1st Unofficial Engrossment - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to human services; excluding crime victim 1.3 reparations from determination of eligibility for 1.4 medical assistance; modifying provisions in long-term 1.5 care; amending Minnesota Statutes 1998, sections 1.6 256B.411, subdivision 2; and 256B.431, subdivisions 1, 1.7 3a, 10, 16, 18, 21, 22, and 25; Minnesota Statutes 1.8 1999 Supplement, sections 256B.056, by adding a 1.9 subdivision; 256B.0575; 256B.0913, subdivision 5; 1.10 256B.431, subdivisions 17 and 26; and 256B.434, 1.11 subdivisions 3 and 4; repealing Minnesota Statutes 1.12 1998, sections 256B.03, subdivision 2; 256B.431, 1.13 subdivisions 2, 2a, 2f, 2h, 2m, 2p, 2q, 3, 3b, 3d, 3h, 1.14 3j, 4, 5, 7, 8, 9, 9a, 12, and 24; 256B.48, 1.15 subdivision 9; 256B.50, subdivision 3; and 256B.74, 1.16 subdivision 3. 1.17 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.18 Section 1. Minnesota Statutes 1999 Supplement, section 1.19 256B.056, is amended by adding a subdivision to read: 1.20 Subd. 3c. [CRIME VICTIMS REPARATIONS.] Crime victims 1.21 reparations awarded under sections 611A.51 to 611A.68 shall not 1.22 be considered as assets in determining eligibility for medical 1.23 assistance. 1.24 Sec. 2. Minnesota Statutes 1999 Supplement, section 1.25 256B.0575, is amended to read: 1.26 256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 1.27 PERSONS.] 1.28 When an institutionalized person is determined eligible for 1.29 medical assistance, the income that exceeds the deductions in 1.30 paragraphs (a) and (b) must be applied to the cost of 1.31 institutional care. 2.1 (a) The following amounts must be deducted from the 2.2 institutionalized person's income in the following order: 2.3 (1) the personal needs allowance under section 256B.35 or, 2.4 for a veteran who does not have a spouse or child, or a 2.5 surviving spouse of a veteran having no child, the amount of an 2.6 improved pension received from the veteran's administration not 2.7 exceeding $90 per month; 2.8 (2) the personal allowance for disabled individuals under 2.9 section 256B.36; 2.10 (3) if the institutionalized person has a legally appointed 2.11 guardian or conservator, five percent of the recipient's gross 2.12 monthly income up to $100 as reimbursement for guardianship or 2.13 conservatorship services; 2.14 (4) a monthly income allowance determined under section 2.15 256B.058, subdivision 2, but only to the extent income of the 2.16 institutionalized spouse is made available to the community 2.17 spouse; 2.18 (5) a monthly allowance for children under age 18 which, 2.19 together with the net income of the children, would provide 2.20 income equal to the medical assistance standard for families and 2.21 children according to section 256B.056, subdivision 4, for a 2.22 family size that includes only the minor children. This 2.23 deduction applies only if the children do not live with the 2.24 community spouse and only to the extent that the deduction is 2.25 not included in the personal needs allowance under section 2.26 256B.35, subdivision 1, as child support garnished under a court 2.27 order; 2.28 (6) a monthly family allowance for other family members, 2.29 equal to one-third of the difference between 122 percent of the 2.30 federal poverty guidelines and the monthly income for that 2.31 family member; 2.32 (7) reparations payments made by the Federal Republic of 2.33 Germany and reparations payments made by the Netherlands for 2.34 victims of Nazi persecution between 1940 and 1945; 2.35 (8) all other exclusions from income for institutionalized 2.36 persons as mandated by federal law;and3.1 (9) crime victims reparations awarded under sections 3.2 611A.51 to 611A.68; and 3.3 (10) amounts for reasonable expenses incurred for necessary 3.4 medical or remedial care for the institutionalized spouse that 3.5 are not medical assistance covered expenses and that are not 3.6 subject to payment by a third party. 3.7 For purposes of clause (6), "other family member" means a 3.8 person who resides with the community spouse and who is a minor 3.9 or dependent child, dependent parent, or dependent sibling of 3.10 either spouse. "Dependent" means a person who could be claimed 3.11 as a dependent for federal income tax purposes under the 3.12 Internal Revenue Code. 3.13 (b) Income shall be allocated to an institutionalized 3.14 person for a period of up to three calendar months, in an amount 3.15 equal to the medical assistance standard for a family size of 3.16 one if: 3.17 (1) a physician certifies that the person is expected to 3.18 reside in the long-term care facility for three calendar months 3.19 or less; 3.20 (2) if the person has expenses of maintaining a residence 3.21 in the community; and 3.22 (3) if one of the following circumstances apply: 3.23 (i) the person was not living together with a spouse or a 3.24 family member as defined in paragraph (a) when the person 3.25 entered a long-term care facility; or 3.26 (ii) the person and the person's spouse become 3.27 institutionalized on the same date, in which case the allocation 3.28 shall be applied to the income of one of the spouses. 3.29 For purposes of this paragraph, a person is determined to be 3.30 residing in a licensed nursing home, regional treatment center, 3.31 or medical institution if the person is expected to remain for a 3.32 period of one full calendar month or more. 3.33 Sec. 3. Minnesota Statutes 1999 Supplement, section 3.34 256B.0913, subdivision 5, is amended to read: 3.35 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 3.36 Alternative care funding may be used for payment of costs of: 4.1 (1) adult foster care; 4.2 (2) adult day care; 4.3 (3) home health aide; 4.4 (4) homemaker services; 4.5 (5) personal care; 4.6 (6) case management; 4.7 (7) respite care; 4.8 (8) assisted living; 4.9 (9) residential care services; 4.10 (10) care-related supplies and equipment; 4.11 (11) meals delivered to the home; 4.12 (12) transportation; 4.13 (13) skilled nursing; 4.14 (14) chore services; 4.15 (15) companion services; 4.16 (16) nutrition services; 4.17 (17) training for direct informal caregivers; 4.18 (18) telemedicine devices to monitor recipients in their 4.19 own homes as an alternative to hospital care, nursing home care, 4.20 or home visits; and 4.21 (19) other services including direct cash payments to 4.22 clients, approved by the county agency, subject to the 4.23 provisions of paragraph (m). Total annual payments for other 4.24 services for all clients within a county may not exceed either 4.25 ten percent of that county's annual alternative care program 4.26 base allocation or $5,000, whichever is greater. In no case 4.27 shall this amount exceed the county's total annual alternative 4.28 care program base allocation. 4.29 (b) The county agency must ensure that the funds are used 4.30 only to supplement and not supplant services available through 4.31 other public assistance or services programs. 4.32 (c) Unless specified in statute, the service standards for 4.33 alternative care services shall be the same as the service 4.34 standards defined in the elderly waiver. Except for the county 4.35 agencies' approval of direct cash payments to clients, persons 4.36 or agencies must be employed by or under a contract with the 5.1 county agency or the public health nursing agency of the local 5.2 board of health in order to receive funding under the 5.3 alternative care program. 5.4 (d) The adult foster care rate shall be considered a 5.5 difficulty of care payment and shall not include room and 5.6 board. The adult foster care daily rate shall be negotiated 5.7 between the county agency and the foster care provider. The 5.8 rate established under this section shall not exceed 75 percent 5.9 of the state average monthly nursing home payment for the case 5.10 mix classification to which the individual receiving foster care 5.11 is assigned, and it must allow for other alternative care 5.12 services to be authorized by the case manager. 5.13 (e) Personal care services may be provided by a personal 5.14 care provider organization. A county agency may contract with a 5.15 relative of the client to provide personal care services, but 5.16 must ensure nursing supervision. Covered personal care services 5.17 defined in section 256B.0627, subdivision 4, must meet 5.18 applicable standards in Minnesota Rules, part 9505.0335. 5.19 (f) A county may use alternative care funds to purchase 5.20 medical supplies and equipment without prior approval from the 5.21 commissioner when: (1) there is no other funding source; (2) 5.22 the supplies and equipment are specified in the individual's 5.23 care plan as medically necessary to enable the individual to 5.24 remain in the community according to the criteria in Minnesota 5.25 Rules, part 9505.0210, item A; and (3) the supplies and 5.26 equipment represent an effective and appropriate use of 5.27 alternative care funds. A county may use alternative care funds 5.28 to purchase supplies and equipment from a non-Medicaid certified 5.29 vendor if the cost for the items is less than that of a Medicaid 5.30 vendor. A county is not required to contract with a provider of 5.31 supplies and equipment if the monthly cost of the supplies and 5.32 equipment is less than $250. 5.33 (g) For purposes of this section, residential care services 5.34 are services which are provided to individuals living in 5.35 residential care homes. Residential care homes are currently 5.36 licensed as board and lodging establishments and are registered 6.1 with the department of health as providing special services. 6.2 Residential care services are defined as "supportive services" 6.3 and "health-related services." "Supportive services" means the 6.4 provision of up to 24-hour supervision and oversight. 