4th Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to human services; adding provisions for 1.3 health and continuing care related to medical 1.4 assistance and general assistance medical care, 1.5 long-term care, health plan regulations; making 1.6 technical and policy changes; appropriating money; 1.7 amending Minnesota Statutes 1994, sections 62D.04, 1.8 subdivision 5; 62N.10, subdivision 4; 62Q.075, 1.9 subdivision 2; 144.0722, by adding a subdivision; 1.10 144.572; 144.71, subdivisions 1 and 2; 144.72, 1.11 subdivisions 1 and 2; 144.73, subdivision 1; 144.74; 1.12 144A.04, by adding a subdivision; 144A.09, subdivision 1.13 1; 144A.20, subdivision 2; 145.61, subdivision 5; 1.14 148.235, by adding a subdivision; 148C.01, by adding a 1.15 subdivision; 148C.09, by adding a subdivision; 1.16 245.462, subdivision 4; 245.4871, subdivision 4; 1.17 245.94, subdivisions 2a and 3; 245.95, subdivision 2; 1.18 245.97, subdivision 6; 246.57, by adding a 1.19 subdivision; 253B.11, subdivision 2; 256.482, by 1.20 adding a subdivision; 256.73, subdivision 1, and by 1.21 adding a subdivision; 256.9355, subdivision 3; 1.22 256B.03, by adding a subdivision; 256B.056, 1.23 subdivisions 1 and 1a; 256B.0595, by adding 1.24 subdivisions; 256B.0627, subdivisions 1, as amended, 1.25 4, as amended, 5, as amended, and by adding a 1.26 subdivision; 256B.0913, subdivision 7, and by adding 1.27 subdivisions; 256B.0915, subdivision 1b, and by adding 1.28 subdivisions; 256B.15, by adding subdivisions; 1.29 256B.35, subdivision 1; 256B.37, subdivision 5; 1.30 256B.49, by adding a subdivision; 256B.501, by adding 1.31 subdivisions; 256B.69, by adding a subdivision; 1.32 256G.01, subdivision 3, and by adding subdivisions; 1.33 256G.02, subdivisions 4 and 6; 256G.03; 256G.06; 1.34 256G.07, subdivisions 1 and 2; 256G.08, subdivision 1; 1.35 256G.09, subdivision 2; 256G.10; 256I.04, subdivision 1.36 1; 256I.05, subdivision 1c, and by adding a 1.37 subdivision; 325F.71, subdivision 2; 327.14, 1.38 subdivision 8; 524.2-403; and 524.3-801; Minnesota 1.39 Statutes 1995 Supplement, sections 62Q.03, subdivision 1.40 8; 62Q.19, subdivisions 1 and 5; 62R.17; 144.122; 1.41 144.9503, subdivisions 6, 8, and 9; 144.9504, 1.42 subdivisions 2, 7, and 8; 144.9505, subdivision 4; 1.43 144A.071, subdivisions 3 and 4a; 148C.01, subdivisions 1.44 12 and 13; 148C.02, subdivisions 1 and 2; 148C.03, 1.45 subdivision 1; 148C.04, subdivisions 3, 4, and by 1.46 adding a subdivision; 148C.05, subdivision 1; 148C.06; 2.1 148C.11, subdivisions 1 and 3; 157.011, subdivision 1; 2.2 157.15, subdivisions 4, 5, 6, 9, 12, 13, 14, and by 2.3 adding subdivisions; 157.16; 157.17, subdivision 2; 2.4 157.20, subdivision 1, and by adding a subdivision; 2.5 157.21; 252.27, subdivision 2a; 256.045, subdivision 2.6 3; 256.969, subdivisions 1, 2b, 9, and 10; 256B.055, 2.7 subdivision 12; 256B.0575; 256B.0595, subdivisions 1, 2.8 2, 3, and 4; 256B.0625, subdivisions 17, 19a, and 30; 2.9 256B.0628, subdivision 2; 256B.0913, subdivisions 5 2.10 and 15a; 256B.0915, subdivisions 3 and 3a; 256B.093, 2.11 subdivision 3; 256B.15, subdivision 5; 256B.431, 2.12 subdivision 25; 256B.432, subdivision 2; 256B.434, 2.13 subdivision 10; 256B.49, subdivisions 6 and 7; 2.14 256B.501, subdivisions 5b and 5c; 256B.69, 2.15 subdivisions 3a, 4, 5b, 6, and 21; 256D.02, 2.16 subdivision 12a; 256D.03, subdivision 4; 256D.045; and 2.17 256I.04, subdivisions 2b and 3; Laws 1995, chapter 2.18 207, article 1, section 2, subdivision 4; proposing 2.19 coding for new law in Minnesota Statutes, chapters 2.20 62J; 144; 145; 252; 252B; 256; 256B; and 299A; 2.21 repealing Minnesota Statutes 1994, sections 144.691, 2.22 subdivision 4; 146.14; and 146.20; Minnesota Statutes 2.23 1995 Supplement, sections 157.03; 157.15, subdivision 2.24 2; 157.18; 157.19; 256B.15, subdivision 5; 256B.69, 2.25 subdivision 4a; 256G.05, subdivision 1; and 256G.07, 2.26 subdivision 3a; Minnesota Rules, part 9505.5230. 2.27 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 2.28 ARTICLE 1 2.29 APPROPRIATIONS 2.30 Section 1. [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 2.31 The sums shown in the columns marked "APPROPRIATIONS" are 2.32 appropriated from the general fund, or any other fund named, to 2.33 the agencies and for the purposes specified in the following 2.34 sections of this article, to be available for the fiscal years 2.35 indicated for each purpose. The figures "1996" and "1997" where 2.36 used in this article, mean that the appropriation or 2.37 appropriations listed under them are available for the fiscal 2.38 year ending June 30, 1996, or June 30, 1997, respectively. 2.39 Where a dollar amount appears in parentheses, it means a 2.40 reduction of an appropriation. 2.41 SUMMARY BY FUND 2.42 BIENNIAL 2.43 1996 1997 TOTAL 2.44 General $ (121,000,000) $ (56,710,000) $(177,710,000) 2.45 State Government 2.46 Special Revenue 50,000 300,000 350,000 2.47 TOTAL $ (120,950,000) $ (56,410,000) $(177,360,000) 2.48 APPROPRIATIONS 2.49 Available for the Year 2.50 Ending June 30 2.51 1996 1997 3.1 Sec. 2. COMMISSIONER OF 3.2 HUMAN SERVICES 3.3 Subdivision 1. Total 3.4 Appropriation (121,000,000) (59,190,000) 3.5 This reduction is taken from the 3.6 appropriation in Laws 1995, chapter 3.7 207, article 1, section 2. 3.8 The amounts that are added to or 3.9 reduced from the appropriation for each 3.10 program are specified in the following 3.11 subdivisions. 3.12 [DHS SPENDING CAP.] The 1998-1999 3.13 general fund spending in the department 3.14 of human services is limited to 3.15 $2,602,561,000 in fiscal year 1998 and 3.16 $2,823,204,000 in fiscal year 1999. 3.17 Policy changes made to meet this 3.18 spending cap will include the effects 3.19 on both revenues and expenditures. 3.20 Changes from end of session revenue 3.21 estimates shall be counted against this 3.22 expenditures limit. Expenditures in 3.23 the department may exceed these 3.24 estimates only if forecast caseloads 3.25 increase. After consultation with the 3.26 legislature, the commissioner of 3.27 finance may also adjust these limits to 3.28 recognize any errors or omissions in 3.29 the workpapers used to generate the 3.30 figure. 3.31 Subd. 2. Life Skills 3.32 Self-Sufficiency 3.33 (3,462,000) 90,000 3.34 The amounts that may be spent from this 3.35 appropriation for each purpose are as 3.36 follows: 3.37 (a) Chemical Dependency 3.38 Consolidated Treatment 3.39 (3,462,000) (1,346,000) 3.40 (b) Deaf and Hard-of-Hearing 3.41 Services Grants 3.42 -0- 100,000 3.43 (c) Community Social Services Grants 3.44 -0- 36,000 3.45 (d) Aging Grants 3.46 -0- 1,050,000 3.47 (e) Administration and Other Grants 3.48 -0- 250,000 3.49 [DEAF AND HARD-OF-HEARING PROGRAMS.] Of 3.50 this appropriation, $100,000 in fiscal 3.51 year 1997 is for a grant to a nonprofit 3.52 agency that is currently serving deaf 4.1 and hard-of-hearing adults with mental 4.2 illness through residential programs 4.3 and supported housing outreach 4.4 activities. The grant must be used to 4.5 expand the services provided by the 4.6 nonprofit agency to include community 4.7 support services for deaf and 4.8 hard-of-hearing adults with mental 4.9 illness. This appropriation shall not 4.10 become part of the base for the 4.11 1998-1999 biennial budget. 4.12 [ADULT DAY CARE.] Of this 4.13 appropriation, $250,000 in fiscal year 4.14 1997 is for grants to counties to 4.15 expand or upgrade adult day care 4.16 services and adult day care 4.17 facilities. This appropriation is 4.18 available until expended but shall not 4.19 become part of the base appropriation 4.20 for the biennium beginning July 1, 4.21 1997. The commissioner shall 4.22 distribute grants to counties outside 4.23 the metropolitan area where there is a 4.24 need for expanded or improved services, 4.25 facilities, or other capital assets, 4.26 including vans for transporting 4.27 clients, and the commissioner shall 4.28 require a ten percent local match from 4.29 the adult day care agency. The county 4.30 shall award grants to nonprofit or 4.31 loans to for-profit adult day care 4.32 agencies in order for the agency to 4.33 physically upgrade the facility, which 4.34 will result in the expansion of the 4.35 number of clients served in adult day 4.36 care, expand the type of services 4.37 offered, or enable programs to service 4.38 persons with greater needs. For-profit 4.39 adult day care agencies eligible for 4.40 funds under this section receive funds 4.41 as a loan. If a county elects to 4.42 provide a loan to a for-profit agency, 4.43 the county shall make provisions for 4.44 the repayment of the loan within five 4.45 years, and redistribute the funds for 4.46 additional expansion or upgrading. A 4.47 grant or loan to an adult day care 4.48 nonprofit or for-profit agency, 4.49 respectively, may not exceed $10,000. 4.50 These funds shall not be used to pay 4.51 for service costs. 4.52 [SENIOR PROGRAMS.] For fiscal year 4.53 1997, of this appropriation, $150,000 4.54 is for volunteer programs for retired 4.55 senior citizens established under 4.56 Minnesota Statutes, section 256.9753, 4.57 $150,000 is for the foster grandparent 4.58 program established under Minnesota 4.59 Statutes, section 256.976, and $150,000 4.60 is for the senior companion program 4.61 established under Minnesota Statutes, 4.62 section 256.977. 4.63 [SENIOR NUTRITION PROGRAM.] Of this 4.64 appropriation, $600,000 in fiscal year 4.65 1997 is for senior nutrition programs 4.66 under Minnesota Statutes, section 4.67 256.9750. Not less than $400,000 of 4.68 this appropriation shall be used for 5.1 congregate dining sites and 5.2 home-delivered meals, and not more than 5.3 $200,000 shall be used for nutritional 5.4 support services. 5.5 Subd. 3. Children's Program -0- 2,400,000 5.6 The amounts that may be spent from this 5.7 appropriation for each purpose are as 5.8 follows: 5.9 (a) Subsidized Adoption Grants 5.10 -0- 1,500,000 5.11 (b) Other Families With Children 5.12 Services Administration 5.13 -0- 900,000 5.14 [SOCIAL SERVICES INFORMATION SYSTEM.] 5.15 Of this appropriation, $850,000 in 5.16 fiscal year 1997 is for the social 5.17 services information system. This 5.18 appropriation shall not become part of 5.19 the base for the 1998-1999 biennial 5.20 budget. 5.21 [CHILD WELFARE TECHNOLOGY GRANT.] Of 5.22 this appropriation, $50,000 is for 5.23 purposes of developing an integrated 5.24 child welfare computer system to 5.25 connect tribal social services, 5.26 counties, nonprofit organizations, and 5.27 state agencies that are involved with 5.28 child welfare issues, including 5.29 adoption, foster care, and out-of-home 5.30 placement issues. The appropriation 5.31 will be provided to the commissioner 5.32 when the commissioner applies for and 5.33 receives a technology grant through the 5.34 United States Department of Commerce, 5.35 Division of National Technology 5.36 Information Administration, to develop 5.37 and implement the child welfare 5.38 network. This $50,000 in state funding 5.39 is part of the 50 percent match that is 5.40 necessary in order to be eligible for 5.41 the federal technology grant. 5.42 Subd. 4. Economic Self-Sufficiency 5.43 General 5.44 (13,668,000) (14,350,000) 5.45 The amounts that may be spent from this 5.46 appropriation for each purpose are as 5.47 follows: 5.48 (a) AFDC Grants 5.49 (13,196,000) (16,000,000) 5.50 (b) General Assistance Grants 5.51 878,000 2,593,000 5.52 (c) Minnesota Supplemental Aid 5.53 (262,000) (328,000) 6.1 (d) Minnesota Family Investment 6.2 Plan (MFIP) Grants 6.3 -0- 64,000 6.4 (e) Child Care Fund Entitlement Grants 6.5 (1,258,000) (1,321,000) 6.6 (f) Administration and Other Grants 6.7 170,000 642,000 6.8 [RESIDENCY REQUIREMENT ADMINISTRATIVE 6.9 COSTS.] (a) Of this appropriation, 6.10 $225,000 in fiscal year 1997 is to 6.11 reimburse the counties for the verified 6.12 administrative costs of implementing 6.13 the 30-day residency requirement in the 6.14 general assistance and general 6.15 assistance medical care programs. 6.16 (b) The commissioner of finance shall 6.17 include in the department of human 6.18 services biennial budget recommendation 6.19 for the 1998-1999 biennium an 6.20 appropriation sufficient to reimburse 6.21 the counties for the verified 6.22 administrative costs of implementing 6.23 the 30-day residency requirement in the 6.24 medical assistance, aid to families 6.25 with dependent children, general 6.26 assistance, and general assistance 6.27 medical care programs. 6.28 [COMBINED MANUAL PRODUCTION COSTS.] For 6.29 the biennium ending June 30, 1997, the 6.30 commissioner may increase the fee 6.31 charged to, and may retain money 6.32 received from, individuals and private 6.33 entities in order to recover the 6.34 difference between the costs of 6.35 producing the department of human 6.36 services combined manual and the 6.37 subsidized price charged to individuals 6.38 and private entities on January 1, 6.39 1996. This provision does not apply to 6.40 government agencies and nonprofit 6.41 agencies serving the legal or social 6.42 service needs of clients. 6.43 Subd. 5. Health Care 6.44 General 6.45 (103,430,000) (47,247,000) 6.46 The amounts that may be spent from this 6.47 appropriation for each purpose are as 6.48 follows: 6.49 (a) Group Residential Housing Grants 6.50 (4,562,000) (3,874,000) 6.51 (b) MA Long-Term Care Facilities 6.52 (24,640,000) (3,231,000) 6.53 (c) MA Long-Term Care Waivers 6.54 and Home Care 7.1 (5,945,000) 2,422,000 7.2 (d) MA Managed Care and 7.3 Fee-for-Service 7.4 (3,386,000) (2,732,000) 7.5 (e) General Assistance Medical Care 7.6 (65,367,000) (47,276,000) 7.7 (f) Administration and Other Grants 7.8 470,000 982,000 7.9 [NEW ICF/MR.] A newly constructed or 7.10 newly established intermediate care 7.11 facility for persons with mental 7.12 retardation that is developed and 7.13 financed during fiscal year 1997 shall 7.14 not be subject to the equity 7.15 requirements in Minnesota Statutes, 7.16 section 256B.501, subdivision 11, 7.17 paragraph (d), or Minnesota Rules, part 7.18 9553.0060, subpart 3, item F, provided 7.19 that the provider's interest rate does 7.20 not exceed the interest rate available 7.21 through state agency tax exempt 7.22 financing. 7.23 [ICF/MR RECEIVERSHIP.] If a facility 7.24 which is in receivership under 7.25 Minnesota Statutes, section 245A.12 or 7.26 245A.13, is sold during fiscal year 7.27 1997 to an unrelated organization: (1) 7.28 the facility shall be considered a 7.29 newly established facility for rate 7.30 setting purposes notwithstanding any 7.31 provisions to the contrary in Minnesota 7.32 Statutes, section 256B.501, subdivision 7.33 11; and (2) the facility's historical 7.34 basis for the physical plant, land, and 7.35 land improvements for each facility 7.36 must not exceed the prior owner's 7.37 aggregate historical basis for these 7.38 same assets for each facility. The 7.39 allocation of the purchase price 7.40 between land, land improvements, and 7.41 physical plant shall be based on the 7.42 real estate appraisal using the 7.43 depreciated replacement cost method. 7.44 [ICF/MR RATE EXEMPTION.] If the 7.45 commissioner of human services is 7.46 unable to complete the rulemaking 7.47 revisions to the ICF/MR reimbursement 7.48 rule by September 30, 1996, for the 7.49 rate year beginning October 1, 1996, 7.50 the commissioner shall exempt ICF/MR 7.51 facilities from reductions to the 7.52 payment rates under Minnesota Statutes, 7.53 section 256B.501, subdivision 5b, 7.54 paragraph (d), clause (6), if the 7.55 facility: (1) has had a settle-up 7.56 payment rate established in the 7.57 reporting year preceding the rate year 7.58 for the one-time rate adjustment; (2) 7.59 is a newly established facility; (3) is 7.60 an A to B conversion under the 7.61 reimbursement rule; (4) has a payment 8.1 rate subject to a community conversion 8.2 project under Minnesota Statutes, 8.3 section 252.292; (5) has a payment rate 8.4 established under Minnesota Statutes, 8.5 section 245A.12 or 245A.13; or (6) is a 8.6 facility created by the relocation of 8.7 more than 25 percent of the capacity of 8.8 a related facility during the reporting 8.9 year. 8.10 [COUNTY WAIVERED SERVICES RESERVE.] 8.11 Notwithstanding the provisions of 8.12 Minnesota Statutes, section 256B.092, 8.13 subdivision 4, and Minnesota Rules, 8.14 part 9525.1830, subpart 2, the 8.15 commissioner may approve written 8.16 procedures and criteria for the 8.17 allocation of home- and community-based 8.18 waivered services funding for persons 8.19 with mental retardation or related 8.20 conditions which enables a county to 8.21 maintain a reserve resource account. 8.22 The reserve resource account may not 8.23 exceed five percent of the county 8.24 agency's total annual allocation of 8.25 home- and community-based waivered 8.26 services funds. The reserve may be 8.27 utilized to ensure the county's ability 8.28 to meet the changing needs of current 8.29 recipients, to ensure the health and 8.30 safety needs of current recipients, or 8.31 to provide short-term emergency 8.32 intervention care to eligible waiver 8.33 recipients. 8.34 [PREADMISSION SCREENING TRANSFER.] 8.35 Effective the day following final 8.36 enactment, up to $40,000 of the 8.37 appropriation for preadmission 8.38 screening and alternative care for 8.39 fiscal year 1996 may be transferred to 8.40 the health care administration account 8.41 to pay the state's share of county 8.42 claims for conducting nursing home 8.43 assessments for persons with mental 8.44 illness or mental retardation as 8.45 required by Public Law Number 100-203. 8.46 [SERVICE ALLOWANCE TRANSFER.] For the 8.47 fiscal year ending June 30, 1997, the 8.48 commissioner may transfer $848,000 from 8.49 the medical assistance grants account 8.50 to the alternative care grants account 8.51 for allocation as service allowances to 8.52 counties under Minnesota Statutes 1995 8.53 Supplement, section 256B.0913, 8.54 subdivision 15. 8.55 [DEMONSTRATION PROJECTS.] Of this 8.56 appropriation, $342,000 in fiscal year 8.57 1997 is for actuarial studies of mental 8.58 health services covered by state 8.59 prepaid health plans and for 8.60 evaluations of county joint purchaser 8.61 demonstration projects and of 8.62 developmental disabilities pilot 8.63 projects authorized under Laws 1995, 8.64 chapter 207, article 8, section 42. 8.65 [HIV/AIDS DRUG REIMBURSEMENT PROGRAM.] 8.66 Of this appropriation, $150,000 in 9.1 fiscal year 1997 is for the HIV/AIDS 9.2 drug reimbursement program and shall be 9.3 added to federal funds available for 9.4 that program. 9.5 [ICF/MR ALTERNATIVE RATE STRUCTURE.] 9.6 The commissioner, in conjunction with 9.7 ICF/MR service providers, shall present 9.8 to the legislature by January 31, 1997, 9.9 recommendations for an alternative rate 9.10 structure that recognizes the small 9.11 size and individual needs of ICFs/MR. 9.12 The system proposed must recognize 9.13 costs incurred, must not penalize 9.14 facilities converted since 1990 as part 9.15 of the A to B conversion project, and 9.16 must reimburse the costs associated 9.17 with federal active treatment 9.18 standards. As part of developing these 9.19 recommendations the commissioner shall 9.20 also examine issues related to the 9.21 relative size and cost of these 9.22 facilities and shall develop 9.23 recommendations regarding whether 9.24 allowing the development of larger 9.25 facilities can be a high-quality, 9.26 cost-efficient service option. 9.27 [NURSING FACILITY RECEIVERSHIP COSTS.] 9.28 Notwithstanding the provisions of 9.29 Minnesota Statutes, section 256B.495, 9.30 for a nursing facility where the 9.31 closure of the facility after resident 9.32 relocation and the loss of the nursing 9.33 home beds will significantly decrease 9.34 the regional average number of 9.35 long-term care beds per thousand 9.36 elderly over 65 in the year 2000 to 9.37 within 11 beds of the hardship standard 9.38 as referenced in the study. The 1993 9.39 Distribution of Nursing Home Beds in 9.40 Minnesota, prepared by the Interagency 9.41 Long-Term Care Planning committee in 9.42 March 1994, the commissioner of human 9.43 services shall extend the period to 9.44 recover receivership costs incurred 9.45 during a department of health 9.46 receivership of a nursing home that 9.47 began on September 15, 1995, over a 9.48 period of not more than 12 months, 9.49 ending June 30, 1997. The extension of 9.50 time for recovery is contingent on the 9.51 following considerations: 9.52 (1) the purchaser of the facility has 9.53 demonstrated to the satisfaction of the 9.54 commissioners of health and human 9.55 services that the facility will be 9.56 operated in accordance with the 9.57 reimbursement system. The purchaser 9.58 must provide documentation to verify 9.59 access to funds to purchase the 9.60 facility, access to appropriate lines 9.61 of credit to cover anticipated and 9.62 unanticipated operating costs, cash 9.63 flow projections which provide a 9.64 realistic estimate of expenses and 9.65 income, and other financial information 9.66 that might be required by the 9.67 commissioners to determine whether a 9.68 license should be granted; 10.1 (2) the cost of continued operation 10.2 under the receivership while residents 10.3 are relocated has been estimated to 10.4 equal or exceed $500,000; 10.5 (3) the purchaser has demonstrated that 10.6 the purchase of the facility and the 10.7 ongoing operation of the facility will 10.8 not occur without the decision to 10.9 forego the recovery of the receivership 10.10 funds, that the former owner of the 10.11 facility does not financially benefit 10.12 by the sale of the facility, and that 10.13 the entities with financial interests 10.14 in the nursing home land and building 10.15 have taken substantial losses; and 10.16 (4) the closure of the facility will 10.17 require the relocation of a majority of 10.18 residents to facilities in different 10.19 counties. 10.20 [TEFRA CRITERIA MODIFICATIONS.] The 10.21 commissioner shall report to the 10.22 legislature by February 1, 1997, on the 10.23 number of children found eligible for 10.24 medical assistance under the TEFRA 10.25 option as a result of the modifications 10.26 in Minnesota Statutes, section 10.27 256B.055, subdivision 12, paragraph 10.28 (e), adopted in this chapter. The 10.29 report must include information on the 10.30 medical condition of the children found 10.31 eligible and on the services provided 10.32 to them. The report must include 10.33 recommendations on any changes in these 10.34 criteria developed in consultation with 10.35 interested family, client, provider, 10.36 and county representatives. 10.37 [TEFRA DENIALS.] Effective the day 10.38 following final enactment, for children 10.39 found ineligible for medical assistance 10.40 under the TEFRA option under criteria 10.41 in Minnesota Statutes, section 10.42 256B.055, subdivision 12, established 10.43 in Laws 1995, chapter 207, article 6, 10.44 if the reason for denial is lack of 10.45 information on the child's condition, 10.46 the commissioner shall notify the 10.47 family of the lack of documentation at 10.48 least 60 days prior to termination of 10.49 eligibility for notices sent between 10.50 April 1 and July 1, l996. All TEFRA 10.51 ineligibility notices sent between 10.52 April 1 and July 1, 1996, must contain 10.53 the telephone number of a department of 10.54 human services staff person whom the 10.55 family can contact about alternative 10.56 sources of health coverage, including 10.57 MinnesotaCare, the Minnesota 10.58 comprehensive health association, 10.59 services for children with special 10.60 health care needs, and other types of 10.61 assistance for children with 10.62 disabilities or chronic illnesses. 10.63 [PUBLIC HEALTH NURSE ASSESSMENT.] 10.64 Effective for public health nurse 10.65 visits on or after July 1, 1996, the 10.66 reimbursement for public health nurse 11.1 visits relating to the provision of 11.2 personal care assistant services under 11.3 Minnesota Statutes, sections 256B.0625, 11.4 subdivision 19a, and 256B.0627, is 11.5 $204.36 for the initial assessment 11.6 visit and $102.18 for each reassessment 11.7 visit. 11.8 [NF PAYMENT INCREASE.] For the rate 11.9 year beginning July 1, 1996, the 11.10 commissioner shall increase each 11.11 nursing facility's payment rate for 11.12 those facilities whose rates are 11.13 determined under Minnesota Statutes, 11.14 section 256B.431, subdivision 25, by 11.15 $0.06 per resident per day. 11.16 Subd. 6. Community Mental Health 11.17 and State-Operated Services 11.18 General 11.19 (440,000) (83,000) 11.20 The amounts that are reduced from this 11.21 appropriation for each purpose are as 11.22 follows: 11.23 (a) Mental Health Grants - Children 11.24 (400,000) 277,000 11.25 (b) Mental Health Grants - Adults 11.26 (40,000) (360,000) 11.27 [CRISIS SERVICES.] Crisis services for 11.28 developmentally disabled persons in 11.29 each regional center catchment area, 11.30 including crisis beds and mobile 11.31 intervention teams, shall be at 11.32 Brainerd, Cambridge, Fergus Falls, St. 11.33 Peter, and Willmar regional centers in 11.34 accordance with the agreement reached 11.35 in 1989, and codified in Minnesota 11.36 Statutes, section 252.025. The program 11.37 design must be negotiated and agreed to 11.38 by the affected exclusive 11.39 representatives. The parties also must 11.40 meet and discuss ways to provide the 11.41 highest quality services, while 11.42 maintaining or increasing cost 11.43 effectiveness. 11.44 [COMPULSIVE GAMBLING.] For the fiscal 11.45 year beginning July 1, 1996, the state 11.46 lottery board shall deposit $800,000 in 11.47 the general fund for use by the 11.48 commissioner of human services to pay 11.49 for compulsive gambling services as 11.50 follows: $500,000 is allocated for 11.51 treatment of compulsive gamblers; 11.52 $150,000 is allocated for the 11.53 compulsive gambling treatment pilot 11.54 project for treating individual 11.55 compulsive gamblers; and $150,000 is 11.56 allocated for education and prevention 11.57 efforts, of which $50,000 is for a 11.58 grant to a compulsive gambling council 11.59 located in St. Louis county for the 11.60 extension of the information gathering 12.1 and dissemination network and the 12.2 establishment of training 12.3 scholarships. The amount deposited by 12.4 the board shall be deducted from the 12.5 lottery prize fund established under 12.6 Minnesota Statutes, section 349A.10, 12.7 subdivision 2. The amount deposited is 12.8 appropriated to the commissioner of 12.9 human services for this purpose. None 12.10 of the amount appropriated for 12.11 compulsive gambling services under this 12.12 section may be used to pay 12.13 administrative costs of the department 12.14 of human services. 12.15 [COMPULSIVE GAMBLING GRANT FOR 12.16 ADOLESCENT PROGRAMS.] Of this 12.17 appropriation, $40,000 in fiscal year 12.18 1997 is for a grant to a compulsive 12.19 gambling council located in St. Louis 12.20 county for a compulsive gambling 12.21 prevention and education project for 12.22 adolescents. This appropriation shall 12.23 not become part of the base level 12.24 funding for the 1998-1999 biennial 12.25 budget. The appropriation in Laws 12.26 1995, chapter 207, article 1, section 12.27 2, subdivision 7, for compulsive 12.28 gambling programs for fiscal year 1996 12.29 is reduced by $40,000. 12.30 [RTC DENTAL SERVICES REPORT.] The 12.31 commissioner shall report to the chairs 12.32 of the house health and human services 12.33 committee and the senate health care 12.34 committee by November 1, 1996, on the 12.35 implementation of Minnesota Statutes, 12.36 section 246,57, subdivision 6. 12.37 Sec. 3. COMMISSIONER OF HEALTH 12.38 Subdivision 1. Total 12.39 Appropriation -0- 2,480,000 12.40 Summary by Fund 12.41 General -0- 2,280,000 12.42 State Government 12.43 Special Revenue -0- 200,000 12.44 This appropriation is added to the 12.45 appropriation in Laws 1995, chapter 12.46 207, article 1, section 3. 