Skip to main content Skip to office menu Skip to footer
Capital IconMinnesota Legislature

HF 2614

3rd Engrossment - 86th Legislature (2009 - 2010) Posted on 05/05/2010 08:38am

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 2.38 2.39 2.40 2.41 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 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 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 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 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 11.36 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 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 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 17.36 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 18.36 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 20.35
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 21.35 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 24.1 24.2
24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13
24.14 24.15 24.16 24.17 24.18
24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 25.33 25.34 25.35 25.36 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 27.34
27.35 27.36
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
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 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 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 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16
33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 34.35 34.36 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23
35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32
35.33 35.34 36.1 36.2 36.3 36.4 36.5 36.6
36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 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 37.36 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
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
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 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 43.36 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 47.33 47.34 48.1 48.2 48.3 48.4 48.5 48.6 48.7
48.8 48.9 48.10 48.11 48.12 48.13 48.14
48.15 48.16 48.17 48.18 48.19
48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 49.1 49.2 49.3 49.4 49.5 49.6
49.7
49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31
49.32
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 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 51.35 52.1 52.2 52.3
52.4 52.5 52.6
52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 53.1 53.2 53.3 53.4 53.5
53.6 53.7
53.8 53.9 53.10 53.11 53.12 53.13 53.14
53.15 53.16 53.17
53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27
53.28 53.29 53.30 53.31 53.32 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
54.34 54.35 54.36
55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14
55.15
55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 55.34
56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12
56.13
56.14 56.15 56.16 56.17 56.18 56.19
56.20 56.21 56.22
56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 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 57.32 57.33 57.34 57.35 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
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 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 60.36 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 63.1 63.2 63.3 63.4 63.5 63.6
63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31
63.32 63.33
64.1 64.2 64.3
64.4
64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14
64.15
64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28
64.29
64.30 64.31 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
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 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 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 68.34 68.35 68.36 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 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 72.34 72.35 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17
73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33
73.34 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 74.34 74.35 74.36 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 75.36 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 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 77.33 77.34 77.35 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 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 80.35 80.36 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 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 83.33 83.34 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 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
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 86.32 86.33 86.34 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 87.36 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 89.33 89.34 89.35 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16
90.17
90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27
90.28
90.29 90.30 90.31 90.32 90.33 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25
91.26
91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 91.35
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 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17
94.18 94.19 94.20 94.21
94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 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 96.35 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 97.34 97.35 97.36 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 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
99.35 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13
100.14 100.15
100.16 100.17 100.18 100.19 100.20
100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 101.1 101.2 101.3 101.4 101.5 101.6
101.7
101.8 101.9
101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13
102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 102.34 102.35
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
103.33 103.34 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16
104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27
104.28 104.29 104.30 104.31 104.32 104.33 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 105.34 105.35 105.36 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13
106.14 106.15 106.16 106.17 106.18
106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 106.34 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21
107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31
107.32 107.33 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10
108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26
108.27
108.28 108.29 108.30 108.31 108.32 108.33 109.1 109.2
109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 109.34 109.35 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14
110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23
110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 111.1 111.2 111.3 111.4 111.5
111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16
111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28
111.29 111.30 111.31 111.32 112.1 112.2
112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 112.34 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25
113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 114.34
115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31
115.32 115.33
115.34 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17
116.18 116.19
116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 117.33 117.34 117.35 117.36 118.1 118.2 118.3 118.4 118.5 118.6 118.7
118.8 118.9
118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 119.34 119.35 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 120.35 120.36 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22
121.23 121.24
121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 122.34 122.35 122.36 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 123.34 123.35 123.36 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20
124.21 124.22
124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 124.34 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 125.35 125.36 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 126.33 126.34 126.35 127.1 127.2 127.3 127.4
127.5 127.6
127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 127.34 127.35 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19
129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 130.1 130.2
130.3
130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14
130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25
130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10
131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19
131.20 131.21 131.22 131.23 131.24 131.25
131.26 131.27 131.28
131.29 131.30
131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11
132.12
132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 132.34 133.1 133.2
133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31
133.32 133.33 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22
134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33
134.34 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 135.33 135.34 135.35 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 136.33 136.34 136.35 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 137.35 137.36 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16
138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 138.34 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34 139.35 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 141.35 141.36 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 142.34 142.35 142.36 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 143.34 143.35 143.36 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17
144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 144.33 144.34 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 145.34 145.35 145.36 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 146.34 146.35 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 147.33 147.34 147.35 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23
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
149.33 149.34 150.1 150.2 150.3 150.4
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
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
153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34 153.35 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9
154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22
154.23 154.24 154.25 154.26 154.27
154.28 154.29 154.30 154.31 154.32 155.1 155.2
155.3
155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26
155.27 155.28 155.29 155.30 155.31 155.32 155.33
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
156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11
157.12 157.13 157.14 157.15 157.16 157.17 157.18
157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 157.34 158.1 158.2
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
159.33 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 160.35 160.36 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15
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
164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 164.33 164.34 164.35 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30
165.31 165.32 165.33 165.34 165.35 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 166.35 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 167.34 167.35 167.36 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 168.34 168.35 168.36 168.37 168.38 168.39 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23
169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 169.34 169.35 169.36 169.37 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28
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
171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 171.34 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26
172.27 172.28
172.29 172.30
172.31 173.1 173.2 173.3 173.4 173.5 173.6
173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24
173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33 173.34 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13
174.14 174.15 174.16 174.17 174.18
174.19 174.20 174.21 174.22 174.23 174.24 174.25
174.26
174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28
175.29 175.30 175.31 175.32 175.33 175.34 175.35 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16
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
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
179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 179.34 179.35 179.36 179.37 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 180.34 180.35 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 181.34 181.35 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 185.35 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 186.34 186.35 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 187.34 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 188.34 188.35 188.36 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 189.33 189.34 189.35 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 190.34 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 191.33 191.34 191.35 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33
192.34 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 193.34 193.35 193.36 193.37 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 194.34 194.35 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 195.34 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19
196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32 196.33 196.34 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17
197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 197.34 198.1 198.2
198.3 198.4 198.5
198.6
198.7 198.8 198.9 198.10 198.11 198.12 198.13
198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25
198.26
198.27 198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 199.34 199.35 199.36 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 201.33 201.34 201.35 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 202.34 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 203.34 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 204.34 204.35 204.36 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28
205.29 205.30 205.31 205.32 205.33 205.34 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17
206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 206.33 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 207.35 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 208.33 208.34 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 209.34 209.35 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 210.33 210.34 210.35 210.36 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 211.34 211.35 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 212.34 212.35 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 213.33 213.34 213.35 213.36 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 214.33 214.34 214.35 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 215.34 215.35 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 216.34 216.35 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33 217.34 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 218.34 218.35 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31
219.32 219.33 219.34 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 220.33 220.34 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 221.34 221.35 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 222.34 222.35 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 223.33 223.34 223.35 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 224.34 224.35 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11
225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 225.34 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29
226.30 226.31 226.32
226.33 227.1 227.2 227.3
227.4 227.5 227.6
227.7 227.8 227.9
227.10 227.11 227.12

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; health plans; assessing administrative penalties; modifying
foreign operating corporation taxes; 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; 62J.692, subdivision 4; 62Q.19,
subdivision 1; 62Q.76, subdivision 1; 62U.05; 119B.025, subdivision 1; 119B.09,
subdivision 4; 119B.11, subdivision 1; 144.05, by adding a subdivision; 144.226,
subdivision 3; 144.291, subdivision 2; 144.293, subdivision 4, by adding a
subdivision; 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; 246B.04, subdivision 2; 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, subdivisions 3, 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.441, by
adding a subdivision; 256B.5012, by adding a subdivision; 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.03, subdivision 3b;
256D.0515; 256D.425, subdivision 2; 256I.05, by adding a subdivision; 256J.20,
subdivision 3; 256J.24, subdivision 10; 256J.37, subdivision 3a; 256J.39, by
adding subdivisions; 256L.02, subdivision 3; 256L.03, subdivision 3, by adding
a subdivision; 256L.04, subdivision 7; 256L.05, by adding a subdivision;
256L.07, subdivision 1, by adding a subdivision; 256L.12, subdivisions 5, 6,
9; 256L.15, subdivision 1; 290.01, subdivision 5, by adding a subdivision;
290.17, subdivision 4; 326B.43, subdivision 2; 626.556, subdivision 10i;
626.557, subdivision 9d; Minnesota Statutes 2009 Supplement, sections
62J.495, subdivisions 1a, 3, by adding a subdivision; 157.16, subdivision 3;
245A.11, subdivision 7b; 245C.27, subdivision 1; 246B.06, subdivision 6;
252.025, subdivision 7; 252.27, subdivision 2a; 256.045, subdivision 3; 256.969,
subdivision 3a; 256B.056, subdivision 3c; 256B.0625, subdivisions 9, 13e;
256B.0653, subdivision 5; 256B.0911, subdivision 1a; 256B.0915, subdivision
3a; 256B.69, subdivisions 5a, 23; 256B.76, subdivision 1; 256B.766; 256D.03,
subdivision 3, as amended; 256D.44, subdivision 5; 256J.425, subdivision 3;
256L.03, subdivision 5; 256L.11, subdivision 1; 289A.08, subdivision 3; 290.01,
subdivisions 19c, 19d; 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 8, sections 2; 51; 81; 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, subdivisions 5, 6, 7, 8; 13, subdivision 1b; 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; proposing coding for new
law as Minnesota Statutes, chapter 62V; 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; 290.01, subdivision 6b; 290.0921, subdivision 7;
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, 10; 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 deleted text beginwhen disqualification is not set asidedeleted text end.

deleted text begin(a) If the
commissioner does not set aside a disqualification of an individual under section
deleted text end new text begin
(a) An individual
new text end 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 new text beginfollowing a reconsideration decision issued under
section 245C.23
new text end
, 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 new text beginfollowing a reconsideration decisionnew text end.