6.5 Supportive services includes: (1) transportation, when provided 6.6 by the residential care center only; (2) socialization, when 6.7 socialization is part of the plan of care, has specific goals 6.8 and outcomes established, and is not diversional or recreational 6.9 in nature; (3) assisting clients in setting up meetings and 6.10 appointments; (4) assisting clients in setting up medical and 6.11 social services; (5) providing assistance with personal laundry, 6.12 such as carrying the client's laundry to the laundry room. 6.13 Assistance with personal laundry does not include any laundry, 6.14 such as bed linen, that is included in the room and board rate. 6.15 Health-related services are limited to minimal assistance with 6.16 dressing, grooming, and bathing and providing reminders to 6.17 residents to take medications that are self-administered or 6.18 providing storage for medications, if requested. Individuals 6.19 receiving residential care services cannot receiveboth personal6.20care services and residential carehomemaking services. 6.21 (h) For the purposes of this section, "assisted living" 6.22 refers to supportive services provided by a single vendor to 6.23 clients who reside in the same apartment building of three or 6.24 more units which are not subject to registration under chapter 6.25 144D. Assisted living services are defined as up to 24-hour 6.26 supervision, and oversight, supportive services as defined in 6.27 clause (1), individualized home care aide tasks as defined in 6.28 clause (2), and individualized home management tasks as defined 6.29 in clause (3) provided to residents of a residential center 6.30 living in their units or apartments with a full kitchen and 6.31 bathroom. A full kitchen includes a stove, oven, refrigerator, 6.32 food preparation counter space, and a kitchen utensil storage 6.33 compartment. Assisted living services must be provided by the 6.34 management of the residential center or by providers under 6.35 contract with the management or with the county. 6.36 (1) Supportive services include: 7.1 (i) socialization, when socialization is part of the plan 7.2 of care, has specific goals and outcomes established, and is not 7.3 diversional or recreational in nature; 7.4 (ii) assisting clients in setting up meetings and 7.5 appointments; and 7.6 (iii) providing transportation, when provided by the 7.7 residential center only. 7.8 Individuals receiving assisted living services will not 7.9 receive both assisted living services and homemakingor personal7.10careservices. Individualized means services are chosen and 7.11 designed specifically for each resident's needs, rather than 7.12 provided or offered to all residents regardless of their 7.13 illnesses, disabilities, or physical conditions. 7.14 (2) Home care aide tasks means: 7.15 (i) preparing modified diets, such as diabetic or low 7.16 sodium diets; 7.17 (ii) reminding residents to take regularly scheduled 7.18 medications or to perform exercises; 7.19 (iii) household chores in the presence of technically 7.20 sophisticated medical equipment or episodes of acute illness or 7.21 infectious disease; 7.22 (iv) household chores when the resident's care requires the 7.23 prevention of exposure to infectious disease or containment of 7.24 infectious disease; and 7.25 (v) assisting with dressing, oral hygiene, hair care, 7.26 grooming, and bathing, if the resident is ambulatory, and if the 7.27 resident has no serious acute illness or infectious disease. 7.28 Oral hygiene means care of teeth, gums, and oral prosthetic 7.29 devices. 7.30 (3) Home management tasks means: 7.31 (i) housekeeping; 7.32 (ii) laundry; 7.33 (iii) preparation of regular snacks and meals; and 7.34 (iv) shopping. 7.35 Assisted living services as defined in this section shall 7.36 not be authorized in boarding and lodging establishments 8.1 licensed according to sections 157.011 and 157.15 to 157.22. 8.2 (i) For establishments registered under chapter 144D, 8.3 assisted living services under this section means the services 8.4 described and licensed under section 144A.4605. 8.5 (j) For the purposes of this section, reimbursement for 8.6 assisted living services and residential care services shall be 8.7 a monthly rate negotiated and authorized by the county agency 8.8 based on an individualized service plan for each resident. The 8.9 rate shall not exceed the nonfederal share of the greater of 8.10 either the statewide or any of the geographic groups' weighted 8.11 average monthly medical assistance nursing facility payment rate 8.12 of the case mix resident class to which the 180-day eligible 8.13 client would be assigned under Minnesota Rules, parts 9549.0050 8.14 to 9549.0059, unless the services are provided by a home care 8.15 provider licensed by the department of health and are provided 8.16 in a building that is registered as a housing with services 8.17 establishment under chapter 144D and that provides 24-hour 8.18 supervision. 8.19 (k) For purposes of this section, companion services are 8.20 defined as nonmedical care, supervision and oversight, provided 8.21 to a functionally impaired adult. Companions may assist the 8.22 individual with such tasks as meal preparation, laundry and 8.23 shopping, but do not perform these activities as discrete 8.24 services. The provision of companion services does not entail 8.25 hands-on medical care. Providers may also perform light 8.26 housekeeping tasks which are incidental to the care and 8.27 supervision of the recipient. This service must be approved by 8.28 the case manager as part of the care plan. Companion services 8.29 must be provided by individuals or organizations who are under 8.30 contract with the local agency to provide the service. Any 8.31 person related to the waiver recipient by blood, marriage or 8.32 adoption cannot be reimbursed under this service. Persons 8.33 providing companion services will be monitored by the case 8.34 manager. 8.35 (l) For purposes of this section, training for direct 8.36 informal caregivers is defined as a classroom or home course of 9.1 instruction which may include: transfer and lifting skills, 9.2 nutrition, personal and physical cares, home safety in a home 9.3 environment, stress reduction and management, behavioral 9.4 management, long-term care decision making, care coordination 9.5 and family dynamics. The training is provided to an informal 9.6 unpaid caregiver of a 180-day eligible client which enables the 9.7 caregiver to deliver care in a home setting with high levels of 9.8 quality. The training must be approved by the case manager as 9.9 part of the individual care plan. Individuals, agencies, and 9.10 educational facilities which provide caregiver training and 9.11 education will be monitored by the case manager. 9.12 (m) A county agency may make payment from their alternative 9.13 care program allocation for other services provided to an 9.14 alternative care program recipient if those services prevent, 9.15 shorten, or delay institutionalization. These services may 9.16 include direct cash payments to the recipient for the purpose of 9.17 purchasing the recipient's services. The following provisions 9.18 apply to payments under this paragraph: 9.19 (1) a cash payment to a client under this provision cannot 9.20 exceed 80 percent of the monthly payment limit for that client 9.21 as specified in subdivision 4, paragraph (a), clause (7); 9.22 (2) a county may not approve any cash payment for a client 9.23 who has been assessed as having a dependency in orientation, 9.24 unless the client has an authorized representative under section 9.25 256.476, subdivision 2, paragraph (g), or for a client who is 9.26 concurrently receiving adult foster care, residential care, or 9.27 assisted living services; 9.28 (3) any service approved under this section must be a 9.29 service which meets the purpose and goals of the program as 9.30 listed in subdivision 1; 9.31 (4) cash payments must also meet the criteria of and are 9.32 governed by the procedures and liability protection established 9.33 in section 256.476, subdivision 4,paragraph9.34 paragraphs (b) through (h), and recipients of cash grants must 9.35 meet the requirements in section 256.476, subdivision 10; and 9.36 (5) the county shall report client outcomes, services, and 10.1 costs under this paragraph in a manner prescribed by the 10.2 commissioner. 10.3 Upon implementation of direct cash payments to clients under 10.4 this section, any person determined eligible for the alternative 10.5 care program who chooses a cash payment approved by the county 10.6 agency shall receive the cash payment under this section and not 10.7 under section 256.476 unless the person was receiving a consumer 10.8 support grant under section 256.476 before implementation of 10.9 direct cash payments under this section. 10.10 Sec. 4. Minnesota Statutes 1998, section 256B.411, 10.11 subdivision 2, is amended to read: 10.12 Subd. 2. [REQUIREMENTS.] No medical assistance payments 10.13 shall be made to any nursing facility unless the nursing 10.14 facility is certified to participate in the medical assistance 10.15 program under title XIX of the federal Social Security Act and 10.16 has in effect a provider agreement with the commissioner meeting 10.17 the requirements of state and federal statutes and rules. No 10.18 medical assistance payments shall be made to any nursing 10.19 facility unless the nursing facility complies with all 10.20 requirements of Minnesota Statutes including, but not limited 10.21 to, this chapter and rules adopted under it that govern 10.22 participation in the program. This section applies whether the 10.23 nursing facility participates fully in the medical assistance 10.24 program or is withdrawing from the medical assistance program. 10.25 No future payments may be made to any nursing facility which has 10.26 withdrawn or is withdrawing from the medical assistance program 10.27 except as provided in section 256B.48, subdivision 1a; provided,10.28however, that, or federal law. Payments may also be made under 10.29 a court order entered on or before June 7, 1985, unless the 10.30 court order is reversed on appeal. 