12.47 The amounts that may be spent from this 12.48 appropriation for each program are 12.49 specified in the following subdivisions. 12.50 Subd. 2. Health Systems and 12.51 Special Populations -0- 2,185,000 12.52 Summary by Fund 12.53 General -0- 1,985,000 12.54 State Government 12.55 Special Revenue -0- 200,000 12.56 [CORE PUBLIC HEALTH FUNCTIONS.] Of this 12.57 appropriation, $1,500,000 in fiscal 13.1 year 1997 is for core public health 13.2 functions. Of this amount, up to five 13.3 percent is available to the 13.4 commissioner for administrative and 13.5 technical support of community health 13.6 boards. Funds distributed shall not be 13.7 used to displace current appropriations 13.8 or to provide individual personal 13.9 health care services which compete with 13.10 or duplicate services otherwise 13.11 available through the prepaid medical 13.12 assistance program. These funds shall 13.13 be distributed on a pro rata basis 13.14 according to the existing community 13.15 health services subsidy formula to 13.16 those community health service areas 13.17 which are participating in the state's 13.18 prepaid medical assistance program. 13.19 This appropriation shall not become 13.20 part of the base for the 1998-1999 13.21 biennial budget. 13.22 [TECHNICAL ASSISTANCE.] Of this 13.23 appropriation, $200,000 is for the 13.24 purpose of providing technical 13.25 assistance to counties interested in 13.26 developing a joint purchaser 13.27 demonstration project. The 13.28 commissioner of health shall contract 13.29 with consultants selected by the 13.30 association of Minnesota counties in 13.31 consultation with the advisory 13.32 committee established under Minnesota 13.33 Statutes, section 256B.78, subdivision 13.34 9, to provide this technical assistance. 13.35 [DIRECT CONTRACTING REPORT.] The 13.36 commissioners of health and commerce 13.37 shall jointly study and report to the 13.38 legislative oversight commission on 13.39 health care access by December 15, 13.40 1996, on the feasibility of allowing 13.41 direct provider contracting of health 13.42 care services. Included in this report 13.43 shall be recommendations on the 13.44 consumer protections, reserve 13.45 requirements, and protections for 13.46 consumers who will not have direct 13.47 contracting available to them that the 13.48 legislature should consider to ensure 13.49 protection of persons receiving health 13.50 coverage through networks allowed to 13.51 conduct direct provider contracting. 13.52 [HOSPITAL CONVERSION; SUPPLEMENTAL 13.53 ALLOCATION.] Of the appropriation from 13.54 the general fund, for the fiscal year 13.55 ending June 30, 1997, the commissioner 13.56 of health shall provide $25,000 to a 13.57 28-bed hospital located in Chisago 13.58 county, to enable that facility to plan 13.59 for closure and conversion, in 13.60 partnership with other entities, in 13.61 order to offer outpatient and emergency 13.62 services at the site. This allocation 13.63 is in addition to funds authorized by 13.64 Laws 1995, article 1, section 3, 13.65 subdivision 2. 13.66 [MEDICARE INITIAL SURVEYS.] (a) 13.67 $200,000 is appropriated to the 14.1 commissioner from the general fund for 14.2 the fiscal year ending June 30, 1997, 14.3 to support initial surveys of Medicare 14.4 providers. This appropriation shall be 14.5 available until the federal law 14.6 prohibiting the collection of fees for 14.7 Medicare initial surveys is repealed. 14.8 (b) $200,000 is appropriated to the 14.9 commissioner from the state government 14.10 special revenue fund for the fiscal 14.11 year ending June 30, 1997, to support 14.12 initial surveys of Medicare providers 14.13 once the federal law prohibiting the 14.14 collection of fees for this activity is 14.15 repealed. Upon repeal of the federal 14.16 law, the commissioner shall charge fees 14.17 as provided under Minnesota Statutes, 14.18 section 144.122, paragraph (e). 14.19 [PROJECT REVIEW BEFORE CONSTRUCTION.] 14.20 Before construction may commence on the 14.21 project authorized in Minnesota 14.22 Statutes, section 144A.071, subdivision 14.23 4a, paragraph (w), the interagency 14.24 long-term care planning committee must 14.25 review the project to ascertain the 14.26 extent to which the project meets the 14.27 objectives of Minnesota Statutes, 14.28 section 144A.073, subdivision 4, and 14.29 approve the project if it meets the 14.30 objectives. 14.31 [SHARED ADMINISTRATOR.] Notwithstanding 14.32 the provisions of Minnesota Statutes, 14.33 section 144A.04, subdivision 5, the 14.34 administrator of a county owned nursing 14.35 home may serve, until September 30, 14.36 1996, as the administrator of a nursing 14.37 home located in a county owned hospital 14.38 provided that the total number of 14.39 nursing home beds in both facilities 14.40 does not exceed 153 beds. This 14.41 provision is effective the day 14.42 following final enactment. 14.43 Subd. 3. Health Protection -0- 295,000 14.44 [BIRTH DEFECTS REGISTRY.] Of this 14.45 appropriation, $195,000 in fiscal year 14.46 1997 is for the birth defects registry 14.47 system under Minnesota Statutes, 14.48 section 144.2215. The startup costs 14.49 shall not become part of the base for 14.50 the 1998-1999 biennial budget. 14.51 [LEAD HAZARD REDUCTION.] Of this 14.52 appropriation, $100,000 in fiscal year 14.53 1997 is for lead hazard reduction under 14.54 Minnesota Statutes, section 144.9504, 14.55 subdivisions 1 and 7, and section 14.56 144.9503, subdivision 9. 14.57 [REPORT ON INSPECTION FEES.] The 14.58 commissioner may spend up to $20,000 of 14.59 the money appropriated for the fiscal 14.60 year ending June 30, 1997, to develop 14.61 recommendations for options to reduce 14.62 inspection fees for establishments 14.63 licensed under Minnesota Statutes, 14.64 chapter 157, which are operating in the 15.1 category of small establishment with 15.2 full menu selection, and which have ten 15.3 or fewer employees. The 15.4 recommendations must not include the 15.5 option of a general fund appropriation 15.6 as a way to reduce inspection fees. 15.7 The commissioner must report the 15.8 recommendations to the legislature by 15.9 October 1, 1996. 15.10 Sec. 4. VETERANS NURSING 15.11 HOMES BOARD -0- 125,000 15.12 This appropriation is added to the 15.13 appropriation in Laws 1995, chapter 15.14 207, article 1, section 4. 15.15 [VETERANS NURSING HOMES BOARD.] 15.16 $125,000 is appropriated from the 15.17 general fund to the veterans nursing 15.18 homes board for the fiscal year ending 15.19 June 30, 1997, for the nursing home in 15.20 Fergus Falls. This appropriation is to 15.21 fund positions and support services, to 15.22 coordinate and oversee the construction 15.23 of the facility, and to begin planning 15.24 for the opening of the facility. 15.25 Sec. 5. HEALTH-RELATED BOARDS 15.26 Subdivision 1. Total 15.27 Appropriation 50,000 175,000 15.28 Summary by Fund 15.29 General -0- 75,000 15.30 State Government 15.31 Special Revenue 50,000 100,000 15.32 Subd. 2. Emergency Medical Services 15.33 Regulatory Board 15.34 General Fund -0- 75,000 15.35 [EMS TRANSFER EXPENSES.] $75,000 is 15.36 appropriated to the emergency medical 15.37 services regulatory board from the 15.38 general fund for the fiscal year ending 15.39 June 30, 1997, for expenses incurred in 15.40 transferring regulatory authority from 15.41 the commissioner of health to the board 15.42 under Laws 1995, chapter 207, article 15.43 9. This appropriation shall not become 15.44 part of the base for the 1998-1999 15.45 biennial budget. 15.46 Subd. 3. Board of Medical 15.47 Practice 15.48 State Government Special 15.49 Fund 50,000 100,000 15.50 [MEDICAL PRACTICE BOARD.] $50,000 in 15.51 fiscal year 1996 and $100,000 in fiscal 15.52 year 1997 is appropriated from the 15.53 state government special revenue fund 15.54 to the board of medical practice for 15.55 the health professionals services 15.56 program, and is added to the 15.57 appropriation in Laws 1995, chapter 16.1 207, article 1, section 5, subdivision 16.2 6. 16.3 This appropriation is added to the 16.4 appropriation in Laws 1995, chapter 16.5 207, article 1, section 5. 16.6 [STATE GOVERNMENT SPECIAL REVENUE 16.7 FUND.] The appropriations in this 16.8 section are from the state government 16.9 special revenue fund. 16.10 [NO SPENDING IN EXCESS OF REVENUES.] 16.11 The commissioner of finance shall not 16.12 permit the allotment, encumbrance, or 16.13 expenditure of money appropriated in 16.14 this section in excess of the 16.15 anticipated biennial revenues or 16.16 accumulated surplus revenues from fees 16.17 collected by the boards. Neither this 16.18 provision nor Minnesota Statutes, 16.19 section 214.06, applies to transfers 16.20 from the general contingent account, if 16.21 the amount transferred does not exceed 16.22 the amount of surplus revenue 16.23 accumulated by the transferee during 16.24 the previous five years. 16.25 Sec. 6. [CARRYOVER LIMITATION.] 16.26 None of the appropriations in this 16.27 article which are allowed to be carried 16.28 forward from fiscal year 1996 to fiscal 16.29 year 1997 shall become part of the base 16.30 level funding for the 1998-1999 16.31 biennial budget, unless specifically 16.32 directed by the legislature. 16.33 Sec. 7. [SUNSET OF UNCODIFIED 16.34 LANGUAGE.] 16.35 All uncodified language contained in 16.36 this article expires on June 30, 1997, 16.37 unless a different expiration is 16.38 explicit. 16.39 ARTICLE 2 16.40 HEALTH AND CONTINUING CARE RELATED TO 16.41 MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE 16.42 Section 1. Minnesota Statutes 1995 Supplement, section 16.43 62Q.19, subdivision 1, is amended to read: 16.44 Subdivision 1. [DESIGNATION.] The commissioner shall 16.45 designate essential community providers. The criteria for 16.46 essential community provider designation shall be the following: 16.47 (1) a demonstrated ability to integrate applicable 16.48 supportive and stabilizing services with medical care for 16.49 uninsured persons and high-risk and special needs populations as 16.50 defined in section 62Q.07, subdivision 2, paragraph (e), 16.51 underserved, and other special needs populations; and 17.1 (2) a commitment to serve low-income and underserved 17.2 populations by meeting the following requirements: 17.3 (i) has nonprofit status in accordance with chapter 317A; 17.4 (ii) has tax exempt status in accordance with the Internal 17.5 Revenue Service Code, section 501(c)(3); 17.6 (iii) charges for services on a sliding fee schedule based 17.7 on current poverty income guidelines; and 17.8 (iv) does not restrict access or services because of a 17.9 client's financial limitation;or17.10 (3) status as a local government unit as defined in section 17.11 62D.02, subdivision 11, an Indian tribal government, an Indian 17.12 health service unit, or community health board as defined in 17.13 chapter 145A; or 17.14 (4) a former state hospital that specializes in the 17.15 treatment of cerebral palsy, spina bifida, epilepsy, closed head 17.16 injuries, specialized orthopedic problems, and other disabling 17.17 conditions. 17.18 Prior to designation, the commissioner shall publish the 17.19 names of all applicants in the State Register. The public shall 17.20 have 30 days from the date of publication to submit written 17.21 comments to the commissioner on the application. No designation 17.22 shall be made by the commissioner until the 30-day period has 17.23 expired. 17.24 The commissioner may designate an eligible provider as an 17.25 essential community provider for all the services offered by 17.26 that provider or for specific services designated by the 17.27 commissioner. 17.28 For the purpose of this subdivision, supportive and 17.29 stabilizing services include at a minimum, transportation, child 17.30 care, cultural, and linguistic services where appropriate. 17.31 Sec. 2. Minnesota Statutes 1995 Supplement, section 17.32 62Q.19, subdivision 5, is amended to read: 17.33 Subd. 5. [CONTRACT PAYMENT RATES.] An essential community 17.34 provider and a health plan company may negotiate the payment 17.35 rate for covered services provided by the essential community 17.36 provider. This rate must be at least the same rate per unit of 18.1 service as is paid to other health plan providers for the same 18.2 or similar services. 18.3 Sec. 3. Minnesota Statutes 1995 Supplement, section 18.4 252.27, subdivision 2a, is amended to read: 18.5 Subd. 2a. [CONTRIBUTION AMOUNT.] (a) The natural or 18.6 adoptive parents of a minor child, including a child determined 18.7 eligible for medical assistance without consideration of 18.8 parental income, must contribute monthly to the cost of 18.9 services, unless the child is married or has been married, 18.10 parental rights have been terminated, or the child's adoption is 18.11 subsidized according to section 259.67 or through title IV-E of 18.12 the Social Security Act. 18.13 (b) The parental contribution shall be the greater of a 18.14 minimum monthly fee of $25 for households with adjusted gross 18.15 income of $30,000 and over, or an amount to be computed by 18.16 applying to the adjusted gross income of the natural or adoptive 18.17 parents that exceeds 150 percent of the federal poverty 18.18 guidelines for the applicable household size, the following 18.19 schedule of rates: 18.20 (1) on the amount of adjusted gross income over 150 percent 18.21 of poverty, but not over $50,000, ten percent; 18.22 (2) on the amount of adjusted gross income over 150 percent 18.23 of poverty and over $50,000 but not over $60,000, 12 percent; 18.24 (3) on the amount of adjusted gross income over 150 percent 18.25 of poverty, and over $60,000 but not over $75,000, 14 percent; 18.26 and 18.27 (4) on all adjusted gross income amounts over 150 percent 18.28 of poverty, and over $75,000, 15 percent. 18.29 If the child lives with the parent, the parental 18.30 contribution is reduced by $200, except that the parent must pay 18.31 the minimum monthly $25 fee under this paragraph. If the child 18.32 resides in an institution specified in section 256B.35, the 18.33 parent is responsible for the personal needs allowance specified 18.34 under that section in addition to the parental contribution 18.35 determined under this section. The parental contribution is 18.36 reduced by any amount required to be paid directly to the child 19.1 pursuant to a court order, but only if actually paid. 19.2 (c) The household size to be used in determining the amount 19.3 of contribution under paragraph (b) includes natural and 19.4 adoptive parents and their dependents under age 21, including 19.5 the child receiving services. Adjustments in the contribution 19.6 amount due to annual changes in the federal poverty guidelines 19.7 shall be implemented on the first day of July following 19.8 publication of the changes. 19.9 (d) For purposes of paragraph (b), "income" means the 19.10 adjusted gross income of the natural or adoptive parents 19.11 determined according to the previous year's federal tax form. 19.12 (e) The contribution shall be explained in writing to the 19.13 parents at the time eligibility for services is being 19.14 determined. The contribution shall be made on a monthly basis 19.15 effective with the first month in which the child receives 19.16 services. Annually upon redetermination or at termination of 19.17 eligibility, if the contribution exceeded the cost of services 19.18 provided, the local agency or the state shall reimburse that 19.19 excess amount to the parents, either by direct reimbursement if 19.20 the parent is no longer required to pay a contribution, or by a 19.21 reduction in or waiver of parental fees until the excess amount 19.22 is exhausted. 19.23 (f) The monthly contribution amount must be reviewed at 19.24 least every 12 months; when there is a change in household size; 19.25 and when there is a loss of or gain in income from one month to 19.26 another in excess of ten percent. The local agency shall mail a 19.27 written notice 30 days in advance of the effective date of a 19.28 change in the contribution amount. A decrease in the 19.29 contribution amount is effective in the month that the parent 19.30 verifies a reduction in income or change in household size. 19.31 (g) Parents of a minor child who do not live with each 19.32 other shall each pay the contribution required under paragraph 19.33 (a), except that a court-ordered child support payment actually 19.34 paid on behalf of the child receiving services shall be deducted 19.35 from the contribution of the parent making the payment. 19.36 (h) The contribution under paragraph (b) shall be increased 20.1 by an additional five percent if the local agency determines 20.2 that insurance coverage is available but not obtained for the 20.3 child. For purposes of this section, "available" means the 20.4 insurance is a benefit of employment for a family member at an 20.5 annual cost of no more than five percent of the family's annual 20.6 income. For purposes of this section, insurance means health 20.7 and accident insurance coverage, enrollment in a nonprofit 20.8 health service plan, health maintenance organization, 20.9 self-insured plan, or preferred provider organization. 20.10 Parents who have more than one child receiving services 20.11 shall not be required to pay more than the amount for the child 20.12 with the highest expenditures. There shall be no resource 20.13 contribution from the parents. The parent shall not be required 20.14 to pay a contribution in excess of the cost of the services 20.15 provided to the child, not counting payments made to school 20.16 districts for education-related services. Notice of an increase 20.17 in fee payment must be given at least 30 days before the 20.18 increased fee is due. 20.19 (i) The contribution under paragraph (b) shall be reduced 20.20 by $300 per fiscal year if, in the 12 months prior to July 1; 20.21 (1) the parent applied for insurance for the child, 20.22 (2) the insurer denied insurance, 20.23 (3) the parents submitted a complaint or appeal, in writing 20.24 to the insurer, submitted a complaint or appeal, in writing, to 20.25 the commissioner of health or the commissioner of commerce, or 20.26 litigated the complaint or appeal, and 20.27 (4) as a result of the dispute, the insurer reversed its 20.28 decision and granted insurance. 20.29 For purposes of this section, insurance has the meaning 20.30 given in paragraph (h). 20.31 A parent who has requested a reduction in the contribution 20.32 amount under this paragraph shall submit proof in the form and 20.33 manner prescribed by the commissioner or county agency, 20.34 including, but not limited to, the insurer's denial of 20.35 insurance, the written letter or complaint of the parents, court 20.36 documents, and the written response of the insurer approving 21.1 insurance. The determinations of the commissioner or county 21.2 agency under this paragraph are not rules subject to chapter 14. 21.3 Sec. 4. [252.54] [DAY TRAINING AND HABILITATION SERVICES.] 21.4 Day training and habilitation license holders are exempt 21.5 from the requirements of Minnesota Rules, part 9525.1630, 21.6 subparts 3 (review of progress toward individual habilitation 21.7 plan goals), 4 (initial assessment), and 5 (reassessment), for 21.8 persons for whom progress reviews, initial assessments, and 21.9 reassessments are completed by the license holder according to 21.10 requirements established in the person's individual service plan 21.11 developed by the county case manager under Minnesota Statutes, 21.12 section 256B.092, subdivision 1b. 21.13 Sec. 5. Minnesota Statutes 1995 Supplement, section 21.14 256.969, subdivision 9, is amended to read: 21.15 Subd. 9. [DISPROPORTIONATE NUMBERS OF LOW-INCOME PATIENTS 21.16 SERVED.] (a) For admissions occurring on or after October 1, 21.17 1992, through December 31, 1992, the medical assistance 21.18 disproportionate population adjustment shall comply with federal 21.19 law and shall be paid to a hospital, excluding regional 21.20 treatment centers and facilities of the federal Indian Health 21.21 Service, with a medical assistance inpatient utilization rate in 21.22 excess of the arithmetic mean. The adjustment must be 21.23 determined as follows: 21.24 (1) for a hospital with a medical assistance inpatient 21.25 utilization rate above the arithmetic mean for all hospitals 21.26 excluding regional treatment centers and facilities of the 21.27 federal Indian Health Service but less than or equal to one 21.28 standard deviation above the mean, the adjustment must be 21.29 determined by multiplying the total of the operating and 21.30 property payment rates by the difference between the hospital's 21.31 actual medical assistance inpatient utilization rate and the 21.32 arithmetic mean for all hospitals excluding regional treatment 21.33 centers and facilities of the federal Indian Health Service; and 21.34 (2) for a hospital with a medical assistance inpatient 21.35 utilization rate above one standard deviation above the mean, 21.36 the adjustment must be determined by multiplying the adjustment 22.1 that would be determined under clause (1) for that hospital by 22.2 1.1. If federal matching funds are not available for all 22.3 adjustments under this subdivision, the commissioner shall 22.4 reduce payments on a pro rata basis so that all adjustments 22.5 qualify for federal match. The commissioner may establish a 22.6 separate disproportionate population operating payment rate 22.7 adjustment under the general assistance medical care program. 22.8 For purposes of this subdivision medical assistance does not 22.9 include general assistance medical care. The commissioner shall 22.10 report annually on the number of hospitals likely to receive the 22.11 adjustment authorized by this paragraph. The commissioner shall 22.12 specifically report on the adjustments received by public 22.13 hospitals and public hospital corporations located in cities of 22.14 the first class. 22.15 (b) For admissions occurring on or after July 1, 1993, the 22.16 medical assistance disproportionate population adjustment shall 22.17 comply with federal law and shall be paid to a hospital, 22.18 excluding regional treatment centers and facilities of the 22.19 federal Indian Health Service, with a medical assistance 22.20 inpatient utilization rate in excess of the arithmetic mean. 22.21 The adjustment must be determined as follows: 22.22 (1) for a hospital with a medical assistance inpatient 22.23 utilization rate above the arithmetic mean for all hospitals 22.24 excluding regional treatment centers and facilities of the 22.25 federal Indian Health Service but less than or equal to one 22.26 standard deviation above the mean, the adjustment must be 22.27 determined by multiplying the total of the operating and 22.28 property payment rates by the difference between the hospital's 22.29 actual medical assistance inpatient utilization rate and the 22.30 arithmetic mean for all hospitals excluding regional treatment 22.31 centers and facilities of the federal Indian Health Service; 22.32 (2) for a hospital with a medical assistance inpatient 22.33 utilization rate above one standard deviation above the mean, 22.34 the adjustment must be determined by multiplying the adjustment 22.35 that would be determined under clause (1) for that hospital by 22.36 1.1. The commissioner may establish a separate disproportionate 23.1 population operating payment rate adjustment under the general 23.2 assistance medical care program. For purposes of this 23.3 subdivision, medical assistance does not include general 23.4 assistance medical care. The commissioner shall report annually 23.5 on the number of hospitals likely to receive the adjustment 23.6 authorized by this paragraph. The commissioner shall 23.7 specifically report on the adjustments received by public 23.8 hospitals and public hospital corporations located in cities of 23.9 the first class; and 23.10 (3) for a hospital that had medical assistance 23.11 fee-for-service payment volume during calendar year 1991 in 23.12 excess of 13 percent of total medical assistance fee-for-service 23.13 payment volume, a medical assistance disproportionate population 23.14 adjustment shall be paid in addition to any other 23.15 disproportionate payment due under this subdivision as follows: 23.16 $1,515,000 due on the 15th of each month after noon, beginning 23.17 July 15, 1995. For a hospital that had medical assistance 23.18 fee-for-service payment volume during calendar year 1991 in 23.19 excess of eight percent of total medical assistance 23.20 fee-for-service payment volume andiswas the primary hospital 23.21 affiliated with the University of Minnesota, a medical 23.22 assistance disproportionate population adjustment shall be paid 23.23 in addition to any other disproportionate payment due under this 23.24 subdivision as follows: $505,000 due on the 15th of each month 23.25 after noon, beginning July 15, 1995. 23.26 (c) The commissioner shall adjust rates paid to a health 23.27 maintenance organization under contract with the commissioner to 23.28 reflect rate increases provided in paragraph (b), clauses (1) 23.29 and (2), on a nondiscounted hospital-specific basis but shall 23.30 not adjust those rates to reflect payments provided in clause 23.31 (3). 23.32 (d) If federal matching funds are not available for all 23.33 adjustments under paragraph (b), the commissioner shall reduce 23.34 payments under paragraph (b), clauses (1) and (2), on a pro rata 23.35 basis so that all adjustments under paragraph (b) qualify for 23.36 federal match. 24.1 (e) For purposes of this subdivision, medical assistance 24.2 does not include general assistance medical care. 24.3 Sec. 6. [256.9692] [EFFECT OF INTEGRATION AGREEMENT ON 24.4 DIVISION OF COST.] 24.5 Beginning in the first calendar month after there is a 24.6 definitive integration agreement affecting the University of 24.7 Minnesota hospital and clinics and Fairview hospital and health 24.8 care services, Fairview hospital and health care services shall 24.9 pay the University of Minnesota $505,000 on the 15th of each 24.10 month, after receiving the state payment, provided that the 24.11 University of Minnesota has fulfilled the requirements of 24.12 section 256B.19, subdivision 1c. 24.13 Sec. 7. Minnesota Statutes 1995 Supplement, section 24.14 256B.055, subdivision 12, is amended to read: 24.15 Subd. 12. [DISABLED CHILDREN.] (a) A person is eligible 24.16 for medical assistance if the person is under age 19 and 24.17 qualifies as a disabled individual under United States Code, 24.18 title 42, section 1382c(a), and would be eligible for medical 24.19 assistance under the state plan if residing in a medical 24.20 institution, and the child requires a level of care provided in 24.21 a hospital, nursing facility, or intermediate care facility for 24.22 persons with mental retardation or related conditions, for whom 24.23 home care is appropriate, provided that the cost to medical 24.24 assistance under this section is not more than the amount that 24.25 medical assistance would pay for if the child resides in an 24.26 institution.Eligibility under this section must be determined24.27annuallyAfter the child is determined to be eligible under this 24.28 section, the commissioner shall review the child's disability 24.29 under United States Code, title 42, section 1382c(a) and level 24.30 of care defined under this section no more often than annually 24.31 and may elect, based on the recommendation of health care 24.32 professionals under contract with the state medical review team, 24.33 to extend the review of disability and level of care up to a 24.34 maximum of four years. The commissioner's decision on the 24.35 frequency of continuing review of disability and level of care 24.36 is not subject to administrative appeal under section 256.045. 25.1 Nothing in this subdivision shall be construed as affecting 25.2 other redeterminations of medical assistance eligibility under 25.3 chapter 256B and annual cost effective reviews under this 25.4 section. 