(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
disqualificationdeleted text begin, which has not been set asidedeleted text endnew text begin following a reconsideration decision under
section 245C.23
new 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) deleted text beginIf the commissioner does not set aside
the disqualification of an
deleted text end new text beginA disqualifiednew text end individual who is an employee of an employer,
as defined in section 179A.03, subdivision 15, deleted text beginthe individualdeleted text end may request a contested
case hearing under chapter 14 new text beginfollowing a reconsideration determination under section
245C.23
new text endnew text begin, unless the disqualification is deemed conclusive under section 245C.29new 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 deleted text beginthat the disqualification
has not been set aside
deleted text endnew text begin of the reconsideration decisionnew 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.

deleted text begin (b) If the commissioner does not set aside a disqualification that isdeleted text end new text begin(b) When an
individual is disqualified
new text end based on a maltreatment determination, the scope of the contested
case hearing new text beginunder paragraph (a)new text end must include the maltreatment determination and the
disqualification. In such cases, a fair hearing must not be conducted under section 256.045.

(c) 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.

(d) When an individual has been disqualified from multiple licensed programs deleted text beginand
the disqualifications have not been set aside under section
deleted text end, 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 deleted text beginwhich were not set asidedeleted text end.

(e) 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, deleted text beginwhich has not been set aside under sections 245C.22 anddeleted text endnew text begin following
a reconsideration decision under section
new text end 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, deleted text beginwhich has not been set aside under sections deleted text enddeleted text begin
and
deleted text endnew text begin and the individual remains disqualified following a reconsideration decisionnew text end,
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 deleted text beginor if the disqualification is not deleted text enddeleted text beginset asidedeleted text enddeleted text begin under sections deleted text enddeleted text begin to
deleted text endnew text begin and the individual remains disqualified following a reconsideration decisionnew text end, 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 ongoing studies. new text end

new text begin The commissioner
shall review all ongoing studies, reports, and program evaluations completed by the
Department of Human Services for state fiscal years 2006 through 2010. For each item,
the commissioner shall report the legislature's 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 on an ongoing basis 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, through June 30,
2013, made to hospitals for inpatient services before third-party liability and spenddown,
is reduced 4.5 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, 2011, through December 31, 2012,
to reflect this reduction.
new text end

new text begin (j) Payment rates for fee-for-service medical assistance admissions occurring
on or after July 1, 2011, through June 30, 2013, for admissions for the following
diagnosis-related groups: 202 peds bronchitis and asthma with major condition; 789
neonates, died or transferred to another acute care facility; 790 extreme immaturity
or respiratory distress syndrome; 791 prematurity with major problems; 793 full
term neonate with major problems; 794 neonate with other significant problems; 881
depressive neuroses; 885 psychoses; and 886 behavior and developmental disorders,
shall be increased for these diagnosis-related groups at a percentage calculated to cost no
more than a total of $7,200,000 per fiscal year, including state and federal shares. For
purposes of this paragraph, medical assistance does not include general assistance medical
care. The commissioner shall adjust rates to a prepaid health plan under contract with
the commissioner on a temporary basis to reflect payments provided in this paragraph,
and prepaid health plans are required to increase rates to providers under contract on a
temporary basis to reflect payments provided in this paragraph.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

new text begin [256B.012] SEX-SELECTION ABORTION FUNDING BAN.
new text end

new text begin Subdivision 1. new text end

new text begin Funding restriction. new text end

new text begin None of the funds appropriated under this
chapter or chapter 256L, nor in any trust fund to which funds are appropriated under this
chapter or chapter 256L, shall be expended for any sex-selection abortion nor for health
benefits coverage that includes coverage of sex-selection abortion.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, "sex-selection abortion"
means an abortion performed when the provider has knowledge that the pregnant woman
is seeking the abortion based solely on the sex of the unborn child.
new text end

new text begin (b) For the purposes of this section, "health benefits coverage" means the package
of services covered by a managed care provider or organization pursuant to a contract or
other arrangement.
new text end

new text begin Subd. 3. new text end

new text begin Severability. new text end

new text begin If any one or more provisions, subdivisions, paragraphs,
sentences, clauses, phrases, or words of this section or the application thereof to any
person or circumstance is found to be unconstitutional, the same is hereby declared to be
severable and the balance of this section shall remain effective notwithstanding such
unconstitutionality. The legislature hereby declares that it would have passed this section,
and each provision, subdivision, paragraph, sentence, clause, phrase, or word thereof,
irrespective of the fact that any one or more provision, subdivision, paragraph, sentence,
clause, phrase, or word be declared unconstitutional.
new text end

new text begin Subd. 4. new text end

new text begin Supreme Court jurisdiction. new text end

new text begin The Minnesota Supreme Court has original
jurisdiction over an action challenging the constitutionality of this section and shall
expedite the resolution of the action.
new text end

Sec. 6.

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. 7.

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:
new text end

new text begin (1) at least age 21 and under age 65;
new text end

new text begin (2) not pregnant;
new text end

new text begin (3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
of the Social Security Act;
new text end

new text begin (4) not an adult in a family with children as defined in section 256L.01, subdivision
3a; and
new text end

new text begin (5) not described in another subdivision of this section.
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. 8.

Minnesota Statutes 2008, section 256B.056, subdivision 3, is amended to read:


Subd. 3.

Asset limitations for individuals and families.

To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. In addition to these maximum amounts, an eligible individual or family may
accrue interest on these amounts, but they must be reduced to the maximum at the time
of an eligibility redetermination. The accumulation of the clothing and personal needs
allowance according to section 256B.35 must also be reduced to the maximum at the
time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the supplemental security income program for aged, blind, and disabled persons, with
the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;

(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income programnew text begin, except that the entire value of a motor vehicle valued at more
than $50,000 shall be treated as a nonexempt asset, regardless of the use of the motor
vehicle, to the extent allowable under federal law and regulations
new text end;

(4) assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses; and

(5) effective upon federal approval, for a person who no longer qualifies as an
employed person with a disability due to loss of earnings, assets allowed while eligible
for medical assistance under section 256B.057, subdivision 9, are not considered for 12
months, beginning with the first month of ineligibility as an employed person with a
disability, to the extent that the person's total assets remain within the allowed limits of
section 256B.057, subdivision 9, paragraph (c).

Sec. 9.

Minnesota Statutes 2009 Supplement, section 256B.056, subdivision 3c,
is amended to read:


Subd. 3c.

Asset limitations for families and children.

A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one
person must not own more than $10,000 in total net assets. In addition to these maximum
amounts, an eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The value of
assets that are not considered in determining eligibility for medical assistance for families
and children is the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business up to $200,000 are not
considered, except that a bank account that contains personal income or assets, or is used to
pay personal expenses, is not considered a capital or operating asset of a trade or business;

(3) one motor vehicle is excluded for each person of legal driving age who is
employed or seeking employmentnew text begin, except that the entire value of a motor vehicle valued
at more than $50,000 shall be treated as a nonexempt asset, regardless of the use of the
motor vehicle, to the extent allowable under federal law and reguations
new text end;

(4) assets designated as burial expenses are excluded to the same extent they are
excluded by the Supplemental Security Income program;

(5) court-ordered settlements up to $10,000 are not considered;

(6) individual retirement accounts and funds are not considered; and

(7) assets owned by children are not considered.

The assets specified in clause (2) must be disclosed to the local agency at the time of
application and at the time of an eligibility redetermination, and must be verified upon
request of the local agency.

