welfare
caseload factor.
deleted text end

deleted text begin (g) The median married couple income for the most recent three-year period
available for the state is divided by the median married couple income for the same period
for each county to determine the income factor for each county.
deleted text end

deleted text begin (h) The county restricted population is multiplied by the sum of the county welfare
caseload factor and the county income factor to determine the adjusted population.
deleted text end

deleted text begin (i) $15,000 shall be allocated to each county.
deleted text end

deleted text begin (j) The remaining funds shall be allocated proportional to the county adjusted
population.
deleted text end

Sec. 12.

Minnesota Statutes 2008, section 254B.02, subdivision 5, is amended to read:


Subd. 5.

Administrative adjustment.

The commissioner may make payments to
local agencies from money allocated under this section to support administrative activities
under sections 254B.03 and 254B.04. The administrative payment must not exceed
new text begin the lesser of (1) new text endfive percent of the first $50,000, four percent of the next $50,000, and
three percent of the remaining payments for services from the deleted text beginallocationdeleted text endnew text begin special revenue
account according to subdivision 1; or (2) the local agency administrative payment for
the fiscal year ending June 30, 2009, adjusted in proportion to the statewide change in
the appropriation for this chapter
new text end.

Sec. 13.

Minnesota Statutes 2008, section 254B.03, subdivision 4, is amended to read:


Subd. 4.

Division of costs.

Except for services provided by a county under
section 254B.09, subdivision 1, or services provided under section 256B.69 or 256D.03,
subdivision 4
, paragraph (b), the county shall, out of local money, pay the state for
deleted text begin 15deleted text endnew text begin 16.14new text end percent of the cost of chemical dependency services, including those services
provided to persons eligible for medical assistance under chapter 256B and general
assistance medical care under chapter 256D. Counties may use the indigent hospitalization
levy for treatment and hospital payments made under this section. deleted text beginFifteendeleted text endnew text begin 16.14new text end percent
of any state collections from private or third-party pay, less 15 percent deleted text beginofdeleted text endnew text begin fornew text end 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 beginIf all funds allocated according to section 254B.02 are
exhausted by a county and the county has met or exceeded the base level of expenditures
under section 254B.02, subdivision 3, the county shall pay the state for 15 percent of the
costs paid by the state under this section. The commissioner may refuse to pay state funds
for services to persons not eligible under section 254B.04, subdivision 1, if the county
financially responsible for the persons has exhausted its allocation.
deleted text end

Sec. 14.

Minnesota Statutes 2008, section 254B.05, subdivision 4, is amended to read:


Subd. 4.

Regional treatment centers.

Regional treatment center chemical
dependency treatment units are eligible vendors. The commissioner may expand the
capacity of chemical dependency treatment units beyond the capacity funded by direct
legislative appropriation to serve individuals who are referred for treatment by counties
and whose treatment will be paid for deleted text beginwith a county's allocation under section 254B.02deleted text endnew text begin by
funding under this chapter
new text end or other funding sources. Notwithstanding the provisions of
sections 254B.03 to 254B.041, payment for any person committed at county request to
a regional treatment center under chapter 253B for chemical dependency treatment and
determined to be ineligible under the chemical dependency consolidated treatment fund,
shall become the responsibility of the county.

Sec. 15.

Minnesota Statutes 2008, section 254B.06, subdivision 2, is amended to read:


Subd. 2.

Allocation of collections.

The commissioner shall allocate all federal
financial participation collections to deleted text beginthe reserve fund under section 254B.02, subdivision 3deleted text endnew text begin
a special revenue account
new text end. The commissioner shall deleted text beginretain 85deleted text endnew text begin allocate 83.86new text end percent of
patient payments and third-party payments new text beginto the special revenue account new text endand deleted text beginallocate
the collections to the treatment allocation for the county that is financially responsible
for the person. Fifteen
deleted text endnew text begin 16.14new text end percent deleted text beginof patient and third-party payments must be paiddeleted text end
to the county financially responsible for the patient. deleted text beginCollections for patient payment and
third-party payment for services provided under section 254B.09 shall be allocated to the
allocation of the tribal unit which placed the person. Collections of federal financial
participation for services provided under section 254B.09 shall be allocated to the tribal
reserve account under section 254B.09, subdivision 5.
deleted text end

Sec. 16.

Minnesota Statutes 2008, section 254B.09, subdivision 8, is amended to read:


Subd. 8.

Payments to improve services to American Indians.

The commissioner
may set rates for chemical dependency services new text beginto American Indians new text endaccording to the
American Indian Health Improvement Act, Public Law 94-437, for eligible vendors.
These rates shall supersede rates set in county purchase of service agreements when
payments are made on behalf of clients eligible according to Public Law 94-437.

Sec. 17.

new text begin [254B.13] PILOT PROJECTS; CHEMICAL HEALTH CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Authorization for pilot projects. new text end

new text begin The commissioner of human
services may approve and implement pilot projects developed under the planning process
required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and
enhance coordination of the delivery of chemical health services required under section
254B.03.
new text end

new text begin Subd. 2. new text end

new text begin Program design and implementation. new text end

new text begin (a) The commissioner of
human services and counties participating in the pilot projects shall continue to work in
partnership to refine and implement the pilot projects initiated under Laws 2009, chapter
79, article 7, section 26.
new text end

new text begin (b) The commissioner and counties participating in the pilot projects shall
complete the planning phase by June 30, 2010, and, if approved by the commissioner for
implementation, enter into agreements governing the operation of the pilot projects with
implementation scheduled no earlier than July 1, 2010.
new text end

new text begin Subd. 3. new text end

new text begin Program evaluation. new text end

new text begin The commissioner of human services shall evaluate
pilot projects under this section and report the results of the evaluation to the legislative
committees with jurisdiction over chemical health by June 30, 2013. Evaluation of the
pilot projects must be based on outcome evaluation criteria negotiated with the projects
prior to implementation.
new text end

new text begin Subd. 4. new text end

new text begin Notice of project discontinuation. new text end

new text begin Each county's participation in the
pilot project may be discontinued for any reason by the county or the commissioner of
human services after 30 days' written notice to the other party. Any unspent funds held
for the exiting county's pro rata share in the special revenue fund under the authority
in subdivision 5, paragraph (c), shall be transferred to the general fund following
discontinuation of the pilot project.
new text end

new text begin Subd. 5. new text end

new text begin Duties of commissioner. new text end

new text begin (a) Notwithstanding any other provisions in
this chapter, the commissioner may authorize pilot projects to use chemical dependency
treatment funds to pay for services:
new text end

new text begin (1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
(a); and
new text end

new text begin (2) by vendors in addition to those authorized under section 254B.05 when not
providing chemical dependency treatment services.
new text end

new text begin (b) State expenditures for chemical dependency services and any other services
provided by or through the pilot projects must not be greater than chemical dependency
treatment fund expenditures expected in the absence of the pilot projects. The
commissioner may restructure the schedule of payments between the state and participating
counties under the local agency share and division of cost provisions under section
254B.03, subdivisions 3 and 4, as necessary to facilitate the operation of the pilot projects.
new text end

new text begin (c) To the extent that state fiscal year expenditures within a pilot project region are
less than expected in the absence of the pilot projects, the commissioner may deposit
these unexpended funds in the special revenue fund and make these funds available for
expenditure by the pilot counties the following year. To the extent that treatment and pilot
project ancillary services expenditures within the pilot project exceed the amount expected
in the absence of the pilot projects, the pilot counties are responsible for the portion of
nontreatment expenditures in excess of otherwise expected expenditures.
new text end

new text begin (d) The commissioner may waive administrative rule requirements which are
incompatible with the implementation of the pilot project.
new text end

new text begin (e) The commissioner shall not approve or enter into any agreement related to pilot
projects authorized under this section which puts current or future federal funding at risk.
new text end

new text begin Subd. 6. new text end

new text begin Duties of county board. new text end

new text begin The county board, or other county entity that is
approved to administer a pilot project, shall:
new text end

new text begin (1) administer the pilot project in a manner consistent with the objectives described
in subdivision 2 and the planning process in subdivision 5;
new text end

new text begin (2) ensure that no one is denied chemical dependency treatment services for which
they would otherwise be eligible under section 254A.03, subdivision 3; and
new text end

new text begin (3) provide the commissioner of human services with timely and pertinent
information as negotiated in agreements governing operation of the pilot projects.
new text end