25.5 (b) For purposes of this subdivision, "hospital" means an 25.6 institution as defined in section 144.696, subdivision 3, 25.7 144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and 25.8 licensed pursuant to sections 144.50 to 144.58 . For purposes 25.9 of this subdivision, a child requires a level of care provided 25.10 in a hospital if the child is determined by the commissioner to 25.11 need an extensive array of health services, including mental 25.12 health services, for an undetermined period of time, whose 25.13 health condition requires frequent monitoring and treatment by a 25.14 health care professional or by a person supervised by a health 25.15 care professional, who would reside in a hospital or require 25.16 frequent hospitalization if these services were not provided, 25.17 and the daily care needs are more complex than a nursing 25.18 facility level of care. 25.19 A child with serious emotional disturbance requires a level 25.20 of care provided in a hospital if the commissioner determines 25.21 that the individual requires 24-hour supervision because the 25.22 person exhibits recurrent or frequent suicidal or homicidal 25.23 ideation or behavior, recurrent or frequent psychosomatic 25.24 disorders or somatopsychic disorders that may become life 25.25 threatening, recurrent or frequent severe socially unacceptable 25.26 behavior associated with psychiatric disorder, ongoing and 25.27 chronic psychosis or severe, ongoing and chronic developmental 25.28 problems requiring continuous skilled observation, or severe 25.29 disabling symptoms for which office-centered outpatient 25.30 treatment is not adequate, and which overall severely impact the 25.31 individual's ability to function. 25.32 (c) For purposes of this subdivision, "nursing facility" 25.33 means a facility which provides nursing care as defined in 25.34 section 144A.01, subdivision 5, licensed pursuant to sections 25.35 144A.02 to 144A.10, which is appropriate if a person is in 25.36 active restorative treatment; is in need of special treatments 26.1 provided or supervised by a licensed nurse; or has unpredictable 26.2 episodes of active disease processes requiring immediate 26.3 judgment by a licensed nurse. For purposes of this subdivision, 26.4 a child requires the level of care provided in a nursing 26.5 facility if the child is determined by the commissioner to meet 26.6 the requirements of the preadmission screening assessment 26.7 document under section 256B.0911 and the home care independent 26.8 rating document under section 256B.0627, subdivision 5, 26.9 paragraph (f), item (iii), adjusted to address age-appropriate 26.10 standards for children age 18 and under, pursuant to section 26.11 256B.0627, subdivision 5, paragraph (d), clause (2). 26.12 (d) For purposes of this subdivision, "intermediate care 26.13 facility for persons with mental retardation or related 26.14 conditions" or "ICF/MR" means a program licensed to provide 26.15 services to persons with mental retardation under section 26.16 252.28, and chapter 245A, and a physical plant licensed as a 26.17 supervised living facility under chapter 144, which together are 26.18 certified by the Minnesota department of health as meeting the 26.19 standards in Code of Federal Regulations, title 42, part 483, 26.20 for an intermediate care facility which provides services for 26.21 persons with mental retardation or persons with related 26.22 conditions who require 24-hour supervision and active treatment 26.23 for medical, behavioral, or habilitation needs. For purposes of 26.24 this subdivision, a child requires a level of care provided in 26.25 an ICF/MR if the commissioner finds that the child has mental 26.26 retardation or a related condition in accordance with section 26.27 256B.092, is in need of a 24-hour plan of care and active 26.28 treatment similar to persons with mental retardation, and there 26.29 is a reasonable indication that the child will need ICF/MR 26.30 services. 26.31 (e) For purposes of this subdivision, a person requires the 26.32 level of care provided in a nursing facility if the person 26.33 requires 24-hour monitoring or supervision and a plan of mental 26.34 health treatment because of specific symptoms or functional 26.35 impairments associated with a serious mental illness or disorder 26.36 diagnosis, which meet severity criteria for mental health 27.1 established by the commissioner based on standards developed for 27.2 the Wisconsin Katie Beckett program published in July 1994. 27.3 (f) The determination of the level of care needed by the 27.4 child shall be made by the commissioner based on information 27.5 supplied to the commissioner by the parent or guardian, the 27.6 child's physician or physicians , and other professionals as 27.7 requested by the commissioner. The commissioner shall establish 27.8 a screening team to conduct the level of care determinations 27.9 according to this subdivision. 27.10(f)(g) If a child meets the conditions in paragraph (b), 27.11 (c),or(d), or (e), the commissioner must assess the case to 27.12 determine whether: 27.13 (1) the child qualifies as a disabled individual under 27.14 United States Code, title 42, section 1382c(a) and would be 27.15 eligible for medical assistance if residing in a medical 27.16 institution; and 27.17 (2) the cost of medical assistance services for the child, 27.18 if eligible under this subdivision, would not be more than the 27.19 cost to medical assistance if the child resides in a medical 27.20 institution to be determined as follows: 27.21 (i) for a child who requires a level of care provided in an 27.22 ICF/MR, the cost of care for the child in an institution shall 27.23 be determined using the average payment rate established for the 27.24 regional treatment centers that are certified as ICFs/MR; 27.25 (ii) for a child who requires a level of care provided in 27.26 an inpatient hospital setting according to paragraph (b), 27.27 cost-effectiveness shall be determined according to Minnesota 27.28 Rules, part 9505.3520, items F and G; and 27.29 (iii) for a child who requires a level of care provided in 27.30 a nursing facility according to paragraph (c) or (e), 27.31 cost-effectiveness shall be determined according to Minnesota 27.32 Rules, part 9505.3040, except that the nursing facility average 27.33 rate shall be adjusted to reflect rates which would be paid for 27.34 children under age 16. The commissioner may authorize an amount 27.35 up to the amount medical assistance would pay for a child 27.36 referred to the commissioner by the preadmission screening team 28.1 under section 256B.0911. 28.2 (g) Children eligible for medical assistance services under 28.3 section 256B.055, subdivision 12, as of June 30, 1995, must be 28.4 screened according to the criteria in this subdivision prior to 28.5 January 1, 1996. Children found to be ineligible may not be 28.6 removed from the program until January 1, 1996. 28.7 Sec. 8. Minnesota Statutes 1994, section 256B.056, 28.8 subdivision 1, is amended to read: 28.9 Subdivision 1. [RESIDENCY.] To be eligible for medical 28.10 assistance, a person mustresidehave resided in Minnesota for 28.11 at least 30 days, or, if absent from the state, be deemed to be 28.12 a resident of Minnesota in accordance with the rules of the 28.13 state agency. 28.14 A person who has resided in the state for less than 30 days 28.15 is considered to be a Minnesota resident if the person: 28.16 (1) was born in the state; 28.17 (2) has in the past resided in the state for at least 365 28.18 consecutive days; 28.19 (3) has come to the state to join a close relative, which, 28.20 for purposes of this subdivision means a parent, grandparent, 28.21 brother, sister, spouse, or child; or 28.22 (4) has come to this state to accept a bona fide offer of 28.23 employment for which the person is eligible. 28.24 A county agency shall waive the 30-day residency 28.25 requirement in cases of medical emergency or where unusual 28.26 hardship would result from denial of assistance. The county 28.27 agency must report to the commissioner within 30 days on any 28.28 waiver granted under this section. The county shall not deny an 28.29 application solely because the applicant does not meet at least 28.30 one of the criteria in this subdivision, but shall continue to 28.31 process the application and leave the application pending until 28.32 the residency requirement is met or until eligibility or 28.33 ineligibility is established. 28.34 Sec. 9. Minnesota Statutes 1994, section 256B.056, 28.35 subdivision 1a, is amended to read: 28.36 Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless 29.1 specifically required by state law or rule or federal law or 29.2 regulation, the methodologies used in counting income and assets 29.3 to determine eligibility for medical assistance for persons 29.4 whose eligibility category is based on blindness, disability, or 29.5 age of 65 or more years, the methodologies for the supplemental 29.6 security income program shall be used, except that payments made 29.7 pursuant to a court order for the support of children shall be 29.8 excluded from income in an amount not to exceed the difference 29.9 between the applicable income standard used in the state's 29.10 medical assistance program for aged, blind, and disabled persons 29.11 and the applicable income standard used in the state's medical 29.12 assistance program for families with children. Exclusion of 29.13 court-ordered child support payments is subject to the condition 29.14 that if there has been a change in the financial circumstances 29.15 of the person with the legal obligation to pay support since the 29.16 support order was entered, the person with the legal obligation 29.17 to pay support has petitioned for modification of the support 29.18 order. For families and children, which includes all other 29.19 eligibility categories, the methodologies for the aid to 29.20 families with dependent children program under section 256.73 29.21 shall be used. Effective upon federal approval, in-kind 29.22 contributions to, and payments made on behalf of, a recipient, 29.23 by an obligor, in satisfaction of or in addition to a temporary 29.24 or permanent order for child support or maintenance, shall be 29.25 considered income to the recipient. For these purposes, a 29.26 "methodology" does not include an asset or income standard, or 29.27 accounting method, or method of determining effective dates. 29.28 Sec. 10. Minnesota Statutes 1995 Supplement, section 29.29 256B.0575, is amended to read: 29.30 256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 29.31 PERSONS.] 29.32 When an institutionalized person is determined eligible for 29.33 medical assistance, the income that exceeds the deductions in 29.34 paragraphs (a) and (b) must be applied to the cost of 29.35 institutional care. 29.36 (a) The following amounts must be deducted from the 30.1 institutionalized person's income in the following order: 30.2 (1) the personal needs allowance under section 256B.35 or, 30.3 for a veteran who does not have a spouse or child, or a 30.4 surviving spouse of a veteran having no child, the amount of an 30.5 improved pension received from the veteran's administration not 30.6 exceeding $90 per month; 30.7 (2) the personal allowance for disabled individuals under 30.8 section 256B.36; 30.9 (3) if the institutionalized person has a legally appointed 30.10 guardian or conservator, five percent of the recipient's gross 30.11 monthly income up to $100 as reimbursement for guardianship or 30.12 conservatorship services; 30.13 (4) a monthly income allowance determined under section 30.14 256B.058, subdivision 2, but only to the extent income of the 30.15 institutionalized spouse is made available to the community 30.16 spouse; 30.17 (5) a monthly allowance for children under age 18 which, 30.18 together with the net income of the children, would provide 30.19 income equal to the medical assistance standard for families and 30.20 children according to section 256B.056, subdivision 4, for a 30.21 family size that includes only the minor children. This 30.22 deduction applies only if the children do not live with the 30.23 community spouse and only to the extent that the deduction is 30.24 not included in the personal needs allowance under section 30.25 256B.35, subdivision 1, as child support garnished under a court 30.26 order; 30.27 (6) a monthly family allowance for other family members, 30.28 equal to one-third of the difference between 122 percent of the 30.29 federal poverty guidelines and the monthly income for that 30.30 family member; 30.31 (7) reparations payments made by the Federal Republic of 30.32 Germany and reparations payments made by the Netherlands for 30.33 victims of Nazi persecution between 1940 and 1945; and 30.34 (8) amounts for reasonable expenses incurred for necessary 30.35 medical or remedial care for the institutionalized spouse that 30.36 are not medical assistance covered expenses and that are not 31.1 subject to payment by a third party. 31.2 For purposes of clause (6), "other family member" means a 31.3 person who resides with the community spouse and who is a minor 31.4 or dependent child, dependent parent, or dependent sibling of 31.5 either spouse. "Dependent" means a person who could be claimed 31.6 as a dependent for federal income tax purposes under the 31.7 Internal Revenue Code. 31.8 (b) Income shall be allocated to an institutionalized 31.9 person for a period of up to three calendar months, in an amount 31.10 equal to the medical assistance standard for a family size of 31.11 one if: 31.12 (1) a physician certifies that the person is expected to 31.13 reside in the long-term care facility for three calendar months 31.14 or less; 31.15 (2) if the person has expenses of maintaining a residence 31.16 in the community; and 31.17 (3) if one of the following circumstances apply: 31.18 (i) the person was not living together with a spouse or a 31.19 family member as defined in paragraph (a) when the person 31.20 entered a long-term care facility; or 31.21 (ii) the person and the person's spouse become 31.22 institutionalized on the same date, in which case the allocation 31.23 shall be applied to the income of one of the spouses. 31.24 For purposes of this paragraph, a person is determined to be 31.25 residing in a licensed nursing home, regional treatment center, 31.26 or medical institution if the person is expected to remain for a 31.27 period of one full calendar month or more. 31.28 Sec. 11. Minnesota Statutes 1995 Supplement, section 31.29 256B.0595, subdivision 1, is amended to read: 31.30 Subdivision 1. [PROHIBITED TRANSFERS.] (a) For transfers 31.31 of assets made on or before August 10, 1993, if a person or the 31.32 person's spouse has given away, sold, or disposed of, for less 31.33 than fair market value, any asset or interest therein, except 31.34 assets other than the homestead that are excluded under the 31.35 supplemental security program, within 30 months before or any 31.36 time after the date of institutionalization if the person has 32.1 been determined eligible for medical assistance, or within 30 32.2 months before or any time after the date of the first approved 32.3 application for medical assistance if the person has not yet 32.4 been determined eligible for medical assistance, the person is 32.5 ineligible for long-term care services for the period of time 32.6 determined under subdivision 2. 32.7 (b) Effective for transfers made after August 10, 1993, a 32.8 person, a person's spouse, or any person, court, or 32.9 administrative body with legal authority to act in place of, on 32.10 behalf of, at the direction of, or upon the request of the 32.11 person or person's spouse, may not give away, sell, or dispose 32.12 of, for less than fair market value, any asset or interest 32.13 therein, except assets other than the homestead that are 32.14 excluded under the supplemental security income program, for the 32.15 purpose of establishing or maintaining medical assistance 32.16 eligibility. For purposes of determining eligibility for 32.17 long-term care services, any transfer of such assets within 36 32.18 months before or any time after an institutionalized person 32.19 applies for medical assistance, or 36 months before or any time 32.20 after a medical assistance recipient becomes institutionalized, 32.21 for less than fair market value may be considered. Any such 32.22 transfer is presumed to have been made for the purpose of 32.23 establishing or maintaining medical assistance eligibility and 32.24 the person is ineligible for long-term care services for the 32.25 period of time determined under subdivision 2, unless the person 32.26 furnishes convincing evidence to establish that the transaction 32.27 was exclusively for another purpose, or unless the transfer is 32.28 permitted under subdivision 3 or 4. Notwithstanding the 32.29 provisions of this paragraph, in the case of payments from a 32.30 trust or portions of a trust that are considered transfers of 32.31 assets under federal law, any transfers made within 60 months 32.32 before or any time after an institutionalized person applies for 32.33 medical assistance and within 60 months before or any time after 32.34 a medical assistance recipient becomes institutionalized, may be 32.35 considered. 32.36 (c) This section applies to transfers, for less than fair 33.1 market value, of income or assets, including assets that are 33.2 considered income in the month received, such as inheritances, 33.3 court settlements, and retroactive benefit payments or income to 33.4 which the person or the person's spouse is entitled but does not 33.5 receive due to action by the person, the person's spouse, or any 33.6 person, court, or administrative body with legal authority to 33.7 act in place of, on behalf of, at the direction of, or upon the 33.8 request of the person or the person's spouse. 33.9 (d) This section applies to payments for care or personal 33.10 services provided by a relative, unless the compensation was 33.11 stipulated in a notarized, written agreement which was in 33.12 existence when the service was performed, the care or services 33.13 directly benefited the person, and the payments made represented 33.14 reasonable compensation for the care or services provided. A 33.15 notarized written agreement is not required if payment for the 33.16 services was made within 60 days after the service was provided. 33.17 (e) This section applies to the portion of any asset or 33.18 interest that a person, a person's spouse, or any person, court, 33.19 or administrative body with legal authority to act in place of, 33.20 on behalf of, at the direction of, or upon the request of the 33.21 person or the person's spouse, transfers to anytrust,annuity,33.22or other instrument,that exceeds the value of the benefit 33.23 likely to be returned to the person or spouse while alive, based 33.24 on estimated life expectancy using the life expectancy tables 33.25 employed by the supplemental security income program to 33.26 determine the value of an agreement for services for life. The 33.27 commissioner may adopt rules reducing life expectancies based on 33.28 the need for long-term care. 33.29 (f) For purposes of this section, long-term care services 33.30 include services in a nursing facility, services that are 33.31 eligible for payment according to section 256B.0625, subdivision 33.32 2, because they are provided in a swing bed, intermediate care 33.33 facility for persons with mental retardation, and home and 33.34 community-based services provided pursuant to sections 33.35 256B.0915, 256B.092, and 256B.49. For purposes of this 33.36 subdivision and subdivisions 2, 3, and 4, "institutionalized 34.1 person" includes a person who is an inpatient in a nursing 34.2 facility or in a swing bed, or intermediate care facility for 34.3 persons with mental retardation or who is receiving home and 34.4 community-based services under sections 256B.0915, 256B.092, and 34.5 256B.49. 34.6 (g) Effective for transfers made on or after July 1, 1995, 34.7 or upon federal approval, whichever is later, a person, a 34.8 person's spouse, or any person, court, or administrative body 34.9 with legal authority to act in place of, on behalf of, at the 34.10 direction of, or upon the request of the person or person's 34.11 spouse, may not give away, sell, or dispose of, for less than 34.12 fair market value, any asset or interest therein, for the 34.13 purpose of establishing or maintaining medical assistance 34.14 eligibility. For purposes of determining eligibility for 34.15 long-term care services, any transfer of such assets within 60 34.16 months before, or any time after, an institutionalized person 34.17 applies for medical assistance, or 60 months before, or any time 34.18 after, a medical assistance recipient becomes institutionalized, 34.19 for less than fair market value may be considered. Any such 34.20 transfer is presumed to have been made for the purpose of 34.21 establishing or maintaining medical assistance eligibility and 34.22 the person is ineligible for long-term care services for the 34.23 period of time determined under subdivision 2, unless the person 34.24 furnishes convincing evidence to establish that the transaction 34.25 was exclusively for another purpose, or unless the transfer is 34.26 permitted under subdivision 3 or 4. 34.27 Sec. 12. Minnesota Statutes 1994, section 256B.0595, is 34.28 amended by adding a subdivision to read: 34.29 Subd. 1a. [PROHIBITED TRANSFERS.] (a) Notwithstanding any 34.30 contrary provisions of this section, this subdivision applies to 34.31 transfers involving recipients of medical assistance that are 34.32 made on or after its effective date and to all transfers 34.33 involving persons who apply for medical assistance on or after 34.34 its effective date if the transfer occurred within 72 months 34.35 before the person applies for medical assistance, except that 34.36 this subdivision does not apply to transfers made prior to March 35.1 1, 1996. A person, a person's spouse, or any person, court, or 35.2 administrative body with legal authority to act in place of, on 35.3 behalf of, at the direction of, or upon the request of the 35.4 person or the person's spouse, may not give away, sell, dispose 35.5 of, or reduce ownership or control of any income, asset, or 35.6 interest therein for less than fair market value for the purpose 35.7 of establishing or maintaining medical assistance eligibility 35.8 for the person. For purposes of determining eligibility for 35.9 medical assistance services, any transfer of such income or 35.10 assets for less than fair market value within 72 months before 35.11 or any time after a person applies for medical assistance may be 35.12 considered. Any such transfer is presumed to have been made for 35.13 the purpose of establishing or maintaining medical assistance 35.14 eligibility, and the person is ineligible for medical assistance 35.15 services for the period of time determined under subdivision 2a, 35.16 unless the person furnishes convincing evidence to establish 35.17 that the transaction was exclusively for another purpose, or 35.18 unless the transfer is permitted under subdivision 3a or 4a. 35.19 (b) This section applies to transfers of income or assets 35.20 for less than fair market value, including assets that are 35.21 considered income in the month received, such as inheritances, 35.22 court settlements, and retroactive benefit payments or income to 35.23 which the person or the person's spouse is entitled but does not 35.24 receive due to action by the person, the person's spouse, or any 35.25 person, court, or administrative body with legal authority to 35.26 act in place of, on behalf of, at the direction of, or upon the 35.27 request of the person or the person's spouse. 35.28 (c) This section applies to payments for care or personal 35.29 services provided by a relative, unless the compensation was 35.30 stipulated in a notarized, written agreement which was in 35.31 existence when the service was performed, the care or services 35.32 directly benefited the person, and the payments made represented 35.33 reasonable compensation for the care or services provided. A 35.34 notarized written agreement is not required if payment for the 35.35 services was made within 60 days after the service was provided. 35.36 (d) This section applies to the portion of any income, 36.1 asset, or interest therein that a person, a person's spouse, or 36.2 any person, court, or administrative body with legal authority 36.3 to act in place of, on behalf of, at the direction of, or upon 36.4 the request of the person or the person's spouse, transfers to 36.5 any annuity that exceeds the value of the benefit likely to be 36.6 returned to the person or spouse while alive, based on estimated 36.7 life expectancy of adults entering long-term care. The 36.8 commissioner shall adopt rules establishing life expectancies of 36.9 adults entering long-term care. 36.10 Sec. 13. Minnesota Statutes 1995 Supplement, section 36.11 256B.0595, subdivision 2, is amended to read: 36.12 Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any 36.13 uncompensated transfer occurring on or before August 10, 1993, 36.14 the number of months of ineligibility for long-term care 36.15 services shall be the lesser of 30 months, or the uncompensated 36.16 transfer amount divided by the average medical assistance rate 36.17 for nursing facility services in the state in effect on the date 36.18 of application. The amount used to calculate the average 36.19 medical assistance payment rate shall be adjusted each July 1 to 36.20 reflect payment rates for the previous calendar year. The 36.21 period of ineligibility begins with the month in which the 36.22 assets were transferred. If the transfer was not reported to 36.23 the local agency at the time of application, and the applicant 36.24 received long-term care services during what would have been the 36.25 period of ineligibility if the transfer had been reported, a 36.26 cause of action exists against the transferee for the cost of 36.27 long-term care services provided during the period of 36.28 ineligibility, or for the uncompensated amount of the transfer, 36.29 whichever is less. The action may be brought by the state or 36.30 the local agency responsible for providing medical assistance 36.31 under chapter 256G. The uncompensated transfer amount is the 36.32 fair market value of the asset at the time it was given away, 36.33 sold, or disposed of, less the amount of compensation received. 36.34 (b) For uncompensated transfers made after August 10, 1993, 36.35 the number of months of ineligibility for long-term care 36.36 services shall be the total uncompensated value of the resources 37.1 transferred divided by the average medical assistance rate for 37.2 nursing facility services in the state in effect on the date of 37.3 application. The amount used to calculate the average medical 37.4 assistance payment rate shall be adjusted each July 1 to reflect 37.5 payment rates for the previous calendar year. The period of 37.6 ineligibility begins with the month in which the assets were 37.7 transferred except that if one or more uncompensated transfers 37.8 are made during a period of ineligibility, the total assets 37.9 transferred during the ineligibility period shall be combined 37.10 and a penalty period calculated to begin in the month the first 37.11 uncompensated transfer was made. If the transfer was not 37.12 reported to the local agency at the time of application, and the 37.13 applicant received medical assistance services during what would 37.14 have been the period of ineligibility if the transfer had been 37.15 reported, a cause of action exists against the transferee for 37.16 the cost of medical assistance services provided during the 37.17 period of ineligibility, or for the uncompensated amount of the 37.18 transfer, whichever is less. The action may be brought by the 37.19 state or the local agency responsible for providing medical 37.20 assistance under chapter 256G. The uncompensated transfer 37.21 amount is the fair market value of the asset at the time it was 37.22 given away, sold, or disposed of, less the amount of 37.23 compensation received. 