10.31 Sec. 5. Minnesota Statutes 1998, section 256B.431, 10.32 subdivision 1, is amended to read: 10.33 Subdivision 1. [IN GENERAL.] The commissioner shall 10.34 determine prospective payment rates for resident care costs.In10.35determining the rates, the commissioner shall group nursing10.36facilities according to different levels of care and geographic11.1location until July 1, 1985.For rates established on or after 11.2 July 1, 1985, the commissioner shall develop procedures for 11.3 determining operating cost payment rates that take into account 11.4 the mix of resident needs, geographic location, and other 11.5 factors as determined by the commissioner. The commissioner 11.6 shall consider whether the fact that a facility is attached to a 11.7 hospital or has an average length of stay of 180 days or less 11.8 should be taken into account in determining rates. The 11.9 commissioner shall consider the use of the standard metropolitan 11.10 statistical areas when developing groups by geographic 11.11 location.Until the commissioner establishes procedures for11.12determining operating cost payment rates, the commissioner shall11.13group all convalescent and nursing care units attached to11.14hospitals into one group for purposes of determining11.15reimbursement for operating costs. On or before June 15, 1983,11.16the commissioner shall mail notices to each nursing facility of11.17the rates to be effective from July 1 of that year to June 30 of11.18the following year. In subsequent years,The commissioner shall 11.19 provide notice to each nursing facility on or before May 1 of 11.20 the rates effective for the following rate year. If a statute11.21enacted after May 1 affects the rates, the commissioner shall11.22provide a revised notice to each nursing facility as soon as11.23possibleexcept that if legislation is pending on May 1 that may 11.24 affect rates for nursing facilities, the commissioner shall set 11.25 the rates after the legislation is enacted and provide notice to 11.26 each facility as soon as possible. 11.27The commissioner shall establish, by rule, limitations on11.28compensation recognized in the historical base for top11.29management personnel. For rate years beginning July 1, 1985,11.30the commissioner shall not provide, by rule, limitations on top11.31management personnel.Compensation for top management personnel 11.32 shall continue to be categorized as a general and administrative 11.33 cost and is subject to any limits imposed on that cost 11.34 category.The commissioner shall also establish, by rule,11.35limitations on allowable nursing hours for each level of care11.36for the rate years beginning July 1, 1983 and July 1, 1984. For12.1the rate year beginning July 1, 1984, nursing facilities in12.2which the nursing hours exceeded 2.9 hours per day for skilled12.3nursing care or 2.3 hours per day for intermediate care for the12.4reporting year ending on September 30, 1983, shall be limited to12.5a maximum of 3.2 hours per day for skilled nursing care and 2.612.6hours per day for intermediate care.12.7 Sec. 6. Minnesota Statutes 1998, section 256B.431, 12.8 subdivision 3a, is amended to read: 12.9 Subd. 3a. [PROPERTY-RELATED COSTS AFTER JULY 1, 1985.] (a) 12.10 For rate years beginning on or after July 1, 1985, the 12.11 commissioner, by permanent rule, shall reimburse nursing 12.12 facility providers that are vendors in the medical assistance 12.13 program for the rental use of real estate and depreciable 12.14 equipment. "Real estate" means land improvements, buildings, 12.15 and attached fixtures used directly for resident care. 12.16 "Depreciable equipment" means the standard movable resident care 12.17 equipment and support service equipment generally used in 12.18 long-term care facilities. 12.19 (b) In developing the method for determining payment rates 12.20 for the rental use of nursing facilities, the commissioner shall 12.21 consider factors designed to: 12.22 (1) simplify the administrative procedures for determining 12.23 payment rates for property-related costs; 12.24 (2) minimize discretionary or appealable decisions; 12.25 (3) eliminate any incentives to sell nursing facilities; 12.26 (4) recognize legitimate costs of preserving and replacing 12.27 property; 12.28 (5) recognize the existing costs of outstanding 12.29 indebtedness allowable under the statutes and rules in effect on 12.30 May 1, 1983; 12.31 (6) address the current value of, if used directly for 12.32 patient care, land improvements, buildings, attached fixtures, 12.33 and equipment; 12.34 (7) establish an investment per bed limitation; 12.35 (8) reward efficient management of capital assets; 12.36 (9) provide equitable treatment of facilities; 13.1 (10) consider a variable rate; and 13.2 (11) phase-in implementation of the rental reimbursement 13.3 method. 13.4(c) No later than January 1, 1984, the commissioner shall13.5report to the legislature on any further action necessary or13.6desirable in order to implement the purposes and provisions of13.7this subdivision.13.8(d)(c) For rate years beginning on or after July 1, 1987, 13.9 a nursing facility which has reduced licensed bed capacity after 13.10 January 1, 1986, shall be allowed to: 13.11 (1) aggregate the applicable investment per bed limits 13.12 based on the number of beds licensed prior to the reduction; and 13.13 (2) establish capacity days for each rate year following 13.14 the licensure reduction based on the number of beds licensed on 13.15 the previous April 1 if the commissioner is notified of the 13.16 change by April 4. The notification must include a copy of the 13.17 delicensure request that has been submitted to the commissioner 13.18 of health. 13.19(e) Until the rental reimbursement method is fully phased13.20in, a nursing facility whose final property-related payment rate13.21is the rental rate shall continue to have its property-related13.22payment rates established based on the rental reimbursement13.23method.13.24(f)(d) For rate years beginning on or after July 1, 1989, 13.25 the interest expense that results from a refinancing of a 13.26 nursing facility's demand call loan, when the loan that must be 13.27 refinanced was incurred before May 22, 1983, is an allowable 13.28 interest expense if: 13.29 (1) the demand call loan or any part of it was in the form 13.30 of a loan that was callable at the demand of the lender; 13.31 (2) the demand call loan or any part of it was called by 13.32 the lender through no fault of the nursing facility; 13.33 (3) the demand call loan or any part of it was made by a 13.34 government agency operating under a statutory or regulatory loan 13.35 program; 13.36 (4) the refinanced debt does not exceed the sum of the 14.1 allowable remaining balance of the demand call loan at the time 14.2 of payment on the demand call loan and refinancing costs; 14.3 (5) the term of the refinanced debt does not exceed the 14.4 remaining term of the demand call loan, had the debt not been 14.5 subject to an on-call payment demand; and 14.6 (6) the refinanced debt is not a debt between related 14.7 organizations as defined in Minnesota Rules, part 9549.0020, 14.8 subpart 38. 14.9 Sec. 7. Minnesota Statutes 1998, section 256B.431, 14.10 subdivision 10, is amended to read: 14.11 Subd. 10. [PROPERTY RATE ADJUSTMENTS AND CONSTRUCTION 14.12 PROJECTS.] A nursing facility's request for a property-related 14.13 payment rate adjustment and the related supporting documentation 14.14 of project construction cost information must be submitted to 14.15 the commissioner within 60 days after the construction project's 14.16 completion date to be considered eligible for a property-related 14.17 payment rate adjustment. Construction projects with completion 14.18 dates within one year of the completion date associated with the 14.19 property rate adjustment request and phased projects with 14.20 project completion dates within three years of the last phase of 14.21 the phased project must be aggregated for purposes of the 14.22 minimum thresholds in subdivisions 16 and 17, and the maximum 14.23 threshold in section 144A.071, subdivision 2. "Construction 14.24 project," and "project construction costs,"and "phased project"14.25 have the meanings given them in MinnesotaRules, part 4655.111014.26(Emergency)Statutes, section 144A.071, subdivision 1a. 14.27 Sec. 8. Minnesota Statutes 1998, section 256B.431, 14.28 subdivision 16, is amended to read: 14.29 Subd. 16. [MAJOR ADDITIONS AND REPLACEMENTS; EQUITY 14.30 INCENTIVE.] For rate years beginning after June 30, 1993, if a 14.31 nursing facility acquires capital assets in connection with a 14.32 project approved under the moratorium exception process in 14.33 section 144A.073 or in connection with an addition to or 14.34 replacement of buildings, attached fixtures, or land 14.35 improvements for which the total historical cost of those 14.36 capital asset additions exceeds the lesser of $150,000 or ten 15.1 percent of the most recent appraised value, the nursing facility 15.2 shall be eligible for an equity incentive payment rate as in 15.3 paragraphs (a) to (d). This computation is separate from the 15.4 determination of the nursing facility's rental rate. An equity 15.5 incentive payment rate as computed under this subdivision is 15.6 limited to one in a 12-month period. 15.7 (a) An eligible nursing facility shall receive an equity 15.8 incentive payment rate equal to the allowable historical cost of 15.9 the capital asset acquired, minus the allowable debt directly 15.10 identified to that capital asset, multiplied by the equity 15.11 incentive factor as described in paragraphs (b) and (c), and 15.12 divided by the nursing facility's occupancy factor under 15.13 subdivision 3f, paragraph (c). This amount shall be added to 15.14 the nursing facility's total payment rate and shall be effective 15.15 the same day as the incremental increase in paragraph (d) or 15.16 subdivision 17. The allowable historical cost of the capital 15.17 assets and the allowable debt shall be determined as provided in 15.18 Minnesota Rules, parts 9549.0010 to 9549.0080, and this section. 15.19 (b) The equity incentive factor shall be determined under 15.20 clauses (1) to (4): 15.21 (1) divide the initial allowable debt in paragraph (a) by 15.22 the initial historical cost of the capital asset additions 15.23 referred to in paragraph (a), then cube the quotient, 15.24 (2) subtract the amount calculated in clause (1) from the 15.25 number one, 15.26 (3) determine the difference between the rental factor and 15.27 the lesser of two percentage points above the posted yield for 15.28 standard conventional fixed rate mortgages of the Federal Home 15.29 Loan Mortgage Corporation as published in the Wall Street 15.30 Journal and in effect on the first day of the month the debt or 15.31 cost is incurred, or 16 percent, 15.32 (4) multiply the amount calculated in clause (2) by the 15.33 amount calculated in clause (3). 