Sec. 18.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:


new text begin Subd. 30. new text end

new text begin Office of Health Care Inspector General. new text end

new text begin (a) The commissioner shall
create within the Department of Human Services an Office of Health Care Inspector
General to enhance antifraud activities and to protect the integrity of the state health care
programs, as well as the health and welfare of the beneficiaries of those programs. The
Office of Health Care Inspector General must periodically report to the commissioner and
to the legislature program and management problems and recommendations to correct
them.
new text end

new text begin (b) The duties of the Office of Health Care Inspector General include, but are not
limited to:
new text end

new text begin (1) promoting economy, efficiency, and effectiveness through the elimination of
waste, fraud, and abuse;
new text end

new text begin (2) conducting and supervising audits, investigations, inspections, and evaluations
relating to the state health care programs under chapters 256B, 256D, and 256L;
new text end

new text begin (3) identifying weaknesses giving rise to opportunities for fraud and abuse in the
state health care programs and operations and making recommendations to prevent their
recurrence;
new text end

new text begin (4) leading and coordinating activities to prevent and detect fraud and abuse in the
state health care programs and operations;
new text end

new text begin (5) detecting wrongdoers and abusers of the state health care programs and
beneficiaries so appropriate remedies may be brought;
new text end

new text begin (6) keeping the commissioner and the legislature fully and currently informed about
problems and deficiencies in the administration of the state health care programs and
operations and about the need for and progress of corrective action;
new text end

new text begin (7) operating a toll-free hotline to permit individuals to call in suspected fraud,
waste, or abuse, referring the calls for appropriate action by the agency, and analyzing the
calls to identify trends and patterns of fraud and abuse needing attention;
new text end

new text begin (8) developing and reviewing legislative, regulatory, and program proposals to
reduce vulnerabilities to fraud, waste, and mismanagement; and
new text end

new text begin (9) recommending changes in program policies, regulations, and laws to improve
efficiency and effectiveness, and to prevent fraud, waste, abuse, and mismanagement.
new text end

new text begin (c) Beginning July 1, 2011, the commissioner, in consultation with the Office of
Health Care Inspector General, shall annually report to the legislature and the governor
new results from the two ongoing federal Medicaid audits. The commissioner shall report
(1) the most recent Medicaid Integrity Program (MIP) audit results, with any corrective
actions needed, and (2) certify the rate of errors determined for the state health care
programs under chapters 256B, 256D, and 256L, as determined from the most recent
Payment Error Rate Measurement (PERM) audit results for Minnesota. When the PERM
audit rate for Minnesota is greater than the national rate for the year or the MIP audit
determines the need for corrective action, the commissioner shall present a plan to the
legislature and the governor for the corrective actions and reduction of the error rate
in the next calendar year.
new text end

Sec. 19.

Laws 2009, chapter 79, article 3, section 18, is amended to read:


Sec. 18. REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED
MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE
ANOKA-METRO REGIONAL TREATMENT CENTER.

deleted text begin In consultation with community partners, the commissioner of human servicesdeleted text endnew text begin The
Advisory Group on State-Operated Services Redesign
new text end shall deleted text begindevelopdeleted text endnew text begin recommendnew text end an array
of community-based services to transform the current services now provided to patients
at the Anoka-Metro Regional Treatment Center. The community-based services may
be provided in facilities with 16 or fewer beds, and must provide the appropriate level
of care for the patients being admitted to the facilities. The planning for this transition
must be completed by October 1, deleted text begin2009deleted text endnew text begin 2010new text end, with an initial report to the committee chairs
of health and human services by November 30, deleted text begin2009deleted text endnew text begin 2010new text end, and a semiannual report on
progress until the transition is completed. deleted text beginThe commissioner of human services shall
solicit interest from stakeholders and potential community partners.
deleted text endThe individuals
working in the community-based services facilities under this section are state employees
supervised by the commissioner of human services. No layoffs shall occur as a result of
restructuring under this section.

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 beginNONSUBMISSION OF HEALTH CARE CLAIM BY
CLEARINGHOUSE; SIGNIFICANT DISRUPTION.
new text end

new text begin (a) A situation shall be considered a significant disruption to normal operations that
materially affects the provider's or facility's ability to conduct business in a normal manner
and to submit claims on a timely basis under Minnesota Statutes, section 62Q.75, if:
new text end

new text begin (1) a clearinghouse loses, or otherwise does not submit, a health care claim as
required by Minnesota Statutes, section 62J.536; and
new text end

new text begin (2) the provider or facility can substantiate that it submitted a complete claim to the
clearinghouse within provisions stated in contract or six months of the date of service,
whichever is less.
new text end

new text begin (b) This section expires January 1, 2012.
new text end

Sec. 21. new text beginREPORT ON HUMAN SERVICES FISCAL NOTES.
new text end

new text begin The commissioner of human services shall issue a report to the legislature no later
than November 15, 2010, making recommendations for the establishment of a legislative
budget office division for the preparation and completion of fiscal notes as required by
Minnesota Statutes, section 3.98. The report must include detailed information regarding
the necessary financial costs, staff resources, and data protection requirements for a
legislative budget office to complete fiscal notes for the Department of Human Services.
The report must describe the methods and procedures used by legislatures in other states
that ensure the independence and accuracy of fiscal estimates on legislative proposals. The
report must include proposed bill language for transferring all fiscal note responsibilities
to an appropriate nonpartisan office within the legislative branch.
new text end

Sec. 22. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 254B.02, subdivisions 2, 3, and 4; and 254B.09,
subdivisions 4, 5, and 7,
new text end new text begin and new text end new text begin Laws 2009, chapter 79, article 7, section 26, subdivision
3,
new text end new text begin are repealed.
new text end

Sec. 23. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 10 to 14 and 22 are effective for claims paid on or after July 1, 2010.
new text end

ARTICLE 6

DEPARTMENT OF HEALTH

Section 1.

Minnesota Statutes 2008, section 62D.08, is amended by adding a
subdivision to read:


new text begin Subd. 7. new text end

new text begin Consistent administrative expenses and investment income reporting.
new text end

new text begin (a) Every health maintenance organization must directly allocate administrative expenses
to specific lines of business or products when such information is available. Remaining
expenses that cannot be directly allocated must be allocated based on other methods, as
recommended by the Advisory Group on Administrative Expenses. Health maintenance
organizations must submit this information, including administrative expenses for dental
services, using the reporting template provided by the commissioner of health.
new text end

new text begin (b) Every health maintenance organization must allocate investment income based
on cumulative net income over time by business line or product and must submit this
information, including investment income for dental services, using the reporting template
provided by the commissioner of health.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 2.

new text begin [62D.31] ADVISORY GROUP ON ADMINISTRATIVE EXPENSES.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Advisory Group on Administrative Expenses
is established to make recommendations on the development of consistent guidelines
and reporting requirements, including development of a reporting template, for health
maintenance organizations and county-based purchasers that participate in publicly
funded programs.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin The membership of the advisory group shall be comprised
of the following, who serve at the pleasure of their appointing authority:
new text end

new text begin (1) the commissioner of health or the commissioner's designee;
new text end

new text begin (2) the commissioner of human services or the commissioner's designee;
new text end

new text begin (3) the commissioner of commerce or the commissioner's designee; and
new text end

new text begin (4) representatives of health maintenance organizations and county-based purchasers
appointed by the commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Administration. new text end

new text begin The commissioner of health shall convene the first
meeting of the advisory group by September 1, 2010, and shall provide administrative
support and staff. The commissioner of health may contract with a consultant to provide
professional assistance and expertise to the advisory group.
new text end

new text begin Subd. 4. new text end

new text begin Recommendations. new text end

new text begin The Advisory Group on Administrative Expenses
must report its recommendations, including any proposed legislation necessary to
implement the recommendations, to the commissioner of health and to the chairs and
ranking minority members of the legislative committees and divisions with jurisdiction
over health policy and finance by July 1, 2011.
new text end

new text begin Subd. 5. new text end

new text begin Expiration. new text end

new text begin This section expires after submission of the report required
under subdivision 4 or June 30, 2012, whichever is sooner.
new text end

Sec. 3.

Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a, is
amended to read:


Subd. 1a.

Definitions.

(a) "Certified electronic health record technology" means an
electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH
Act to meet the standards and implementation specifications adopted under section 3004
as applicable.

(b) "Commissioner" means the commissioner of health.

(c) "Pharmaceutical electronic data intermediary" means any entity that provides
the infrastructure to connect computer systems or other electronic devices utilized
by prescribing practitioners with those used by pharmacies, health plans, third-party
administrators, and pharmacy benefit managers in order to facilitate the secure
transmission of electronic prescriptions, refill authorization requests, communications,
and other prescription-related information between such entities.

(d) "HITECH Act" means the Health Information Technology for Economic and
Clinical Health Act in division A, title XIII and division B, title IV of the American
Recovery and Reinvestment Act of 2009, including federal regulations adopted under
that act.

(e) "Interoperable electronic health record" means an electronic health record that
securely exchanges health information with another electronic health record system that
meetsnew text begin requirements specified in subdivision 3, andnew text end national requirements for certification
under the HITECH Act.

(f) "Qualified electronic health record" means an electronic record of health-related
information on an individual that includes patient demographic and clinical health
information and has the capacity to:

(1) provide clinical decision support;

(2) support physician order entry;

(3) capture and query information relevant to health care quality; and

(4) exchange electronic health information with, and integrate such information
from, other sources.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is
amended to read:


Subd. 3.

Interoperable electronic health record requirements.

To meet the
requirements of subdivision 1, hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.

(a) The electronic health record must be a qualified electronic health record.