37.24 (c) If a calculation of a penalty period results in a 37.25 partial month, payments for long-term care services shall be 37.26 reduced in an amount equal to the fraction, except that in 37.27 calculating the value of uncompensated transfers, if the total 37.28 value of all uncompensated transfers made in a month not 37.29 included in an existing penalty period does not exceed 37.30$1,000$500, then such transfers shall be disregarded for each 37.31 month prior to the month of application for or during receipt of 37.32 medical assistance. 37.33 Sec. 14. Minnesota Statutes 1994, section 256B.0595, is 37.34 amended by adding a subdivision to read: 37.35 Subd. 2a. [PERIOD OF INELIGIBILITY.] (a) Notwithstanding 37.36 any contrary provisions of this section, this subdivision 38.1 applies to transfers involving recipients of medical assistance 38.2 that are made on or after its effective date and to all 38.3 transfers involving persons who apply for medical assistance on 38.4 or after its effective date, regardless of when the transfer 38.5 occurred, except that this subdivision does not apply to 38.6 transfers made prior to March 1, 1996. For any uncompensated 38.7 transfer occurring within 72 months prior to the date of 38.8 application, at any time after application, or while eligible, 38.9 the number of months of cumulative ineligibility for medical 38.10 assistance services shall be the total uncompensated value of 38.11 the assets and income transferred divided by the statewide 38.12 average per person nursing facility payment made by the state in 38.13 effect on the date of application. The amount used to calculate 38.14 the average per person payment shall be adjusted each July 1 to 38.15 reflect average payments for the previous calendar year. For 38.16 applicants, the period of ineligibility begins with the month in 38.17 which the person applied for medical assistance and satisfied 38.18 all other requirements for eligibility, or the month the local 38.19 agency becomes aware of the transfer, if later. For recipients, 38.20 the period of ineligibility begins in the month the agency 38.21 becomes aware of the transfer, except that penalty periods for 38.22 transfers made during a period of ineligibility as determined 38.23 under this section shall begin in the month following the 38.24 existing period of ineligibility. If the transfer was not 38.25 reported to the local agency at the time of application, and the 38.26 applicant received medical assistance services during what would 38.27 have been the period of ineligibility if the transfer had been 38.28 reported, a cause of action exists against the transferee for 38.29 the cost of medical assistance services provided during the 38.30 period of ineligibility, or for the uncompensated amount of the 38.31 transfer that was not recovered from the transferor through the 38.32 implementation of a penalty period under this subdivision, 38.33 whichever is less. The action may be brought by the state or 38.34 the local agency responsible for providing medical assistance 38.35 under chapter 256G. The total uncompensated value is the fair 38.36 market value of the income or asset at the time it was given 39.1 away, sold, or disposed of, less the amount of compensation 39.2 received. No cause of action exists for a transfer, unless: 39.3 (1) the transferee knew or should have known that the transfer 39.4 was being made by a person who was a resident of a long-term 39.5 care facility or was receiving that level of care in the 39.6 community at the time of the transfer; (2) the transferee knew 39.7 or should have known that the transfer was being made to assist 39.8 the person to qualify for or retain medical assistance 39.9 eligibility; or (3) the transferee actively solicited the 39.10 transfer with intent to assist the person to qualify for or 39.11 retain eligibility for medical assistance. 39.12 (b) If a calculation of a penalty period results in a 39.13 partial month, payments for medical assistance services shall be 39.14 reduced in an amount equal to the fraction, except that in 39.15 calculating the value of uncompensated transfers, if the total 39.16 value of all uncompensated transfers made in a month not 39.17 included in an existing penalty period does not exceed $500, 39.18 then such transfers shall be disregarded for each month prior to 39.19 the month of application for or during receipt of medical 39.20 assistance. 39.21 Sec. 15. Minnesota Statutes 1995 Supplement, section 39.22 256B.0595, subdivision 3, is amended to read: 39.23 Subd. 3. [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.] 39.24 (a) An institutionalized person is not ineligible for long-term 39.25 care services due to a transfer of assets for less than fair 39.26 market value if the asset transferred was a homestead and: 39.27 (1) title to the homestead was transferred to the 39.28 individual's 39.29 (i) spouse; 39.30 (ii) child who is under age 21; 39.31 (iii) blind or permanently and totally disabled child as 39.32 defined in the supplemental security income program; 39.33 (iv) sibling who has equity interest in the home and who 39.34 was residing in the home for a period of at least one year 39.35 immediately before the date of the individual's admission to the 39.36 facility; or 40.1 (v) son or daughter who was residing in the individual's 40.2 home for a period of at least two years immediately before the 40.3 date of the individual's admission to the facility, and who 40.4 provided care to the individual that, as certified by the 40.5 individual's attending physician, permitted the individual to 40.6 reside at home rather than in an institution or facility; 40.7 (2) a satisfactory showing is made that the individual 40.8 intended to dispose of the homestead at fair market value or for 40.9 other valuable consideration; or 40.10 (3) the local agency grants a waiver ofthe excess40.11resources created by the uncompensated transfera penalty 40.12 resulting from a transfer for less than fair market value 40.13 because denial of eligibility would cause undue hardship for the 40.14 individual, based on imminent threat to the individual's health 40.15 and well-being. Whenever an applicant or recipient is denied 40.16 eligibility because of a transfer for less than fair market 40.17 value, the local agency shall notify the applicant or recipient 40.18 that they may request a waiver of the penalty if the denial of 40.19 eligibility will cause undue hardship. In evaluating a waiver, 40.20 the local agency shall take into account whether the individual 40.21 was the victim of financial exploitation, whether the individual 40.22 has made reasonable efforts to recover the transferred property 40.23 or resource, and other factors relevant to a determination of 40.24 hardship. If the local agency does not approve a hardship 40.25 waiver, the local agency shall issue a written notice to the 40.26 individual stating the reasons for the denial and the process 40.27 for appealing the local agency's decision. 40.28 (b) When a waiver is granted under paragraph (a), clause 40.29 (3), a cause of action exists against the person to whom the 40.30 homestead was transferred for that portion of long-term care 40.31 services granted within: 40.32 (1) 30 months of a transfer made on or before August 10, 40.33 1993; 40.34 (2) 60 months if the homestead was transferred after August 40.35 10, 1993, to a trust or portion of a trust that is considered a 40.36 transfer of assets under federal law; or 41.1 (3) 36 months if transferred in any other manner after 41.2 August 10, 1993, 41.3 or the amount of the uncompensated transfer, whichever is less, 41.4 together with the costs incurred due to the action. The action 41.5mayshall be brought by the stateorunless the state delegates 41.6 this responsibility to the local agency responsible for 41.7 providing medical assistance under chapter 256G. 41.8 Sec. 16. Minnesota Statutes 1994, section 256B.0595, is 41.9 amended by adding a subdivision to read: 41.10 Subd. 3a. [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.] 41.11 (a) This subdivision applies to transfers involving recipients 41.12 of medical assistance that are made on or after its effective 41.13 date and to all transfers involving persons who apply for 41.14 medical assistance on or after its effective date, regardless of 41.15 when the transfer occurred, except that this subdivision does 41.16 not apply to transfers made prior to March 1, 1996. A person is 41.17 not ineligible for medical assistance services due to a transfer 41.18 of assets for less than fair market value as described in 41.19 subdivision 1a if the asset transferred was a homestead and: 41.20 (1) title to the homestead was transferred to the 41.21 individual's relatives who are residing in the homestead and are 41.22 the individual's 41.23 (i) spouse; 41.24 (ii) child who is under age 21; 41.25 (iii) blind or permanently and totally disabled child as 41.26 defined in the supplemental security income program; 41.27 (iv) sibling who has equity interest in the home and who 41.28 was residing in the home for a period of at least one year 41.29 immediately before the date of the individual's admission to the 41.30 facility; or 41.31 (v) son or daughter who was residing in the individual's 41.32 home for a period of at least two years immediately before the 41.33 date of the individual's admission to the facility, and who 41.34 provided care to the individual that, as certified by the 41.35 individual's attending physician, permitted the individual to 41.36 reside at home rather than in an institution or facility; 42.1 (2) a satisfactory showing is made that the individual 42.2 intended to dispose of the homestead at fair market value or for 42.3 other valuable consideration; or 42.4 (3) the local agency grants a waiver of a penalty resulting 42.5 from a transfer for less than fair market value because denial 42.6 of eligibility would cause undue hardship for the individual and 42.7 there exists an imminent threat to the individual's health and 42.8 well-being. Whenever an applicant or recipient is denied 42.9 eligibility because of a transfer for less than fair market 42.10 value, the local agency shall notify the applicant or recipient 42.11 that they may request a waiver of the penalty if the denial of 42.12 eligibility will cause undue hardship. In evaluating a waiver, 42.13 the local agency shall take into account whether the individual 42.14 was the victim of financial exploitation, whether the individual 42.15 has made reasonable efforts to recover the transferred property 42.16 or resource, and other factors relevant to a determination of 42.17 hardship. If the local agency does not approve a hardship 42.18 waiver, the local agency shall issue a written notice to the 42.19 individual stating the reasons for the denial and the process 42.20 for appealing the local agency's decision. 42.21 (b) When a waiver is granted under paragraph (a), clause 42.22 (3), a cause of action exists against the person to whom the 42.23 homestead was transferred for that portion of medical assistance 42.24 services granted within 72 months of the date the transferor 42.25 applied for medical assistance and satisfied all other 42.26 requirements for eligibility, or the amount of the uncompensated 42.27 transfer, whichever is less, together with the costs incurred 42.28 due to the action. The action shall be brought by the state 42.29 unless the state delegates this responsibility to the local 42.30 agency responsible for providing medical assistance under 42.31 chapter 256G. 42.32 Sec. 17. Minnesota Statutes 1995 Supplement, section 42.33 256B.0595, subdivision 4, is amended to read: 42.34 Subd. 4. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] An 42.35 institutionalized person who has made, or whose spouse has made 42.36 a transfer prohibited by subdivision 1, is not ineligible for 43.1 long-term care services if one of the following conditions 43.2 applies: 43.3 (1) the assets were transferred to the individual's spouse 43.4 or to another for the sole benefit of the spouse; or 43.5 (2) the institutionalized spouse, prior to being 43.6 institutionalized, transferred assets to a spouse, provided that 43.7 the spouse to whom the assets were transferred does not then 43.8 transfer those assets to another person for less than fair 43.9 market value. (At the time when one spouse is 43.10 institutionalized, assets must be allocated between the spouses 43.11 as provided under section 256B.059); or 43.12 (3) the assets were transferred to the individual's child 43.13 who is blind or permanently and totally disabled as determined 43.14 in the supplemental security income program; or 43.15 (4) a satisfactory showing is made that the individual 43.16 intended to dispose of the assets either at fair market value or 43.17 for other valuable consideration; or 43.18 (5) the local agency determines that denial of eligibility 43.19 for long-term care services would work an undue hardship and 43.20 grants a waiver ofexcess assetsa penalty resulting from a 43.21 transfer for less than fair market value based on an imminent 43.22 threat to the individual's health and well-being. Whenever an 43.23 applicant or recipient is denied eligibility because of a 43.24 transfer for less than fair market value, the local agency shall 43.25 notify the applicant or recipient that they may request a waiver 43.26 of the penalty if the denial of eligibility will cause undue 43.27 hardship. In evaluating a waiver, the local agency shall take 43.28 into account whether the individual was the victim of financial 43.29 exploitation, whether the individual has made reasonable efforts 43.30 to recover the transferred property or resource, and other 43.31 factors relevant to a determination of hardship. If the local 43.32 agency does not approve a hardship waiver, the local agency 43.33 shall issue a written notice to the individual stating the 43.34 reasons for the denial and the process for appealing the local 43.35 agency's decision. When a waiver is granted, a cause of action 43.36 exists against the person to whom the assets were transferred 44.1 for that portion of long-term care services granted within: 44.2 (i) 30 months of a transfer made on or before August 10, 44.3 1993; 44.4 (ii) 60 months of a transfer if the assets were transferred 44.5 after August 30, 1993, to a trust or portion of a trust that is 44.6 considered a transfer of assets under federal law; or 44.7 (iii) 36 months of a transfer if transferred in any other 44.8 manner after August 10, 1993, 44.9 or the amount of the uncompensated transfer, whichever is less, 44.10 together with the costs incurred due to the action. The action 44.11mayshall be brought by the stateorunless the state delegates 44.12 this responsibility to the local agency responsible for 44.13 providing medical assistance under this chapter; or 44.14 (6) for transfers occurring after August 10, 1993, the 44.15 assets were transferred by the person or person's spouse: (i) 44.16 into a trust established solely for the benefit of a son or 44.17 daughter of any age who is blind or disabled as defined by the 44.18 Supplemental Security Income program; or (ii) into a trust 44.19 established solely for the benefit of an individual who is under 44.20 65 years of age who is disabled as defined by the Supplemental 44.21 Security Income program. 44.22 Sec. 18. Minnesota Statutes 1994, section 256B.0595, is 44.23 amended by adding a subdivision to read: 44.24 Subd. 4a. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.] This 44.25 subdivision applies to transfers involving recipients of medical 44.26 assistance that are made on or after its effective date and to 44.27 all transfers involving persons who apply for medical assistance 44.28 on or after its effective date, regardless of when the transfer 44.29 occurred, except that this subdivision does not apply to 44.30 transfers made prior to March 1, 1996. A person or a person's 44.31 spouse who has made a transfer prohibited by subdivision 1a is 44.32 not ineligible for medical assistance services if one of the 44.33 following conditions applies: 44.34 (1) the assets or income were transferred to the 44.35 individual's spouse or to another for the sole benefit of the 44.36 spouse, except that after eligibility is established, transfers 45.1 to a spouse are permitted only to comply with the provisions of 45.2 section 256B.059; or 45.3 (2) the institutionalized spouse, prior to being 45.4 institutionalized, transferred assets or income to a spouse, 45.5 provided that the spouse to whom the assets or income were 45.6 transferred does not then transfer those assets or income to 45.7 another person for less than fair market value. (At the time 45.8 when one spouse is institutionalized, assets must be allocated 45.9 between the spouses as provided under section 256B.059); or 45.10 (3) the assets or income were transferred to a trust for 45.11 the sole benefit of the individual's child who is blind or 45.12 permanently and totally disabled as determined in the 45.13 supplemental security income program and the trust reverts to 45.14 the state upon the disabled child's death to the extent medical 45.15 assistance has paid for services for the child. This paragraph 45.16 paragraph applies to a trust established after the commissioner 45.17 publishes a notice in the State Register that the commissioner 45.18 has been authorized to implement this paragraph due to a change 45.19 in federal law or the approval of a federal waiver; or 45.20 (4) a satisfactory showing is made that the individual 45.21 intended to dispose of the assets or income either at fair 45.22 market value or for other valuable consideration; or 45.23 (5) the local agency determines that denial of eligibility 45.24 for medical assistance services would work an undue hardship and 45.25 grants a waiver of a penalty resulting from a transfer for less 45.26 than fair market value because there exists an imminent threat 45.27 to the individual's health and well-being. Whenever an 45.28 applicant or recipient is denied eligibility because of a 45.29 transfer for less than fair market value, the local agency shall 45.30 notify the applicant or recipient that they may request a waiver 45.31 of the penalty if the denial of eligibility will cause undue 45.32 hardship. In evaluating a waiver, the local agency shall take 45.33 into account whether the individual was the victim of financial 45.34 exploitation, whether the individual has made reasonable efforts 45.35 to recover the transferred property or resource, and other 45.36 factors relevant to a determination of hardship. If the local 46.1 agency does not approve a hardship waiver, the local agency 46.2 shall issue a written notice to the individual stating the 46.3 reasons for the denial and the process for appealing the local 46.4 agency's decision. When a waiver is granted, a cause of action 46.5 exists against the person to whom the assets were transferred 46.6 for that portion of medical assistance services granted within 46.7 72 months of the date the transferor applied for medical 46.8 assistance and satisfied all other requirements for eligibility, 46.9 or the amount of the uncompensated transfer, whichever is less, 46.10 together with the costs incurred due to the action. The action 46.11 shall be brought by the state unless the state delegates this 46.12 responsibility to the local agency responsible for providing 46.13 medical assistance under this chapter. 46.14 Sec. 19. Minnesota Statutes 1994, section 256B.0595, is 46.15 amended by adding a subdivision to read: 46.16 Subd. 8. [NOTICE OF RIGHTS.] If a period of ineligibility 46.17 is imposed under subdivision 2 or 2a, the local agency shall 46.18 inform the applicant or recipient subject to the penalty of the 46.19 person's rights under section 325F.71, subdivision 2. 46.20 Sec. 20. Minnesota Statutes 1995 Supplement, section 46.21 256B.0625, subdivision 19a, is amended to read: 46.22 Subd. 19a. [PERSONAL CARE SERVICES.] Medical assistance 46.23 covers personal care services in a recipient's home. To qualify 46.24 for personal care services, recipients or responsible parties 46.25 must be able to identifytheirthe recipient's needs, direct and 46.26 evaluate task accomplishment, andassure theirprovide for 46.27 health and safety. Approved hours may be used outside the home 46.28 when normal life activities take them outside the home and when, 46.29 without the provision of personal care, their health and safety 46.30 would be jeopardized. Total hours for services, whether 46.31 actually performed inside or outside the recipient's home, 46.32 cannot exceed that which is otherwise allowed for personal care 46.33 services in an in-home setting according to section 256B.0627. 46.34 Medical assistance does not cover personal care services for 46.35 residents of a hospital, nursing facility, intermediate care 46.36 facility, health care facility licensed by the commissioner of 47.1 health, or unless a resident who is otherwise eligible is on 47.2 leave from the facility and the facility either pays for the 47.3 personal care services or forgoes the facility per diem for the 47.4 leave days that personal care services are used. All personal 47.5 care services must be provided according to section 256B.0627. 47.6 Personal care services may not be reimbursed if the personal 47.7 care assistant is the spouse or legal guardian of the recipient 47.8 or the parent of a recipient under age 18, or the responsible 47.9 party or the foster care provider of a recipient who cannot 47.10 direct the recipient's own care unless, in the case of a foster 47.11 care provider, a county or state case manager visits the 47.12 recipient as needed, but not less than every six months, to 47.13 monitor the health and safety of the recipient and to ensure the 47.14 goals of the care plan are met. Parents of adult recipients, 47.15 adult children of the recipient or adult siblings of the 47.16 recipient may be reimbursed for personal care services if they 47.17 are not the recipient's legal guardian and are granted a waiver 47.18 under section 256B.0627. 47.19 Sec. 21. Minnesota Statutes 1995 Supplement, section 47.20 256B.0628, subdivision 2, is amended to read: 47.21 Subd. 2. [DUTIES.] (a) The commissioner may contract with 47.22 or employ qualified registered nurses and necessary support 47.23 staff, or contract with qualified agencies, to provide home care 47.24 prior authorization and review services for medical assistance 47.25 recipients who are receiving home care services. 47.26 (b) Reimbursement for the prior authorization function 47.27 shall be made through the medical assistance administrative 47.28 authority. The state shall pay the nonfederal share. The 47.29 functions will be to: 47.30 (1) assess the recipient's individual need for services 47.31 required to be cared for safely in the community; 47.32 (2) ensure that a service plan that meets the recipient's 47.33 needs is developed by the appropriate agency or individual; 47.34 (3) ensure cost-effectiveness of medical assistance home 47.35 care services; 47.36 (4) recommend the approval or denial of the use of medical 48.1 assistance funds to pay for home care services; 48.2 (5) reassess the recipient's need for and level of home 48.3 care services at a frequency determined by the commissioner; and 48.4 (6) conduct on-site assessments when determined necessary 48.5 by the commissioner and recommend changes to care plans that 48.6 will provide more efficient and appropriate home care. 48.7 (c) In addition, the commissioner or the commissioner's 48.8 designee may: 48.9 (1) review service plans and reimbursement data for 48.10 utilization of services that exceed community-based standards 48.11 for home care, inappropriate home care services, medical 48.12 necessity, home care services that do not meet quality of care 48.13 standards, or unauthorized services and make appropriate 48.14 referrals within the department or to other appropriate entities 48.15 based on the findings; 48.16 (2) assist the recipient in obtaining services necessary to 48.17 allow the recipient to remain safely in or return to the 48.18 community; 48.19 (3) coordinate home care services with other medical 48.20 assistance services under section 256B.0625; 48.21 (4) assist the recipient with problems related to the 48.22 provision of home care services;and48.23 (5) assure the quality of home care services.; and 48.24 (6) assure that all liable third-party payers including 48.25 Medicare have been used prior to medical assistance for home 48.26 care services, including but not limited to, home health agency, 48.27 elected hospice benefit, waivered services, alternative care 48.28 program services, and personal care services. 48.29 (d) For the purposes of this section, "home care services" 48.30 means medical assistance services defined under section 48.31 256B.0625, subdivisions 6a, 7, and 19a. 48.32 Sec. 22. [256B.07] [MEDICARE MAXIMIZATION PROGRAM.] 48.33 Subdivision 1. [DEFINITION.] (a) "Dual entitlees" means 48.34 recipients eligible for either the medical assistance program or 48.35 the alternative care program who are also eligible for the 48.36 federal Medicare program. 49.1 (b) For purposes of this section "home care services" means 49.2 home health agency services, private duty nursing services, 49.3 personal care assistant services, waivered services, alternative 49.4 care program services, hospice services, rehabilitation therapy 49.5 services, and medical supplies and equipment. 49.6 Subd. 2. [TECHNICAL ASSISTANCE TO PROVIDERS.] (a) The 49.7 commissioner shall establish a technical assistance program to 49.8 require providers of services and equipment under this section 49.9 to maximize collections from the federal Medicare program. The 49.10 technical assistance may include the provision of materials to 49.11 help providers determine those services and equipment likely to 49.12 be reimbursed by Medicare. The technical assistance may also 49.13 include the provision of computer software to providers to 49.14 assist in this process. The commissioner may expand the 49.15 technical assistance program to include providers of other 49.16 services under this chapter. 49.17 (b) Any provider of home care services enrolled in the 49.18 medical assistance program, or county public health nursing 49.19 agency responsible for personal care assessments, or county case 49.20 managers for alternative care or medical assistance waiver 49.21 programs, is required to use the method developed and supplied 49.22 by the department of human services for determining Medicare 49.23 coverage for home care equipment and services provided to dual 49.24 entitlees to ensure appropriate billing of Medicare. The method 49.25 will be developed in two phases; the first phase is a manual 49.26 system effective July 1, 1996, and the second phase will 49.27 automate the manual procedure by expanding the current Medicaid 49.28 Management Information System (MMIS) effective January 1, 1997. 49.29 Both methods will determine Medicare coverage for the dates of 49.30 service, Medicare coverage for home care services, and create an 49.31 audit trail including reports. Both methods will be linked to 49.32 prior authorization, therefore, either method must be used 49.33 before home care services are authorized and when there is a 49.34 change of condition affecting medical assistance authorization. 