15.34 (c) The equity incentive payment rate shall be limited to 15.35 the term of the allowable debt in paragraph (a), not greater 15.36 than 20 years nor less than ten years. If no debt is incurred 16.1 in acquiring the capital asset, the equity incentive payment 16.2 rate shall be paid for ten years. The sale of a nursing 16.3 facility under subdivision 14 shall terminate application of the 16.4 equity incentive payment rate effective on the date provided in 16.5 subdivision414, paragraph (f), for the sale. 16.6 (d) A nursing facility with an addition to or a renovation 16.7 of its buildings, attached fixtures, or land improvements 16.8 meeting the criteria in this subdivision and not receiving the 16.9 property-related payment rate adjustment in subdivision 17, 16.10 shall receive the incremental increase in the nursing facility's 16.11 rental rate as determined under Minnesota Rules, parts 9549.0010 16.12 to 9549.0080, and this section. The incremental increase shall 16.13 be added to the nursing facility's property-related payment rate. 16.14 The effective date of this incremental increase shall be the 16.15 first day of the month following the month in which the addition 16.16 or replacement is completed. 16.17 Sec. 9. Minnesota Statutes 1999 Supplement, section 16.18 256B.431, subdivision 17, is amended to read: 16.19 Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 16.20 (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 16.21 for rate periods beginning on October 1, 1992, and for rate 16.22 years beginning after June 30, 1993, a nursing facility that (1) 16.23 has completed a construction project approved under section 16.24 144A.071, subdivision 4a, clause (m); (2) has completed a 16.25 construction project approved under section 144A.071, 16.26 subdivision 4a, and effective after June 30, 1995; or (3) has 16.27 completed a renovation, replacement, or upgrading project 16.28 approved under the moratorium exception process in section 16.29 144A.073 shall be reimbursed for costs directly identified to 16.30 that project as provided in subdivision 16 and this subdivision. 16.31 (b) Notwithstanding Minnesota Rules, part 9549.0060, 16.32 subparts 5, item A, subitems (1) and (3), and 7, item D, 16.33 allowable interest expense on debt shall include: 16.34 (1) interest expense on debt related to the cost of 16.35 purchasing or replacing depreciable equipment, excluding 16.36 vehicles, not to exceed six percent of the total historical cost 17.1 of the project; and 17.2 (2) interest expense on debt related to financing or 17.3 refinancing costs, including costs related to points, loan 17.4 origination fees, financing charges, legal fees, and title 17.5 searches; and issuance costs including bond discounts, bond 17.6 counsel, underwriter's counsel, corporate counsel, printing, and 17.7 financial forecasts. Allowable debt related to items in this 17.8 clause shall not exceed seven percent of the total historical 17.9 cost of the project. To the extent these costs are financed, 17.10 the straight-line amortization of the costs in this clause is 17.11 not an allowable cost; and 17.12 (3) interest on debt incurred for the establishment of a 17.13 debt reserve fund, net of the interest earned on the debt 17.14 reserve fund. 17.15 (c) Debt incurred for costs under paragraph (b) is not 17.16 subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 17.17 subitem (5) or (6). 17.18 (d) The incremental increase in a nursing facility's rental 17.19 rate, determined under Minnesota Rules, parts 9549.0010 to 17.20 9549.0080, and this section, resulting from the acquisition of 17.21 allowable capital assets, and allowable debt and interest 17.22 expense under this subdivision shall be added to its 17.23 property-related payment rate and shall be effective on the 17.24 first day of the month following the month in which the 17.25 moratorium project was completed. 17.26 (e) Notwithstanding subdivision 3f, paragraph (a), for rate 17.27 periods beginning on October 1, 1992, and for rate years 17.28 beginning after June 30, 1993, the replacement-costs-new per bed 17.29 limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 17.30 item B, for a nursing facility that has completed a renovation, 17.31 replacement, or upgrading project that has been approved under 17.32 the moratorium exception process in section 144A.073, or that 17.33 has completed an addition to or replacement of buildings, 17.34 attached fixtures, or land improvements for which the total 17.35 historical cost exceeds the lesser of $150,000 or ten percent of 17.36 the most recent appraised value, must be $47,500 per licensed 18.1 bed in multiple-bed rooms and $71,250 per licensed bed in a 18.2 single-bed room. These amounts must be adjusted annually as 18.3 specified in subdivision 3f, paragraph (a), beginning January 1, 18.4 1993. 18.5(f) A nursing facility that completes a project identified18.6in this subdivision and, as of April 17, 1992, has not been18.7mailed a rate notice with a special appraisal for a completed18.8project, or completes a project after April 17, 1992, but before18.9September 1, 1992, may elect either to request a special18.10reappraisal with the corresponding adjustment to the18.11property-related payment rate under the laws in effect on June18.1230, 1992, or to submit their capital asset and debt information18.13after that date and obtain the property-related payment rate18.14adjustment under this section, but not both.18.15(g)(f) For purposes of this paragraph, a total replacement 18.16 means the complete replacement of the nursing facility's 18.17 physical plant through the construction of a new physical plant 18.18 or the transfer of the nursing facility's license from one 18.19 physical plant location to another. For total replacement 18.20 projects completed on or after July 1, 1992, the commissioner 18.21 shall compute the incremental change in the nursing facility's 18.22 rental per diem, for rate years beginning on or after July 1, 18.23 1995, by replacing its appraised value, including the historical 18.24 capital asset costs, and the capital debt and interest costs 18.25 with the new nursing facility's allowable capital asset costs 18.26 and the related allowable capital debt and interest costs. If 18.27 the new nursing facility has decreased its licensed capacity, 18.28 the aggregate investment per bed limit in subdivision 3a, 18.29 paragraph(d)(c), shall apply. If the new nursing facility has 18.30 retained a portion of the original physical plant for nursing 18.31 facility usage, then a portion of the appraised value prior to 18.32 the replacement must be retained and included in the calculation 18.33 of the incremental change in the nursing facility's rental per 18.34 diem. For purposes of this part, the original nursing facility 18.35 means the nursing facility prior to the total replacement 18.36 project. The portion of the appraised value to be retained 19.1 shall be calculated according to clauses (1) to (3): 19.2 (1) The numerator of the allocation ratio shall be the 19.3 square footage of the area in the original physical plant which 19.4 is being retained for nursing facility usage. 19.5 (2) The denominator of the allocation ratio shall be the 19.6 total square footage of the original nursing facility physical 19.7 plant. 19.8 (3) Each component of the nursing facility's allowable 19.9 appraised value prior to the total replacement project shall be 19.10 multiplied by the allocation ratio developed by dividing clause 19.11 (1) by clause (2). 19.12 In the case of either type of total replacement as 19.13 authorized under section 144A.071 or 144A.073, the provisions of 19.14 this subdivision shall also apply. For purposes of the 19.15 moratorium exception authorized under section 144A.071, 19.16 subdivision 4a, paragraph (s), if the total replacement involves 19.17 the renovation and use of an existing health care facility 19.18 physical plant, the new allowable capital asset costs and 19.19 related debt and interest costs shall include first the 19.20 allowable capital asset costs and related debt and interest 19.21 costs of the renovation, to which shall be added the allowable 19.22 capital asset costs of the existing physical plant prior to the 19.23 renovation, and if reported by the facility, the related 19.24 allowable capital debt and interest costs. 19.25(h)(g) Notwithstanding Minnesota Rules, part 9549.0060, 19.26 subpart 11, item C, subitem (2), for a total replacement, as 19.27 defined in paragraph(g)(f), authorized under section 144A.071 19.28 or 144A.073 after July 1, 1999, the replacement-costs-new per 19.29 bed limit shall be $74,280 per licensed bed in multiple-bed 19.30 rooms, $92,850 per licensed bed in semiprivate rooms with a 19.31 fixed partition separating the resident beds, and $111,420 per 19.32 licensed bed in single rooms. Minnesota Rules, part 9549.0060, 19.33 subpart 11, item C, subitem (2), does not apply. These amounts 19.34 must be adjusted annually as specified in subdivision 3f, 19.35 paragraph (a), beginning January 1, 2000. 19.36(i)(h) For a total replacement, as defined in paragraph 20.1(g)(f), authorized under section 144A.073 for a 96-bed nursing 20.2 home in Carlton county, the replacement-costs-new per bed limit 20.3 shall be $74,280 per licensed bed in multiple-bed rooms, $92,850 20.4 per licensed bed in semiprivate rooms with a fixed partition 20.5 separating the resident's beds, and $111,420 per licensed bed in 20.6 a single room. Minnesota Rules, part 9549.0060, subpart 11, 20.7 item C, subitem (2), does not apply. The resulting maximum 20.8 allowable replacement-costs-new multiplied by 1.25 shall 20.9 constitute the project's dollar threshold for purposes of 20.10 application of the limit set forth in section 144A.071, 20.11 subdivision 2. The commissioner of health may waive the 20.12 requirements of section 144A.073, subdivision 3b, paragraph (b), 20.13 clause (2), on the condition that the other requirements of that 20.14 paragraph are met. 20.15 Sec. 10. Minnesota Statutes 1998, section 256B.431, 20.16 subdivision 18, is amended to read: 20.17 Subd. 18. [APPRAISALS;UPDATING APPRAISALS, ADDITIONS, AND 20.18 REPLACEMENTS.] (a) Notwithstanding Minnesota Rules, part 20.19 9549.0060, subparts 1 to 3, the appraised value, routine 20.20 updating of the appraised value, and special reappraisals are 20.21 subject to this subdivision. 