Sec. 10.

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 gross countable 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 January 1, 2011, or upon federal
approval.
new text end

Sec. 11.

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. 12.

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. 13.

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. 14.

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. 15.

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. 16.

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. 17.

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


new text begin Subd. 16a. new text end

new text begin Provider reimbursement. new text end

new text begin Provider reimbursement for abortion services
under this section or chapter 256L is reduced by the amount of the reduction under section
256B.76, subdivision 1, paragraph (d).
new text end

Sec. 18.

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
face-to-face 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. 19.

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. 20.

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. 21.

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. 22.

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. 23.

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) For purposes of paragraphs (a) and (b), participation in the general assistance
medical care program applies only to pharmacy providers.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2010, only if the
commissioner of human services determines, on May 15, 2010, that: (1) 80 percent of
general assistance medical care enrollees are not enrolled in a coordinated care delivery
system established under Minnesota Statutes, section 256D.031; or (2) the coordinated
care delivery system does not provide access to care in all geographic areas of the state.
If the commissioner does not make this determination, 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. 24.

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. 25.

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
January 1, 2011. 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 July 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. 26.

Minnesota Statutes 2008, section 256B.441, is amended by adding a
subdivision to read:


new text begin Subd. 60. new text end

new text begin Nursing facility rate reductions effective July 1, 2010. new text end

new text begin (a) Effective for
the rate period July 1, 2010, through June 30, 2011, the commissioner shall increase the
operating payment rate of each nursing facility reimbursed under this section or section
256B.434 by 2.0 percent of the operating payment rate in effect on June 30, 2010.
new text end

new text begin (b) Effective July 1, 2011, the commissioner shall increase the operating payment
rate of each nursing facility reimbursed under this section or section 256B.434 by 1.5
percent.
new text end

Sec. 27.

Minnesota Statutes 2008, section 256B.5012, is amended by adding a
subdivision to read:


new text begin Subd. 9. new text end

new text begin ICF/MR rate reductions effective July 1, 2010. new text end

new text begin Effective for the rate
period July 1, 2010, through June 30, 2011, the commissioner shall increase the operating
payment rate of each facility reimbursed under this section by 2.0 percent of the operating
payment rates in effect on June 30, 2010. Effective July 1, 2011, the commissioner
shall increase the operating payment rate of each facility reimbursed under this section
by 1.5 percent.
new text end

Sec. 28.

Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 5a,
is amended to read:


Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section and
county-based purchasing plan's payment rate under section 256B.692 for the prepaid
medical assistance and general assistance medical care programs 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, including characteristics of the plan's enrollee
population. The withheld funds must be returned no sooner than July of the following
year if performance targets in the contract are achieved. The commissioner may exclude
special demonstration projects under subdivision 23.

(d) Effective for services rendered on or after January 1, 2009, through December 31,
2009, the commissioner shall withhold three percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance and general assistance medical care programs. The withheld
funds must be returned no sooner than July 1 and no later than July 31 of the following
year. The commissioner may exclude special demonstration projects under subdivision 23.

The return of the withhold under this paragraph is not subject to the requirements of
paragraph (c).

(e) Effective for services provided on or after January 1, 2010, the commissioner
shall require that managed care plans use the assessment and authorization processes,
forms, timelines, standards, documentation, and data reporting requirements, protocols,
billing processes, and policies consistent with medical assistance fee-for-service or the
Department of Human Services contract requirements consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all
personal care assistance services under section 256B.0659.

(f) Effective for services rendered on or after January 1, 2010, through December
31, 2010, the commissioner shall withhold 3.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(g) Effective for services rendered on or after January 1, 2011, through December
31, 2011, the commissioner shall withhold four percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(h) Effective for services rendered on or after January 1, 2012, through December
31, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(i) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.

(j) Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance and prepaid general assistance medical care programs. The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following year. The
commissioner may exclude special demonstration projects under subdivision 23.

(k) 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 that is reasonably expected to be returned.

(l) Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.

new text begin (m) Effective for services rendered on or after January 1, 2011, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction in
the health plan's emergency room utilization rate for state health care program enrollees
by a measurable rate of five percent from the plan's utilization rate for state health care
program enrollees for the previous calendar year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for each consecutive contract
period until the managed care plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the managed care plan's emergency room
utilization rate for state health care program enrollees for calendar year 2009.
new text end

Sec. 29.

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 July 1,
2011, 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 1.3 percent.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 30.

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 and MinnesotaCare programs is reduced by one percent. 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. 31.

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


new text begin Subd. 5m. new text end

new text begin Limits on net income and administrative costs; enabling expansion of
prepaid medical assistance.
new text end

new text begin (a) Notwithstanding any other law to the contrary, the total
monthly net income received by a managed care plan for providing covered services under
the public programs must not exceed six percent of the total monthly revenues the managed
care plan receives from the program. For purposes of this paragraph, "net income" means
total revenues received by the managed care plan under the program minus expenses and
other adjustments, all as required to be defined for purposes of the managed care plan's
annual Statement of Revenue, Expenses, and Net Income, prepared using the appropriate
National Association of Insurance Commissioners Blank and related instructions for health
maintenance organizations, as required and amended by Minnesota Rules, part 4685.1940.
The managed care plan shall refund any amounts of net monthly income in excess of six
percent to the commissioner, no later than 30 days after the end of each month.
new text end

new text begin (b) For services rendered under paragraph (a), allowable administrative costs for a
managed care plan are the per-enrollee dollar amount allowed in 2009.
new text end

new text begin (c) The commissioner shall use 100 percent of savings in costs to the state achieved
under this subdivision to provide equal percentage increases in operating payment rates
for nursing facilities under section 256B.441.
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. 32.

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 June 1, 2010, only if the
commissioner of human services determines, on May 15, 2010, that: (1) 80 percent of
general assistance medical care enrollees are not enrolled in a coordinated care delivery
system established under Minnesota Statutes, section 256D.031; or (2) the coordinated
care delivery system does not provide access to care in all geographic areas of the state.
If the commissioner does not make this determination, 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. 33.

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. 34.

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. 35.

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 the specified fiscal years 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. 36.

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. 37.

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 services rendered on or after October 1, 2010, medical assistance
payment for dental services for state-operated dental clinics shall be paid on a cost-based
payment system that is based on the cost-finding methods and allowable costs of the
Medicare program. This paragraph is effective January 1, 2011, for enrollees in managed
care receiving services at state-operated dental clinics.
new text end

new text begin (g) Effective beginning with fiscal year 2011, if the payments to state-operated
dental clinics in paragraph (f), including state and federal shares, are less than $1,800,000
per year, a supplemental state payment, equal to the difference between the total payments
in paragraph (f) and $1,800,000 shall be made from the general fund to state-operated
services to operate the dental clinics.
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. 38.

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. 39.

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. 40.

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. 41.

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. The commissioner shall implement
this section after any other rate adjustment that is effective July 1, 2010, and shall reduce
rates under this section by first reducing or eliminating provider rate add-ons.
new text end

Sec. 42.

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. 43.

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 December 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. 44.

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


Subd. 3b.

Cooperation.

(a) General assistance or general assistance medical care
applicants and recipients must cooperate with the state and local agency to identify
potentially liable third-party payors and assist the state in obtaining third-party payments.
Cooperation includes identifying any third party who may be liable for care and services
provided under this chapter to the applicant, recipient, or any other family member for
whom application is made and providing relevant information to assist the state in pursuing
a potentially liable third party. deleted text beginGeneral assistance medical care applicants and recipients
must cooperate by providing information about any group health plan in which they may
be eligible to enroll. They must cooperate with the state and local agency in determining
if the plan is cost-effective. For purposes of this subdivision, coverage provided by the
Minnesota Comprehensive Health Association under chapter 62E shall not be considered
group health plan coverage or cost-effective by the state and local agency. If the plan is
determined cost-effective and the premium will be paid by the state or local agency or is
available at no cost to the person, they must enroll or remain enrolled in the group health
plan. Cost-effective insurance premiums approved for payment by the state agency and
paid by the local agency are eligible for reimbursement according to subdivision 6.
deleted text end

(b) Effective for all premiums due on or after June 30, 1997, general assistance
medical care does not cover premiums that a recipient is required to pay under a qualified
or Medicare supplement plan issued by the Minnesota Comprehensive Health Association.
General assistance medical care shall continue to cover premiums for recipients who are
covered under a plan issued by the Minnesota Comprehensive Health Association on June
30, 1997, for a period of six months following receipt of the notice of termination or
until December 31, 1997, whichever is later.

new text begin EFFECTIVE DATE. new text end

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

Sec. 45.

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. 46.

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 July 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 47.

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) 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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 48.