(b) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and
health care providers deleted text beginonlydeleted text end if a certified electronic health record product for the provider's
particular practice setting is available. This criterion shall be considered met if a hospital
or health care provider is using an electronic health records system that has been certified
within the last three years, even if a more current version of the system has been certified
within the three-year period.

(c) The electronic health record must meet the standards established according to
section 3004 of the HITECH Act as applicable.

(d) The electronic health record must have the ability to generate information on
clinical quality measures and other measures reported under sections 4101, 4102, and
4201 of the HITECH Act.

new text begin (e) The electronic health record system must be connected to a state-certified
health information organization either directly or through a connection facilitated by a
state-certified health data intermediary as defined in section 62J.498.
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end A health care provider who is a prescriber or dispenser of legend drugs must
have an electronic health record system that meets the requirements of section 62J.497.

Sec. 5.

Minnesota Statutes 2009 Supplement, section 62J.495, is amended by adding a
subdivision to read:


new text begin Subd. 6. new text end

new text begin State agency information system. new text end

new text begin Development of a state agency
information system necessary to implement this section is subject to the authority of the
Office of Enterprise Technology in chapter 16E, including, but not limited to:
new text end

new text begin (1) evaluation and approval of the system as specified in section 16E.03, subdivisions
3 and 4;
new text end

new text begin (2) review of the system to ensure compliance with security policies, guidelines, and
standards as specified in section 16E.03, subdivision 7; and
new text end

new text begin (3) assurance that the system complies with accessibility standards developed under
section 16E.03, subdivision 9.
new text end

Sec. 6.

new text begin [62J.498] HEALTH INFORMATION EXCHANGE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin The following definitions apply to sections 62J.498 to
62J.4982:
new text end

new text begin (a) "Clinical transaction" means any meaningful use transaction that is not covered
by section 62J.536.
new text end

new text begin (b) "Commissioner" means the commissioner of health.
new text end

new text begin (c) "Direct health information exchange" means the electronic transmission of
health-related information through a direct connection between the electronic health
record systems of health care providers without the use of a health data intermediary.
new text end

new text begin (d) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.
new text end

new text begin (e) "Health data intermediary" means an entity that provides the infrastructure to
connect computer systems or other electronic devices used by health care providers,
laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit
managers to facilitate the secure transmission of health information, including
pharmaceutical electronic data intermediaries as defined in section 62J.495. This does not
include health care providers engaged in a direct health information exchange.
new text end

new text begin (f) "Health information exchange" means the electronic transmission of
health-related information between organizations according to nationally recognized
standards.
new text end

new text begin (g) "Health information exchange service provider" means a health data intermediary
or health information organization that has been issued a certificate of authority by the
commissioner under section 62J.4981.
new text end

new text begin (h) "Health information organization" means an organization that oversees, governs,
and facilitates the exchange of health-related information among organizations according
to nationally recognized standards.
new text end

new text begin (i) "HITECH Act" means the Health Information Technology for Economic and
Clinical Health Act as defined in section 62J.495.
new text end

new text begin (j) "Major participating entity" means:
new text end

new text begin (1) a participating entity that receives compensation for services that is greater
than 30 percent of the health information organization's gross annual revenues from the
health information exchange service provider;
new text end

new text begin (2) a participating entity providing administrative, financial, or management services
to the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and
new text end

new text begin (3) a participating entity that nominates or appoints 30 percent or more of the board
of directors of the health information organization.
new text end

new text begin (k) "Meaningful use" means use of certified electronic health record technology that
includes e-prescribing, and is connected in a manner that provides for the electronic
exchange of health information and used for the submission of clinical quality measures
as established by the Center for Medicare and Medicaid Services and the Minnesota
Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH
Act.
new text end

new text begin (l) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
new text end

new text begin (m) "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization or health
data intermediary has contracts or other agreements for the provision of health information
exchange service providers:
new text end

new text begin (1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;
new text end

new text begin (2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;
new text end

new text begin (3) a group, professional corporation, or other organization that provides the
services of individuals or entities identified in clause (2), including but not limited to a
medical clinic, a medical group, a home health care agency, an urgent care center, and
an emergent care center;
new text end

new text begin (4) a health plan as defined in section 62A.011, subdivision 3; and
new text end

new text begin (5) a state agency as defined in section 13.02, subdivision 17.
new text end

new text begin (n) "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of meaningful use transactions.
new text end

new text begin (o) "State-certified health data intermediary" means a health data intermediary that:
new text end

new text begin (1) provides a subset of the meaningful use transaction capabilities necessary for
hospitals and providers to achieve meaningful use of electronic health records;
new text end

new text begin (2) is not exclusively engaged in the exchange of meaningful use transactions
covered by section 62J.536; and
new text end

new text begin (3) has been issued a certificate of authority to operate in Minnesota.
new text end

new text begin (p) "State-certified health information organization" means a nonprofit health
information organization that provides transaction capabilities necessary to fully support
clinical transactions required for meaningful use of electronic health records that has been
issued a certificate of authority to operate in Minnesota.
new text end

new text begin Subd. 2. new text end

new text begin Health information exchange oversight. new text end

new text begin (a) The commissioner shall
protect the public interest on matters pertaining to health information exchange. The
commissioner shall:
new text end

new text begin (1) review and act on applications from health data intermediaries and health
information organizations for certificates of authority to operate in Minnesota;
new text end

new text begin (2) provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;
new text end

new text begin (3) respond to public complaints related to health information exchange services;
new text end

new text begin (4) take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;
new text end

new text begin (5) provide a biannual report on the status of health information exchange services
that includes but is not limited to:
new text end

new text begin (i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;
new text end

new text begin (ii) recommendations on enforcement actions to ensure that health information
exchange service providers act in the public interest without causing disruption in health
information exchange services;
new text end

new text begin (iii) recommendations on updates to criteria for obtaining certificates of authority
under this section; and
new text end

new text begin (iv) recommendations on standard operating procedures for health information
exchange, including but not limited to the management of consumer preferences; and
new text end

new text begin (6) other duties necessary to protect the public interest.
new text end

new text begin (b) As part of the application review process for certification under paragraph (a),
prior to issuing a certificate of authority, the commissioner shall:
new text end

new text begin (1) hold public hearings that provide an adequate opportunity for participating
entities and consumers to provide feedback and recommendations on the application under
consideration. The commissioner shall make all portions of the application classified
as public data available to the public at least ten days in advance of the hearing. The
applicant shall participate in the hearing by presenting an application overview and
responding to questions from interested parties;
new text end

new text begin (2) make available all feedback and recommendations from the hearing available to
the public prior to issuing a certificate of authority; and
new text end

new text begin (3) consult with hospitals, physicians, and other professionals eligible to receive
meaningful use incentive payments or are subject to penalties as established in the
HITECH Act, and their respective statewide associations, prior to issuing a certificate of
authority.
new text end

new text begin (c)(1) When the commissioner is actively considering a suspension or revocation of
a certificate of authority as described in section 62J.4982, subdivision 3, all investigatory
data that are collected, created, or maintained related to the suspension or revocation
are classified as confidential data on individuals and as protected nonpublic data in the
case of data not on individuals.
new text end

new text begin (2) The commissioner may disclose data classified as protected nonpublic or
confidential under this paragraph if disclosing the data will protect the health or safety of
patients.
new text end

new text begin (d) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified
as public data.
new text end

Sec. 7.

new text begin [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Authority to require organizations to apply. new text end

new text begin The commissioner
shall require an entity providing health information exchange services to apply for a
certificate of authority under this section. An applicant may continue to operate until
the commissioner acts on the application. If the application is denied, the applicant is
considered a health information organization whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).
new text end

new text begin Subd. 2. new text end

new text begin Certificate of authority for health data intermediaries. new text end

new text begin (a) A health
data intermediary that provides health information exchange services for the transmission
of one or more clinical transactions necessary for hospitals, providers, or eligible
professionals to achieve meaningful use must be registered with the state and comply with
requirements established in this section.
new text end

new text begin (b) Notwithstanding any law to the contrary, any corporation organized to do so
may apply to the commissioner for a certificate of authority to establish and operate as
a health data intermediary in compliance with this section. No person shall establish or
operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers
to purchase or receive advance or periodic consideration in conjunction with a health
data intermediary contract unless the organization has a certificate of authority or has an
application under active consideration under this section.
new text end

new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether
the applicant for the certificate of authority has demonstrated that the applicant meets
the following minimum criteria:
new text end

new text begin (1) can interoperate with at least one state-certified health information organization;
new text end

new text begin (2) can provide an option for Minnesota entities to connect to their services through
at least one state-certified health information organization;
new text end

new text begin (3) has a record locator service as defined in section 144.291, subdivision 2,
paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8,
when conducting meaningful use transactions; and
new text end

new text begin (4) holds reciprocal agreements with at least one state-certified health information
organization to enable access to record locator services to find patient data, and for the
transmission and receipt of meaningful use transactions consistent with the format and
content required by national standards established by Centers for Medicare and Medicaid
Services. Reciprocal agreements must meet the requirements established in subdivision 5.
new text end