20.22(1) For rate years beginning after June 30, 1993, the20.23commissioner shall permit a nursing facility to appeal its20.24appraisal. Any reappraisals conducted in connection with that20.25appeal must utilize the comparative-unit method as described in20.26the Marshall Valuation Service published by Marshall-Swift in20.27establishing the nursing facility's depreciated replacement cost.20.28Nursing facilities electing to appeal their appraised value20.29shall file written notice of appeal with the commissioner of20.30human services before December 30, 1992. The cost of the20.31reappraisal, if any, shall be considered an allowable cost under20.32Minnesota Rules, parts 9549.0040, subpart 9, and 9549.0061.20.33(2) The redetermination of a nursing facility's appraised20.34value under this paragraph shall have no impact on the rental20.35payment rate determined under subdivision 13 but shall only be20.36used for calculating the nursing facility's rental rate under21.1Minnesota Rules, parts 9549.0010 to 9549.0080, and this section21.2for rate years beginning after June 30, 1993.21.3(3)For all rate years after June 30, 1993, the 21.4 commissioner shall no longer conduct any appraisals under 21.5 Minnesota Rules, part 9549.0060, for the purpose of determining 21.6 property-related payment rates. 21.7 (b) Notwithstanding Minnesota Rules, part 9549.0060, 21.8 subpart 2, for rate years beginning after June 30, 1993, the 21.9 commissioner shall routinely update the appraised value of each 21.10 nursing facility by adding the cost of capital asset 21.11 acquisitions to its allowable appraised value. 21.12 The commissioner shall also annually index each nursing 21.13 facility's allowable appraised value by the inflation index 21.14 referenced in subdivision 3f, paragraph (a), for the purpose of 21.15 computing the nursing facility's annual rental rate. In 21.16 annually adjusting the nursing facility's appraised value, the 21.17 commissioner must not include the historical cost of capital 21.18 assets acquired during the reporting year in the nursing 21.19 facility's appraised value. 21.20 In addition, the nursing facility's appraised value must be 21.21 reduced by the historical cost of capital asset disposals or 21.22 applicable credits such as public grants and insurance 21.23 proceeds. Capital asset additions and disposals must be 21.24 reported on the nursing facility's annual cost report in the 21.25 reporting year of acquisition or disposal. The incremental 21.26 increase in the nursing facility's rental rate resulting from 21.27 this annual adjustment as determined under Minnesota Rules, 21.28 parts 9549.0010 to 9549.0080, and this section shall be added to 21.29 the nursing facility's property-related payment rate for the 21.30 rate year following the reporting year. 21.31 Sec. 11. Minnesota Statutes 1998, section 256B.431, 21.32 subdivision 21, is amended to read: 21.33 Subd. 21. [INDEXING THRESHOLDS.] Beginning January 1, 21.34 1993, and each January 1 thereafter, the commissioner shall 21.35 annually update the dollar thresholds in subdivisions 15, 21.36 paragraph(d)(e), 16, and 17, and in section 144A.071, 22.1 subdivisions 2 and 4a, clauses (b) and (e), by the inflation 22.2 index referenced in subdivision 3f, paragraph (a). 22.3 Sec. 12. Minnesota Statutes 1998, section 256B.431, 22.4 subdivision 22, is amended to read: 22.5 Subd. 22. [CHANGES TO NURSING FACILITY REIMBURSEMENT.] The 22.6 nursing facility reimbursement changes in paragraphs (a) 22.7 to(e)(d) apply to Minnesota Rules, parts 9549.0010 to 22.8 9549.0080, and this section, and are effective for rate years 22.9 beginning on or after July 1, 1993, unless otherwise indicated. 22.10 (a) In addition to the approved pension or profit sharing 22.11 plans allowed by the reimbursement rule, the commissioner shall 22.12 allow those plans specified in Internal Revenue Code, sections 22.13 403(b) and 408(k). 22.14 (b) The commissioner shall allow as workers' compensation 22.15 insurance costs under section 256B.421, subdivision 14, the 22.16 costs of workers' compensation coverage obtained under the 22.17 following conditions: 22.18 (1) a plan approved by the commissioner of commerce as a 22.19 Minnesota group or individual self-insurance plan as provided in 22.20 section 79A.03; 22.21 (2) a plan in which: 22.22 (i) the nursing facility, directly or indirectly, purchases 22.23 workers' compensation coverage in compliance with section 22.24 176.181, subdivision 2, from an authorized insurance carrier; 22.25 (ii) a related organization to the nursing facility 22.26 reinsures the workers' compensation coverage purchased, directly 22.27 or indirectly, by the nursing facility; and 22.28 (iii) all of the conditions in clause (4) are met; 22.29 (3) a plan in which: 22.30 (i) the nursing facility, directly or indirectly, purchases 22.31 workers' compensation coverage in compliance with section 22.32 176.181, subdivision 2, from an authorized insurance carrier; 22.33 (ii) the insurance premium is calculated retrospectively, 22.34 including a maximum premium limit, and paid using the paid loss 22.35 retro method; and 22.36 (iii) all of the conditions in clause (4) are met; 23.1 (4) additional conditions are: 23.2 (i) the costs of the plan are allowable under the federal 23.3 Medicare program; 23.4 (ii) the reserves for the plan are maintained in an account 23.5 controlled and administered by a person which is not a related 23.6 organization to the nursing facility; 23.7 (iii) the reserves for the plan cannot be used, directly or 23.8 indirectly, as collateral for debts incurred or other 23.9 obligations of the nursing facility or related organizations to 23.10 the nursing facility; 23.11 (iv) if the plan provides workers' compensation coverage 23.12 for non-Minnesota nursing facilities, the plan's cost 23.13 methodology must be consistent among all nursing facilities 23.14 covered by the plan, and if reasonable, is allowed 23.15 notwithstanding any reimbursement laws regarding cost allocation 23.16 to the contrary; 23.17 (v) central, affiliated, corporate, or nursing facility 23.18 costs related to their administration of the plan are costs 23.19 which must remain in the nursing facility's administrative cost 23.20 category and must not be allocated to other cost categories; 23.21 (vi) required security deposits, whether in the form of 23.22 cash, investments, securities, assets, letters of credit, or in 23.23 any other form are not allowable costs for purposes of 23.24 establishing the facilities payment rate; and 23.25 (vii) for the rate year beginning on July 1, 1998, a group 23.26 of nursing facilities related by common ownership that 23.27 self-insures workers' compensation may allocate its directly 23.28 identified costs of self-insuring its Minnesota nursing facility 23.29 workers among those nursing facilities in the group that are 23.30 reimbursed under this section or section 256B.434. The method 23.31 of cost allocation shall be based on the ratio of each nursing 23.32 facility's total allowable salaries and wages to that of the 23.33 nursing facility group's total allowable salaries and wages, 23.34 then similarly allocated within each nursing facility's 23.35 operating cost categories. The costs associated with the 23.36 administration of the group's self-insurance plan must remain 24.1 classified in the nursing facility's administrative cost 24.2 category. A written request of the nursing facility group's 24.3 election to use this alternate method of allocation of 24.4 self-insurance costs must be received by the commissioner no 24.5 later than May 1, 1998, to take effect July 1, 1998, or such 24.6 costs shall continue to be allocated under the existing cost 24.7 allocation methods. Once a nursing facility group elects this 24.8 method of cost allocation for its workers' compensation 24.9 self-insurance costs, it shall remain in effect until such time 24.10 as the group no longer self-insures these costs; 24.11 (5) any costs allowed pursuant to clauses (1) to (3) are 24.12 subject to the following requirements: 24.13 (i) if the nursing facility is sold or otherwise ceases 24.14 operations, the plan's reserves must be subject to an 24.15 actuarially based settle-up after 36 months from the date of 24.16 sale or the date on which operations ceased. The facility's 24.17 medical assistance portion of the total excess plan reserves 24.18 must be paid to the state within 30 days following the date on 24.19 which excess plan reserves are determined; 24.20 (ii) any distribution of excess plan reserves made to or 24.21 withdrawals made by the nursing facility or a related 24.22 organization are applicable credits and must be used to reduce 24.23 the nursing facility's workers' compensation insurance costs in 24.24 the reporting period in which a distribution or withdrawal is 24.25 received; 24.26 (iii) if reimbursement for the plan is sought under the 24.27 federal Medicare program, and is audited pursuant to the 24.28 Medicare program, the nursing facility must provide a copy of 24.29 Medicare's final audit report, including attachments and 24.30 exhibits, to the commissioner within 30 days of receipt by the 24.31 nursing facility or any related organization. The commissioner 24.32 shall implement the audit findings associated with the plan upon 24.33 receipt of Medicare's final audit report. The department's 24.34 authority to implement the audit findings is independent of its 24.35 authority to conduct a field audit. 