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. 49.

Minnesota Statutes 2008, section 256L.04, subdivision 7, is amended to read:


Subd. 7.

Single adults and households with no children.

deleted text begin(a) The definition of
eligible persons includes all individuals and households with no children who have gross
family incomes that are equal to or less than 200 percent of the federal poverty guidelines.
deleted text end

deleted text begin (b) Effective July 1, 2009,deleted text end The definition of eligible persons includes all individuals
and households with no children who have gross family incomes that arenew text begin above 75 percent
and
new text end equal to or less than 250 percent of the federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon
implementation of medical assistance for adults without children under Minnesota Statutes,
sections 256B.055, subdivision 15, and 256B.056, subdivision 4, whichever is later.
new text end

Sec. 50.

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. 51.

Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.

new text begin (b) new text endFamilies enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above 275 percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner.

new text begin (c) new text enddeleted text beginBeginning January 1, 2008,deleted text end Individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose incomenew text begin decreases to 75 percent of the federal poverty
guidelines or less, or
new text end increases above deleted text begin200 percent of the federal poverty guidelines ordeleted text end
250 percent of the federal poverty guidelines deleted text beginon or after July 1, 2009deleted text end, are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivisionnew text begin due to income above the income limitsnew text end, MinnesotaCare
coverage terminates the last day of the calendar month following the month in which the
commissioner determines that the income of a family or individual exceeds program
income limits.new text begin Persons disenrolled under this subdivision due to income at or above 75
percent of the federal poverty guidelines shall have eligibility redetermined for medical
assistance under section 256B.055, subdivision 15.
new text end

deleted text begin (b)deleted text endnew text begin (d)new text end Notwithstanding paragraph (a), children may remain enrolled in
MinnesotaCare if ten percent of their gross individual or gross family income as defined in
section 256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (c)deleted text endnew text begin (e)new text end Notwithstanding paragraphs (a) and deleted text begin(b)deleted text endnew text begin (d)new text end, parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon
implementation of medical assistance for adults without children under Minnesota Statutes,
sections 256B.055, subdivision 15, and 256B.056, subdivision 4, whichever is later.
new text end

Sec. 52.

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 53.

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. 54.

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. 55.

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 July 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 56.

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. 57.

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. 58.

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 August 31, 2011. Subdivision 4 expires February 28, 2012new text end.

Sec. 59.

Laws 2010, chapter 200, article 1, section 12, subdivision 5, is amended to
read:


Subd. 5.

Payment rates and contract modification; April 1, 2010, to deleted text beginMaydeleted text endnew text begin
December
new text end 31, 2010.

(a) For the period April 1, 2010, to deleted text beginMaydeleted text endnew text begin Decembernew text end 31, 2010, general
assistance medical care shall be paid on a fee-for-service basis. Fee-for-service payment
rates for services other than outpatient prescription drugs shall be set at deleted text begin37deleted text endnew text begin 27new text end percent of
the payment rate in effect on March 31, 2010.

(b) Outpatient prescription drugs covered under section 256D.03, subdivision
3
, provided on or after April 1, 2010, to deleted text beginMaydeleted text endnew text begin Decembernew text end 31, 2010, shall be paid on a
fee-for-service basis according to section 256B.0625, subdivisions 13 to 13g.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2010, only if the
commissioner of human services determines, on May 15, 2010, that: (1) 80 percent of
general assistance medical care enrollees are not enrolled in a coordinated care delivery
system established under Minnesota Statutes, section 256D.031; or (2) the coordinated
care delivery system does not provide access to care in all geographic areas of the state.
If the commissioner does not make this determination, 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. 60.

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 to 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 systemdeleted text begin, except in cases of an emergency. For purposes of this section,
deleted text enddeleted text beginemergency services are defined in accordance with Code of Federal Regulations, title
deleted text enddeleted text begin42, section deleted text enddeleted text begin(a)deleted text end.

(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. 61.

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. 62.

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, 2010.

(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. 63.

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 3, paragraph (e), regarding MinnesotaCare eligibility, and
subdivision 4 are effective June 1, 2010
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. 64.

Laws 2010, chapter 200, article 1, section 13, subdivision 1b, is amended to
read:


Subd. 1b.

MinnesotaCare enrollment by county agencies.

Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3. County agencies
shall perform all duties necessary to administer the MinnesotaCare program ongoing for
these enrollees, including the redetermination of MinnesotaCare eligibility at renewalnew text begin,
through January 1, 2011, or implementation of medical assistance for adults without
children under section 256B.055, subdivision 15, whichever is later
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. 65.

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. 66.

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
deleted text begin effective April 1, 2010deleted text endnew text begin effective January 1, 2011new text end.

(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. 67.

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. 68.

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. 69. new text beginHENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
new text end

new text begin (a) The commissioner, upon federal approval of a new waiver request or amendment
of an existing demonstration, may establish a pilot program in Hennepin County or
Ramsey County, or both, to test alternative and innovative integrated health care delivery
networks.
new text end

new text begin (b) Individuals eligible for the pilot program shall be individuals who are eligible for
medical assistance under Minnesota Statutes, section 256B.055, subdivision 15, and who
reside in Hennepin County or Ramsey County.
new text end

new text begin (c) Individuals enrolled in the pilot shall be enrolled in an integrated health care
delivery network in their county of residence. The integrated health care delivery network
in Hennepin County shall be a network, such as an accountable care organization or a
community-based collaborative care network, created by or including Hennepin County
Medical Center. The integrated health care delivery network in Ramsey County shall be
a network, such as an accountable care organization or community-based collaborative
care network, created by or including Regions Hospital.
new text end

new text begin (d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
Hennepin County and 3,500 enrollees for Ramsey County.
new text end

new text begin (e) In developing a payment system for the pilot programs, the commissioner shall
establish a total cost of care for the recipients enrolled in the pilot programs that equals
the cost of care that would otherwise be spent for these enrollees in the prepaid medical
assistance program.
new text end

new text begin (f) Counties may transfer funds necessary to support the nonfederal share of
payments for integrated health care delivery networks in their county. Such transfers per
county shall not exceed 15 percent of the expected expenses for county enrollees.
new text end

new text begin (g) The commissioner shall apply to the federal government for, or as appropriate,
cooperate with counties, providers, or other entities that are applying for any applicable
grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
111-152, that would further the purposes of or assist in the creation of an integrated health
care delivery network for the purposes of this subdivision, including, but not limited to, a
global payment demonstration or the community-based collaborative care network grants.
new text end

Sec. 70. 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 January 1, 2011, or upon federal
approval.
new text end

Sec. 71. new text beginPROVIDER RATE AND GRANT REDUCTIONS.
new text end

new text begin (a) The commissioner of human services, for the rate period July 1, 2010, through
June 30, 2011, shall increase grants, allocations, reimbursement rates, or rate limits, as
applicable, by 2.0 percent from the applicable amount in effect on June 30, 2010. Effective
July 1, 2011, the commissioner of human services shall increase grants, allocations,
reimbursement rates, or rate limits, as applicable, by 1.5 percent.
new text end

new text begin (b) The rate changes described in this section must be provided to:
new text end

new text begin (1) home and community-based waivered services for persons with developmental
disabilities or related conditions, including consumer-directed community supports, under
Minnesota Statutes, section 256B.501;
new text end

new text begin (2) home and community-based waivered services for the elderly, including
consumer-directed community supports, under Minnesota Statutes, section 256B.0915;
new text end

new text begin (3) waivered services under community alternatives for disabled individuals,
including consumer-directed community supports, under Minnesota Statutes, section
256B.49;
new text end

new text begin (4) community alternative care waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
new text end

new text begin (5) traumatic brain injury waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
new text end

new text begin (6) nursing services and home health services under Minnesota Statutes, section
256B.0625, subdivision 6a;
new text end

new text begin (7) personal care services and qualified professional supervision of personal care
services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
new text end

new text begin (8) private duty nursing services under Minnesota Statutes, section 256B.0625,
subdivision 7;
new text end

new text begin (9) day training and habilitation services for adults with developmental disabilities
or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
additional cost of rate adjustments on day training and habilitation services, provided as a
social service under Minnesota Statutes, section 256M.60;
new text end

new text begin (10) alternative care services under Minnesota Statutes, section 256B.0913;
new text end

new text begin (11) semi-independent living services (SILS) under Minnesota Statutes, section
252.275, including SILS funding under county social services grants formerly funded
under Minnesota Statutes, chapter 256I;
new text end

new text begin (12) community support services for deaf and hard-of-hearing adults with mental
illness who use or wish to use sign language as their primary means of communication
under Minnesota Statutes, section 256.01, subdivision 2; and deaf and hard-of-hearing
grants under Minnesota Statutes, sections 256C.233, 256C.25, and 256C.261; Laws 1985,
First Special Session chapter 9, article 1; Laws 1997, chapter 203, article 1, section 2,
subdivision 8, as amended by Laws 1997, First Special Session chapter 5, section 20;
and Laws 2007, chapter 147, article 19, section 3, subdivision 8, as amended by Laws
2008, chapter 317, section 3;
new text end

new text begin (13) consumer support grants under Minnesota Statutes, section 256.476;
new text end

new text begin (14) family support grants under Minnesota Statutes, section 252.32;
new text end

new text begin (15) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917,
and 256B.0928;
new text end

new text begin (16) disability linkage line grants under Minnesota Statutes, section 256.01,
subdivision 24; and
new text end

new text begin (17) housing access grants under Minnesota Statutes, section 256B.0658.
new text end