new text begin Subd. 3. new text end

new text begin Certificate of authority for health information organizations.
new text end

new text begin (a) A health information organization that provides all electronic capabilities for the
transmission of clinical transactions necessary for meaningful use of electronic health
records must obtain a certificate of authority from the commissioner and demonstrate
compliance with the criteria in paragraph (c).
new text end

new text begin (b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do
so may apply for a certificate of authority to establish and operate a health information
organization under this section. No person shall establish or operate a health information
organization in this state, or sell or offer to sell, or solicit offers to purchase or receive
advance or periodic consideration in conjunction with a health information organization
or health information contract unless the organization has a certificate of authority under
this section.
new text end

new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether
the applicant for the certificate of authority has demonstrated that the applicant meets
the following minimum criteria:
new text end

new text begin (1) the entity is a legally established, nonprofit organization;
new text end

new text begin (2) has appropriate insurance, including liability insurance, for the operation of the
health information organization is in place and sufficient to protect the interest of the
public and participating entities;
new text end

new text begin (3) has strategic and operational plans that clearly address how the organization will
expand technical capacity of the health information organization to support providers in
achieving meaningful use of electronic health records over time;
new text end

new text begin (4) the entity addresses the parameters to be used with participating entities and
other health information organizations for meaningful use transactions, compliance with
Minnesota law, and interstate health information exchange in trust agreements;
new text end

new text begin (5) the entity's board of directors is comprised of members that broadly represent the
health information organization's participating entities and consumers;
new text end

new text begin (6) the entity maintains a professional staff responsible to the board of directors with
the capacity to ensure accountability to the organization's mission;
new text end

new text begin (7) the entity is compliant with criteria established under the Health Information
Exchange Accreditation Program of the Electronic Healthcare Network Accreditation
Commission (EHNAC) or equivalent criteria established by the commissioner;
new text end

new text begin (8) the entity maintains a record locator service as defined in section 144.291,
subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293,
subdivision 8, when conducting meaningful use transactions;
new text end

new text begin (9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;
new text end

new text begin (10) the organization demonstrates compliance with all privacy and security
requirements required by state and federal law; and
new text end

new text begin (11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's
financials on an annual basis.
new text end

new text begin (d) Health information organizations that have obtained a certificate of authority
must:
new text end

new text begin (1) meet the requirements established for connecting to the Nationwide Health
Information Network (NHIN) within the federally mandated timeline or within a time
frame established by the commissioner and published in the State Register. If the state
timeline for implementation varies from the federal timeline, the State Register notice
shall include an explanation for the variation;
new text end

new text begin (2) annually submit strategic and operational plans for review by the commissioner
that address:
new text end

new text begin (i) increasing adoption rates to include a sufficient number of participating entities to
achieve financial sustainability; and
new text end

new text begin (ii) progress in achieving objectives included in previously submitted strategic
and operational plans across the following domains: business and technical operations,
technical infrastructure, legal and policy issues, finance, and organizational governance;
new text end

new text begin (3) develop and maintain a business plan that addresses:
new text end

new text begin (i) plans for ensuring the necessary capacity to support meaningful use transactions;
new text end

new text begin (ii) approach for attaining financial sustainability, including public and private
financing strategies, and rate structures;
new text end

new text begin (iii) rates of adoption, utilization, and transaction volume, and mechanisms to
support health information exchange; and
new text end

new text begin (iv) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;
new text end

new text begin (4) annually submit a rate plan outlining fee structures for health information
exchange services for approval by the commissioner. The commissioner shall approve the
rate plan if it:
new text end

new text begin (i) distributes costs equitably among users of health information services;
new text end

new text begin (ii) provides predictable costs for participating entities;
new text end

new text begin (iii) covers all costs associated with conducting the full range of meaningful use
clinical transactions, including access to health information retrieved through other
state-certified health information exchange service providers; and
new text end

new text begin (iv) provides for a predictable revenue stream for the health information organization
and generates sufficient resources to maintain operating costs and develop technical
infrastructure necessary to serve the public interest;
new text end

new text begin (5) enter into reciprocal agreements with all other state-certified health information
organizations to enable access to record locator services to find patient data, and
transmission and receipt of meaningful use transactions consistent with the format and
content required by national standards established by Centers for Medicare and Medicaid
Services. Reciprocal agreements must meet the requirements in subdivision 5; and
new text end

new text begin (6) comply with additional requirements for the certification or recertification of
health information organizations that may be established by the commissioner.
new text end

new text begin Subd. 4. new text end

new text begin Application for certificate of authority for health information exchange
service providers.
new text end

new text begin (a) Each application for a certificate of authority shall be in a form
prescribed by the commissioner and verified by an officer or authorized representative of
the applicant. Each application shall include the following:
new text end

new text begin (1) a copy of the basic organizational document, if any, of the applicant and of
each major participating entity, such as the articles of incorporation, or other applicable
documents, and all amendments to it;
new text end

new text begin (2) a list of the names, addresses, and official positions of the following:
new text end

new text begin (i) all members of the board of directors and the principal officers and, if applicable,
shareholders of the applicant organization; and
new text end

new text begin (ii) all members of the board of directors and the principal officers of each major
participating entity and, if applicable, each shareholder beneficially owning more than ten
percent of any voting stock of the major participating entity;
new text end

new text begin (3) the name and address of each participating entity and the agreed-upon duration
of each contract or agreement if applicable;
new text end

new text begin (4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information organization. Contractual provisions shall be consistent
with the purposes of this section in regard to the services to be performed under the
standard agreement or contract, the manner in which payment for services is determined,
the nature and extent of responsibilities to be retained by the health information
organization, and contractual termination provisions;
new text end

new text begin (5) a copy of each contract intended to bind major participating entities and the
health information organization. Contract information filed with the commissioner under
this section shall be nonpublic as defined in section 13.02, subdivision 9;
new text end

new text begin (6) a statement generally describing the health information organization, its health
information exchange contracts, facilities, and personnel, including a statement describing
the manner in which the applicant proposes to provide participants with comprehensive
health information exchange services;
new text end

new text begin (7) financial statements showing the applicant's assets, liabilities, and sources
of financial support, including a copy of the applicant's most recent certified financial
statement;
new text end

new text begin (8) strategic and operational plans that specifically address how the organization
will expand technical capacity of the health information organization to support providers
in achieving meaningful use of electronic health records over time, a description of
the proposed method of marketing the services, a schedule of proposed charges, and a
financial plan that includes a three-year projection of the expenses and income and other
sources of future capital;
new text end

new text begin (9) a statement reasonably describing the geographic area or areas to be served and
the type or types of participants to be served;
new text end

new text begin (10) a description of the complaint procedures to be used as required under this
section;
new text end

new text begin (11) a description of the mechanism by which participating entities will have an
opportunity to participate in matters of policy and operation;
new text end

new text begin (12) a copy of any pertinent agreements between the health information organization
and insurers, including liability insurers, demonstrating coverage is in place;
new text end

new text begin (13) a copy of the conflict of interest policy that applies to all members of the board
of directors and the principal officers of the health information organization; and
new text end

new text begin (14) other information as the commissioner may reasonably require to be provided.
new text end

new text begin (b) Thirty days after the receipt of the application for a certificate of authority,
the commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.
new text end

new text begin (c) Ninety days after the receipt of a complete application for a certificate of
authority, the commissioner shall issue a certificate of authority to the applicant if the
commissioner determines that the applicant meets the minimum criteria requirements
of subdivision 2 for health data intermediaries or subdivision 3 for health information
organizations. If the commissioner determines that the applicant is not qualified, the
commissioner shall notify the applicant and specify the reasons for disqualification.
new text end

new text begin (d) Upon being granted a certificate of authority to operate as a health information
organization, the organization must operate in compliance with the provisions of this
section. Noncompliance may result in the imposition of a fine or the suspension or
revocation of the certificate of authority according to section 62J.4982.
new text end

new text begin Subd. 5. new text end

new text begin Reciprocal agreements between health information exchange entities.
new text end

new text begin (a) Reciprocal agreements between two health information organizations or between a
health information organization and a health data intermediary must include a fair and
equitable model for charges between the entities that:
new text end

new text begin (1) does not impede the secure transmission of transactions necessary to achieve
meaningful use;
new text end

new text begin (2) does not charge a fee for the exchange of meaningful use transactions transmitted
according to nationally recognized standards where no additional value-added service
is rendered to the sending or receiving health information organization or health data
intermediary either directly or on behalf of the client;
new text end

new text begin (3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and
new text end

new text begin (4) prevents health care stakeholders from being charged multiple times for the
same service.
new text end

new text begin (b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.
new text end

new text begin (c) Reciprocal agreements are subject to review and approval by the commissioner.
new text end

new text begin (d) Nothing in this section precludes a state-certified health information organization
or state-certified health data intermediary from entering into contractual agreements for
the provision of value-added services beyond meaningful use.
new text end

new text begin (e) The commissioner of human services or health, when providing access to data or
services through a certified health information organization, must offer the same data or
services directly through any certified health information organization at the same pricing,
if the health information organization pays for all connection costs to the state data or
service. For all external connectivity to the respective agencies through existing or future
information exchange implementations, the respective agency shall establish the required
connectivity methods as well as protocol standards to be utilized.
new text end

new text begin Subd. 6. new text end

new text begin State participation in health information exchange. new text end

new text begin A state agency
that connects to a health information exchange service provider for the purpose of
exchanging meaningful use transactions must ensure that the contracted health information
exchange service provider has reciprocal agreements in place as required by this section.
The reciprocal agreements must provide equal access to information supplied by the
agency and necessary for meaningful use by the participating entities of the other health
information service providers.
new text end