49.35 The department will conduct periodic reviews of participant 49.36 performance with the method and upon demonstrating appropriate 50.1 referral and billing of Medicare, participants may be determined 50.2 exempt from regular performance audits. 50.3 Subd. 3. [REFERRALS TO MEDICARE CERTIFIED PROVIDERS 50.4 REQUIRED.] Non-Medicare certified and nonparticipating Medicare 50.5 certified home care service providers must refer dual eligible 50.6 recipients to Medicare certified providers when Medicare is 50.7 determined to be the appropriate payer for supplies and 50.8 equipment or services. Non-Medicare certified and 50.9 nonparticipating Medicare certified home care service providers 50.10 will be terminated from participation in the medical assistance 50.11 program for failure to make such referrals. 50.12 Subd. 4. [MEDICARE CERTIFICATION REQUIREMENT.] Medicare 50.13 certification is required of all medical assistance enrolled 50.14 home care service providers as defined in subdivision 1 within 50.15 one year of the date the Minnesota department of health gives 50.16 notice to the department that initial Medicare surveys will 50.17 resume. 50.18 Subd. 5. [ADVISORY COMMITTEE.] The commissioner shall 50.19 establish an advisory committee comprised of home care services 50.20 recipients, providers, county public health nurses, home care 50.21 and county nursing associations, and department of human 50.22 services staff to make recommendations to the Medicare 50.23 maximization program. The recommendations shall include: 50.24 nursing practice issues as they relate to home care services 50.25 funded by Medicare and medical assistance; and streamlining 50.26 assessment, prior authorization, and up-front payer 50.27 determination processes to achieve administrative efficiencies. 50.28 Sec. 23. Minnesota Statutes 1995 Supplement, section 50.29 256B.0913, subdivision 15a, is amended to read: 50.30 Subd. 15a. [REIMBURSEMENT RATE; ANOKA COUNTY.] 50.31 Notwithstanding subdivision 14, paragraph (e),or any other law50.32to the contrary, for services rendered on or aftereffective 50.33 January 1, 1996, Anokacounty may pay vendors, and the50.34commissioner shall reimburse the county, for actual costs up to50.35a limit which is the maximum rate in effect on December 31,50.361995, plus half the difference between that rate and the maximum51.1allowed statecounty's maximum allowed rate for home health aide 51.2 services per 15-minute unit is $4.39, and its maximum allowed 51.3 rate for homemaker services per 15-minute unit is $2.90. Any 51.4 adjustments in fiscal year 1997 to the maximum allowed rates for 51.5 home health aide or homemaker services for Anoka county shall be 51.6 calculated from the maximum rate in effect on January 1, 1996. 51.7 Sec. 24. Minnesota Statutes 1994, section 256B.0913, is 51.8 amended by adding a subdivision to read: 51.9 Subd. 15b. [REIMBURSEMENT RATE; AITKIN COUNTY.] 51.10 Notwithstanding subdivision 14, paragraph (e), effective April 51.11 1, 1996, Aitkin county's maximum allowed rate for in-home 51.12 respite care services is $6.62 per 30-minute unit. Any 51.13 adjustments in fiscal year 1997 to the maximum allowed rate for 51.14 in-home respite care services for Aitkin county shall be 51.15 calculated from the maximum rate in effect on April 1, 1996. 51.16 Sec. 25. Minnesota Statutes 1994, section 256B.0913, is 51.17 amended by adding a subdivision to read: 51.18 Subd. 15c. [REIMBURSEMENT RATE; POLK AND PENNINGTON 51.19 COUNTIES.] Notwithstanding subdivision 14, paragraph (e), 51.20 effective July 1, 1996, Polk and Pennington counties' maximum 51.21 allowed rate for homemaker services is $6.18 per 30-minute 51.22 unit. Any adjustments in fiscal year 1997 to the maximum 51.23 allowed rate for homemaker services for Polk and Pennington 51.24 counties shall be calculated from the maximum rate in effect on 51.25 July 1, 1996. 51.26 Sec. 26. Minnesota Statutes 1995 Supplement, section 51.27 256B.0915, subdivision 3a, is amended to read: 51.28 Subd. 3a. [REIMBURSEMENT RATE; ANOKA COUNTY.] 51.29 Notwithstanding subdivision 3, paragraph (h),or any other law51.30to the contrary, for services rendered on or aftereffective 51.31 January 1, 1996, Anokacounty may pay vendors, and the51.32commissioner shall reimburse the county, for actual costs up to51.33a limit which is the maximum rate in effect on December 31,51.341995, plus half the difference between that rate and the maximum51.35allowed statecounty's maximum allowed rate for home health aide 51.36 services per 15-minute unit is $4.43, and its maximum allowed 52.1 rate for homemaker services per 15-minute unit is $2.93. Any 52.2 adjustments in fiscal year 1997 to the maximum allowed rates for 52.3 home health aide or homemaker services for Anoka county shall be 52.4 calculated from the maximum rate in effect on January 1, 1996. 52.5 Sec. 27. Minnesota Statutes 1994, section 256B.0915, is 52.6 amended by adding a subdivision to read: 52.7 Subd. 3b. [REIMBURSEMENT RATE; AITKIN COUNTY.] 52.8 Notwithstanding subdivision 3, paragraph (h), effective April 1, 52.9 1996, Aitkin county's maximum allowed rate for in-home respite 52.10 care services is $6.67 per 30-minute unit. Any adjustments in 52.11 fiscal year 1997 to the maximum allowed rate for in-home respite 52.12 care services for Aitkin county shall be calculated from the 52.13 maximum rate in effect on April 1, 1996. 52.14 Sec. 28. Minnesota Statutes 1994, section 256B.0915, is 52.15 amended by adding a subdivision to read: 52.16 Subd. 3c. [REIMBURSEMENT RATE; POLK AND PENNINGTON 52.17 COUNTIES.] Notwithstanding subdivision 3, paragraph (h), 52.18 effective July 1, 1996, Polk and Pennington counties' maximum 52.19 allowed rate for homemaker services is $6.25 per 30-minute 52.20 unit. Any adjustments in fiscal year 1997 to the maximum 52.21 allowed rate for homemaker services for Polk and Pennington 52.22 counties shall be calculated from the maximum rate in effect on 52.23 July 1, 1996. 52.24 Sec. 29. Minnesota Statutes 1994, section 256B.15, is 52.25 amended by adding a subdivision to read: 52.26 Subd. 1b. [CLAIMS ON THE ESTATE OF A PREDECEASED 52.27 SPOUSE.] Upon the death of a spouse who did not receive medical 52.28 assistance and who predeceases a spouse who did or does receive 52.29 medical assistance, a claim for the total amount paid for 52.30 medical assistance rendered for the surviving spouse through the 52.31 date the deceased spouse died shall be filed against the 52.32 deceased spouse's estate in the court having jurisdiction to 52.33 probate the estate. The claim shall be filed if medical 52.34 assistance was rendered for the surviving spouse under any one 52.35 of the circumstances in subdivision 1a, paragraphs (a), (b), or 52.36 (c). Claims under this subdivision shall have the same priority 53.1 for purposes of section 524.3-805, and the same exceptions with 53.2 respect to statutes of limitations as claims under subdivision 53.3 1a. 53.4 Sec. 30. Minnesota Statutes 1994, section 256B.15, is 53.5 amended by adding a subdivision to read: 53.6 Subd. 2a. [LIMITATIONS ON CLAIMS ON THE ESTATE OF A 53.7 PREDECEASED SPOUSE.] A claim under subdivision 1b shall include 53.8 only the total amount of medical assistance rendered after age 53.9 55 or during a period of institutionalization described in 53.10 subdivision 1a, clause (b), and the total amount of general 53.11 assistance medical care rendered, and shall not include 53.12 interest. Claims that have been allowed but not paid shall bear 53.13 interest according to section 524.3-806, paragraph (d). A claim 53.14 against the estate of a spouse who did not receive medical 53.15 assistance who predeceases the spouse who did receive medical 53.16 assistance, for medical assistance rendered for the spouse, is 53.17 limited to the value of the assets of the estate that were 53.18 marital property or jointly owned property at any time during 53.19 the marriage. 53.20 Sec. 31. Minnesota Statutes 1994, section 256B.35, 53.21 subdivision 1, is amended to read: 53.22 Subdivision 1. [PERSONAL NEEDS ALLOWANCE.] (a) 53.23 Notwithstanding any law to the contrary, welfare allowances for 53.24 clothing and personal needs for individuals receiving medical 53.25 assistance while residing in any skilled nursing home, 53.26 intermediate care facility, or medical institution including 53.27 recipients of supplemental security income, in this state shall 53.28 not be less than $45 per month from all sources. When benefit 53.29 amounts for social security or supplemental security income 53.30 recipients are increased pursuant to United States Code, title 53.31 42, sections 415(i) and 1382f, the commissioner shall, effective 53.32 in the month in which the increase takes effect, increase by the 53.33 same percentage to the nearest whole dollar the clothing and 53.34 personal needs allowance for individuals receiving medical 53.35 assistance while residing in any skilled nursing home, medical 53.36 institution, or intermediate care facility. The commissioner 54.1 shall provide timely notice to local agencies, providers, and 54.2 recipients of increases under this provision. 54.3 (b) The personal needs allowance may be paid as part of the 54.4 Minnesota supplemental aid program, notwithstanding the 54.5 provisions of section 256D.37, subdivision 2, and payments to 54.6 recipients of Minnesota supplemental aid may be made once each 54.7 three months covering liabilities that accrued during the 54.8 preceding three months. 54.9 (c) The personal needs allowance shall be increased to 54.10 include income garnished for child support under a court order, 54.11 up to a maximum of $250 per month but only to the extent that 54.12 the amount garnished is not deducted as a monthly allowance for 54.13 children under section 256B.0575, paragraph (a), clause (5). 54.14 Sec. 32. Minnesota Statutes 1994, section 256B.37, 54.15 subdivision 5, is amended to read: 54.16 Subd. 5. [PRIVATE BENEFITS TO BE USED FIRST.] Private 54.17 accident and health care coverage including Medicare for medical 54.18 services is primary coverage and must be exhausted before 54.19 medical assistance is paid for medical services including home 54.20 health care, personal care assistant services, hospice, or 54.21 services covered under a Health Care Financing Administration 54.22 (HCFA) waiver. When a person who is otherwise eligible for 54.23 medical assistance has private accident or health care coverage, 54.24 including Medicare or a prepaid health plan, the private health 54.25 care benefits available to the person must be used first and to 54.26 the fullest extent. 54.27 Sec. 33. Minnesota Statutes 1995 Supplement, section 54.28 256B.69, subdivision 3a, is amended to read: 54.29 Subd. 3a. [COUNTY AUTHORITY.] (a) The commissioner, when 54.30 implementing the general assistance medical care, or medical 54.31 assistance prepayment program within a county, must include the 54.32 county board in the process of development, approval, and 54.33 issuance of the request for proposals to provide services to 54.34 eligible individuals within the proposed county. County boards 54.35 must be given reasonable opportunity to make recommendations 54.36 regarding the development, issuance, review of responses, and 55.1 changes needed in the request for proposals. The commissioner 55.2 must provide county boards the opportunity to review each 55.3 proposal based on the identification of community needs under 55.4 chapters 145A and 256E and county advocacy activities. If a 55.5 county board finds that a proposal does not address certain 55.6 community needs, the county board and commissioner shall 55.7 continue efforts for improving the proposal and network prior to 55.8 the approval of the contract. The county board shall make 55.9 recommendations regarding the approval of local networks and 55.10 their operations to ensure adequate availability and access to 55.11 covered services. The provider or health plan must respond 55.12 directly to county advocates and the state prepaid medical 55.13 assistance ombudsperson regarding service delivery and must be 55.14 accountable to the state regarding contracts with medical 55.15 assistance and general assistance medical care funds. The 55.16 county board may recommend a maximum number of participating 55.17 health plans after considering the size of the enrolling 55.18 population; ensuring adequate access and capacity; considering 55.19 the client and county administrative complexity; and considering 55.20 the need to promote the viability of locally developed health 55.21 plans. The commissioner shall actively seek to develop a 55.22 mutually agreeable timetable prior to the development of the 55.23 request for proposal, there shall be established a mutually55.24agreed upon timetable. This process shall in no way delay the 55.25 department's ability to secure and finalize contracts for the 55.26 medical assistance or general assistance medical care prepayment 55.27 program. 55.28 (b) The prepaid MinnesotaCare program may be implemented or 55.29 expanded by the commissioner without regard to whether or not a 55.30 county establishes a joint purchaser demonstration project under 55.31 section 256B.78. In a county that establishes a joint purchaser 55.32 demonstration project, MinnesotaCare enrollees must be offered 55.33 the option to enroll under the demonstration project once 55.34 enrollment in the project begins. 55.35 (c) The commissioner shall seek a federal waiver to allow a 55.36 fee-for-service plan option to MinnesotaCare enrollees. The 56.1 commissioner shall develop an increase of the premium fees 56.2 required under section 256.9356 up to 20 percent of the premium 56.3 fees for the enrollees who elect the fee-for-service option. 56.4 Prior to implementation, the commissioner shall submit this fee 56.5 schedule to the chair and ranking minority member of the senate 56.6 health care committee, the senate health care and family 56.7 services funding division, the house of representatives health 56.8 and human services committee, and the house of representatives 56.9 health and human services finance division. 56.10 Sec. 34. Minnesota Statutes 1995 Supplement, section 56.11 256B.69, subdivision 4, is amended to read: 56.12 Subd. 4. [LIMITATION OF CHOICE.] The commissioner shall 56.13 develop criteria to determine when limitation of choice may be 56.14 implemented in the experimental counties. The criteria shall 56.15 ensure that all eligible individuals in the county have 56.16 continuing access to the full range of medical assistance 56.17 services as specified in subdivision 6. The commissioner shall 56.18 exempt the following persons from participation in the project, 56.19 in addition to those who do not meet the criteria for limitation 56.20 of choice: (1) persons eligible for medical assistance 56.21 according to section 256B.055, subdivision 1; (2) persons 56.22 eligible for medical assistance due to blindness or disability 56.23 as determined by the social security administration or the state 56.24 medical review team, unless: (i) they are 65 years of age or 56.25 older, or (ii)they are eligible for medical assistance56.26according to section 256B.055, subdivision 12, or (iii) unless56.27 they reside in Itasca county or they reside in a county in which 56.28 the commissioner conducts a pilot project under a waiver granted 56.29 pursuant to section 1115 of the Social Security Act; (3) 56.30 recipients who currently have private coverage through a health 56.31 maintenance organization; (4) recipients who are eligible for 56.32 medical assistance by spending down excess income for medical 56.33 expenses other than the nursing facility per diem 56.34 expense;and(5) recipients who receive benefits under the 56.35 Refugee Assistance Program, established under United States 56.36 Code, title 8, section 1522(e); (6) children who are both 57.1 determined to be severely emotionally disturbed and receiving 57.2 case management services according to section 256B.0625, 57.3 subdivision 20; and (7) adults who are both determined to be 57.4 seriously and persistently mentally ill and received case 57.5 management services according to section 256B.0625, subdivision 57.6 20. Children under age 21 who are in foster placement may 57.7 enroll in the project on an elective basis. Individuals excluded 57.8 under clauses (6) and (7) may choose to enroll on an elective 57.9 basis. The commissioner may allow persons with a one-month 57.10 spenddown who are otherwise eligible to enroll to voluntarily 57.11 enroll or remain enrolled, if they elect to prepay their monthly 57.12 spenddown to the state. Beginning on or after July 1, 1997, the 57.13 commissioner may require those individuals to enroll in the 57.14 prepaid medical assistance program who otherwise would have been 57.15 excluded under clauses (1) and (3) and under Minnesota Rules, 57.16 part 9500.1452, subpart 2, items H, K, and L. Before limitation 57.17 of choice is implemented, eligible individuals shall be notified 57.18 and after notification, shall be allowed to choose only among 57.19 demonstration providers. The commissioner may assign an 57.20 individual with private coverage through a health maintenance 57.21 organization, to the same health maintenance organization for 57.22 medical assistance coverage, if the health maintenance 57.23 organization is under contract for medical assistance in the 57.24 individual's county of residence. After initially choosing a 57.25 provider, the recipient is allowed to change that choice only at 57.26 specified times as allowed by the commissioner. If a 57.27 demonstration provider ends participation in the project for any 57.28 reason, a recipient enrolled with that provider must select a 57.29 new provider but may change providers without cause once more 57.30 within the first 60 days after enrollment with the second 57.31 provider. 57.32 Sec. 35. Minnesota Statutes 1995 Supplement, section 57.33 256B.69, subdivision 5b, is amended to read: 57.34 Subd. 5b. [PROSPECTIVE REIMBURSEMENT RATES.] For prepaid 57.35 medical assistance and general assistance medical care program 57.36 contract rates set by the commissioner under subdivision 5 and 58.1 effective on or after January 1,19961997, through December 31, 58.219961998, capitation rates for nonmetropolitan counties shall 58.3 on a weighted average be no less than 85 percent of the 58.4 capitation rates for metropolitan counties, excluding Hennepin 58.5 county. 58.6 Sec. 36. Minnesota Statutes 1995 Supplement, section 58.7 256B.69, subdivision 21, is amended to read: 58.8 Subd. 21. [PREPAYMENT COORDINATOR.] Thelocal agency58.9 county board shall designate a prepayment coordinator to assist 58.10 the state agency in implementing this section and section 58.11 256D.03, subdivision 4. Assistance must include educating 58.12 recipients about available health care options, enrolling 58.13 recipients under subdivision 5, providing necessary eligibility 58.14 and enrollment information to health plans and the state agency, 58.15 and coordinating complaints and appeals with the ombudsman 58.16 established in subdivision 18. 58.17 Sec. 37. Minnesota Statutes 1994, section 256B.69, is 58.18 amended by adding a subdivision to read: 58.19 Subd. 24. [SOCIAL SERVICE AND PUBLIC HEALTH COSTS.] The 58.20 commissioner shall report on recommendations to the legislature 58.21 by January 15, 1997, identifying county social services and 58.22 public health administrative costs for each target population 58.23 that should be excluded from the overall capitation rate. 58.24 Sec. 38. [256B.78] [JOINT PURCHASER DEMONSTRATION 58.25 PROJECTS.] 58.26 Subdivision 1. [OBJECTIVES.] The objectives of the 58.27 demonstration project are to promote the development of local 58.28 provider networks and retain the availability and accountability 58.29 of local service providers; further define the county and state 58.30 roles, authorities, and functions related to publicly reimbursed 58.31 and publicly provided health and social services, including 58.32 services funded by county property tax revenues; promote better 58.33 coordination of services for all enrollees and target 58.34 populations; further define an outcome-based system, including 58.35 definitions of outcomes and processes for collecting, 58.36 publicizing, and utilizing outcome data; facilitate appropriate 59.1 competition, consumer choice, and entry of providers into the 59.2 marketplace while defining appropriate publicly operated safety 59.3 net services; identify mechanisms to ensure short-term and 59.4 long-term control of costs and avoidance of cost shifting; 59.5 define adequate financing within a capitated allocation; develop 59.6 risk management and risk adjustment strategies, which may 59.7 include stop-loss protection, reinsurance, and retrospective 59.8 risk adjustment; and define state-county shares of the cost 59.9 savings achieved for a return on the public investment. 59.10 Subd. 2. [AUTHORIZATION.] (a) Subject to federal waiver 59.11 approval, a county or group of counties may establish a 59.12 county-based joint purchaser demonstration project, for services 59.13 provided to eligible individuals under medical assistance, 59.14 except medical assistance recipients who are age 65 or older who 59.15 reside in the Twin Cities seven-county metropolitan area, 59.16 general assistance medical care, MinnesotaCare, state health and 59.17 social service grants, and county-funded programs for these or 59.18 other participants. The county must purchase or arrange for the 59.19 purchase of all covered services for the targeted populations 59.20 served under the demonstration project. 59.21 (b) As part of a project, the county may explore the option 59.22 of direct contracting with local providers, provider networks, 59.23 or public providers. If a county or group of counties 59.24 implements direct contracting, the county or counties shall be 59.25 considered a health plan company for purposes of Minnesota 59.26 Statutes, section 62Q.19, and must meet the requirements of 59.27 Minnesota Statutes, section 62Q.19. At the option of the county 59.28 board, the project may include county employees or employees of 59.29 other units of local government. Groups of counties 59.30 participating in a joint purchaser demonstration project must 59.31 execute a joint powers agreement in accordance with Minnesota 59.32 Statutes, section 471.59, for purposes of the demonstration 59.33 project. 59.34 Subd. 3. [LONG-TERM CARE OPTIONS PROJECT EXCEPTION.] 59.35 Medical assistance recipients who are age 65 or older who reside 59.36 in the seven-county metropolitan area shall not be included in a 60.1 joint purchaser demonstration project. Medical assistance 60.2 recipients who are age 65 or older who reside outside the 60.3 seven-county metropolitan area may be included in a joint 60.4 purchaser demonstration project. A county board or group of 60.5 county boards, other than the seven metropolitan counties, that 60.6 notifies the commissioner of intent to participate in a 60.7 demonstration project, in accordance with subdivision 8, must 60.8 include notice of their intent and preference for participation 60.9 in the long-term care options project. Counties participating 60.10 in the long-term care options project must meet all requirements 60.11 of the federal waivers governing the long-term care options 60.12 project demonstration. 60.13 Subd. 4. [PROJECT SCOPE.] (a) A county or group of 60.14 counties may establish a demonstration project or projects to 60.15 purchase all covered services to the categorically and medically 60.16 needy families with children and adults without children. 60.17 (b) A county or group of counties may establish a separate 60.18 demonstration project or projects to purchase or coordinate 60.19 covered services for disabled individuals, including those with 60.20 mental illness, chemical dependency, developmental disabilities 60.21 and physical disabilities, and for persons who are seriously and 60.22 persistently mentally ill or severely emotionally disturbed who 60.23 have county case managers, or any combination thereof, or, if 60.24 the county is located outside the Twin Cities seven-county 60.25 metropolitan area, services to the elderly. The demonstration 60.26 projects for persons with mental health, chemical dependency, 60.27 developmental disabilities, and physical disabilities are 60.28 limited, in total, to serving no more than ten counties in which 60.29 all of these population groups are included, and no more than 60.30 ten additional counties in which not all of these population 60.31 groups are included. If the county establishes a demonstration 60.32 project to purchase mental health services and the county is 60.33 participating in a mental health collaborative under Minnesota 60.34 Statutes, sections 245.491 to 245.496, families must have the 60.35 opportunity to be enrolled in one network. For residential 60.36 services, day training and habilitation services, and other 61.1 covered nonmedical services for persons with developmental 61.2 disabilities, local providers must be offered the opportunity to 61.3 contract with a county or counties if the local provider agrees 61.4 to the terms of the contract offered other providers or networks. 61.5 (c) In counties where any specialized services are provided 61.6 by one network and other health care services are provided by a 61.7 different network, the demonstration project contract must 61.8 require a binding agreement between the two provider networks to 61.9 share patient records and coordinate patient care. The enrollee 61.10 must agree to these requirements as a condition of enrollment 61.11 under the demonstration project. 61.12 Subd. 5. [SERVICE REQUIREMENTS.] A demonstration project 61.13 is subject to the current eligibility, benefits, enrollee 61.14 protection, and appeal process requirements under the medical 61.15 assistance, general assistance medical care, and MinnesotaCare 61.16 programs. The project must institute recipient grievance 61.17 procedures utilizing applicable requirements of Minnesota 61.18 Statutes, section 256B.69. 61.19 Subd. 6. [CONSUMER CHOICE.] (a) In counties where 61.20 enrollment under state prepayment programs has begun as of March 61.21 1, 1996, and a county demonstration project has subsequently 61.22 been established, the recipients must continue to be offered the 61.23 choice of enrolling in a health plan under contract with the 61.24 state through state prepayment programs in addition to any 61.25 enrollment options established under a county demonstration 61.26 project. This offer must be made for a period of two years 61.27 after the county has begun enrollment in the demonstration 61.28 project to the recipients enrolled in a state prepayment program 61.29 before the date enrollment begins under the demonstration 61.30 project. After this period, the county must contract with all 61.31 service delivery networks that satisfy the requirements of the 61.32 request for proposals on a nondiscriminatory basis. 61.33 (b) In order to maintain an opportunity for choice, a 61.34 county or counties must contract with two or more service 61.35 delivery networks, unless there are less than two health 61.36 maintenance organizations, integrated service networks, 62.1 community integrated service networks, or health provider 62.2 cooperatives, as defined in Minnesota Statutes, section 62R.04, 62.3 willing to provide services in the county or counties. If only 62.4 one network is providing services within the county or counties, 62.5 the project must demonstrate that enrollees have a choice of 62.6 providers within the existing network. 