Sec. 72. new text beginSALARY REDUCTION; BENEFITS.
new text end

new text begin (a) The salaries of the commissioner of human services, the assistant commissioner
for chemical and mental health services, and all managerial employees of state-operated
services who are not subject to a collective bargaining agreement must be reduced by 20
percent until all full-time state-operated services employees who are subject to a collective
bargaining agreement who have been subject to a 20 percent reduction in hours since
May 1, 2009, have been offered the opportunity to return to full-time employment. The
Department of Human Services and affected employee groups or unions shall certify
when all affected employees have been offered the opportunity to return to full-time
employment.
new text end

new text begin (b) Cost savings resulting from the reduction in salaries for the commissioner,
assistant commissioner, and managerial employees shall be expended to restore benefits
and wages for the affected employee groups or unions who have been adversely affected
by the reduction in hours and loss of benefits.
new text end

Sec. 73. new text beginAPPROPRIATION.
new text end

new text begin (a) Any fiscal savings resulting from the cap on abortion services in section 17 are
appropriated to the Department of Human Services for fiscal year 2011 for the purposes of
the Mothers First program.
new text end

new text begin (b) Any fiscal savings resulting from the cap on abortion services in section 17 are
appropriated to the Department of Human Services for children and economic assistance
grants for fiscal years 2012 and 2013.
new text end

Sec. 74. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Laws 2010, chapter 200, article 1, section 12, subdivisions 6, 7, 8, 9, and 10, new text end new text begin are
repealed effective June 1, 2010, only if the commissioner of human services determines,
on May 15, 2010, that: (1) 80 percent of general assistance medical care enrollees are not
enrolled in a coordinated care delivery system established under Minnesota Statutes,
section 256D.031; or (2) the coordinated care delivery system does not provide access
to care in all geographic areas of the state. If the commissioner does not make this
determination, this paragraph 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

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

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
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

new text begin (d) Upon federal approval of the amendments to Minnesota Statutes, sections
256B.055, subdivision 15 and 256B.056, subdivision 4, or January 1, 2011, whichever
is later, all remaining unspent appropriations for the program established by Laws 2010,
chapter 200 are transferred to the health care access fund.
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.

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. 3.

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 The amendments to paragraph (e) are effective July 1, 2011.
The amendments to all other paragraphs in this section are effective January 1, 2011.
new text end

Sec. 4.

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. 5.

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. 6.

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 deleted text beginfordeleted text end
deleted text begin contract years starting in 2012,deleted text end 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 deleted text beginyearsdeleted text endnew text begin yearnew text end 2010 deleted text beginand 2011deleted text end 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. new text beginEffective December
31, 2010, enrollment and operation of the MnDHO program in effect during calendar year
2010 must close. The commissioner may reopen the program provided all applicable
conditions of this section are met.
new text end 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
deleted text begin further expansion ofdeleted text end 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 deleted text beginby February 1, 2007deleted text endnew text begin prior to any further implementation or expansionnew text end.

(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. 7.

Laws 2009, chapter 79, article 8, section 51, the effective date, is amended to
read:


EFFECTIVE DATE.

This section is effective deleted text beginJanuarydeleted text endnew text begin Julynew text end 1, 2011.

Sec. 8. 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. 9.

Laws 2009, chapter 79, article 8, section 81, is amended to read:


Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.

(a) The commissioner of human services shall consult with disability service
providers, advocates, counties, and consumer families to develop a single set of standardsnew text begin,
to be referred to as "quality outcome standards,"
new text end governing services for people with
disabilities receiving services under the home and community-based waiver services
program to replace all or portions of existing laws and rules including, but not limited
to, data practices, licensure of facilities and providers, background studies, reporting
of maltreatment of minors, reporting of maltreatment of vulnerable adults, and the
psychotropic medication checklist. The standards must:

(1) enable optimum consumer choice;

(2) be consumer driven;

(3) link services to individual needs and life goals;

(4) be based on quality assurance and individual outcomes;

(5) utilize the people closest to the recipient, who may include family, friends, and
health and service providers, in conjunction with the recipient's risk management plan to
assist the recipient or the recipient's guardian in making decisions that meet the recipient's
needs in a cost-effective manner and assure the recipient's health and safety;

(6) utilize person-centered planning; and

(7) maximize federal financial participation.

(b) The commissioner may consult with existing stakeholder groups convened under
the commissioner's authority, including the home and community-based expert services
panel established by the commissioner in 2008, to meet all or some of the requirements
of this section.

(c) The commissioner shall provide the reports and plans required by this section to
the legislative committees and budget divisions with jurisdiction over health and human
services policy and finance by January 15, 2012.

Sec. 10. 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

Sec. 11. new text beginICF/MR RATE INCREASE.
new text end

new text begin The daily rate at an intermediate care facility for the developmentally disabled
located in Clearwater County and classified as a Class A facility with 15 beds shall be
increased from $112.73 to $138.23 for the rate period July 1, 2010, to June 30, 2011.
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 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 that:

(1) 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

(2) deleted text beginthey have financial resources, excluding vehicles, of less than $7,000.deleted text endnew text begin to the
extent allowable under federal law and regulations, they have a vehicle valued at less than
$50,000, regardless of the use of the vehicle.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2008, section 256D.425, subdivision 2, is amended to read:


Subd. 2.

Resource standards.

The resource standards and restrictions for
supplemental aid under this section shall be those used to determine eligibility for
disabled individuals in the supplemental security income programnew text begin, except that to the
extent allowable under federal law and regulations, vehicles must be valued at less than
$50,000, regardless of the use of the vehicle
new text end.

Sec. 6.

Minnesota Statutes 2009 Supplement, section 256D.44, subdivision 5, is
amended to read:


Subd. 5.

Special needs.

In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential housing facility.

(a) The county agency shall pay a monthly allowance for medically prescribed
diets if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for special diets or dietary items must be prescribed by
a licensed physician. Costs for special diets shall be determined as percentages of the
allotment for a one-person household under the thrifty food plan as defined by the United
States Department of Agriculture. The types of diets and the percentages of the thrifty
food plan that are covered are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
of thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using
the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent
of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
guardian or conservator is a member of the county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
1990, and who eats two or more meals in a restaurant daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full calendar month
or until the person's living arrangement changes and the person no longer meets the criteria
for the restaurant meal allowance, whichever occurs first.

(e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets the
requirements under SSI regulations to charge a fee for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid regardless of
their living arrangement.

(f)(1) Notwithstanding the language in this subdivision, an amount equal to the
maximum allotment authorized by the federal Food Stamp Program for a single individual
which is in effect on the first day of July of each year will be added to the standards of
assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
as shelter needy and are: (i) relocating from an institution, or an adult mental health
residential treatment program under section 256B.0622; (ii) eligible for the self-directed
supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
community-based waiver recipients deleted text beginliving in their own home or rented or leased apartment
which is not owned, operated, or controlled by a provider of service not related by blood
or marriage
deleted text end.

(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
shelter needy benefit under this paragraph is considered a household of one. An eligible
individual who receives this benefit prior to age 65 may continue to receive the benefit
after the age of 65.

(3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
exceed 40 percent of the assistance unit's gross income before the application of this
special needs standard. "Gross income" for the purposes of this section is the applicant's or
recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
considered shelter needy for purposes of this paragraph.

(g) Notwithstanding this subdivision, to access housing and services as provided in
paragraph (f), the recipient may choose housing that may or may not be owned, operated,
or controlled by the recipient's service provider deleted text beginif the housing is located in a multifamily
deleted text enddeleted text beginbuilding of six or more unitsdeleted text end. new text beginIn a multiunit building of six or more units,new text end the maximum
number of units that may be used by recipients of this program shall be 50 percent of the
units in a building. deleted text beginThe department deleted text enddeleted text beginshall develop an exception process to the 50 percent
maximum.
deleted text end This paragraph expires on June 30, deleted text begin2011deleted text end new text begin2012new text end.