Sec. 8.

new text begin [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Penalties and enforcement. new text end

new text begin (a) The commissioner may, for any
violation of statute or rule applicable to a health information exchange service provider,
levy an administrative penalty in an amount up to $25,000 for each violation. In
determining the level of an administrative penalty, the commissioner shall consider the
following factors:
new text end

new text begin (1) the number of participating entities affected by the violation;
new text end

new text begin (2) the effect of the violation on participating entities' access to health information
exchange services;
new text end

new text begin (3) if only one participating entity is affected, the effect of the violation on the
patients of that entity;
new text end

new text begin (4) whether the violation is an isolated incident or part of a pattern of violations;
new text end

new text begin (5) the economic benefits derived by the health information organization or a health
data intermediary by virtue of the violation;
new text end

new text begin (6) whether the violation hindered or facilitated an individual's ability to obtain
health care;
new text end

new text begin (7) whether the violation was intentional;
new text end

new text begin (8) whether the violation was beyond the direct control of the health information
exchange service provider;
new text end

new text begin (9) any history of prior compliance with the provisions of this section, including
violations;
new text end

new text begin (10) whether and to what extent the health information exchange service provider
attempted to correct previous violations;
new text end

new text begin (11) how the health information exchange service provider responded to technical
assistance from the commissioner provided in the context of a compliance effort; and
new text end

new text begin (12) the financial condition of the health information exchange service provider
including, but not limited to, whether the health information exchange service provider
had financial difficulties that affected its ability to comply or whether the imposition of an
administrative monetary penalty would jeopardize the ability of the health information
exchange service provider to continue to deliver health information exchange services.
new text end

new text begin Reasonable notice in writing shall be given to the health information exchange
service provider of the intent to levy the penalty and the reasons for them. A health
information exchange service provider may have 15 days within which to contest whether
the finding of facts constitute a violation of this section and section 62J.4981, according to
the contested case and judicial review provisions of sections 14.57 to 14.69.
new text end

new text begin (b) If the commissioner has reason to believe that a violation of this section or
section 62J.4981 has occurred or is likely, the commissioner may confer with the persons
involved before commencing action under subdivision 2. The commissioner may notify
the health information exchange service provider and the representatives, or other persons
who appear to be involved in the suspected violation, to arrange a voluntary conference
with the alleged violators or their authorized representatives. The purpose of the
conference is to attempt to learn the facts about the suspected violation and if it appears
that a violation has occurred or is threatened, to find a way to correct or prevent it. The
conference is not governed by any formal procedural requirements and may be conducted
as the commissioner considers appropriate.
new text end

new text begin (c) The commissioner may issue an order directing a health information exchange
service provider or a representative of a health information exchange service provider to
cease and desist from engaging in any act or practice in violation of this section and
section 62J.4981.
new text end

new text begin (d) Within 20 days after service of the order to cease and desist, a health information
exchange service provider may contest whether the finding of facts constitutes a violation
of this section and section 62J.4981 according to the contested case and judicial review
provisions of sections 14.57 to 14.69.
new text end

new text begin (e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or
other appropriate relief in Ramsey County District Court.
new text end

new text begin Subd. 2. new text end

new text begin Suspension or revocation of certificates of authority. new text end

new text begin (a) The
commissioner may suspend or revoke a certificate of authority issued to a health
data intermediary or health information organization under section 62J.4981 if the
commissioner finds that:
new text end

new text begin (1) the health information exchange service provider is operating significantly
in contravention of its basic organizational document, or in a manner contrary to that
described in and reasonably inferred from any other information submitted under section
62J.4981, unless amendments to the submissions have been filed with and approved by
the commissioner;
new text end

new text begin (2) the health information exchange service provider is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;
new text end

new text begin (3) the health information exchange service provider is no longer financially solvent
or may not reasonably be expected to meet its obligations to participating entities;
new text end

new text begin (4) the health information exchange service provider has failed to implement the
complaint system in a manner designed to reasonably resolve valid complaints;
new text end

new text begin (5) the health information exchange service provider, or any person acting with its
sanction, has advertised or merchandised its services in an untrue, misleading, deceptive,
or unfair manner;
new text end

new text begin (6) the continued operation of the health information exchange service provider
would be hazardous to its participating entities or the patients served by the participating
entities; or
new text end

new text begin (7) the health information exchange service provider has otherwise failed to
substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.
new text end

new text begin (b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.
new text end

new text begin (c) If the certificate of authority of a health information exchange service provider is
suspended, the health information exchange service provider shall not, during the period
of suspension, enroll any additional participating entities, and shall not engage in any
advertising or solicitation.
new text end

new text begin (d) If the certificate of authority of a health information exchange service provider is
revoked, the organization shall proceed, immediately following the effective date of the
order of revocation, to wind up its affairs and shall conduct no further business except as
necessary to the orderly conclusion of the affairs of the organization. The organization
shall engage in no further advertising or solicitation. The commissioner may, by written
order, permit further operation of the organization as the commissioner finds to be in the
best interest of participating entities, to the end that participating entities will be given the
greatest practical opportunity to access continuing health information exchange services.
new text end

new text begin Subd. 3. new text end

new text begin Denial, suspension, and revocation; administrative procedures. new text end

new text begin (a)
When the commissioner has cause to believe that grounds for the denial, suspension,
or revocation of a certificate of authority exists, the commissioner shall notify the
health information exchange service provider in writing stating the grounds for denial,
suspension, or revocation and setting a time within 20 days for a hearing on the matter.
new text end

new text begin (b) After a hearing before the commissioner at which the health information
exchange service provider may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information exchange service provider to
appear at the hearing, the commissioner shall take action as deemed necessary and shall
issue written findings that shall be mailed to the health information exchange service
provider.
new text end

new text begin (c) If suspension, revocation, or an administrative penalty is proposed according
to this section, the commissioner must deliver, or send by certified mail with return
receipt requested, to the health information exchange service provider written notice of
the commissioner's intent to impose a penalty. This notice of proposed determination
must include:
new text end

new text begin (1) a reference to the statutory basis for the penalty;
new text end

new text begin (2) a description of the findings of fact regarding the violations with respect to
which the penalty is proposed;
new text end

new text begin (3) the nature and amount of the proposed penalty;
new text end

new text begin (4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;
new text end

new text begin (5) instructions for responding to the notice, including a statement of the health
information exchange service provider's right to a contested case proceeding and a
statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and
new text end

new text begin (6) the address to which the contested case proceeding request must be sent.
new text end

new text begin Subd. 4. new text end

new text begin Coordination. new text end

new text begin (a) To the extent possible when implementing sections
62J.498 to 62J.4982, the commissioner shall seek the advice of the Minnesota e-Health
Advisory Committee, in the review and update of criteria for the certification and
recertification of health information exchange service providers.
new text end

new text begin (b) By January 1, 2011, the commissioner shall report to the governor and the
chairs of the senate and house of representatives committees having jurisdiction over
health information policy issues on the status of the health information exchange in
Minnesota and provide recommendations on further action necessary to facilitate the
secure electronic movement of health information among health providers that will enable
Minnesota providers and hospitals to meet meaningful use exchange requirements.
new text end

new text begin Subd. 5. new text end

new text begin Fees and monetary penalties. new text end

new text begin (a) Every health information exchange
service provider subject to this section and section 62J.4981 shall be assessed fees as
follows:
new text end

new text begin (1) filing an application for certificate of authority to operate as a health information
organization, $10,500;
new text end

new text begin (2) filing an application for certificate of authority to operate as a health data
intermediary, $7,000;
new text end

new text begin (3) annual health information organization certificate fee, $14,000;
new text end

new text begin (4) annual health data intermediary certificate fee, $7,000; and
new text end

new text begin (5) fees for other filings, as specified by rule.
new text end

new text begin (b) Administrative monetary penalties imposed under this subdivision shall be
deposited into a revolving fund and are appropriated to the commissioner for the purposes
of sections 62J.498 to 62J.4982.
new text end

Sec. 9.

Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:


Subdivision 1.

Designation.