24.36 (c) In the determination of incremental increases in the 25.1 nursing facility's rental rate as required in subdivisions 14 to 25.2 21, except for a refinancing permitted under subdivision 19, the 25.3 commissioner must adjust the nursing facility's property-related 25.4 payment rate for both incremental increases and decreases in 25.5 recomputations of its rental rate; 25.6 (d) A nursing facility's administrative cost limitation 25.7 must be modified as follows: 25.8 (1) if the nursing facility's licensed beds exceed 195 25.9 licensed beds, the general and administrative cost category 25.10 limitation shall be 13 percent; 25.11 (2) if the nursing facility's licensed beds are more than 25.12 150 licensed beds, but less than 196 licensed beds, the general 25.13 and administrative cost category limitation shall be 14 percent; 25.14 or 25.15 (3) if the nursing facility's licensed beds is less than 25.16 151 licensed beds, the general and administrative cost category 25.17 limitation shall remain at 15 percent. 25.18 (e)The care related operating rate shall be increased by25.19eight cents to reimburse facilities for unfunded federal25.20mandates, including costs related to hepatitis B vaccinations.25.21(f)For the rate year beginning on July 1, 1998, a group of 25.22 nursing facilities related by common ownership that self-insures 25.23 group health, dental, or life insurance may allocate its 25.24 directly identified costs of self-insuring its Minnesota nursing 25.25 facility workers among those nursing facilities in the group 25.26 that are reimbursed under this section or section 256B.434. The 25.27 method of cost allocation shall be based on the ratio of each 25.28 nursing facility's total allowable salaries and wages to that of 25.29 the nursing facility group's total allowable salaries and wages, 25.30 then similarly allocated within each nursing facility's 25.31 operating cost categories. The costs associated with the 25.32 administration of the group's self-insurance plan must remain 25.33 classified in the nursing facility's administrative cost 25.34 category. A written request of the nursing facility group's 25.35 election to use this alternate method of allocation of 25.36 self-insurance costs must be received by the commissioner no 26.1 later than May 1, 1998, to take effect July 1, 1998, or those 26.2 self-insurance costs shall continue to be allocated under the 26.3 existing cost allocation methods. Once a nursing facility group 26.4 elects this method of cost allocation for its group health, 26.5 dental, or life insurance self-insurance costs, it shall remain 26.6 in effect until such time as the group no longer self-insures 26.7 these costs. 26.8 Sec. 13. Minnesota Statutes 1998, section 256B.431, 26.9 subdivision 25, is amended to read: 26.10 Subd. 25. [CHANGES TO NURSING FACILITY REIMBURSEMENT 26.11 BEGINNING JULY 1, 1995.]The nursing facility reimbursement26.12changes in paragraphs (a) to (g) shall apply in the sequence26.13specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and26.14this section, beginning July 1, 1995.26.15(a) The eight-cent adjustment to care-related rates in26.16subdivision 22, paragraph (e), shall no longer apply.26.17(b) For rate years beginning on or after July 1, 1995, the26.18commissioner shall limit a nursing facility's allowable26.19operating per diem for each case mix category for each rate year26.20as in clauses (1) to (3).26.21(1) For the rate year beginning July 1, 1995, the26.22commissioner shall group nursing facilities into two groups,26.23freestanding and nonfreestanding, within each geographic group,26.24using their operating cost per diem for the case mix A26.25classification. A nonfreestanding nursing facility is a nursing26.26facility whose other operating cost per diem is subject to the26.27hospital attached, short length of stay, or the rule 80 limits.26.28All other nursing facilities shall be considered freestanding26.29nursing facilities. The commissioner shall then array all26.30nursing facilities in each grouping by their allowable case mix26.31A operating cost per diem. In calculating a nursing facility's26.32operating cost per diem for this purpose, the commissioner shall26.33exclude the raw food cost per diem related to providing special26.34diets that are based on religious beliefs, as determined in26.35subdivision 2b, paragraph (h). For those nursing facilities in26.36each grouping whose case mix A operating cost per diem:27.1(i) is at or below the median minus 1.0 standard deviation27.2of the array, the commissioner shall limit the nursing27.3facility's allowable operating cost per diem for each case mix27.4category to the lesser of the prior reporting year's allowable27.5operating cost per diems plus the inflation factor as27.6established in paragraph (f), clause (2), increased by six27.7percentage points, or the current reporting year's corresponding27.8allowable operating cost per diem;27.9(ii) is between minus .5 standard deviation and minus 1.027.10standard deviation below the median of the array, the27.11commissioner shall limit the nursing facility's allowable27.12operating cost per diem for each case mix category to the lesser27.13of the prior reporting year's allowable operating cost per diems27.14plus the inflation factor as established in paragraph (f),27.15clause (2), increased by four percentage points, or the current27.16reporting year's corresponding allowable operating cost per27.17diem; or27.18(iii) is equal to or above minus .5 standard deviation27.19below the median of the array, the commissioner shall limit the27.20nursing facility's allowable operating cost per diem for each27.21case mix category to the lesser of the prior reporting year's27.22allowable operating cost per diems plus the inflation factor as27.23established in paragraph (f), clause (2), increased by three27.24percentage points, or the current reporting year's corresponding27.25allowable operating cost per diem.27.26(2) For the rate year beginning on July 1, 1996, the27.27commissioner shall limit the nursing facility's allowable27.28operating cost per diem for each case mix category to the lesser27.29of the prior reporting year's allowable operating cost per diems27.30plus the inflation factor as established in paragraph (f),27.31clause (2), increased by one percentage point or the current27.32reporting year's corresponding allowable operating cost per27.33diems; and27.34(3) For rate years beginning on or after July 1, 1997, the27.35commissioner shall limit the nursing facility's allowable27.36operating cost per diem for each case mix category to the lesser28.1of the reporting year prior to the current reporting year's28.2allowable operating cost per diems plus the inflation factor as28.3established in paragraph (f), clause (2), or the current28.4reporting year's corresponding allowable operating cost per28.5diems.28.6(c) For rate years beginning on July 1, 1995, the28.7commissioner shall limit the allowable operating cost per diems28.8for high cost nursing facilities. After application of the28.9limits in paragraph (b) to each nursing facility's operating28.10cost per diems, the commissioner shall group nursing facilities28.11into two groups, freestanding or nonfreestanding, within each28.12geographic group. A nonfreestanding nursing facility is a28.13nursing facility whose other operating cost per diems are28.14subject to hospital attached, short length of stay, or rule 8028.15limits. All other nursing facilities shall be considered28.16freestanding nursing facilities. The commissioner shall then28.17array all nursing facilities within each grouping by their28.18allowable case mix A operating cost per diems. In calculating a28.19nursing facility's operating cost per diem for this purpose, the28.20commissioner shall exclude the raw food cost per diem related to28.21providing special diets that are based on religious beliefs, as28.22determined in subdivision 2b, paragraph (h). For those nursing28.23facilities in each grouping whose case mix A operating cost per28.24diem exceeds 1.0 standard deviation above the median, the28.25commissioner shall reduce their allowable operating cost per28.26diems by two percent. For those nursing facilities in each28.27grouping whose case mix A operating cost per diem exceeds 0.528.28standard deviation above the median but is less than or equal to28.291.0 standard deviation above the median, the commissioner shall28.30reduce their allowable operating cost per diems by one percent.28.31(d) For rate years beginning on or after July 1, 1996, the28.32commissioner shall limit the allowable operating cost per diems28.33for high cost nursing facilities. After application of the28.34limits in paragraph (b) to each nursing facility's operating28.35cost per diems, the commissioner shall group nursing facilities28.36into two groups, freestanding or nonfreestanding, within each29.1geographic group. A nonfreestanding nursing facility is a29.2nursing facility whose other operating cost per diems are29.3subject to hospital attached, short length of stay, or rule 8029.4limits. All other nursing facilities shall be considered29.5freestanding nursing facilities. The commissioner shall then29.6array all nursing facilities within each grouping by their29.7allowable case mix A operating cost per diems. In calculating a29.8nursing facility's operating cost per diem for this purpose, the29.9commissioner shall exclude the raw food cost per diem related to29.10providing special diets that are based on religious beliefs, as29.11determined in subdivision 2b, paragraph (h). In those nursing29.12facilities in each grouping whose case mix A operating cost per29.13diem exceeds 1.0 standard deviation above the median, the29.14commissioner shall reduce their allowable operating cost per29.15diems by three percent. For those nursing facilities in each29.16grouping whose case mix A operating cost per diem exceeds 0.529.17standard deviation above the median but is less than or equal to29.181.0 standard deviation above the median, the commissioner shall29.19reduce their allowable operating cost per diems by two percent.29.20(e) For rate years beginning on or after July 1, 1995, the29.21commissioner shall determine a nursing facility's efficiency29.22incentive by first computing the allowable difference, which is29.23the lesser of $4.50 or the amount by which the facility's other29.24operating cost limit exceeds its nonadjusted other operating29.25cost per diem for that rate year. The commissioner