Sec. 7.

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


new text begin Subd. 1n. new text end

new text begin Supplemental rate; Mahnomen County. new text end

new text begin Notwithstanding the
provisions of this section, for the rate period July 1, 2010, to June 30, 2011, a county
agency shall negotiate a supplemental service rate in addition to the rate specified in
subdivision 1, not to exceed $753 per month or the existing rate, including any legislative
authorized inflationary adjustments, for a group residential provider located in Mahnomen
County that operates a 28-bed facility providing 24-hour care to individuals who are
homeless, disabled, chemically dependent, mentally ill, or chronically homeless.
new text end

Sec. 8.

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 March 1, 2011.
new text end

Sec. 9.

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. 10.

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 February 1, 2011.
new text end

Sec. 11.

Minnesota Statutes 2008, section 256J.39, is amended by adding a subdivision
to read:


new text begin Subd. 1a. new text end

new text begin EBT cards; prohibited activities. new text end

new text begin (a) MFIP recipients are prohibited
from using MFIP monthly cash assistance payments issued in the form of an electronic
benefits transfer to purchase tobacco products, alcoholic beverages, as defined in section
340A.101, subdivision 2, or lottery tickets.
new text end

new text begin (b) MFIP recipients are prohibited from using MFIP monthly cash assistance
payments issued in the form of an electronic benefits transfer at vendors located outside
of Minnesota.
new text end

Sec. 12.

Minnesota Statutes 2008, section 256J.39, is amended by adding a subdivision
to read:


new text begin Subd. 1b. new text end

new text begin EBT cards; photo identification required. new text end

new text begin Cashiers at points-of-sale
shall request photo identification when an MFIP electronic benefits transfer card is
presented.
new text end

Sec. 13.

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. 14. 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. 15. 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 (e) A health plan company is in compliance with this section if it does not include
orally administered anticancer medication in the fourth tier of its pharmacy benefit.
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. These programs must maintain current levels of coverage, and section
256B.0644 shall continue to apply. The state employee group insurance plan is not subject
to this section until July 1, 2013, but must fully comply with this section on and after
that date. 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) Private duty nursing services, as provided under section 256B.0625, subdivision
7, with the exception of section 256B.0654, subdivision 4, shall be provided by a
health plan company for persons who require private duty nursing services and who
are concurrently covered by a health plan, as defined in section 62Q.01, and enrolled in
medical assistance under chapter 256B.
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.
Nothing in this section is intended to prevent a health plan company from requiring
prior authorization by the health plan company for services required under 256B.0625,
subdivision 7, or using contracted providers under the applicable provisions of the plan.
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 [62V.01] CITATION AND PURPOSE.
new text end

new text begin This chapter may be cited as the "Interstate Health Insurance Competition Act."
new text end

Sec. 8.

new text begin [62V.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The definitions in this section apply to this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of commerce.
new text end

new text begin Subd. 3. new text end

new text begin Covered person. new text end

new text begin "Covered person" means an individual, whether a
policyholder, subscriber, enrollee, or member of a health plan who is entitled to health
care services provided, arranged for, paid for, or reimbursed pursuant to a health plan.
new text end

new text begin Subd. 4. new text end

new text begin Domestic health insurer. new text end

new text begin "Domestic health insurer" means an insurer
licensed to sell, offer, or provide health plans in Minnesota.
new text end

new text begin Subd. 5. new text end

new text begin Hazardous financial condition. new text end

new text begin "Hazardous financial condition" means
that, based on its present or reasonably anticipated financial condition, an out-of-state
health insurer is unlikely to be able to meet obligations to policyholders with respect to
known claims or to any other obligations in the normal course of business.
new text end

new text begin Subd. 6. new text end

new text begin Health care provider or provider. new text end

new text begin "Health care provider" or "provider"
means any hospital, physician, or other person authorized by statute, licensed, or certified
to furnish health care services.
new text end

new text begin Subd. 7. new text end

new text begin Health care services. new text end

new text begin "Health care services" means the furnishing of
services to any individual for the purpose of preventing, alleviating, curing, or healing
human illness, injury, or physical disability.
new text end

new text begin Subd. 8. new text end

new text begin Health plan. new text end

new text begin "Health plan" means an arrangement for the delivery of
health care, on an individual basis, in which an insurer undertakes to provide, arrange
for, pay for, or reimburse any of the costs of health care services for a covered person
that is in accordance with the laws of any state. Health plan does not include short-term
health coverage, accident only, limited or specified disease, long-term care or individual
conversion policies or contracts, or policies or contracts designed for issuance to persons
eligible for coverage under title XVIII of the federal Social Security Act, known as
Medicare, or any other similar coverage under state or federal governmental plans.
new text end

new text begin Subd. 9. new text end

new text begin Insurer. new text end

new text begin "Insurer" means any entity that is authorized to sell, offer, or
provide a health plan, including an entity providing a plan of health insurance, health
benefits, or health services, an accident and sickness insurance company, a health
maintenance organization, a corporation offering a health plan, a fraternal benefit society,
a community integrated service network, or any other entity that provides health plans
subject to state insurance regulation, or a health carrier described in section 62A.011,
subdivision 2.
new text end

new text begin Subd. 10. new text end

new text begin Out-of-state health plan. new text end

new text begin "Out-of-state health plan" means a health plan
that was filed for use in any other state.
new text end

new text begin Subd. 11. new text end

new text begin Resident. new text end

new text begin "Resident" means an individual whose primary residence is in
Minnesota and who is present in Minnesota for at least six months of the calendar year.
new text end

Sec. 9.

new text begin [62V.03] OUT-OF-STATE HEALTH PLANS TO MINNESOTA
RESIDENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin (a) Notwithstanding any other law to the contrary, a
health insurer may sell, offer, or issue an out-of-state health plan to residents in Minnesota,
if the following requirements are met:
new text end

new text begin (1) the out-of-state health plan must be in compliance with all applicable Minnesota
laws that apply to the type of health plan offered;
new text end

new text begin (2) the out-of-state health plan must not be issued, nor any application, rider, or
endorsement be used in connection with the plan, until the form has received prior
approval in Minnesota;
new text end

new text begin (3) the offering insurer must have a certificate of authority to do business in
Minnesota pursuant to section 60A.07; and
new text end

new text begin (4) the out-of-state health plan shall participate, on a nondiscriminatory basis, in the
Minnesota Life and Health Insurance Guaranty Association created under chapter 61B.
new text end

new text begin (b) The provisions of section 62A.02, subdivision 2, shall not apply to plans issued
under this section.
new text end

new text begin Subd. 2. new text end

new text begin Minnesota laws applicable. new text end

new text begin An out-of-state health plan sold, offered, or
provided by a health insurer in Minnesota in accordance with this chapter is subject to laws
applicable to the sale, offering, or provision of accident and sickness insurance or health
plans including, but not limited to, requirements imposed by chapters 62A, 62E, and 62Q.
new text end

new text begin Subd. 3. new text end

new text begin Nature of out-of-state health insurer. new text end

new text begin The out-of-state health insurer
may be a for-profit or nonprofit company.
new text end

Sec. 10.

new text begin [62V.04] CERTIFICATE OF AUTHORITY TO OFFER OUT-OF-STATE
HEALTH PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Issuance of certificate. new text end

new text begin A health insurer may apply for a certificate
that authorizes the health insurer to offer out-of-state health insurance plans in Minnesota,
using a form prescribed by the commissioner. Upon application, the commissioner shall
issue a certificate to the health insurer unless the commissioner determines that the
out-of-state health insurer:
new text end

new text begin (1) will not provide a health plan in compliance with this chapter;
new text end

new text begin (2) is in a hazardous financial condition, as determined by an examination by the
commissioner conducted in accordance with the Financial Analysis Handbook of the
National Association of Insurance Commissioners; or
new text end

new text begin (3) has not adopted procedures to ensure compliance with all applicable laws
governing the confidentiality of its records with respect to providers and covered persons.
new text end

new text begin Subd. 2. new text end

new text begin Validity. new text end

new text begin A certificate of authority issued pursuant to this section is valid
for three years from the date of issuance by the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Rulemaking authority. new text end

new text begin The commissioner shall adopt rules that include:
new text end

new text begin (1) procedures for an out-of-state health insurer to renew a certificate of authority,
consistent with this chapter; and
new text end

new text begin (2) a certificate of authority application and renewal fees, the amount of which must
be no greater than is reasonably necessary to enable the commissioner of commerce
to carry out the provisions of this chapter.
new text end

new text begin Subd. 4. new text end

new text begin Applicability of certain statutory requirements. new text end

new text begin A health insurer
offering health plans pursuant to this chapter shall comply with:
new text end

new text begin (1) protections for covered persons from unfair trade practices applicable to accident
and sickness insurance or health plans pursuant to chapter 72A;
new text end

new text begin (2) the capital and surplus requirements for licensure specified in chapter 60A, as
determined applicable to out-of-state health insurers by the commissioner;
new text end

new text begin (3) applicable requirements of this chapter and sections 297I.05, subdivision 12, and
62E.11, pertaining to taxes and assessments imposed on health insurers selling individual
health insurance policies in Minnesota; and
new text end

new text begin (4) applicable requirements of chapter 60A regarding the obtaining of authority to
transact business in Minnesota.
new text end