(a) The commissioner shall designate essential
community providers. The criteria for essential community provider designation shall be
the following:

(1) a demonstrated ability to integrate applicable supportive and stabilizing services
with medical care for uninsured persons and high-risk and special needs populations,
underserved, and other special needs populations; and

(2) a commitment to serve low-income and underserved populations by meeting the
following requirements:

(i) has nonprofit status in accordance with chapter 317A;

(ii) has tax exempt status in accordance with the Internal Revenue Service Code,
section 501(c)(3);

(iii) charges for services on a sliding fee schedule based on current poverty income
guidelines; and

(iv) does not restrict access or services because of a client's financial limitation;

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health board as defined in
chapter 145A;

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
conditions; deleted text beginor
deleted text end

(5) a sole community hospital. For these rural hospitals, the essential community
provider designation applies to all health services provided, including both inpatient and
outpatient services. For purposes of this section, "sole community hospital" means a
rural hospital that:

(i) is eligible to be classified as a sole community hospital according to Code
of Federal Regulations, title 42, section 412.92, or is located in a community with a
population of less than 5,000 and located more than 25 miles from a like hospital currently
providing acute short-term services;

(ii) has experienced net operating income losses in two of the previous three
most recent consecutive hospital fiscal years for which audited financial information is
available; and

(iii) consists of 40 or fewer licensed bedsnew text begin; or
new text end

new text begin (6) a birth center licensed under section 144.615new text end.

(b) Prior to designation, the commissioner shall publish the names of all applicants
in the State Register. The public shall have 30 days from the date of publication to submit
written comments to the commissioner on the application. No designation shall be made
by the commissioner until the 30-day period has expired.

(c) The commissioner may designate an eligible provider as an essential community
provider for all the services offered by that provider or for specific services designated by
the commissioner.

(d) For the purpose of this subdivision, supportive and stabilizing services include at
a minimum, transportation, child care, cultural, and linguistic services where appropriate.

Sec. 10.

Minnesota Statutes 2008, section 144.226, subdivision 3, is amended to read:


Subd. 3.

Birth record surcharge.

new text begin(a) new text endIn addition to any fee prescribed under
subdivision 1, there shall be a nonrefundable surcharge of $3 for each certified birth or
stillbirth record and for a certification that the vital record cannot be found. The local or
state registrar shall forward this amount to the commissioner of management and budget
for deposit into the account for the children's trust fund for the prevention of child abuse
established under section 256E.22. This surcharge shall not be charged under those
circumstances in which no fee for a certified birth or stillbirth record is permitted under
subdivision 1, paragraph (a). Upon certification by the commissioner of management and
budget that the assets in that fund exceed $20,000,000, this surcharge shall be discontinued.

new text begin (b) In addition to any fee prescribed under subdivision 1, there shall be a
nonrefundable surcharge of $10 for each certified birth record. The local or state registrar
shall forward this amount to the commissioner of finance for deposit in the general fund
for the Minnesota Birth Defects Information System established under section 144.2215.
This surcharge shall not be charged under those circumstances in which no fee for a
certified birth record is permitted under subdivision 1, paragraph (a).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 11.

new text begin [144.615] BIRTH CENTERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
have the meanings given them.
new text end

new text begin (b) "Birth center" means a facility licensed for the primary purpose of performing
low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are
planned to occur away from the mother's usual residence following a low-risk pregnancy.
new text end

new text begin (c) "CABC" means the Commission for the Accreditation of Birth Centers.
new text end

new text begin (d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as
determined by documentation of adequate prenatal care and the anticipation of a normal
uncomplicated labor and birth, as defined by reasonable and generally accepted criteria
adopted by professional groups for maternal, fetal, and neonatal health care.
new text end

new text begin Subd. 2. new text end

new text begin License required. new text end

new text begin (a) Beginning January 1, 2011, no birth center shall be
established, operated, or maintained in the state without first obtaining a license from the
commissioner of health according to this section.
new text end

new text begin (b) A license issued under this section is not transferable or assignable and is subject
to suspension or revocation at any time for failure to comply with this section.
new text end

new text begin (c) A birth center licensed under this section shall not assert, represent, offer,
provide, or imply that the center is or may render care or services other than the services it
is permitted to render within the scope of the license or the accreditation issued.
new text end

new text begin (d) The license must be conspicuously posted in an area where patients are admitted.
new text end

new text begin Subd. 3. new text end

new text begin Temporary license. new text end

new text begin For new birth centers planning to begin operations
after January 1, 2011, the commissioner may issue a temporary license to the birth center
that is valid for a period of six months from the date of issuance. The birth center must
submit to the commissioner an application and applicable fee for licensure as required
under subdivision 4. The application must include the information required in subdivision
4, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted
an application for accreditation to the CABC. Upon receipt of accreditation from the
CABC, the birth center must submit to the commissioner the information required in
subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner
shall issue a new license.
new text end

new text begin Subd. 4. new text end

new text begin Application. new text end

new text begin An application for a license to operate a birth center and the
applicable fee under subdivision 8 must be submitted to the commissioner on a form
provided by the commissioner and must contain:
new text end

new text begin (1) the name of the applicant;
new text end

new text begin (2) the site location of the birth center;
new text end

new text begin (3) the name of the person in charge of the center;
new text end

new text begin (4) documentation that the accreditation described under subdivision 6 has been
issued, including the effective date and the expiration date of the accreditation, and the
date of the last site visit by the CABC;
new text end

new text begin (5) the number of patients the birth center is capable of serving at a given time;
new text end

new text begin (6) the names and license numbers, if applicable, of the health care professionals
on staff at the birth center; and
new text end

new text begin (7) any other information the commissioner deems necessary.
new text end

new text begin Subd. 5. new text end

new text begin Suspension, revocation, and refusal to renew. new text end

new text begin The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the grounds
described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or
upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice
and a hearing as described under section 144.55, subdivision 7, and a new license may be
issued after proper inspection of the birth center has been conducted.
new text end

new text begin Subd. 6. new text end

new text begin Standards for licensure. new text end

new text begin (a) To be eligible for licensure under this
section, a birth center must be accredited by the CABC or must obtain accreditation
within six months of the date of the application for licensure. If the birth center loses its
accreditation, the birth center must immediately notify the commissioner.
new text end

new text begin (b) The center must have procedures in place specifying criteria by which risk status
will be established and applied to each woman at admission and during labor.
new text end

new text begin (c) Upon request, the birth center shall provide the commissioner of health with any
material submitted by the birth center to the CABC as part of the accreditation process,
including the accreditation application, the self-evaluation report, the accreditation
decision letter from the CABC, and any reports from the CABC following a site visit.
new text end

new text begin Subd. 7. new text end

new text begin Limitations of services. new text end

new text begin (a) The following limitations apply to the services
performed at a birth center:
new text end

new text begin (1) surgical procedures must be limited to those normally accomplished during an
uncomplicated birth, including episiotomy and repair;
new text end

new text begin (2) no abortions may be administered; and
new text end

new text begin (3) no general or regional anesthesia may be administered.
new text end

new text begin (b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth
center if the administration of the anesthetic is performed within the scope of practice of a
health care professional.
new text end

new text begin Subd. 8. new text end

new text begin Fees. new text end

new text begin (a) The biennial license fee for a birth center is $365.
new text end

new text begin (b) The temporary license fee is $365.
new text end

new text begin (c) Fees shall be collected and deposited according to section 144.122.
new text end

new text begin Subd. 9. new text end

new text begin Renewal. new text end

new text begin (a) Except as provided in paragraph (b), a license issued under
this section expires two years from the date of issue.
new text end

new text begin (b) A temporary license issued under subdivision 3 expires six months from the date
of issue, and may be renewed for one additional six-month period.
new text end

new text begin (c) An application for renewal shall be submitted at least 60 days prior to expiration
of the license on forms prescribed by the commissioner of health.
new text end

new text begin Subd. 10. new text end

new text begin Records. new text end

new text begin All health records maintained on each client by a birth center
are subject to sections 144.292 to 144.298.
new text end

new text begin Subd. 11. new text end

new text begin Report. new text end

new text begin (a) The commissioner of health, in consultation with the
commissioner of human services and representatives of the licensed birth centers,
the American College of Obstetricians and Gynecologists, the American Academy
of Pediatrics, the Minnesota Hospital Association, and the Minnesota Ambulance
Association, shall evaluate the quality of care and outcomes for services provided in
licensed birth centers, including, but not limited to, the utilization of services provided at a
birth center, the outcomes of care provided to both mothers and newborns, and the numbers
of transfers to other health care facilities that are required and the reasons for the transfers.
The commissioner shall work with the birth centers to establish a process to gather and
analyze the data within protocols that protect the confidentiality of patient identification.
new text end

new text begin (b) The commissioner of health shall report the findings of the evaluation to the
legislature by January 15, 2014.
new text end

Sec. 12.

Minnesota Statutes 2008, section 144.651, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For the purposes of this section, "patient" means a person
who is admitted to an acute care inpatient facility for a continuous period longer than
24 hours, for the purpose of diagnosis or treatment bearing on the physical or mental
health of that person. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20,
"patient" also means a person who receives health care services at an outpatient surgical
centernew text begin or at a birth center licensed under section 144.615new text end. "Patient" also means a minor
who is admitted to a residential program as defined in section 253C.01. For purposes of
subdivisions 1, 3 to 16, 18, 20 and 30, "patient" also means any person who is receiving
mental health treatment on an outpatient basis or in a community support program or other
community-based program. "Resident" means a person who is admitted to a nonacute care
facility including extended care facilities, nursing homes, and boarding care homes for
care required because of prolonged mental or physical illness or disability, recovery from
injury or disease, or advancing age. For purposes of all subdivisions except subdivisions
28 and 29, "resident" also means a person who is admitted to a facility licensed as a board
and lodging facility under Minnesota Rules, parts 4625.0100 to 4625.2355, or a supervised
living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which operates
a rehabilitation program licensed under Minnesota Rules, parts 9530.4100 to 9530.4450.