shall29.26compute the efficiency incentive by:29.27(1) subtracting the allowable difference from $4.50 and29.28dividing the result by $4.50;29.29(2) multiplying 0.20 by the ratio resulting from clause29.30(1), and then;29.31(3) adding 0.50 to the result from clause (2); and29.32(4) multiplying the result from clause (3) times the29.33allowable difference.29.34The nursing facility's efficiency incentive payment shall29.35be the lesser of $2.25 or the product obtained in clause (4).29.36(f) For rate years beginning on or after July 1, 1995, the30.1forecasted price index for a nursing facility's allowable30.2operating cost per diems shall be determined under clauses (1)30.3to (3) using the change in the Consumer Price Index-All Items30.4(United States city average) (CPI-U) or the change in the30.5Nursing Home Market Basket, both as forecasted by Data Resources30.6Inc., whichever is applicable. The commissioner shall use the30.7indices as forecasted in the fourth quarter of the calendar year30.8preceding the rate year, subject to subdivision 2l, paragraph30.9(c). If, as a result of federal legislative or administrative30.10action, the methodology used to calculate the Consumer Price30.11Index-All Items (United States city average) (CPI-U) changes,30.12the commissioner shall develop a conversion factor or other30.13methodology to convert the CPI-U index factor that results from30.14the new methodology to an index factor that approximates, as30.15closely as possible, the index factor that would have resulted30.16from application of the original CPI-U methodology prior to any30.17changes in methodology. The commissioner shall use the30.18conversion factor or other methodology to calculate an adjusted30.19inflation index. The adjusted inflation index must be used to30.20calculate payment rates under this section instead of the CPI-U30.21index specified in paragraph (d). If the commissioner is30.22required to develop an adjusted inflation index, the30.23commissioner shall report to the legislature as part of the next30.24budget submission the fiscal impact of applying this index.30.25(1) The CPI-U forecasted index for allowable operating cost30.26per diems shall be based on the 21-month period from the30.27midpoint of the nursing facility's reporting year to the30.28midpoint of the rate year following the reporting year.30.29(2) The Nursing Home Market Basket forecasted index for30.30allowable operating costs and per diem limits shall be based on30.31the 12-month period between the midpoints of the two reporting30.32years preceding the rate year.30.33(3) For rate years beginning on or after July 1, 1996, the30.34forecasted index for operating cost limits referred to in30.35subdivision 21, paragraph (b), shall be based on the CPI-U for30.36the 12-month period between the midpoints of the two reporting31.1years preceding the rate year.31.2(g) After applying these provisions for the respective rate31.3years, the commissioner shall index these allowable operating31.4costs per diems by the inflation factor provided for in31.5paragraph (f), clause (1), and add the nursing facility's31.6efficiency incentive as computed in paragraph (e).31.7(h)(1)A nursing facility licensed for 302 beds on 31.8 September 30, 1993, that was approved under the moratorium 31.9 exception process in section 144A.073 for a partial replacement, 31.10 and completed the replacement project in December 1994, is 31.11 exempt from Minnesota Statutes 1998, section 256B.431, 31.12 subdivision 25, paragraphs (b) to (d) for rate years beginning 31.13 on or after July 1, 1995. 31.14(2)For the rate year beginning July 1, 1997, after 31.15 computing this nursing facility's payment rate according to 31.16 section 256B.434, the commissioner shall make a one-year rate 31.17 adjustment of $8.62 to the facility's contract payment rate for 31.18 the rate effect of operating cost changes associated with the 31.19 facility's 1994 downsizing project. 31.20(3)For rate years beginning on or after July 1, 1997, the 31.21 commissioner shall add 35 cents to the facility's base property 31.22 related payment rate for the rate effect of reducing its 31.23 licensed capacity to 290 beds from 302 beds and shall add 83 31.24 cents to the facility's real estate tax and special assessment 31.25 payment rate for payments in lieu of real estate taxes. The 31.26 adjustments in this clause shall remain in effect for the 31.27 duration of the facility's contract under section 256B.434. 31.28(i) Notwithstanding Laws 1996, chapter 451, article 3,31.29section 11, paragraph (h), for the rate years beginning on July31.301, 1996, July 1, 1997, and July 1, 1998, a nursing facility31.31licensed for 40 beds effective May 1, 1992, with a subsequent31.32increase of 20 Medicare/Medicaid certified beds, effective31.33January 26, 1993, in accordance with an increase in licensure is31.34exempt from paragraphs (b) to (d).31.35 Sec. 14. Minnesota Statutes 1999 Supplement, section 31.36 256B.431, subdivision 26, is amended to read: 32.1 Subd. 26. [CHANGES TO NURSING FACILITY REIMBURSEMENT 32.2 BEGINNING JULY 1, 1997.] The nursing facility reimbursement 32.3 changes in paragraphs (a) to(f)(e) shall apply in the sequence 32.4 specified in Minnesota Rules, parts 9549.0010 to 9549.0080, and 32.5 this section, beginning July 1, 1997. 32.6 (a) For rate years beginning on or after July 1, 1997, the 32.7 commissioner shall limit a nursing facility's allowable 32.8 operating per diem for each case mix category for each rate year. 32.9 The commissioner shall group nursing facilities into two groups, 32.10 freestanding and nonfreestanding, within each geographic group, 32.11 using their operating cost per diem for the case mix A 32.12 classification. A nonfreestanding nursing facility is a nursing 32.13 facility whose other operating cost per diem is subject to the 32.14 hospital attached, short length of stay, or the rule 80 limits. 32.15 All other nursing facilities shall be considered freestanding 32.16 nursing facilities. The commissioner shall then array all 32.17 nursing facilities in each grouping by their allowable case mix 32.18 A operating cost per diem. In calculating a nursing facility's 32.19 operating cost per diem for this purpose, the commissioner shall 32.20 exclude the raw food cost per diem related to providing special 32.21 diets that are based on religious beliefs, as determined in 32.22 subdivision 2b, paragraph (h). For those nursing facilities in 32.23 each grouping whose case mix A operating cost per diem: 32.24 (1) is at or below the median of the array, the 32.25 commissioner shall limit the nursing facility's allowable 32.26 operating cost per diem for each case mix category to the lesser 32.27 of the prior reporting year's allowable operating cost per diem 32.28 as specified in Laws 1996, chapter 451, article 3, section 11, 32.29 paragraph (h), plus the inflation factor as established in 32.30 paragraph (d), clause (2), increased by two percentage points, 32.31 or the current reporting year's corresponding allowable 32.32 operating cost per diem; or 32.33 (2) is above the median of the array, the commissioner 32.34 shall limit the nursing facility's allowable operating cost per 32.35 diem for each case mix category to the lesser of the prior 32.36 reporting year's allowable operating cost per diem as specified 33.1 in Laws 1996, chapter 451, article 3, section 11, paragraph (h), 33.2 plus the inflation factor as established in paragraph (d), 33.3 clause (2), increased by one percentage point, or the current 33.4 reporting year's corresponding allowable operating cost per diem. 33.5 For purposes of paragraph (a), if a nursing facility 33.6 reports on its cost report a reduction in cost due to a refund 33.7 or credit for a rate year beginning on or after July 1, 1998, 33.8 the commissioner shall increase that facility's spend-up limit 33.9 for the rate year following the current rate year by the amount 33.10 of the cost reduction divided by its resident days for the 33.11 reporting year preceding the rate year in which the adjustment 33.12 is to be made. 33.13 (b) For rate years beginning on or after July 1, 1997, the 33.14 commissioner shall limit the allowable operating cost per diem 33.15 for high cost nursing facilities. After application of the 33.16 limits in paragraph (a) to each nursing facility's operating 33.17 cost per diem, the commissioner shall group nursing facilities 33.18 into two groups, freestanding or nonfreestanding, within each 33.19 geographic group. A nonfreestanding nursing facility is a 33.20 nursing facility whose other operating cost per diem are subject 33.21 to hospital attached, short length of stay, or rule 80 limits. 33.22 All other nursing facilities shall be considered freestanding 33.23 nursing facilities. The commissioner shall then array all 33.24 nursing facilities within each grouping by their allowable case 33.25 mix A operating cost per diem. In calculating a nursing 33.26 facility's operating cost per diem for this purpose, the 33.27 commissioner shall exclude the raw food cost per diem related to 33.28 providing special diets that are based on religious beliefs, as 33.29 determined in subdivision 2b, paragraph (h). For those nursing 33.30 facilities in each grouping whose case mix A operating cost per 33.31 diem exceeds 1.0 standard deviation above the median, the 33.32 commissioner shall reduce their allowable operating cost per 33.33 diem by three percent. For those nursing facilities in each 33.34 grouping whose case mix A operating cost per diem exceeds 0.5 33.35 standard deviation above the median but is less than or equal to 33.36 1.0 standard deviation above the median, the commissioner shall 34.1 reduce their allowable operating cost per diem by two percent. 34.2 However, in no case shall a nursing facility's operating cost 34.3 per diem be reduced below its grouping's limit established at 34.4 0.5 standard deviations above the median. 