Sec. 11.

new text begin [62V.06] REVOCATION OF CERTIFICATE OF AUTHORITY;
MARKETING MATERIALS.
new text end

new text begin Subdivision 1. new text end

new text begin Revocation. new text end

new text begin The commissioner may deny, revoke, or suspend, after
notice and opportunity to be heard, a certificate of authority issued to a health insurer
pursuant to this chapter for a violation of this chapter, including any finding by the
commissioner that a health insurer is no longer in compliance with any of the conditions
for issuance of a certificate of authority set forth in section 60A.07, or the administrative
rules adopted pursuant to this chapter. The commissioner shall provide for an appropriate
and timely right of appeal for the out-of-state health insurer whose certificate is denied,
revoked, or suspended.
new text end

new text begin Subd. 2. new text end

new text begin Fair marketing standards. new text end

new text begin The commissioner shall establish fair
marketing standards for marketing materials used by out-of-state health insurers to market
health plans to residents in Minnesota, which standards must be consistent with those
applicable to health plans offered by a domestic health insurer pursuant to chapter 72A.
new text end

new text begin Subd. 3. new text end

new text begin Nondiscrimination. new text end

new text begin The procedures and standards established under
subdivision 2 must be applied on a nondiscriminatory basis so as not to place greater
responsibilities on out-of-state health insurers than the responsibilities placed on domestic
health insurers doing business in Minnesota.
new text end

Sec. 12.

new text begin [62V.07] RULES.
new text end

new text begin The commissioner shall adopt rules to effectuate the purposes of this chapter. The
rules must not:
new text end

new text begin (1) directly or indirectly require an insurer offering out-of-state health plans to,
directly or indirectly, modify coverage or benefit requirements or restrict underwriting
requirements or premium ratings in any way that conflicts with the insurer's domiciliary
state's laws or regulations, except as necessary to comply with Minnesota law;
new text end

new text begin (2) provide for regulatory requirements that are more stringent than those applicable
to carriers providing Minnesota health plans; or
new text end

new text begin (3) require any out-of-state health plan issued by the health insurer to be
countersigned by an insurance agent or broker residing in Minnesota.
new text end

Sec. 13.

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. 14.

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. 15.

Minnesota Statutes 2009 Supplement, section 245A.11, subdivision 7b,
is amended to read:


Subd. 7b.

Adult foster care data privacy and security.

(a) An adult foster
care license holder who creates, collects, records, maintains, stores, or discloses any
individually identifiable recipient data, whether in an electronic or any other format,
must comply with the privacy and security provisions of applicable privacy laws and
regulations, including:

(1) the federal Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
title 45, part 160, and subparts A and E of part 164; and

(2) the Minnesota Government Data Practices Act as codified in chapter 13.

(b) For purposes of licensure, the license holder shall be monitored for compliance
with the following data privacy and security provisions:

(1) the license holder must control access to data on foster care recipients according
to the definitions of public and private data on individuals under section 13.02;
classification of the data on individuals as private under section 13.46, subdivision 2;
and control over the collection, storage, use, access, protection, and contracting related
to data according to section 13.05, in which the license holder is assigned the duties
of a government entity;

(2) the license holder must provide each foster care recipient with a notice that
meets the requirements under section 13.04, in which the license holder is assigned the
duties of the government entity, and that meets the requirements of Code of Federal
Regulations, title 45, part 164.52. The notice shall describe the purpose for collection of
the data, and to whom and why it may be disclosed pursuant to law. The notice must
inform the recipient that the license holder uses electronic monitoring and, if applicable,
that recording technology is used;

(3) the license holder must not install monitoring cameras in bathrooms;

(4) electronic monitoring cameras must not be concealed from the foster care
recipients; and

(5) electronic video and audio recordings of foster care recipients shall not be stored
by the license holder for more than five daysnew text begin unless the recording is pertinent to an
investigation of a reported incident of abuse or neglect under section 626.556 or 626.557,
or if requested by a recipient or the recipient's legal representative for a specific reported
incident of abuse or neglect
new text end.

(c) The commissioner shall develop, and make available to license holders and
county licensing workers, a checklist of the data privacy provisions to be monitored
for purposes of licensure.

Sec. 16.

Minnesota Statutes 2008, section 246B.04, subdivision 2, is amended to read:


Subd. 2.

Ban on obscene materialdeleted text begin ordeleted text endnew text begin,new text end pornographic worknew text begin, or certain drugsnew text end.

The commissioner shall prohibit persons civilly committed as sexual psychopathic
personalities or sexually dangerous persons under section 253B.185 from having or
receiving material that is obscene as defined under section 617.241, subdivision 1,
material that depicts sexual conduct as defined under section 617.241, subdivision 1, deleted text beginordeleted text end
pornographic work as defined under section 617.246, subdivision 1, new text beginor drug used for the
treatment of impotence or erectile dysfunction
new text endwhile receiving services in any secure
treatment facilities operated by the Minnesota sex offender program or any other facilities
operated by the commissioner.

Sec. 17.

Minnesota Statutes 2009 Supplement, section 246B.06, subdivision 6, is
amended to read:


Subd. 6.

Wages.

new text begin(a) new text endNotwithstanding section 177.24 or any other law to the
contrary, the commissioner of human services has the discretion to set the pay rate for
clients participating in the vocational work program. The commissioner has the authority
to retain up to 50 percent of any payments made to a client participating in the vocational
work program for the purpose of reducing state costs associated with operating the
Minnesota sex offender program.

new text begin (b) A client who receives payments is prohibited from spending any of the funds
received on drugs used for the treatment of impotence or erectile dysfunction while
receiving services in any treatment facilities operated by the Minnesota sex offender
program or any other facilities operated by the commissioner.
new text end

Sec. 18.

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. Remaining
beds shall be converted into community-based transitional intensive treatment foster
homes in the Cambridge area and staffed by state employees.
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. 19.

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. 20.

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. 21.

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. 22.

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. 23.

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. 24.

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. 25.

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. 26.

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. 27.

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. 28.

Minnesota Statutes 2009 Supplement, section 289A.08, subdivision 3, is
amended to read:


Subd. 3.

Corporations.

(a) A corporation that is subject to the state's jurisdiction to
tax under section 290.014, subdivision 5, must file a returndeleted text begin, except that a foreign operating
corporation as defined in section 290.01, subdivision 6b, is not required to file a return
deleted text end.

(b) Members of a unitary business that are required to file a combined report on one
return must designate a member of the unitary business to be responsible for tax matters,
including the filing of returns, the payment of taxes, additions to tax, penalties, interest,
or any other payment, and for the receipt of refunds of taxes or interest paid in excess of
taxes lawfully due. The designated member must be a member of the unitary business that
is filing the single combined report and either:

(1) a corporation that is subject to the taxes imposed by chapter 290; or

(2) a corporation that is not subject to the taxes imposed by chapter 290:

(i) Such corporation consents by filing the return as a designated member under this
clause to remit taxes, penalties, interest, or additions to tax due from the members of the
unitary business subject to tax, and receive refunds or other payments on behalf of other
members of the unitary business. The member designated under this clause is a "taxpayer"
for the purposes of this chapter and chapter 270C, and is liable for any liability imposed
on the unitary business under this chapter and chapter 290.

(ii) If the state does not otherwise have the jurisdiction to tax the member designated
under this clause, consenting to be the designated member does not create the jurisdiction
to impose tax on the designated member, other than as described in item (i).

(iii) The member designated under this clause must apply for a business tax account
identification number.

(c) The commissioner shall adopt rules for the filing of one return on behalf of the
members of an affiliated group of corporations that are required to file a combined report.
All members of an affiliated group that are required to file a combined report must file one
return on behalf of the members of the group under rules adopted by the commissioner.

(d) If a corporation claims on a return that it has paid tax in excess of the amount of
taxes lawfully due, that corporation must include on that return information necessary for
payment of the tax in excess of the amount lawfully due by electronic means.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after
December 31, 2009.
new text end

Sec. 29.