Sec. 13.

Minnesota Statutes 2008, section 144.9504, is amended by adding a
subdivision to read:


new text begin Subd. 12. new text end

new text begin Blood lead level guidelines. new text end

new text begin (a) By January 1, 2011, the commissioner
must revise clinical and case management guidelines to include recommendations
for protective health actions and follow-up services when a child's blood lead level
exceeds five micrograms of lead per deciliter of blood. The revised guidelines must be
implemented to the extent possible using available resources.
new text end

new text begin (b) In revising the clinical and case management guidelines for blood lead levels
greater than five micrograms of lead per deciliter of blood under this subdivision,
the commissioner of health must consult with a statewide organization representing
physicians, the public health department of Minneapolis and other public health
departments, and a nonprofit organization with expertise in lead abatement.
new text end

Sec. 14.

Minnesota Statutes 2008, section 144A.51, subdivision 5, is amended to read:


Subd. 5.

Health facility.

"Health facility" means a facility or that part of a facility
which is required to be licensed pursuant to sections 144.50 to 144.58, new text begin144.615, new text endand a
facility or that part of a facility which is required to be licensed under any law of this state
which provides for the licensure of nursing homes.

Sec. 15.

Minnesota Statutes 2008, section 144E.37, is amended to read:


144E.37 COMPREHENSIVE ADVANCED LIFE SUPPORT.

The deleted text beginboarddeleted text endnew text begin commissioner of healthnew text end shall establish a comprehensive advanced
life-support educational program to train rural medical personnel, including physicians,
physician assistants, nurses, and allied health care providers, in a team approach to
anticipate, recognize, and treat life-threatening emergencies before serious injury or
cardiac arrest occurs.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 16. new text beginHEALTH PLAN AND COUNTY ADMINISTRATIVE COST
REDUCTION; REPORTING REQUIREMENTS.
new text end

new text begin (a) Minnesota health plans and county-based purchasing plans may complete an
inventory of existing data collection and reporting requirements for health plans and
county-based purchasing plans and submit to the commissioners of health and human
services a list of data, documentation, and reports that:
new text end

new text begin (1) are collected from the same health plan or county-based purchasing plan more
than once;
new text end

new text begin (2) are collected directly from the health plan or county-based purchasing plan but
are available to the state agencies from other sources;
new text end

new text begin (3) are not currently being used by state agencies; or
new text end

new text begin (4) collect similar information more than once in different formats, at different
times, or by more than one state agency.
new text end

new text begin (b) The report to the commissioners may also identify the percentage of health
plan and county-based purchasing plan administrative time and expense attributed to
fulfilling reporting requirements and include recommendations regarding ways to reduce
duplicative reporting requirements.
new text end

new text begin (c) Upon receipt, the commissioners shall submit the inventory and recommendations
to the chairs of the appropriate legislative committees, along with their comments
and recommendations as to whether any action should be taken by the legislature to
establish a consolidated and streamlined reporting system under which data, reports, and
documentation are collected only once and only when needed for the state agencies to
fulfill their duties under law and applicable regulations.
new text end

Sec. 17. new text beginAPPLICATION PROCESS FOR HEALTH INFORMATION
EXCHANGE.
new text end

new text begin To the extent that the commissioner of health applies for additional federal funding
to support the commissioner's responsibilities of developing and maintaining state level
health information exchange under section 3013 of the HITECH Act, the commissioner of
health shall ensure that applications are made through an open process that provides health
information exchange service providers equal opportunity to receive funding.
new text end

Sec. 18. new text beginTRANSFER.
new text end

new text begin The powers and duties of the Emergency Medical Services Regulatory Board with
respect to the comprehensive advanced life-support educational program under Minnesota
Statutes, section 144E.37, are transferred to the commissioner of health under Minnesota
Statutes, section 15.039.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 19. new text beginREVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall renumber Minnesota Statutes, section 144E.37, as
Minnesota Statutes, section 144.6062, and make all necessary changes in statutory
cross-references in Minnesota Statutes and Minnesota Rules.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

ARTICLE 7

HEALTH CARE REFORM

Section 1.

new text begin [62E.20] RELATIONSHIP TO TEMPORARY FEDERAL HIGH-RISK
POOL.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
this subdivision have the meanings given.
new text end

new text begin (b) "Association" means the Minnesota Comprehensive Health Association.
new text end

new text begin (c) "Federal law" means Title I, subtitle B, section 1101, of the federal Patient
Protection and Affordable Care Act, Public Law 111-148, including any federal
regulations adopted under it.
new text end

new text begin (d) "Federal qualified high-risk pool" means an arrangement established by the
federal secretary of health and human services that meets the requirements of the federal
law.
new text end

new text begin Subd. 2. new text end

new text begin Timing of this section. new text end

new text begin This section applies beginning as of the date the
temporary federal qualified high risk health pool created under the federal law begins
to provide coverage in this state.
new text end

new text begin Subd. 3. new text end

new text begin Maintenance of effort. new text end

new text begin The assessments made by the comprehensive
health association on its member insurers must comply with the maintenance of effort
requirement contained in paragraph (b), clause (3), of the federal law, to the extent that
requirement applies to assessments made by the association.
new text end

new text begin Subd. 4. new text end

new text begin Coordination with federal law. new text end

new text begin Upon the date a federal qualified high-risk
pool begins to provide coverage in this state, the comprehensive health association must
not enroll new enrollees, notwithstanding section 62E.14 or other law to the contrary. If
the lack of new enrollees would otherwise lead to noncompliance with subdivision 3, the
association shall reduce the premiums to levels below those otherwise required under
section 62E.08, to the extent necessary to comply with subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Coordination with state health care programs. new text end

new text begin The commissioner of
human services, in consultation with the commissioner of commerce and the Minnesota
Comprehensive Health Association, shall coordinate enrollment between medical
assistance, MinnesotaCare, the federal qualified high-risk pool, and the Minnesota
Comprehensive Health Association, to ensure that:
new text end

new text begin (1) applicants for coverage through the federal qualified high-risk pool, or through
the Minnesota Comprehensive Health Association to the extent the association is enrolling
new members, are referred to the medical assistance or MinnesotaCare programs if they
are determined to be potentially eligible for coverage through those programs; and
new text end

new text begin (2) applicants for coverage under medical assistance or MinnesotaCare who are
determined not to be eligible for those programs are provided information about coverage
through the federal qualified high-risk pool and the Minnesota Comprehensive Health
Association.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62J.07, subdivision 2, is amended to read:


Subd. 2.

Membership.

The Legislative Commission on Health Care Access
consists of deleted text beginfivedeleted text endnew text begin sevennew text end members of the senate appointed under the rules of the senate and
deleted text begin fivedeleted text endnew text begin sevennew text end members of the house of representatives appointed under the rules of the house
of representatives. The Legislative Commission on Health Care Access must include deleted text beginthreedeleted text endnew text begin
five
new text end members of the majority party and two members of the minority party in each house.

Sec. 3.

Minnesota Statutes 2008, section 62J.07, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Federal health care reform. new text end

new text begin (a) The Legislative Commission on
Health Care Access shall analyze options and make recommendations regarding the
implementation of provisions of the Patient Protection and Affordable Health Care Act,
Public Law 111-148, and the health care reform provisions in the Health Care and
Education Reconciliation Act of 2010, Public Law 111-152, including:
new text end

new text begin (1) development of accountable care organizations;
new text end

new text begin (2) health insurance reform, including options related to coverage, purchasing,
exchange development, and coverage for high-risk individuals; and
new text end

new text begin (3) other provisions that will require changes in state law.
new text end

new text begin (b) Before finalizing and submitting federal applications for pilot projects authorized
under federal health care reform, the governor and state agencies shall seek review and
advice from the commission.
new text end

new text begin (c) The commission may create and make appointments to work groups to assist the
commission in its work. Work group members may include legislators, representatives
of businesses and nonprofit agencies impacted by federal health care reform, academic
experts, and consumer representatives.
new text end

Sec. 4.

Minnesota Statutes 2008, section 62U.05, is amended to read:


62U.05 PROVIDER PRICING FOR BASKETS OF CAREnew text begin; ACCOUNTABLE
CARE ORGANIZATIONS
new text end.

Subdivision 1.

Establishment of definitions.

(a) By July 1, 2009, the commissioner
of health shall establish uniform definitions for baskets of care beginning with a minimum
of seven baskets of care. In selecting health conditions for which baskets of care should
be defined, the commissioner shall consider coronary artery and heart disease, diabetes,
asthma, and depression. In selecting health conditions, the commissioner shall also
consider the prevalence of the health conditions, the cost of treating the health conditions,
and the potential for innovations to reduce cost and improve quality.