62.7 Subd. 7. [PROJECT DESIGN AND IMPLEMENTATION.] (a) The 62.8 demonstration project must ensure that consumer representatives 62.9 and providers are involved in the planning process for the 62.10 design of the demonstration projects. A participating county or 62.11 group of counties shall issue a request for proposals to provide 62.12 services to eligible individuals residing within the 62.13 participating county or counties. The participating county 62.14 board shall review the proposals and shall approve all 62.15 contracts. Individual county staff who are employed by a 62.16 publicly owned health plan that intends to respond to a request 62.17 for proposal are prohibited from reviewing, critiquing, or 62.18 approving any proposals submitted in this subdivision. Before a 62.19 participating county can enter into a contract with a service 62.20 delivery network, the commissioner of human services must review 62.21 the contract and determine whether the contracting network 62.22 offers adequate services to recipients. If the commissioner 62.23 determines that the contract does not provide adequate services, 62.24 the commissioner and county board shall continue negotiations 62.25 with the network to ensure the provision of all necessary 62.26 services. 62.27 Subd. 8. [NOTICE OF INTENT; PROJECT PROPOSALS.] (a) In 62.28 counties where the state has entered into a managed care 62.29 contract, a county board or a group of county boards shall 62.30 notify the commissioner of their intent to participate in a 62.31 joint purchaser demonstration project no later than October 1, 62.32 1996. In counties where the prepayment program is not currently 62.33 being implemented, a county board or group of county boards 62.34 shall notify the commissioner of their intent to participate in 62.35 a joint purchaser demonstration project by October 1, 1996. 62.36 (b) For any geographic area in which enrollment in the 63.1 prepaid medical assistance or prepaid general assistance medical 63.2 care program has not begun by March 1, 1996, the commissioner 63.3 shall not expand the prepaid medical assistance or the prepaid 63.4 general assistance medical care program to that area prior to 63.5 October 1, 1996, unless the county board requests earlier 63.6 implementation. 63.7 (c) For any geographic area, and for any population for 63.8 which the state has not received a notice of intent by October 63.9 1, 1996, nothing shall prohibit the implementation of the 63.10 prepaid medical assistance or prepaid general assistance medical 63.11 care programs in accordance with Minnesota Statutes, section 63.12 256B.69. For any geographic area, and for any population for 63.13 which the commissioner has received a notice of intent by 63.14 October 1, 1996, the commissioner shall be prohibited from 63.15 implementing the prepaid medical assistance or prepaid general 63.16 assistance medical care programs. 63.17 (d) By July 1, 1997, each county board that has submitted a 63.18 notice of intent in accordance with this subdivision shall 63.19 submit a final proposal that demonstrates the ability to provide 63.20 services by January 1, 1998, in accordance with this section. 63.21 For any geographic area and for any population for which the 63.22 state has not received a final proposal satisfying the 63.23 requirements of this section by July 1, 1997, nothing shall 63.24 prohibit the implementation of the prepaid medical assistance or 63.25 prepaid general assistance medical care programs in accordance 63.26 with Minnesota Statutes, section 256B.69. For any geographic 63.27 area and for any population for which the state has received a 63.28 final proposal by July 1, 1997, the commissioner shall be 63.29 prohibited from implementing the prepaid medical assistance and 63.30 prepaid general assistance medical care programs. The 63.31 commissioner must accept or reject final proposals on or before 63.32 September 1, 1997. The commissioner must authorize any proposal 63.33 that complies with the requirements of this section and 63.34 satisfies the criteria listed in subdivision 15. The 63.35 commissioner must negotiate the contract for the joint purchaser 63.36 demonstration project with the appropriate county or counties by 64.1 October 1, 1997, for enrollment effective by January 1, 1998. 64.2 (e) In counties in which the prepaid medical assistance or 64.3 prepaid general assistance medical care programs are not 64.4 currently operating, and enrollment in a county demonstration 64.5 project does not begin by January 1, 1998, nothing shall 64.6 prohibit the implementation of the prepaid medical assistance or 64.7 prepaid general assistance medical care programs after January 64.8 1, 1998. 64.9 (f) In counties in which enrollment under a county 64.10 demonstration project has begun by January 1, 1998, beginning 64.11 January 1, 2000, the county must contract with all service 64.12 delivery networks that satisfy the requirements of the request 64.13 for proposals on a nondiscriminatory basis. 64.14 Subd. 9. [PROJECT REPORTING AND EVALUATION.] (a) 64.15 County-based purchasing demonstration projects shall report to 64.16 the legislature by January 15, 1997, with recommendations for 64.17 reserve requirements for local provider networks; county 64.18 reporting, including data required to assess client needs, 64.19 satisfaction, outcomes, and quality of care, cost, and 64.20 utilization of services for purposes of project evaluation; 64.21 state and county functions and financing, including funding 64.22 recommendations for county eligibility determinations, 64.23 enrollment, advocacy, and public health and social services 64.24 functions; risk management and risk adjustment strategies; 64.25 purchasing arrangements and development of geographic service 64.26 areas; future methods of contracting for health care services 64.27 for MinnesotaCare enrollees; and other recommendations related 64.28 to project objectives. The data must be collected separately 64.29 for different disability categories and major disability 64.30 diagnosis, in a manner that allows comparisons on costs, 64.31 quality, and utilization across these disability categories and 64.32 diagnosis. Interim reports by the county-based projects shall 64.33 be presented to the legislative commission on health care access. 64.34 (b) The commissioner of human services shall contract for 64.35 an independent evaluation of the demonstration projects and 64.36 submit the results of the evaluation in a report to the 65.1 legislature no later than January 15, 1999. The evaluation must 65.2 determine the impact of each joint purchasing demonstration 65.3 project on quality of care, costs, and access to services. Each 65.4 evaluation must also compare demonstration project outcomes to 65.5 outcomes under the prepaid medical assistance program. 65.6 (c) The commissioner of human services and representatives 65.7 of the counties participating in the demonstration project shall 65.8 address the issue of risk and shall consider options for 65.9 state/county risk management and risk adjustment strategies that 65.10 are possible within the limits of the federal regulations or 65.11 current waivers. The commissioner shall report to the 65.12 legislature by January 15, 1997, with recommendations on how to 65.13 address state/county risk management and risk adjustment 65.14 strategies. 65.15 (d) The commissioner of health shall provide technical 65.16 assistance to counties interested in developing a joint 65.17 purchaser demonstration project. 65.18 (e) The Minnesota counties research foundation shall 65.19 establish a statewide advisory committee to provide assistance 65.20 in the development, implementation, and monitoring of the 65.21 demonstration projects. The advisory committee shall include 65.22 representatives from various disability populations, families 65.23 with children, adults without children, advocacy organizations, 65.24 providers of services and counties, as well as, representatives 65.25 of the ombudsman for mental health and mental retardation and 65.26 ombudsman for managed care authorized under Minnesota Statutes, 65.27 section 256B.69, and the ombudsman for long-term care. The 65.28 Minnesota counties research foundation shall report to the 65.29 legislative commission on health care access and to the 65.30 legislature by January 15, 1997, on the development and 65.31 implementation of the joint purchaser demonstration projects. 65.32 Subd. 10. [PAYMENT RATES.] The commissioner shall 65.33 determine rates to be paid by the state to county joint 65.34 purchaser demonstration projects according to categories in 65.35 paragraphs (a) to (c). 65.36 (a) For families and children and adults without children, 66.1 and medical assistance recipients over age 65, the total payment 66.2 shall be determined according to the department's methodology 66.3 for determining prepaid medical assistance demonstration rates 66.4 for families and children. The commissioner shall develop per 66.5 member, per month, payment rates for each project year, in 66.6 consultation with an independent actuary, to ensure that the 66.7 cost of services under these demonstration projects does not 66.8 exceed the prepaid medical assistance, prepaid general 66.9 assistance medical care, and prepaid MinnesotaCare program rates. 66.10 (b) The payment rate for persons dually eligible for 66.11 Medicare and medical assistance shall be determined according to 66.12 the methodology of the long-term care options project. 66.13 (c) The payment rate for projects involving medical 66.14 assistance, general assistance medical care, and MinnesotaCare 66.15 program recipients who are disabled or who have severe emotional 66.16 disturbance or serious and persistent mental illness, or any 66.17 combination thereof, shall be developed in consultation with an 66.18 independent actuary to ensure that the costs to the state do not 66.19 exceed 95 percent of the estimated cost for medical assistance 66.20 and general assistance medical care services for the covered 66.21 population under the fee-for-service system. Payments to 66.22 counties shall be made in accordance with Minnesota Statutes, 66.23 section 256B.69. This payment is in addition to the state 66.24 administrative allocation to participating counties for 66.25 eligibility enrollment and advocacy functions. Prepaid medical 66.26 assistance program administrative funds shall not be used for 66.27 county demonstration administrative functions. 66.28 Subd. 11. [ASSURANCES.] If the county chooses to establish 66.29 a demonstration project serving more than one category of 66.30 disabled persons, the entity must provide assurances to the 66.31 commissioner that the established payment rates for each 66.32 category of disabled persons are only used to meet the needs of 66.33 recipients within that category of persons. 66.34 Subd. 12. [FEDERAL WAIVER.] The commissioner of human 66.35 services shall apply by September 15, 1996, for any new federal 66.36 waivers required to implement this section. The commissioner 67.1 shall confer with the chairs of the senate health care committee 67.2 and health care and family services finance division, house of 67.3 representatives health and human services committee and health 67.4 and human services finance division, and one minority member 67.5 from the house of representatives and senate appointed by the 67.6 minority leaders of the house and senate, and a representative 67.7 of county commissioners appointed by the association of 67.8 Minnesota counties regarding the waiver application and in 67.9 waiver negotiations. No payments shall be made to any county 67.10 under this section, and no recipient shall be disenrolled from 67.11 the prepaid medical assistance or general assistance medical 67.12 care program under this section without prior federal approval. 67.13 Subd. 13. [CONSUMER RIGHTS AND PROTECTIONS.] All services 67.14 provided in the demonstration projects shall be provided 67.15 according to current eligibility and services laws and rules, 67.16 including consumer due process procedures and appeal rights 67.17 within the medical assistance program. For persons with 67.18 developmental disabilities, the commissioner shall ensure that 67.19 the rights and protections afforded under existing rules and 67.20 statutes are not abridged. The commissioner shall not waive the 67.21 rights or procedural protections under Minnesota Statutes, 67.22 sections 245.825; 245.91 to 245.97; 252.41, subdivision 9; 67.23 256.045; 256B.092; 626.556; and 626.557, including the county 67.24 agency's responsibility to arrange for appropriate services and 67.25 procedures for the monitoring of psychotropic medications. 67.26 Subd. 14. [ACTUARIAL STUDY; COST-SHARING STUDY.] (a) The 67.27 commissioner of human services shall contract with an 67.28 independent actuary to prepare an analysis of the amount of 67.29 funding for mental health services. 67.30 (b) The commissioner of human services and county 67.31 representatives shall study the extent of cost shifting from 67.32 federal and state Medicaid funding to county property taxes due 67.33 to managed care. The commissioner shall report findings to the 67.34 legislature by January 15, 1997. 67.35 Subd. 15. [STANDARDS AND CRITERIA.] Any demonstration 67.36 project must demonstrate the ability to: 68.1 (1) purchase all covered services for included populations 68.2 for a fixed amount that does not exceed the estimated cost to 68.3 the state that would have occurred under the prepaid medical 68.4 assistance, prepaid general assistance medical care, and prepaid 68.5 MinnesotaCare programs; 68.6 (2) ensure that covered services are accessible to all 68.7 enrollees and that enrollees have a choice of providers whenever 68.8 possible; 68.9 (3) issue payments to participating vendors or networks in 68.10 a timely manner; 68.11 (4) establish a process to ensure and improve the quality 68.12 of the care received; 68.13 (5) provide appropriate quality and other required data in 68.14 a format required by the state that will allow comparisons 68.15 between plans and providers; and 68.16 (6) provide an advocacy and enrollee protection and 68.17 complaints and appeals system that is independent from care 68.18 providers or other risk bearers and complies with Minnesota 68.19 Statutes, section 256B.69. 68.20 Sec. 39. Minnesota Statutes 1995 Supplement, section 68.21 256D.02, subdivision 12a, is amended to read: 68.22 Subd. 12a. [RESIDENT.] (a) For purposes of eligibility for 68.23 general assistanceunder section 256D.05, and payments under68.24section 256D.051and general assistance medical care, a 68.25 "resident" is a person living in the state for at least 30 days 68.26 with the intention of making the person's home here and not for 68.27 any temporary purpose. All applicants for these programs are 68.28 required to demonstrate the requisite intent and can do so in 68.29 any of the following ways: 68.30 (1) by showing that the applicant maintains a residence at 68.31 a verified address, other than a place of public accommodation. 68.32 An applicant may verify a residence address by presenting a 68.33 valid state driver's license, a state identification card, a 68.34 voter registration card, a rent receipt, a statement by the 68.35 landlord, apartment manager, or homeowner verifying that the 68.36 individual is residing at the address, or other form of 69.1 verification approved by the commissioner; or 69.2 (2) byproviding written documentationverifying residence 69.3 in accordance with Minnesota Rules, part 9500.1219, subpart 3, 69.4 item (c). 69.5 (b) An applicant who has been in the state for less than 30 69.6 days shall be considered a resident if the applicant can provide 69.7 documentation: 69.8 (1) that the applicantcame towas born in the statein69.9response to an offer of employment; 69.10(3) by providing verification(2) that the applicant has 69.11 been a long-time resident of the state or was formerly a 69.12 resident of the state for at least 365 days and is returning to 69.13 the state from a temporary absence, as those terms are defined 69.14 in rulesto beadopted by the commissioner; 69.15 (3) that the applicant has come to the state to join a 69.16 close relative which, for purposes of this subdivision, means a 69.17 parent, grandparent, brother, sister, spouse, or child; or 69.18 (4)by providing other persuasive evidence to show that the69.19applicant is a resident of the state, according to rules adopted69.20by the commissionerthat the applicant has come to this state to 69.21 accept a bona fide offer of employment for which the applicant 69.22 is eligible. 69.23 A county agency shall waive the 30-day residency 69.24 requirement in cases of emergencies, including medical 69.25 emergencies, or where unusual hardship would result from denial 69.26 of general assistance medical care. A county may waive the 69.27 30-day residency requirement in cases of emergencies, including 69.28 medical emergencies, or where unusual hardship would result from 69.29 denial of general assistance. The county agency must report to 69.30 the commissioner within 30 days on any waiver granted under this 69.31 section. The county shall not deny an application solely 69.32 because the applicant does not meet at least one of the criteria 69.33 in this subdivision, but shall continue to process the 69.34 application and leave the application pending until the 69.35 residency requirement is met or until eligibility or 69.36 ineligibility is established. 70.1 Sec. 40. Minnesota Statutes 1995 Supplement, section 70.2 256D.045, is amended to read: 70.3 256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 70.4 To be eligible for general assistance under sections 70.5 256D.01 to 256D.21, an individual must provide the individual's 70.6 social security number to the county agency or submit proof that 70.7 an application has been made. The provisions of this section do 70.8 not apply to the determination of eligibility for emergency 70.9 general assistance under section 256D.06, subdivision 2. This 70.10 provision applies to eligible children under the age of 18 70.11 effective July 1, 1997. 70.12 Sec. 41. Minnesota Statutes 1994, section 256G.01, 70.13 subdivision 3, is amended to read: 70.14 Subd. 3. [PROGRAM COVERAGE.] This chapter applies to 70.15 all social service programs administered by the commissioner in 70.16 which residence is the determining factor in establishing 70.17 financial responsibility. These include, but are not limited 70.18 to:aid to families with dependent children; medical70.19assistance; general assistance; work readiness; general70.20assistance medical care; Minnesota supplemental aid;commitment 70.21 proceedings, including voluntary admissions; emergency holds; 70.22 poor relief funded wholly through local agencies;andsocial 70.23 services, including title XX, IV-E and other components of the 70.24 community social services act, sections 256E.01 to 256E.12; 70.25 social services programs funded wholly through the resources of 70.26 county agencies; social services provided under the Minnesota 70.27 Indian family preservation act, sections 257.35 to 257.356; 70.28 costs for delinquency confinement under section 393.07, 70.29 subdivision 2; service responsibility for these programs; and 70.30 group residential housing. 70.31 Sec. 42. Minnesota Statutes 1994, section 256G.01, is 70.32 amended by adding a subdivision to read: 70.33 Subd. 4. [ADDITIONAL COVERAGE.] The provisions in sections 70.34 256G.02, subdivision 4, paragraphs (a) to (d); 256G.02, 70.35 subdivisions 5 to 8; 256G.03; 256G.04; 256G.05; and 256G.07, 70.36 subdivisions 1 to 3, apply to the following programs: aid to 71.1 families with dependent children; medical assistance; general 71.2 assistance; family general assistance; general assistance 71.3 medical care; and Minnesota supplemental aid. 71.4 Sec. 43. Minnesota Statutes 1994, section 256G.01, is 71.5 amended by adding a subdivision to read: 71.6 Subd. 5. [SCOPE AND EFFECT.] Unless stated otherwise, the 71.7 provisions of this chapter also apply to disputes involving 71.8 financial responsibility for social services when another 71.9 definition of the county of financial responsibility has been 71.10 created in Minnesota Statutes. 71.11 Sec. 44. Minnesota Statutes 1994, section 256G.02, 71.12 subdivision 4, is amended to read: 71.13 Subd. 4. [COUNTY OF FINANCIAL RESPONSIBILITY.] (a) "County 71.14 of financial responsibility" has the meanings in paragraphs (b) 71.15 to (h). 71.16 (b) For an applicant who resides in the state and is not in 71.17 a facility described in subdivision 6, it means the county in 71.18 which the applicant resides at the time of application. 71.19 (c) For an applicant who resides in a facility described in 71.20 subdivision 6, it means the county in which the applicant last 71.21 resided in nonexcluded status immediately before entering the 71.22 facility. 71.23 (d) For an applicant who has not resided in this state for 71.24 any time other than the excluded time, and subject to the 71.25 limitations in section 256G.03, subdivision 2, it means the 71.26 county in which the applicant resides at the time of making 71.27 application. 71.28 (e)For medical assistance purposes only, and for an infant71.29who has resided only in an excluded time facility, it means the71.30county that would have been responsible for the infant if71.31eligibility had been established, based on that of the birth71.32mother, at the time of application.71.33(f) Notwithstanding paragraphs (b) to (d), the county of71.34financial responsibility for medical assistance recipients is71.35the county from which a recipient is receiving a maintenance71.36grant or money payment under the program of aid to families with72.1dependent children or Minnesota supplemental aid.72.2(g) Notwithstanding paragraphs (b) to (f), the county of72.3financial responsibility for social services for a person72.4receiving aid to families with dependent children, general72.5assistance, general assistance medical care, medical assistance,72.6or Minnesota supplemental aid is the county from which that72.7person is receiving the aid or assistance. If more than one72.8named program is open concurrentlyFor an individual already 72.9 having a social service case open in one county, financial 72.10 responsibility for any additional social services attaches to 72.11 theprogramcase that has the earliest date of application and 72.12 has been open without interruption. 72.13(h)(f) Notwithstanding paragraphs (b) to(g)(e), the 72.14 county of financial responsibility for semi-independent living 72.15 services provided under section 252.275, and Minnesota Rules, 72.16 parts 9525.0500 to 9525.0660, is the county of residence in 72.17 nonexcluded status immediately before the placement into or 72.18 request for those services. 72.19 Sec. 45. Minnesota Statutes 1994, section 256G.02, 72.20 subdivision 6, is amended to read: 72.21 Subd. 6. [EXCLUDED TIME.] "Excluded time" means: 72.22 (a) any period an applicant spends in a hospital, 72.23 sanitarium, nursing home, shelter other than an emergency 72.24 shelter, halfway house, foster home, semi-independent living 72.25 domicile or services program, residential facility offering 72.26 care, board and lodging facility or other institution for the 72.27 hospitalization or care of human beings, as defined in section 72.28 144.50, 144A.01, or 245A.02, subdivision 14;or in amaternity 72.29 home, battered women's shelter, or correctional facility.72.30"Excluded time" also means that time during which an applicant72.31participates in a rehabilitation facility as defined in section72.32268A.01, or is receiving personal care assistant services72.33pursuant to section 256B.0625, subdivision 19.; or any facility 72.34 based on an emergency hold under sections 253B.05, subdivisions 72.35 1 and 2, and 253B.07, subdivision 6; 72.36 (b) any period an applicant spends on a placement basis in 73.1 a training and habilitation program, including a rehabilitation 73.2 facility or work or employment program as defined in section 73.3 268A.01; or receiving personal care assistant services pursuant 73.4 to section 256B.0627, subdivision 4; semi-independent living 73.5 services provided under section 252.275, and Minnesota Rules, 73.6 parts 9525.0500 to 9525.0660; day training and habilitation 73.7 programs, and community-based services and assisted living 73.8 services; and 73.9 (c) any placement for a person with an indeterminate 73.10 commitment, including independent living. 73.11 Sec. 46. Minnesota Statutes 1994, section 256G.03, is 73.12 amended to read: 73.13 256G.03 [ESTABLISHING RESIDENCE.] 73.14 Subdivision 1. [STATE RESIDENCE.] For purposes of this 73.15 chapter, a resident of any Minnesota county is considered a 73.16 state resident.For purposes of eligibility for general73.17assistance or work readiness, residency must be substantiated73.18according to section 256D.02, subdivision 12a.73.19 Subd. 2. [NO DURATIONAL TEST.] Except as otherwise 73.20 provided in sections 256.73, subdivisions 1 and 1a; 256B.056, 73.21 subdivision 1; and 256D.02, subdivision 12a, for purposes of 73.22 this chapter, no waiting period is required before securing 73.23 county or state residence. A person cannot, however, gain 73.24 residence while physically present in an excluded time facility 73.25 unless otherwise specified in this chapter or in a federal 73.26 regulation controlling a federally funded human service program. 73.27 Subd. 3. [USE OF CODE OF FEDERAL REGULATIONS.] In the 73.28 event that federal legislation eliminates the federal regulatory 73.29 basis for medical assistance, the state shall continue to 73.30 determine eligibility for Minnesota's medical assistance program 73.31 using the provisions of Code of Federal Regulations, title 42, 73.32 as construed on the day prior to their federal repeal, except as 73.33 expressly superseded in chapter 256B, or as superseded by 73.34 federal law, or as modified by state rule or by regulatory 73.35 waiver granted to the state. 73.36 Sec. 47. Minnesota Statutes 1994, section 256G.06, is 74.1 amended to read: 74.2 256G.06 [DETOXIFICATION SERVICES.] 74.3 The county of financial responsibility for detoxification 74.4 services is the county where the client is physically present 74.5 when the need for services is identified. If that need is 74.6 identified while the client is a resident of a chemical 74.7 dependency facility, the provisions of section 256G.02, 74.8 subdivision 4, paragraphs(b),(c),and(e)(d), apply. 74.9 Sec. 48. Minnesota Statutes 1994, section 256G.07, 74.10 subdivision 1, is amended to read: 74.11 Subdivision 1. [EFFECT OF MOVING.] Except as provided in 74.12 subdivision 4, a person who has applied for and is receiving 74.13 services or assistance under a program governed by this chapter, 74.14 in any county in this state, and who moves to another county in 74.15 this state, is entitled to continue to receive thatassistance74.16 service from the county from which that person has moved until 74.17 that person has resided in nonexcluded status for two full 74.18 calendar months in the county to which that person has 74.19 moved.For purposes of general assistance and general74.20assistance medical care, this time period is, however, one full74.21calendar month.74.22 Sec. 49. Minnesota Statutes 1994, section 256G.07, 74.23 subdivision 2, is amended to read: 74.24 Subd. 2. [TRANSFER OF RECORDS.] Before the person has 74.25 resided in nonexcluded status for two calendar monthsor one74.26calendar month in the case of general assistance and general74.27assistance medical care,in the county to which that person has 74.28 moved, the local agency of the county from which the person has 74.29 moved shall complete an eligibility review and transfer all 74.30 necessary records relating to that person to the local agency of 74.31 the county to which the person has moved. 74.32 Sec. 50. Minnesota Statutes 1994, section 256G.08, 74.33 subdivision 1, is amended to read: 74.34 Subdivision 1. [COMMITMENTSCOMMITMENT ACT PROCEEDINGS.] 