Minnesota Statutes 2008, section 290.01, subdivision 5, is amended to read:


Subd. 5.

Domestic corporation.

The term "domestic" when applied to a corporation
means a corporation:

(1) created or organized in the United States, or under the laws of the United States
or of any state, the District of Columbia, or any political subdivision of any of the
foregoing but not including the Commonwealth of Puerto Rico, or any possession of
the United States;

(2) which qualifies as a DISC, as defined in section 992(a) of the Internal Revenue
Code; deleted text beginor
deleted text end

(3) which qualifies as a FSC, as defined in section 922 of the Internal Revenue Codedeleted text begin.deleted text endnew text begin;
new text end

new text begin (4) which is incorporated in a tax haven;
new text end

new text begin (5) which is engaged in activity in a tax haven sufficient for the tax haven to impose
a net income tax under United States constitutional standards and section 290.015, and
which reports that 20 percent or more of its income is attributable to business in the tax
haven; or
new text end

new text begin (6) which has the average of its property, payroll, and sales factors, as defined under
section 290.191, within the 50 states of the United States and the District of Columbia of
20 percent or more.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after
December 31, 2009.
new text end

Sec. 30.

Minnesota Statutes 2008, section 290.01, is amended by adding a subdivision
to read:


new text begin Subd. 5c. new text end

new text begin Tax haven. new text end

new text begin (a) "Tax haven" means a foreign jurisdiction designated
under this subdivision.
new text end

new text begin (b) The commissioner may designate a foreign jurisdiction as a tax haven by
administrative rule if the jurisdiction:
new text end

new text begin (1) has no or nominal effective tax on the relevant income; and
new text end

new text begin (2)(i) has laws or practices that prevent effective exchange of information for tax
purposes with other governments on taxpayers benefiting from the tax regime;
new text end

new text begin (ii) has a tax regime that lacks transparency. A tax regime lacks transparency if the
details of legislative, legal, or administrative provisions are not open and apparent or are
not consistently applied among similarly situated taxpayers, or if the information needed
by tax authorities to determine a taxpayer's correct tax liability, such as accounting records
and underlying documentation, is not adequately available;
new text end

new text begin (iii) facilitates the establishment of foreign-owned entities without the need for a
local substantive presence or prohibits these entities from having any commercial impact
on the local economy;
new text end

new text begin (iv) explicitly or implicitly excludes the jurisdiction's resident taxpayers from taking
advantage of the tax regime's benefits or prohibits enterprises that benefit from the regime
from operating in the jurisdiction's domestic markets; or
new text end

new text begin (v) has created a tax regime that is favorable for tax avoidance, based upon an
overall assessment of relevant factors, including whether the jurisdiction has a significant
untaxed offshore financial or other services sector relative to its overall economy.
new text end

new text begin (c) The following foreign jurisdictions are deemed to be tax havens:
new text end

new text begin (1) Anguilla;
new text end

new text begin (2) Antigua and Barbuda;
new text end

new text begin (3) Aruba;
new text end

new text begin (4) Bahamas;
new text end

new text begin (5) Barbados;
new text end

new text begin (6) Belize;
new text end

new text begin (7) Bermuda;
new text end

new text begin (8) British Virgin Islands;
new text end

new text begin (9) Cayman Islands;
new text end

new text begin (10) Cook Islands;
new text end

new text begin (11) Dominica;
new text end

new text begin (12) Gibraltar;
new text end

new text begin (13) Grenada;
new text end

new text begin (14) Guernsey-Sark-Alderney;
new text end

new text begin (15) Isle of Man;
new text end

new text begin (16) Jersey;
new text end

new text begin (17) Latvia;
new text end

new text begin (18) Liechtenstein;
new text end

new text begin (19) Luxembourg;
new text end

new text begin (20) Nauru;
new text end

new text begin (21) Netherlands Antilles;
new text end

new text begin (22) Panama;
new text end

new text begin (23) Samoa;
new text end

new text begin (24) St. Kitts and Nevis;
new text end

new text begin (25) St. Lucia;
new text end

new text begin (26) St. Vincent and Grenadines;
new text end

new text begin (27) Turks and Caicos; and
new text end

new text begin (28) Vanuatu.
new text end

new text begin (d) The commissioner shall revoke a foreign jurisdiction's listing under paragraph
(b) or (c), as applicable, if the United States enters into a tax treaty or other agreement
with the foreign jurisdiction that provides for prompt, obligatory, and automatic exchange
of information with the United States government relevant to enforcing the provisions of
federal tax laws and the treaty or other agreement was in effect for the taxable year.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after
December 31, 2009.
new text end

Sec. 31.

Minnesota Statutes 2009 Supplement, section 290.01, subdivision 19c,
is amended to read:


Subd. 19c.

Corporations; additions to federal taxable income.

For corporations,
there shall be added to federal taxable income:

(1) the amount of any deduction taken for federal income tax purposes for income,
excise, or franchise taxes based on net income or related minimum taxes, including but not
limited to the tax imposed under section 290.0922, paid by the corporation to Minnesota,
another state, a political subdivision of another state, the District of Columbia, or any
foreign country or possession of the United States;

(2) interest not subject to federal tax upon obligations of: the United States, its
possessions, its agencies, or its instrumentalities; the state of Minnesota or any other
state, any of its political or governmental subdivisions, any of its municipalities, or any
of its governmental agencies or instrumentalities; the District of Columbia; or Indian
tribal governments;

(3) exempt-interest dividends received as defined in section 852(b)(5) of the Internal
Revenue Code;

(4) the amount of any net operating loss deduction taken for federal income tax
purposes under section 172 or 832(c)(10) of the Internal Revenue Code or operations loss
deduction under section 810 of the Internal Revenue Code;

(5) the amount of any special deductions taken for federal income tax purposes
under sections 241 to 247 and 965 of the Internal Revenue Code;

(6) losses from the business of mining, as defined in section 290.05, subdivision 1,
clause (a), that are not subject to Minnesota income tax;

(7) the amount of any capital losses deducted for federal income tax purposes under
sections 1211 and 1212 of the Internal Revenue Code;

(8) the exempt foreign trade income of a foreign sales corporation under sections
921(a) and 291 of the Internal Revenue Code;

(9) the amount of percentage depletion deducted under sections 611 through 614 and
291 of the Internal Revenue Code;

(10) for certified pollution control facilities placed in service in a taxable year
beginning before December 31, 1986, and for which amortization deductions were elected
under section 169 of the Internal Revenue Code of 1954, as amended through December
31, 1985, the amount of the amortization deduction allowed in computing federal taxable
income for those facilities;

(11) new text beginfor taxable years beginning before January 1, 2010, new text endthe amount of any deemed
dividend from a foreign operating corporation determined pursuant to section 290.17,
subdivision 4
, paragraph (g). The deemed dividend shall be reduced by the amount of the
addition to income required by clauses (20), (21), (22), and (23);

(12) the amount of a partner's pro rata share of net income which does not flow
through to the partner because the partnership elected to pay the tax on the income under
section 6242(a)(2) of the Internal Revenue Code;

(13) the amount of net income excluded under section 114 of the Internal Revenue
Code;

(14) new text beginfor taxable years beginning before January 1, 2010, new text endany increase in subpart F
income, as defined in section 952(a) of the Internal Revenue Code, for the taxable year
when subpart F income is calculated without regard to the provisions of Division C, title
III, section 303(b) of Public Law 110-343;

(15) 80 percent of the depreciation deduction allowed under section 168(k)(1)(A)
and (k)(4)(A) of the Internal Revenue Code. For purposes of this clause, if the taxpayer
has an activity that in the taxable year generates a deduction for depreciation under
section 168(k)(1)(A) and (k)(4)(A) and the activity generates a loss for the taxable year
that the taxpayer is not allowed to claim for the taxable year, "the depreciation allowed
under section 168(k)(1)(A) and (k)(4)(A)" for the taxable year is limited to excess of the
depreciation claimed by the activity under section 168(k)(1)(A) and (k)(4)(A) over the
amount of the loss from the activity that is not allowed in the taxable year. In succeeding
taxable years when the losses not allowed in the taxable year are allowed, the depreciation
under section 168(k)(1)(A) and (k)(4)(A) is allowed;

(16) 80 percent of the amount by which the deduction allowed by section 179 of the
Internal Revenue Code exceeds the deduction allowable by section 179 of the Internal
Revenue Code of 1986, as amended through December 31, 2003;

(17) to the extent deducted in computing federal taxable income, the amount of the
deduction allowable under section 199 of the Internal Revenue Code;

(18) the exclusion allowed under section 139A of the Internal Revenue Code for
federal subsidies for prescription drug plans;

(19) the amount of expenses disallowed under section 290.10, subdivision 2