(b) The commissioner shall convene one or more work groups to assist in
establishing these definitions. Each work group shall include members appointed by
statewide associations representing relevant health care providers and health plan
companies, and organizations that work to improve health care quality in Minnesota.

(c) To the extent possible, the baskets of care must incorporate a patient-directed,
decision-making support model.

new text begin (d) By January 1, 2012, the commissioner shall establish uniform definitions for the
total cost of providing all necessary services to a patient through an accountable care
organization meeting the standards specified in section 3022 of the Patient Protection
and Affordable Care Act, Public Law 111-148, and shall develop a standard method
and format for accountable care organizations to use for submitting package prices for
the total cost of care. This method must be published in the State Register and must be
made available to all providers.
new text end

Subd. 2.

Package prices.

(a) Beginning January 1, 2010, health care providers may
establish package prices for the baskets of care defined under subdivision 1.new text begin Beginning
July 1, 2012, accountable care organizations may establish package prices for the total
cost of care defined under subdivision 1.
new text end

(b) Beginning January 1, 2010, no health care provider or group of providers that
has established a package price for a basket of care under this sectionnew text begin, and beginning
July 1, 2012, no accountable care organization that has established a package price for
the total cost of care under this section,
new text end shall vary the payment amount that the provider
new text begin or organization new text endaccepts as full payment for a health care service based upon the identity of
the payer, upon a contractual relationship with a payer, upon the identity of the patient,
or upon whether the patient has coverage through a group purchaser. This paragraph
applies only to health care services provided to Minnesota residents or to non-Minnesota
residents who obtain health insurance through a Minnesota employer. This paragraph does
not apply to services paid for by Medicare, state public health care programs through
fee-for-service or prepaid arrangements, workers' compensation, or no-fault automobile
insurance. This paragraph does not affect the right of a provider to provide charity care
or care for a reduced price due to financial hardship of the patient or due to the patient
being a relative or friend of the provider.

Subd. 3.

Quality measurements for baskets of care.

(a) The commissioner shall
establish quality measurements for the defined baskets of care by December 31, 2009.new text begin
The commissioner shall establish quality measures for the total cost of care for services
delivered through an accountable care organization by June 30, 2012.
new text end The commissioner
may contract with an organization that works to improve health care quality to make
recommendations about the use of existing measures or establishing new measures where
no measures currently exist.

(b) Beginning July 1, 2010, the commissioner or the commissioner's designee shall
publish comparative price and quality information on the baskets of care in a manner
that is easily accessible and understandable to the public, as this information becomes
available.new text begin Beginning January 1, 2013, the commissioner or the commissioner's designee
shall publish comparative price and quality information on the total cost of care for
services delivered through an accountable care organization in a manner that is easily
accessible and understandable to the public, as this information becomes available.
new text end

Sec. 5.

Minnesota Statutes 2008, section 256B.0754, is amended by adding a
subdivision to read:


new text begin Subd. 3. new text end

new text begin Accountable care organizations. new text end

new text begin By July 1, 2012, the commissioner of
human services shall deliver services to enrollees in state health care programs through
accountable care organizations, and shall provide incentive payments to accountable care
organizations that meet or exceed annual quality and performance targets. Accountable
care organizations and incentive payments must meet the standards specified in the Patient
Protection and Affordable Care Act, Public Law 111-148.
new text end

Sec. 6.

new text begin [256B.0756] COORDINATED CARE THROUGH A HEALTH HOME.
new text end

new text begin Subdivision 1. new text end

new text begin Provision of coverage. new text end

new text begin (a) The commissioner shall provide
medical assistance coverage of health home services for eligible individuals with chronic
conditions who select a designated provider, a team of health care professionals, or a
health team as the individual's health home.
new text end

new text begin (b) The commissioner shall implement this section in compliance with the
requirements of the state option to provide health homes for enrollees with chronic
conditions, as provided under the Patient Protection and Affordable Care Act, Public
Law 111-148, sections 2703 and 3502. Terms used in this section have the meaning
provided in that act.
new text end

new text begin Subd. 2. new text end

new text begin Eligible individual. new text end

new text begin An individual is eligible for health home services
under this section if the individual is eligible for medical assistance under this chapter
and has at least:
new text end

new text begin (1) two chronic conditions;
new text end

new text begin (2) one chronic condition and is at risk of having a second chronic condition; or
new text end

new text begin (3) one serious and persistent mental health condition.
new text end

new text begin Subd. 3. new text end

new text begin Health home services. new text end

new text begin (a) Health home services means comprehensive and
timely high-quality services that are provided by a health home. These services include:
new text end

new text begin (1) comprehensive care management;
new text end

new text begin (2) care coordination and health promotion;
new text end

new text begin (3) comprehensive transitional care, including appropriate follow-up, from inpatient
to other settings;
new text end

new text begin (4) patient and family support, including authorized representatives;
new text end

new text begin (5) referral to community and social support services, if relevant; and
new text end

new text begin (6) use of health information technology to link services, as feasible and appropriate.
new text end

new text begin (b) The commissioner shall maximize the number and type of services
included in this subdivision to the extent permissible under federal law, including
physician, outpatient, mental health treatment, and rehabilitation services necessary for
comprehensive transitional care following hospitalization.
new text end

new text begin Subd. 4. new text end

new text begin Health teams. new text end

new text begin The commissioner shall establish health teams to support
the patient-centered health home and provide the services described in subdivision 3 to
individuals eligible under subdivision 2. The commissioner shall apply for grants or
contracts as provided under section 3502 of the Patient Protection and Affordable Care
Act to establish health teams and provide capitated payments to primary care providers.
For purposes of this section, "health teams" means community-based, interdisciplinary,
inter-professional teams of health care providers that support primary care practices.
These providers may include medical specialists, nurses, advanced practice registered
nurses, pharmacists, nutritionists, social workers, behavioral and mental health providers,
doctors of chiropractic, licensed complementary and alternative medicine practitioners,
and physician's assistants.
new text end

new text begin Subd. 5. new text end

new text begin Payments. new text end

new text begin The commissioner shall make payments to each health home
and each health team for the provision of health home services to each eligible individual
with chronic conditions that selects the health home as a provider.
new text end

new text begin Subd. 6. new text end

new text begin Coordination. new text end

new text begin The commissioner, to the extent feasible, shall ensure that
the requirements and payment methods for health homes and health teams developed
under this section are consistent with the requirements and payment methods for health
care homes established under sections 256B.0751 and 256B.0753. The commissioner may
modify requirements and payment methods under sections 256B.0751 and 256B.0753 in
order to be consistent with federal health home requirements and payment methods.
new text end

new text begin Subd. 7. new text end

new text begin State plan amendment. new text end

new text begin The commissioner shall submit a state plan
amendment to implement this section to the federal Centers for Medicare and Medicaid
Services by January 1, 2011.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 7. new text beginFEDERAL HEALTH CARE REFORM DEMONSTRATION PROJECTS
AND GRANTS.
new text end

new text begin (a) The commissioner of human services shall seek to participate in the following
demonstration projects, or apply for the following grants, as described in the federal
Patient Protection and Affordable Care Act, Public Law 111-148:
new text end

new text begin (1) the demonstration project to evaluate integrated care around a hospitalization,
Public Law 111-148, section 2704;
new text end

new text begin (2) the Medicaid global payment system demonstration project, Public Law 111-148,
section 2705;
new text end

new text begin (3) the pediatric accountable care organization demonstration project, Public Law
111-148, section 2706;
new text end

new text begin (4) the Medicaid emergency psychiatric demonstration project, Public Law 111-148,
section 2707; and
new text end

new text begin (5) grants to provide incentives for prevention of chronic diseases in Medicaid,
Public Law 111-148, section 4108.
new text end

new text begin (b) The commissioner of human services shall report to the chairs and ranking
minority members of the house of representatives and senate committees or divisions with
jurisdiction over health care policy and finance on the status of the demonstration project
and grant applications. If the state is accepted as a demonstration project participant, or is
awarded a grant, the commissioner shall notify the chairs and ranking minority members
of those committees or divisions of any legislative changes necessary to implement the
demonstration projects or grants.
new text end

Sec. 8. new text beginHEALTH CARE REFORM TASK FORCE.
new text end

new text begin Subdivision 1. new text end

new text begin Task force. new text end

new text begin (a) The governor shall convene a Health Care
Reform Task Force to advise and assist the governor and the legislature regarding state
implementation of federal health care reform legislation. For purposes of this section,
"federal health care reform legislation" means the Patient Protection and Affordable Care
Act, Public Law 111-148, and the health care reform provisions in the Health Care and
Education Reconciliation Act of 2010, Public Law 111-152. The task force shall consist of:
new text end

new text begin (1) two legislators from the house of representatives appointed by the speaker and
two legislators from the senate appointed by the Subcommittee on Committees of the
Committee on Rules and Administration;
new text end

new text be