74.35 In cases of voluntary admission or commitment to state or other 74.36 institutions, the committing county shall initially pay for all 75.1 costs. This includes the expenses of the taking into custody, 75.2 confinement, emergency holds under sections 253B.05, 75.3 subdivisions 1 and 2, and 253B.07, examination, commitment, 75.4 conveyance to the place of detention, and rehearing. 75.5 Sec. 51. Minnesota Statutes 1994, section 256G.09, 75.6 subdivision 2, is amended to read: 75.7 Subd. 2. [FINANCIAL DISPUTES.] (a) If the county receiving 75.8 the transmittal does not believe it is financially responsible, 75.9 it should provide to the department and the initially 75.10 responsible county a statement of all facts and documents 75.11 necessary for the department to make the requested determination 75.12 of financial responsibility. The submission must clearly state 75.13 the program area in dispute and must state the specific basis 75.14 upon which the submitting county is denying financial 75.15 responsibility. 75.16 (b) The initially responsible county then has 15 calendar 75.17 days to submit its position and any supporting evidence to the 75.18 department. The absence of a submission by the initially 75.19 responsible county does not limit the right of the department to 75.20 issue a binding opinion based on the evidence actually submitted. 75.21 (c) A case must not be submitted until the local agency 75.22 taking the application or making the commitment has made an 75.23 initial determination about eligibility and financial 75.24 responsibility, and servicesor assistance hashave been 75.25 initiated. This paragraph does not prohibit the submission of 75.26 closed cases that otherwise meet the applicable statute of 75.27 limitations. 75.28 Sec. 52. Minnesota Statutes 1994, section 256G.10, is 75.29 amended to read: 75.30 256G.10 [DERIVATIVE SETTLEMENTELIMINATED.] 75.31Except as described in section 256G.02, subdivision 4,75.32paragraph (e), residence under this chapter must be determined75.33independently for each applicant.The residence of the parent 75.34 of a minor child, with whom that child last lived in a 75.35 nonexcluded time setting, or guardiandoes notof a ward shall 75.36 determine the residence of the child or ward for all social 76.1 services governed by this chapter. 76.2 For purposes of this chapter, a minor child is defined as 76.3 being under 18 years of age unless otherwise specified in a 76.4 program administered by the commissioner. 76.5 Physical or legal custody has no bearing on residence 76.6 determinations. This section does not, however, apply to 76.7 situations involving another stateor, limit the application of 76.8 an interstate compact, or apply to situations involving state 76.9 wards where the commissioner is defined by law as the guardian. 76.10 Sec. 53. Minnesota Statutes 1994, section 256I.05, is 76.11 amended by adding a subdivision to read: 76.12 Subd. 7c. [DEMONSTRATION PROJECT.] The commissioner is 76.13 authorized to pursue a demonstration project under federal food 76.14 stamp regulation for the purpose of gaining federal 76.15 reimbursement of food and nutritional costs currently paid by 76.16 the state group residential housing program. 76.17 Sec. 54. Minnesota Statutes 1994, section 325F.71, 76.18 subdivision 2, is amended to read: 76.19 Subd. 2. [SUPPLEMENTAL CIVIL PENALTY.] (a) In addition to 76.20 any liability for a civil penalty pursuant to Minnesota 76.21 Statutes, sections 325D.43 to 325D.48, regarding deceptive trade 76.22 practices; 325F.67, regarding false advertising; and 325F.68 to 76.23 325F.70, regarding consumer fraud; a person who engages in any 76.24 conduct prohibited by those statutes, and whose conduct is 76.25 perpetrated against one or more senior citizens or handicapped 76.26 persons, is liable for an additional civil penalty not to exceed 76.27 $10,000 for each violation, if one or more of the factors in 76.28 paragraph (b) are present. 76.29 (b) In determining whether to impose a civil penalty 76.30 pursuant to paragraph (a), and the amount of the penalty, the 76.31 court shall consider, in addition to other appropriate factors, 76.32 the extent to which one or more of the following factors are 76.33 present: 76.34 (1) whether the defendant knew or should have known that 76.35 the defendant's conduct was directed to one or more senior 76.36 citizens or handicapped persons; 77.1 (2) whether the defendant's conduct caused senior citizens 77.2 or handicapped persons to suffer: loss or encumbrance of a 77.3 primary residence, principal employment, or source of income; 77.4 substantial loss of property set aside for retirement or for 77.5 personal or family care and maintenance; substantial loss of 77.6 payments received under a pension or retirement plan or a 77.7 government benefits program; or assets essential to the health 77.8 or welfare of the senior citizen or handicapped person; 77.9 (3) whether one or more senior citizens or handicapped 77.10 persons are more vulnerable to the defendant's conduct than 77.11 other members of the public because of age, poor health or 77.12 infirmity, impaired understanding, restricted mobility, or 77.13 disability, and actually suffered physical, emotional, or 77.14 economic damage resulting from the defendant's conduct; or 77.15 (4) whether the defendant's conduct caused senior citizens 77.16 or handicapped persons to make an uncompensated asset transfer 77.17 that resulted in the person being found ineligible for medical 77.18 assistance. 77.19 Sec. 55. Minnesota Statutes 1994, section 524.2-403, is 77.20 amended to read: 77.21 524.2-403 [EXEMPT PROPERTY.] 77.22 (a) If there is a surviving spouse, then, in addition to 77.23 the homestead and family allowance, the surviving spouse is 77.24 entitled from the estate to: 77.25 (1) property not exceeding $10,000 in value in excess of 77.26 any security interests therein, in household furniture, 77.27 furnishings, appliances, and personal effects, subject to an 77.28 award of sentimental value property under section 525.152; and 77.29 (2) one automobile, if any, without regard to value. 77.30 (b) If there is no surviving spouse, the decedent's 77.31 children are entitled jointly to the same property as provided 77.32 in paragraph (a). 77.33 (c) If encumbered chattels are selected and the value in 77.34 excess of security interests, plus that of other exempt 77.35 property, is less than $10,000, or if there is not $10,000 worth 77.36 of exempt property in the estate, the surviving spouse or 78.1 children are entitled to other personal property of the estate, 78.2 if any, to the extent necessary to make up the $10,000 value. 78.3 (d) Rights to exempt property and assets needed to make up 78.4 a deficiency of exempt property have priority over all claims 78.5 against the estate, but the right to any assets to make up a 78.6 deficiency of exempt property abates as necessary to permit 78.7 earlier payment of the family allowance. 78.8 (e) The rights granted by this section are in addition to 78.9 any benefit or share passing to the surviving spouse or children 78.10 by the decedent's will, unless otherwise provided by intestate 78.11 succession or by way of elective share. 78.12 (f) A claim under section 246.53, 261.04, 256B.15, or 78.13 256D.16 takes precedence over any rights granted to a decedent's 78.14 adult children under this section. 78.15 Sec. 56. Minnesota Statutes 1994, section 524.3-801, is 78.16 amended to read: 78.17 524.3-801 [NOTICE TO CREDITORS.] 78.18 (a) Unless notice has already been given under this 78.19 section, upon appointment of a general personal representative 78.20 in informal proceedings or upon the filing of a petition for 78.21 formal appointment of a general personal representative, notice 78.22 thereof, in the form prescribed by court rule, shall be given 78.23 under the direction of the court administrator by publication 78.24 once a week for two successive weeks in a legal newspaper in the 78.25 county wherein the proceedings are pending giving the name and 78.26 address of the general personal representative and notifying 78.27 creditors of the estate to present their claims within four 78.28 months after the date of the court administrator's notice which 78.29 is subsequently published or be forever barred, unless they are 78.30 entitled to further service of notice under paragraph (b) or (c). 78.31 (b)(1) Within three months after: (i) the date of the 78.32 first publication of the notice; or (ii) June 16, 1989, 78.33 whichever is later, the personal representative may determine, 78.34 in the personal representative's discretion, that it is or is 78.35 not advisable to conduct a reasonably diligent search for 78.36 creditors of the decedent who are either not known or not 79.1 identified. If the personal representative determines that a 79.2 reasonably diligent search is advisable, the personal 79.3 representative shall conduct the search. 79.4 (2) If the notice is first published after June 16, 1989, 79.5 the personal representative shall, within three months after the 79.6 date of the first publication of the notice, serve a copy of the 79.7 notice upon each then known and identified creditor in the 79.8 manner provided in paragraph (c). If the decedent or a 79.9 predeceased spouse of the decedent received assistance for which 79.10 a claim could be filed under section 246.53, 256B.15, 256D.16, 79.11 or 261.04, the personal representative shall serve a copy of the 79.12 notice on the commissioner of human services in the manner 79.13 provided in paragraph (c) on or before the date of the first 79.14 publication of the notice. The copy of the notice served on the 79.15 commissioner of human services shall include the full name, date 79.16 of birth, and social security number of the decedent or the 79.17 predeceased spouse who received assistance for which a claim 79.18 could be filed under any of the sections listed in this 79.19 paragraph. Notwithstanding any will or other instrument or law 79.20 to the contrary, except as allowed in this paragraph no property 79.21 subject to administration by the estate may be distributed by 79.22 the estate or the personal representative until 70 days after 79.23 the date the notice is served upon the commissioner, as provided 79.24 in paragraph (c) unless the local agency consents. An affidavit 79.25 of service shall be prima facie evidence of service and, if it 79.26 contains a legal description of the affected real property, may 79.27 be filed or recorded in the office of the county recorder or 79.28 registrar of titles to establish compliance with the notice 79.29 requirement established in this paragraph. This restriction on 79.30 distribution does not apply to the personal representative's 79.31 sale of real or personal property while the estate is open but 79.32 does apply to the net proceeds the estate receives from the 79.33 sale. If notice was first published under the applicable 79.34 provisions of law under the direction of the court administrator 79.35 before June 16, 1989, and if a personal representative is 79.36 empowered to act at any time after June 16, 1989, the personal 80.1 representative shall, within three months after June 16, 1989, 80.2 serve upon the then known and identified creditors in the manner 80.3 provided in paragraph (c) a copy of the notice as published, 80.4 together with a supplementary notice requiring each of the 80.5 creditors to present any claim within one month after the date 80.6 of the service of the notice or be forever barred. 80.7 (3) Under this section, a creditor is "known" if: (i) the 80.8 personal representative knows that the creditor has asserted a 80.9 claim that arose during the decedent's life against either the 80.10 decedent or the decedent's estate; or (ii) the creditor has 80.11 asserted a claim that arose during the decedent's life and the 80.12 fact is clearly disclosed in accessible financial records known 80.13 and available to the personal representative. Under this 80.14 section, a creditor is "identified" if the personal 80.15 representative's knowledge of the name and address of the 80.16 creditor will permit service of notice to be made under 80.17 paragraph (c). 80.18 (c) The personal representative shall serve a copy of any 80.19 notice and any supplementary notice required by paragraph (b), 80.20 clause (1) or (2), upon each creditor of the decedent who is 80.21 then known to the personal representative and identified, except 80.22 a creditor whose claim has either been presented to the personal 80.23 representative or paid, either by delivery of a copy of the 80.24 required notice to the creditor, or by mailing a copy of the 80.25 notice to the creditor by certified, registered, or ordinary 80.26 first class mail addressed to the creditor at the creditor's 80.27 office or place of residence. 80.28 Sec. 57. [INDIVIDUAL COMPULSIVE GAMBLING TREATMENT PILOT 80.29 PROJECT.] 80.30 Subdivision 1. [ESTABLISHMENT.] The commissioner of human 80.31 services shall establish a pilot project in the southeast area 80.32 of the state to provide compulsive gambling treatment services 80.33 to individuals seeking treatment. The pilot project shall 80.34 directly reimburse qualified providers for treatment to 80.35 individuals on a case-by-case basis. The pilot project shall 80.36 seek to utilize existing qualified providers and shall provide 81.1 treatment reimbursement to the maximum number of persons who 81.2 qualify for treatment. 81.3 Subd. 2. [PLAN.] The commissioner shall submit to the 81.4 legislature by December 15, 1996, a plan for expansion of the 81.5 treatment pilot project to all areas of the state. The plan 81.6 shall include the necessary legislative changes needed to move 81.7 from a treatment center model to a provider reimbursement model. 81.8 Sec. 58. [REPORT ON COMPENSATING CLIENTS ON PUBLIC HEALTH 81.9 CARE PROGRAMS.] 81.10 The commissioner of human services shall study and report 81.11 to the legislature by January 15, 1997, the advisability and 81.12 feasibility of compensating clients on the public health care 81.13 programs if a client has successfully reversed a private 81.14 insurer's denial of health insurance. The report shall also 81.15 include recommendations on reducing the parental fees under 81.16 Minnesota Statutes, section 252.27, subdivision 2a, if a parent 81.17 has successfully reversed a private insurer's denial of 81.18 insurance. The commissioner shall ask clients, advocates, other 81.19 interested persons, and the parental fee advisory committee to 81.20 assist with the study. 81.21 Sec. 59. [WAIVER AUTHORITY.] 81.22 The commissioner of human services shall seek federal 81.23 waivers as necessary to implement section 8. 81.24 Sec. 60. [SEVERABILITY.] 81.25 If any provision of sections 8 and 39 are found to be 81.26 unconstitutional or void by a court of competent jurisdiction, 81.27 all remaining provisions of the law shall remain valid and shall 81.28 be given full effect. 81.29 Sec. 61. [AUGMENTATIVE COMMUNICATION DEVICES.] 81.30 Augmentative communication devices that are prior 81.31 authorized through pass through vendors during the period July 81.32 1, 1995, to December 31, 1996, and have not been delivered shall 81.33 be paid under the medical assistance program at the actual price 81.34 charged the pass through vendor for the device as limited to the 81.35 suggested retail price on March 1, 1996. For retroactive 81.36 periods in which a state plan had not been submitted to reflect 82.1 this payment, the state shall not seek a federal share. The 82.2 governor's advisory council on technology for people with 82.3 disabilities, in consultation with the commissioner of human 82.4 services, shall study alternatives to this payment approach and 82.5 make recommendations to the legislature by December 31, 1996, 82.6 related to effective methods of cost control and the following: 82.7 (1) comparative payment equity between augmentative 82.8 communication device vendors and other provider groups that 82.9 provide equipment to medical assistance recipients; 82.10 (2) methods, including competitive bidding, that create 82.11 incentives for dealers and manufacturers to provide augmentative 82.12 communication devices at a price that is discounted from retail; 82.13 (3) substitution between augmentative communication devices 82.14 and alternative methods of access by recipients to augmentative 82.15 communication devices; and 82.16 (4) payment equity between pass through vendors and 82.17 distributors of augmentative communication devices. 82.18 Sec. 62. [REPEALER.] 82.19 Minnesota Statutes 1995 Supplement, sections 256B.15, 82.20 subdivision 5; 256G.05, subdivision 1; and 256G.07, subdivision 82.21 3a, are repealed. 82.22 Sec. 63. [EFFECTIVE DATE; APPLICATION.] 82.23 (a) Sections 12, 14, 16, 18, 29, 30, and the portion of 82.24 section 62 that repeals section 256B.15, subdivision 5, are 82.25 effective the day following final enactment to the extent 82.26 permitted by federal law. If any provisions of these sections 82.27 are prohibited by federal law, the provisions shall become 82.28 effective when federal law is changed to permit their 82.29 application or a waiver is received. The commissioner of human 82.30 services shall notify the revisor of statutes when federal law 82.31 is enacted or a waiver is received and publish a notice in the 82.32 State Register. The commissioner must include the notice in the 82.33 first State Register published after the effective date of the 82.34 federal changes. 82.35 (b) If, by July 1, 1996, any provisions of the sections 82.36 mentioned in paragraph (a) are not effective because of 83.1 prohibitions in federal law, the commissioner shall apply to the 83.2 federal government for a waiver of those prohibitions, and those 83.3 provisions shall become effective upon receipt of a federal 83.4 waiver, notification to the revisor of statutes, and publication 83.5 of a notice in the State Register to that effect. If the 83.6 commissioner applies for a waiver of the lookback period, the 83.7 commissioner shall seek the longest lookback period the health 83.8 care financing administration will approve, not to exceed 72 83.9 months. 83.10 (c) Section 55 applies to estates of decedents dying on or 83.11 after its effective date. Section 56 applies to estates where 83.12 the notice under Minnesota Statutes, section 524.3-801, 83.13 paragraph (a), was first published on or after its effective 83.14 date. Section 56 does not affect any right or duty to provide 83.15 notice to known creditors, including a local agency, before its 83.16 effective date. 83.17 (d) Sections 7, 13, 15, 17, 33, 34, 35, 38, and 61 are 83.18 effective the day following final enactment. 83.19 (e) Section 11 is effective retroactive to October 1, 1993. 83.20 (f) Sections 8, 22, subdivision 3, and 34 are effective 83.21 upon federal approval. 83.22 (g) Sections 10 and 31 are effective upon receipt of 83.23 federal approval, retroactive to January 1, 1996. 83.24 ARTICLE 3 83.25 LONG-TERM CARE 83.26 Section 1. Minnesota Statutes 1995 Supplement, section 83.27 144A.071, subdivision 3, is amended to read: 83.28 Subd. 3. [EXCEPTIONS AUTHORIZING AN INCREASE IN BEDS.] The 83.29 commissioner of health, in coordination with the commissioner of 83.30 human services, may approve the addition of a new certified bed 83.31 or the addition of a new licensed nursing home bed, under the 83.32 following conditions: 83.33 (a) to license or certify a new bed in place of one 83.34 decertified after July 1, 1993, as long as the number of 83.35 certified plus newly certified or recertified beds does not 83.36 exceed the number of beds licensed or certified on July 1, 1993, 84.1 or to address an extreme hardship situation, in a particular 84.2 county that, together with all contiguous Minnesota counties, 84.3 has fewer nursing home beds per 1,000 elderly than the number 84.4 that is ten percent higher than the national average of nursing 84.5 home beds per 1,000 elderly individuals. For the purposes of 84.6 this section, the national average of nursing home beds shall be 84.7 the most recent figure that can be supplied by the federal 84.8 health care financing administration and the number of elderly 84.9 in the county or the nation shall be determined by the most 84.10 recent federal census or the most recent estimate of the state 84.11 demographer as of July 1, of each year of persons age 65 and 84.12 older, whichever is the most recent at the time of the request 84.13 for replacement. An extreme hardship situation can only be 84.14 found after the county documents the existence of unmet medical 84.15 needs that cannot be addressed by any other alternatives; 84.16 (b) to certify or license new beds in a new facility that 84.17 is to be operated by the commissioner of veterans affairs or 84.18 when the costs of constructing and operating the new beds are to 84.19 be reimbursed by the commissioner of veterans affairs or the 84.20 United States Veterans Administration; 84.21 (c) to license or certify beds in a facility that has been 84.22 involuntarily delicensed or decertified for participation in the 84.23 medical assistance program, provided that an application for 84.24 relicensure or recertification is submitted to the commissioner 84.25 within 120 days after delicensure or decertification;or84.26 (d) to certify two existing beds in a facility with 66 84.27 licensed beds on January 1, 1994, that had an average occupancy 84.28 rate of 98 percent or higher in both calendar years 1992 and 84.29 1993, and which began construction of four attached assisted 84.30 living units in April 1993; or 84.31 (e) to certify four existing beds in a facility in Winona 84.32 with 139 beds, of which 129 beds are certified. 84.33 Sec. 2. Minnesota Statutes 1995 Supplement, section 84.34 144A.071, subdivision 4a, is amended to read: 84.35 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 84.36 best interest of the state to ensure that nursing homes and 85.1 boarding care homes continue to meet the physical plant 85.2 licensing and certification requirements by permitting certain 85.3 construction projects. Facilities should be maintained in 85.4 condition to satisfy the physical and emotional needs of 85.5 residents while allowing the state to maintain control over 85.6 nursing home expenditure growth. 85.7 The commissioner of health in coordination with the 85.8 commissioner of human services, may approve the renovation, 85.9 replacement, upgrading, or relocation of a nursing home or 85.10 boarding care home, under the following conditions: 85.11 (a) to license or certify beds in a new facility 85.12 constructed to replace a facility or to make repairs in an 85.13 existing facility that was destroyed or damaged after June 30, 85.14 1987, by fire, lightning, or other hazard provided: 85.15 (i) destruction was not caused by the intentional act of or 85.16 at the direction of a controlling person of the facility; 85.17 (ii) at the time the facility was destroyed or damaged the 85.18 controlling persons of the facility maintained insurance 85.19 coverage for the type of hazard that occurred in an amount that 85.20 a reasonable person would conclude was adequate; 85.21 (iii) the net proceeds from an insurance settlement for the 85.22 damages caused by the hazard are applied to the cost of the new 85.23 facility or repairs; 85.24 (iv) the new facility is constructed on the same site as 85.25 the destroyed facility or on another site subject to the 85.26 restrictions in section 144A.073, subdivision 5; 85.27 (v) the number of licensed and certified beds in the new 85.28 facility does not exceed the number of licensed and certified 85.29 beds in the destroyed facility; and 85.30 (vi) the commissioner determines that the replacement beds 85.31 are needed to prevent an inadequate supply of beds. 85.32 Project construction costs incurred for repairs authorized under 85.33 this clause shall not be considered in the dollar threshold 85.34 amount defined in subdivision 2; 85.35 (b) to license or certify beds that are moved from one 85.36 location to another within a nursing home facility, provided the 86.1 total costs of remodeling performed in conjunction with the 86.2 relocation of beds does not exceed 25 percent of the appraised 86.3 value of the facility or $500,000, whichever is less; 86.4 (c) to license or certify beds in a project recommended for 86.5 approval under section 144A.073; 86.6 (d) to license or certify beds that are moved from an 86.7 existing state nursing home to a different state facility, 86.8 provided there is no net increase in the number of state nursing 86.9 home beds; 86.10 (e) to certify and license as nursing home beds boarding 86.11 care beds in a certified boarding care facility if the beds meet 86.12 the standards for nursing home licensure, or in a facility that 86.13 was granted an exception to the moratorium under section 86.14 144A.073, and if the cost of any remodeling of the facility does 86.15 not exceed 25 percent of the appraised value of the facility or 86.16 $500,000, whichever is less. If boarding care beds are licensed 86.17 as nursing home beds, the number of boarding care beds in the 86.18 facility must not increase beyond the number remaining at the 86.19 time of the upgrade in licensure. The provisions contained in 86.20 section 144A.073 regarding the upgrading of the facilities do 86.21 not apply to facilities that satisfy these requirements; 86.22 (f) to license and certify up to 40 beds transferred from 86.23 an existing facility owned and operated by the Amherst H. Wilder 86.24 Foundation in the city of St. Paul to a new unit at the same 86.25 location as the existing facility that will serve persons with 86.26 Alzheimer's disease and other related disorders. The transfer 86.27 of beds may occur gradually or in stages, provided the total 86.28 number of beds transferred does not exceed 40. At the time of 86.29 licensure and certification of a bed or beds in the new unit, 86.30 the commissioner of health shall delicense and decertify the 86.31 same number of beds in the existing facility. As a condition of 86.32 receiving a license or certification under this clause, the 86.33 facility must make a written commitment to the commissioner of 86.34 human services that it will not seek to receive an increase in 86.35 its property-related payment rate as a result of the transfers 86.36 allowed under this paragraph; 87.1 (g) to license and certify nursing home beds to replace 87.2 currently licensed and certified boarding care beds which may be 87.3 located either in a remodeled or renovated boarding care or 87.4 nursing home facility or in a remodeled, renovated, newly 87.5 constructed, or replacement nursing home facility within the 87.6 identifiable complex of health care facilities in which the 87.7 currently licensed boarding care beds are presently located, 87.8 provided that the number of boarding care beds in the facility 87.9 or complex are decreased by the number to be licensed as nursing 87.10 home beds and further provided that, if the total costs of new 87.11 construction, replacement, remodeling, or renovation exceed ten 87.12 percent of the appraised value of the facility or $200,000, 87.13 whichever is less, the facility makes a written commitment to 87.14 the commissioner of human services that it will not seek to 87.15 receive an increase in its property-related payment rate by 87.16 reason of the new construction, replacement, remodeling, or 87.17 renovation. The provisions contained in section 144A.073 87.18 regarding the upgrading of facilities do not apply to facilities 87.19 that satisfy these requirements; 87.20 (h) to license as a nursing home and certify as a nursing 87.21 facility a facility that is licensed as a boarding care facility 87.22 but not certified under the medical assistance program, but only 87.23 if the commissioner of human services certifies to the 87.24 commissioner of health that licensing the facility as a nursing 87.25 home and certifying the facility as a nursing facility will 87.26 result in a net annual savings to the state general fund of 87.27 $200,000 or more; 87.28 (i) to certify, after September 30, 1992, and prior to July 87.29 1, 1993, existing nursing home beds in a facility that was 87.30 licensed and in operation prior to January 1, 1992; 87.31 (j) to license and certify new nursing home beds to replace 87.32 beds in a facility condemned as part of an economic 87.33 redevelopment plan in a city of the first class, provided the 87.34 new facility is located within one mile of the site of the old 87.35 facility. Operating and property costs for the new facility 87.36 must be determined and allowed under existing reimbursement 88.1 rules; 88.2 (k) to license and certify up to 20 new nursing home beds 88.3 in a community-operated hospital and attached convalescent and 88.4 nursing care facility with 40 beds on April 21, 1991, that 88.5 suspended operation of the hospital in April 1986. The 88.6 commissioner of human services shall provide the facility with 88.7 the same per diem property-related payment rate for each 88.8 additional licensed and certified bed as it will receive for its 88.9 existing 40 beds; 88.10 (l) to license or certify beds in renovation, replacement, 88.11 or upgrading projects as defined in section 144A.073, 88.12 subdivision 1, so long as the cumulative total costs of the 88.13 facility's remodeling projects do not exceed 25 percent of the 88.14 appraised value of the facility or $500,000, whichever is less; 88.15 (m) to license and certify beds that are moved from one 88.16 location to another for the purposes of converting up to five 88.17 four-bed wards to single or double occupancy rooms in a nursing 88.18 home that, as of January 1, 1993, was county-owned and had a 88.19 licensed capacity of 115 beds; 88.20 (n) to allow a facility that on April 16, 1993, was a 88.21 106-bed licensed and certified nursing facility located in 88.22 Minneapolis to layaway all of its licensed and certified nursing 88.23 home beds. These beds may be relicensed and recertified in a 88.24 newly-constructed teaching nursing home facility affiliated with 88.25 a teaching hospital upon approval by the legislature. The 88.26 proposal must be developed in consultation with the interagency 88.27 committee on long-term care planning. The beds on layaway 88.28 status shall have the same status as voluntarily delicensed and 88.29 decertified beds, except that beds on layaway status remain 88.30 subject to the surcharge in section 256.9657. This layaway 88.31 provision expires July 1, 1997; 88.32 (o) to allow a project which will be completed in 88.33 conjunction with an approved moratorium exception project for a 88.34 nursing home in southern Cass county and which is directly 88.35 related to that portion of the facility that must be repaired, 88.36 renovated, or replaced, to correct an emergency plumbing problem 89.1 for which a state correction order has been issued and which 89.2 must be corrected by August 31, 1993; 89.3 (p) to allow a facility that on April 16, 1993, was a 89.4 368-bed licensed and certified nursing facility located in 89.5 Minneapolis to layaway, upon 30 days prior written notice to the 89.6 commissioner, up to 30 of the facility's licensed and certified 89.7 beds by converting three-bed wards to single or double 89.8 occupancy. Beds on layaway status shall have the same status as 89.9 voluntarily delicensed and decertified beds except that beds on 89.10 layaway status remain subject to the surcharge in section 89.11 256.9657, remain subject to the license application and renewal 89.12 fees under section 144A.07 and shall be subject to a $100 per 89.13 bed reactivation fee. In addition, at any time within three 89.14 years of the effective date of the layaway, the beds on layaway 89.15 status may be: 89.16 (1) relicensed and recertified upon relocation and 89.17 reactivation of some or all of the beds to an existing licensed 89.18 and certified facility or facilities located in Pine River, 89.19 Brainerd, or International Falls; provided that the total 89.20 project construction costs related to the relocation of beds 89.21 from layaway status for any facility receiving relocated beds 89.22 may not exceed the dollar threshold provided in subdivision 2 89.23 unless the construction project has been approved through the 89.24 moratorium exception process under section 144A.073; 89.25 (2) relicensed and recertified, upon reactivation of some 89.26 or all of the beds within the facility which placed the beds in 89.27 layaway status, if the commissioner has determined a need for 89.28 the reactivation of the beds on layaway status. 89.29 The property-related payment rate of a facility placing 89.30 beds on layaway status must be adjusted by the incremental 89.31 change in its rental per diem after recalculating the rental per 89.32 diem as provided in section 256B.431, subdivision 3a, paragraph 89.33 (d). The property-related payment rate for a facility 89.34 relicensing and recertifying beds from layaway status must be 89.35 adjusted by the incremental change in its rental per diem after 89.36 recalculating its rental per diem using the number of beds after 90.1 the relicensing to establish the facility's capacity day 90.2 divisor, which shall be effective the first day of the month 90.3 following the month in which the relicensing and recertification 90.4 became effective. Any beds remaining on layaway status more 90.5 than three years after the date the layaway status became 90.6 effective must be removed from layaway status and immediately 90.7 delicensed and decertified; 90.8 (q) to license and certify beds in a renovation and 90.9 remodeling project to convert 13 three-bed wards into 13 two-bed 90.10 rooms and 13 single-bed rooms, expand space, and add 90.11 improvements in a nursing home that, as of January 1, 1994, met 90.12 the following conditions: the nursing home was located in 90.13 Ramsey county; was not owned by a hospital corporation; had a 90.14 licensed capacity of 64 beds; and had been ranked among the top 90.15 15 applicants by the 1993 moratorium exceptions advisory review 90.16 panel. The total project construction cost estimate for this 90.17 project must not exceed the cost estimate submitted in 90.18 connection with the 1993 moratorium exception process; 90.19 (r) to license and certify beds in a renovation and 90.20 remodeling project to convert 12 four-bed wards into 24 two-bed 90.21 rooms, expand space, and add improvements in a nursing home 90.22 that, as of January 1, 1994, met the following conditions: the 90.23 nursing home was located in Ramsey county; had a licensed 90.24 capacity of 154 beds; and had been ranked among the top 15 90.25 applicants by the 1993 moratorium exceptions advisory review 90.26 panel. The total project construction cost estimate for this 90.27 project must not exceed the cost estimate submitted in 90.28 connection with the 1993 moratorium exception process; 90.29 (s) to license and certify up to 117 beds that are 90.30 relocated from a licensed and certified 138-bed nursing facility 90.31 located in St. Paul to a hospital with 130 licensed hospital 90.32 beds located in South St. Paul, provided that the nursing 90.33 facility and hospital are owned by the same or a related 90.34 organization and that prior to the date the relocation is 90.35 completed the hospital ceases operation of its inpatient 90.36 hospital services at that hospital. After relocation, the 91.1 nursing facility's status under section 256B.431, subdivision 91.2 2j, shall be the same as it was prior to relocation. The 91.3 nursing facility's property-related payment rate resulting from 91.4 the project authorized in this paragraph shall become effective 91.5 no earlier than April 1, 1996. For purposes of calculating the 91.6 incremental change in the facility's rental per diem resulting 91.7 from this project, the allowable appraised value of the nursing 91.8 facility portion of the existing health care facility physical 91.9 plant prior to the renovation and relocation may not exceed 91.10 $2,490,000; 91.11 (t) to license and certify two beds in a facility to 91.12 replace beds that were voluntarily delicensed and decertified on 91.13 June 28, 1991; 91.14 (u) to allow 16 licensed and certified beds located on July 91.15 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 91.16 facility in Minneapolis, notwithstanding the licensure and 91.17 certification after July 1, 1995, of the Minneapolis facility as 91.18 a 147-bed nursing home facility after completion of a 91.19 construction project approved in 1993 under section 144A.073, to 91.20 be laid away upon 30 days' prior written notice to the 91.21 commissioner. Beds on layaway status shall have the same status 91.22 as voluntarily delicensed or decertified beds except that they 91.23 shall remain subject to the surcharge in section 256.9657. The 91.24 16 beds on layaway status may be relicensed as nursing home beds 91.25 and recertified at any time within five years of the effective 91.26 date of the layaway upon relocation of some or all of the beds 91.27 to a licensed and certified facility located in Watertown, 91.28 provided that the total project construction costs related to 91.29 the relocation of beds from layaway status for the Watertown 91.30 facility may not exceed the dollar threshold provided in 91.31 subdivision 2 unless the construction project has been approved 91.32 through the moratorium exception process under section 144A.073. 91.33 The property-related payment rate of the facility placing 91.34 beds on layaway status must be adjusted by the incremental 91.35 change in its rental per diem after recalculating the rental per 91.36 diem as provided in section 256B.431, subdivision 3a, paragraph 92.1 (d). The property-related payment rate for the facility 92.2 relicensing and recertifying beds from layaway status must be 92.3 adjusted by the incremental change in its rental per diem after 92.4 recalculating its rental per diem using the number of beds after 92.5 the relicensing to establish the facility's capacity day 92.6 divisor, which shall be effective the first day of the month 92.7 following the month in which the relicensing and recertification 92.8 became effective. Any beds remaining on layaway status more 92.9 than five years after the date the layaway status became 92.10 effective must be removed from layaway status and immediately 92.11 delicensed and decertified;or92.12 (v) to license and certify beds that are moved within an 92.13 existing area of a facility or to a newly-constructed addition 92.14 which is built for the purpose of eliminating three- and 92.15 four-bed rooms and adding space for dining, lounge areas, 92.16 bathing rooms, and ancillary service areas in a nursing home 92.17 that, as of January 1, 1995, was located in Fridley and had a 92.18 licensed capacity of 129 beds; or 92.19 (w) to relocate 36 beds in Crow Wing county and four beds 92.20 from Hennepin county to a 160-bed facility in Crow Wing county, 92.21 provided all the affected beds are under common ownership. 92.22 Sec. 3. Minnesota Statutes 1995 Supplement, section 92.23 256B.431, subdivision 25, is amended to read: 92.24 Subd. 25. [CHANGES TO NURSING FACILITY REIMBURSEMENT 92.25 BEGINNING JULY 1, 1995.] The nursing facility reimbursement 92.26 changes in paragraphs (a) to(g)(h) shall apply in the sequence 92.27 specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and 92.28 this section, beginning July 1, 1995. 92.29 (a) The eight-cent adjustment to care-related rates in 92.30 subdivision 22, paragraph (e), shall no longer apply. 92.31 (b) For rate years beginning on or after July 1, 1995, the 92.32 commissioner shall limit a nursing facility's allowable 92.33 operating per diem for each case mix category for each rate year 92.34 as in clauses (1) to (3). 92.35 (1) For the rate year beginning July 1, 1995, the 92.36 commissioner shall group nursing facilities into two groups, 93.1 freestanding and nonfreestanding, within each geographic group, 93.2 using their operating cost per diem for the case mix A 93.3 classification. A nonfreestanding nursing facility is a nursing 93.4 facility whose other operating cost per diem is subject to the 93.5 hospital attached, short length of stay, or the rule 80 limits. 93.6 All other nursing facilities shall be considered freestanding 93.7 nursing facilities. The commissioner shall then array all 93.8 nursing facilities in each grouping by their allowable case mix 93.9 A operating cost per diem. In calculating a nursing facility's 93.10 operating cost per diem for this purpose, the commissioner shall 93.11 exclude the raw food cost per diem related to providing special 93.12 diets that are based on religious beliefs, as determined in 93.13 subdivision 2b, paragraph (h). For those nursing facilities in 93.14 each grouping whose case mix A operating cost per diem: 93.15 (i) is at or below the median minus 1.0 standard deviation 93.16 of the array, the commissioner shall limit the nursing 93.17 facility's allowable operating cost per diem for each case mix 93.18 category to the lesser of the prior reporting year's allowable 93.19 operating cost per diems plus the inflation factor as 93.20 established in paragraph (f), clause (2), increased by six 93.21 percentage points, or the current reporting year's corresponding 93.22 allowable operating cost per diem; 93.23 (ii) is between minus .5 standard deviation and minus 1.0 93.24 standard deviation below the median of the array, the 93.25 commissioner shall limit the nursing facility's allowable 93.26 operating cost per diem for each case mix category to the lesser 93.27 of the prior reporting year's allowable operating cost per diems 93.28 plus the inflation factor as established in paragraph (f), 93.29 clause (2), increased by four percentage points, or the current 93.30 reporting year's corresponding allowable operating cost per 93.31 diem; or 93.32 (iii) is equal to or above minus .5 standard deviation 93.33 below the median of the array, the commissioner shall limit the 93.34 nursing facility's allowable operating cost per diem for each 93.35 case mix category to the lesser of the prior reporting year's 93.36 allowable operating cost per diems plus the inflation factor as 94.1 established in paragraph (f), clause (2), increased by three 94.2 percentage points, or the current reporting year's corresponding 94.3 allowable operating cost per diem. 94.4 (2) For the rate year beginning on July 1, 1996, the 94.5 commissioner shall limit the nursing facility's allowable 94.6 operating cost per diem for each case mix category to the lesser 94.7 of the prior reporting year's allowable operating cost per diems 94.8 plus the inflation factor as established in paragraph (f), 94.9 clause (2), increased by one percentage point or the current 94.10 reporting year's corresponding allowable operating cost per 94.11 diems; and 94.12 (3) For rate years beginning on or after July 1, 1997, the 94.13 commissioner shall limit the nursing facility's allowable 94.14 operating cost per diem for each case mix category to the lesser 94.15 of the reporting year prior to the current reporting year's 94.16 allowable operating cost per diems plus the inflation factor as 94.17 established in paragraph (f), clause (2), or the current 94.18 reporting year's corresponding allowable operating cost per 94.19 diems. 94.20 (c) For rate years beginning on July 1, 1995, the 94.21 commissioner shall limit the allowable operating cost per diems 94.22 for high cost nursing facilities. After application of the 94.23 limits in paragraph (b) to each nursing facility's operating 94.24 cost per diems, the commissioner shall group nursing facilities 94.25 into two groups, freestanding or nonfreestanding, within each 94.26 geographic group. A nonfreestanding nursing facility is a 94.27 nursing facility whose other operating cost per diems are 94.28 subject to hospital attached, short length of stay, or rule 80 94.29 limits. All other nursing facilities shall be considered 94.30 freestanding nursing facilities. The commissioner shall then 94.31 array all nursing facilities within each grouping by their 94.32 allowable case mix A operating cost per diems. In calculating a 94.33 nursing facility's operating cost per diem for this purpose, the 94.34 commissioner shall exclude the raw food cost per diem related to 94.35 providing special diets that are based on religious beliefs, as 94.36 determined in subdivision 2b, paragraph (h). For those nursing 95.1 facilities in each grouping whose case mix A operating cost per 95.2 diem exceeds 1.0 standard deviation above the median, the 95.3 commissioner shall reduce their allowable operating cost per 95.4 diems by two percent. For those nursing facilities in each 95.5 grouping whose case mix A operating cost per diem exceeds 0.5 95.6 standard deviation above the median but is less than or equal to 95.7 1.0 standard deviation above the median, the commissioner shall 95.8 reduce their allowable operating cost per diems by one percent. 95.9 (d) For rate years beginning on or after July 1, 1996, the 95.10 commissioner shall limit the allowable operating cost per diems 95.11 for high cost nursing facilities. After application of the 95.12 limits in paragraph (b) to each nursing facility's operating 95.13 cost per diems, the commissioner shall group nursing facilities 95.14 into two groups, freestanding or nonfreestanding, within each 95.15 geographic group. A nonfreestanding nursing facility is a 95.16 nursing facility whose other operating cost per diems are 95.17 subject to hospital attached, short length of stay, or rule 80 95.18 limits. All other nursing facilities shall be considered 95.19 freestanding nursing facilities. The commissioner shall then 95.20 array all nursing facilities within each grouping by their 95.21 allowable case mix A operating cost per diems. In calculating a 95.22 nursing facility's operating cost per diem for this purpose, the 95.23 commissioner shall exclude the raw food cost per diem related to 95.24 providing special diets that are based on religious beliefs, as 95.25 determined in subdivision 2b, paragraph (h). In those nursing 95.26 facilities in each grouping whose case mix A operating cost per 95.27 diem exceeds 1.0 standard deviation above the median, the 95.28 commissioner shall reduce their allowable operating cost per 95.29 diems by three percent. For those nursing facilities in each 95.30 grouping whose case mix A operating cost per diem exceeds 0.5 95.31 standard deviation above the median but is less than or equal to 95.32 1.0 standard deviation above the median, the commissioner shall 95.33 reduce their allowable operating cost per diems by two percent. 95.34 (e) For rate years beginning on or after July 1, 1995, the 95.35 commissioner shall determine a nursing facility's efficiency 95.36 incentive by first computing the allowable difference, which is 96.1 the lesser of $4.50 or the amount by which the facility's other 96.2 operating cost limit exceeds its nonadjusted other operating 96.3 cost per diem for that rate year. The commissioner shall 96.4 compute the efficiency incentive by: 96.5 (1) subtracting the allowable difference from $4.50 and 96.6 dividing the result by $4.50; 96.7 (2) multiplying 0.20 by the ratio resulting from clause 96.8 (1), and then; 96.9 (3) adding 0.50 to the result from clause (2); and 96.10 (4) multiplying the result from clause (3) times the 96.11 allowable difference. 96.12 The nursing facility's efficiency incentive payment shall 96.13 be the lesser of $2.25 or the product obtained in clause (4). 96.14 (f) For rate years beginning on or after July 1, 1995, the 96.15 forecasted price index for a nursing facility's allowable 96.16 operating cost per diems shall be determined under clauses (1) 96.17 to (3) using the change in the Consumer Price Index-All Items 96.18 (United States city average) (CPI-U) or the change in the 96.19 Nursing Home Market Basket, both as forecasted by Data Resources 96.20 Inc., whichever is applicable. The commissioner shall use the 96.21 indices as forecasted in the fourth quarter of the calendar year 96.22 preceding the rate year, subject to subdivision 2l, paragraph 96.23 (c). If, as a result of federal legislative or administrative 96.24 action, the methodology used to calculate the Consumer Price 96.25 Index-All Items (United States city average) (CPI-U) changes, 96.26 the commissioner shall develop a conversion factor or other 96.27 methodology to convert the CPI-U index factor that results from 96.28 the new methodology to an index factor that approximates, as 96.29 closely as possible, the index factor that would have resulted 96.30 from application of the original CPI-U methodology prior to any 96.31 changes in methodology. The commissioner shall use the 96.32 conversion factor or other methodology to calculate an adjusted 96.33 inflation index. The adjusted inflation index must be used to 96.34 calculate payment rates under this section instead of the CPI-U 96.35 index specified in paragraph (d). If the commissioner is 96.36 required to develop an adjusted inflation index, the 97.1 commissioner shall report to the legislature as part of the next 97.2 budget submission the fiscal impact of applying this index. 97.3 (1) The CPI-U forecasted index for allowable operating cost 97.4 per diems shall be based on the 21-month period from the 97.5 midpoint of the nursing facility's reporting year to the 97.6 midpoint of the rate year following the reporting year. 97.7 (2) The Nursing Home Market Basket forecasted index for 97.8 allowable operating costs and per diem limits shall be based on 97.9 the 12-month period between the midpoints of the two reporting 97.10 years preceding the rate year. 97.11 (3) For rate years beginning on or after July 1, 1996, the 97.12 forecasted index for operating cost limits referred to in 97.13 subdivision 21, paragraph (b), shall be based on the CPI-U for 97.14 the 12-month period between the midpoints of the two reporting 97.15 years preceding the rate year. 97.16 (g) After applying these provisions for the respective rate 97.17 years, the commissioner shall index these allowable operating 97.18 costs per diems by the inflation factor provided for in 97.19 paragraph (f), clause (1), and add the nursing facility's 97.20 efficiency incentive as computed in paragraph (e). 97.21 (h) A nursing facility licensed for 302 beds on September 97.22 30, 1993, that was approved under the moratorium exception 97.23 process in section 144A.073 for a partial replacement, and 97.24 completed the replacement project in December 1994, is exempt 97.25 from paragraphs (b) to (d) for rate years beginning on or after 97.26 July 1, 1995. 97.27 (i) Notwithstanding section 11, paragraph (h), for the rate 97.28 years beginning on July 1, 1996, July 1, 1997, and July 1, 1998, 97.29 a nursing facility licensed for 40 beds effective May 1, 1992, 97.30 with a subsequent increase of 20 Medicare/Medicaid certified 97.31 beds, effective January 26, 1993, in accordance with an increase 97.32 in licensure is exempt from paragraphs (b) to (d). 97.33 Sec. 4. Minnesota Statutes 1995 Supplement, section 97.34 256B.501, subdivision 5b, is amended to read: 97.35 Subd. 5b. [ICF/MR OPERATING COST LIMITATION AFTER 97.36 SEPTEMBER 30, 1995.] (a) For the rateyearsyear beginning on 98.1 October 1, 1995,and October 1, 1996and for rate years 98.2 beginning on or after October 1, 1997, the commissioner shall 98.3 limit the allowable operating cost per diems, as determined 98.4 under this subdivision and the reimbursement rules, for high 98.5 cost ICF's/MR. Prior to indexing each facility's operating cost 98.6 per diems for inflation, the commissioner shall group the 98.7 facilities into eight groups. The commissioner shall then array 98.8 all facilities within each grouping by their general operating 98.9 cost per service unit per diems. 98.10 (b) The commissioner shall annually review and adjust the 98.11 general operating costs incurred by the facility during the 98.12 reporting year preceding the rate year to determine the 98.13 facility's allowable historical general operating costs. For 98.14 this purpose, the term general operating costs means the 98.15 facility's allowable operating costs included in the program, 98.16 maintenance, and administrative operating costs categories, as 98.17 well as the facility's related payroll taxes and fringe 98.18 benefits, real estate insurance, and professional liability 98.19 insurance. A facility's total operating cost payment rate shall 98.20 be limited according to paragraphs (c) and (d) as follows: 98.21 (c) A facility's total operating cost payment rate shall be 98.22 equal to its allowable historical operating cost per diems for 98.23 program, maintenance, and administrative cost categories 98.24 multiplied by the forecasted inflation index in subdivision 3c, 98.25 clause (1), subject to the limitations in paragraph (d). 98.26 (d) For the rate years beginning on or after October 1, 98.27 1995, the commissioner shall establish maximum overall general 98.28 operating cost per service unit limits for facilities according 98.29 to clauses (1) to (8). Each facility's allowable historical 98.30 general operating costs and client assessment information 98.31 obtained from client assessments completed under subdivision 3g 98.32 for the reporting year ending December 31, 1994 (the base year), 98.33 shall be used for establishing the overall limits. If a 98.34 facility's proportion of temporary care resident days to total 98.35 resident days exceeds 80 percent, the commissioner must exempt 98.36 that facility from the overall general operating cost per 99.1 service unit limits in clauses (1) to (8). For this purpose, 99.2 "temporary care" means care provided by a facility to a client 99.3 for less than 30 consecutive resident days. 99.4 (1) The commissioner shall determine each facility's 99.5 weighted service units for the reporting year by multiplying its 99.6 resident days in each client classification level as established 99.7 in subdivision 3g, paragraph (d), by the corresponding weights 99.8 for that classification level, as established in subdivision 3g, 99.9 paragraph (i), and summing the results. For the reporting year 99.10 ending December 31, 1994, the commissioner shall use the service 99.11 unit score computed from the client classifications determined 99.12 by the Minnesota department of health's annual review, including 99.13 those of clients admitted during that year. 99.14 (2) The facility's service unit score is equal to its 99.15 weighted service units as computed in clause (1), divided by the 99.16 facility's total resident days excluding temporary care resident 99.17 days, for the reporting year. 99.18 (3) For each facility, the commissioner shall determine the 99.19 facility's cost per service unit by dividing its allowable 99.20 historical general operating costs for the reporting year by the 99.21 facility's service unit score in clause (2) multiplied by its 99.22 total resident days, or 85 percent of the facility's capacity 99.23 days times its service unit score in clause (2), if the 99.24 facility's occupancy is less than 85 percent of licensed 99.25 capacity. If a facility reports temporary care resident days, 99.26 the temporary care resident days shall be multiplied by the 99.27 service unit score in clause (2), and the resulting weighted 99.28 resident days shall be added to the facility's weighted service 99.29 units in clause (1) prior to computing the facility's cost per 99.30 service unit under this clause. 99.31 (4) The commissioner shall group facilities based on class 99.32 A or class B licensure designation, number of licensed beds, and 99.33 geographic location. For purposes of this grouping, facilities 99.34 with six beds or less shall be designated as small facilities 99.35 and facilities with more than six beds shall be designated as 99.36 large facilities. If a facility has both class A and class B