34.5 (c) For rate years beginning on or after July 1, 1997, the 34.6 commissioner shall determine a nursing facility's efficiency 34.7 incentive by first computing the allowable difference, which is 34.8 the lesser of $4.50 or the amount by which the facility's other 34.9 operating cost limit exceeds its nonadjusted other operating 34.10 cost per diem for that rate year. The commissioner shall 34.11 compute the efficiency incentive by: 34.12 (1) subtracting the allowable difference from $4.50 and 34.13 dividing the result by $4.50; 34.14 (2) multiplying 0.20 by the ratio resulting from clause 34.15 (1), and then; 34.16 (3) adding 0.50 to the result from clause (2); and 34.17 (4) multiplying the result from clause (3) times the 34.18 allowable difference. 34.19 The nursing facility's efficiency incentive payment shall 34.20 be the lesser of $2.25 or the product obtained in clause (4). 34.21 (d) For rate years beginning on or after July 1, 1997, the 34.22 forecasted price index for a nursing facility's allowable 34.23 operating cost per diem shall be determined under clauses (1) 34.24 and (2) using the change in the Consumer Price Index-All Items 34.25 (United States city average) (CPI-U) as forecasted by Data 34.26 Resources, Inc. The commissioner shall use the indices as 34.27 forecasted in the fourth quarter of the calendar year preceding 34.28 the rate year, subject to subdivision 2l, paragraph (c). 34.29 (1) The CPI-U forecasted index for allowable operating cost 34.30 per diem shall be based on the 21-month period from the midpoint 34.31 of the nursing facility's reporting year to the midpoint of the 34.32 rate year following the reporting year. 34.33 (2) For rate years beginning on or after July 1, 1997, the 34.34 forecasted index for operating cost limits referred to in 34.35 subdivision 21, paragraph (b), shall be based on the CPI-U for 34.36 the 12-month period between the midpoints of the two reporting 35.1 years preceding the rate year. 35.2 (e) After applying these provisions for the respective rate 35.3 years, the commissioner shall index these allowable operating 35.4 cost per diem by the inflation factor provided for in paragraph 35.5 (d), clause (1), and add the nursing facility's efficiency 35.6 incentive as computed in paragraph (c). 35.7(f) For rate years beginning on or after July 1, 1997, the35.8total operating cost payment rates for a nursing facility shall35.9be the greater of the total operating cost payment rates35.10determined under this section or the total operating cost35.11payment rates in effect on June 30, 1997, subject to rate35.12adjustments due to field audit or rate appeal resolution. This35.13provision shall not apply to subsequent field audit adjustments35.14of the nursing facility's operating cost rates for rate years35.15beginning on or after July 1, 1997.35.16(g)(f) For the rate years beginning on July 1, 1997, July 35.17 1, 1998, and July 1, 1999, a nursing facility licensed for 40 35.18 beds effective May 1, 1992, with a subsequent increase of 20 35.19 Medicare/Medicaid certified beds, effective January 26, 1993, in 35.20 accordance with an increase in licensure is exempt from 35.21 paragraphs (a) and (b). 35.22(h)(g) For a nursing facility whose construction project 35.23 was authorized according to section 144A.073, subdivision 5, 35.24 paragraph (g), the operating cost payment rates for the new 35.25 location shall be determined based on Minnesota Rules, part 35.26 9549.0057. The relocation allowed under section 144A.073, 35.27 subdivision 5, paragraph (g), and the rate determination allowed 35.28 under this paragraph must meet the cost neutrality requirements 35.29 of section 144A.073, subdivision 3c. Paragraphs (a) and (b) 35.30 shall not apply until the second rate year after the settle-up 35.31 cost report is filed. Notwithstanding subdivision 2b, paragraph 35.32 (g), real estate taxes and special assessments payable by the 35.33 new location, a 501(c)(3) nonprofit corporation, shall be 35.34 included in the payment rates determined under this subdivision 35.35 for all subsequent rate years. 35.36(i)(h) For the rate year beginning July 1, 1997, the 36.1 commissioner shall compute the payment rate for a nursing 36.2 facility licensed for 94 beds on September 30, 1996, that 36.3 applied in October 1993 for approval of a total replacement 36.4 under the moratorium exception process in section 144A.073, and 36.5 completed the approved replacement in June 1995, with other 36.6 operating cost spend-up limit under paragraph (a), increased by 36.7 $3.98, and after computing the facility's payment rate according 36.8 to this section, the commissioner shall make a one-year positive 36.9 rate adjustment of $3.19 for operating costs related to the 36.10 newly constructed total replacement, without application of 36.11 paragraphs (a) and (b). The facility's per diem, before the 36.12 $3.19 adjustment, shall be used as the prior reporting year's 36.13 allowable operating cost per diem for payment rate calculation 36.14 for the rate year beginning July 1, 1998. A facility described 36.15 in this paragraph is exempt from paragraph (b) for the rate 36.16 years beginning July 1, 1997, and July 1, 1998. 36.17(j)(i) For the purpose of applying the limit stated in 36.18 paragraph (a), a nursing facility in Kandiyohi county licensed 36.19 for 86 beds that was granted hospital-attached status on 36.20 December 1, 1994, shall have the prior year's allowable 36.21 care-related per diem increased by $3.207 and the prior year's 36.22 other operating cost per diem increased by $4.777 before adding 36.23 the inflation in paragraph (d), clause (2), for the rate year 36.24 beginning on July 1, 1997. 36.25(k)(j) For the purpose of applying the limit stated in 36.26 paragraph (a), a 117 bed nursing facility located in Pine county 36.27 shall have the prior year's allowable other operating cost per 36.28 diem increased by $1.50 before adding the inflation in paragraph 36.29 (d), clause (2), for the rate year beginning on July 1, 1997. 36.30(l)(k) For the purpose of applying the limit under 36.31 paragraph (a), a nursing facility in Hibbing licensed for 192 36.32 beds shall have the prior year's allowable other operating cost 36.33 per diem increased by $2.67 before adding the inflation in 36.34 paragraph (d), clause (2), for the rate year beginning July 1, 36.35 1997. 36.36 Sec. 15. Minnesota Statutes 1999 Supplement, section 37.1 256B.434, subdivision 3, is amended to read: 37.2 Subd. 3. [DURATION AND TERMINATION OF CONTRACTS.] (a) 37.3 Subject to available resources, the commissioner may begin to 37.4 execute contracts with nursing facilities November 1, 1995. 37.5 (b) All contracts entered into under this section are for a 37.6 term of one year. Either party may terminate a contract at any 37.7 time without cause by providing 90 calendar days advance written 37.8 notice to the other party. The decision to terminate a contract 37.9 is not appealable. Notwithstanding section 16C.05, subdivision 37.10 2, paragraph (a), clause (5), the contract shall be renegotiated 37.11 for additional one-year terms, unless either party provides 37.12 written notice of termination. The provisions of the contract 37.13 shall be renegotiated annually by the parties prior to the 37.14 expiration date of the contract. The parties may voluntarily 37.15 renegotiate the terms of the contract at any time by mutual 37.16 agreement. 37.17 (c) If a nursing facility fails to comply with the terms of 37.18 a contract, the commissioner shall provide reasonable notice 37.19 regarding the breach of contract and a reasonable opportunity 37.20 for the facility to come into compliance. If the facility fails 37.21 to come into compliance or to remain in compliance, the 37.22 commissioner may terminate the contract. If a contract is 37.23 terminated, the contract payment remains in effect for the 37.24 remainder of the rate year in which the contract was terminated, 37.25 but in all other respects the provisions of this section do not 37.26 apply to that facility effective the date the contract is 37.27 terminated. The contract shall contain a provision governing 37.28 the transition back to the cost-based reimbursement system 37.29 established under section 256B.431, subdivision 25,and 37.30 Minnesota Rules, parts 9549.0010 to 9549.0080. A contract 37.31 entered into under this section may be amended by mutual 37.32 agreement of the parties. 37.33 Sec. 16. Minnesota Statutes 1999 Supplement, section 37.34 256B.434, subdivision 4, is amended to read: 37.35 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 37.36 nursing facilities which have their payment rates determined 38.1 under this section rather than section 256B.431,subdivision 25,38.2 the commissioner shall establish a rate under this subdivision. 38.3 The nursing facility must enter into a written contract with the 38.4 commissioner. 38.5 (b) A nursing facility's case mix payment rate for the 38.6 first rate year of a facility's contract under this section is 38.7 the payment rate the facility would have received under section 38.8 256B.431, subdivision 25. 38.9 (c) A nursing facility's case mix payment rates for the 38.10 second and subsequent years of a facility's contract under this 38.11 section are the previous rate year's contract payment rates plus 38.12 an inflation adjustment. The index for the inflation adjustment 38.13 must be based on the change in the Consumer Price Index-All 38.14 Items (United States City average) (CPI-U) forecasted by Data 38.15 Resources, Inc., as forecasted in the fourth quarter of the 38.16 calendar year preceding the rate year. The inflation adjustment 38.17 must be based on the 12-month period from the midpoint of the 38.18 previous rate year to the midpoint of the rate year for which 38.19 the rate is being determined. For the rate years beginning on 38.20 July 1, 1999, and July 1, 2000, this paragraph shall apply only 38.21 to the property-related payment rate. In determining the amount 38.22 of the property-related payment rate adjustment under this 38.23 paragraph, the commissioner shall determine the proportion of 38.24 the facility's rates that are property-related based on the 38.25 facility's most recent cost report. 38.26 (d) The commissioner shall develop additional 38.27 incentive-based payments of up to five percent above the 38.28 standard contract rate for achieving outcomes specified in each 38.29 contract. The specified facility-specific outcomes must be 38.30 measurable and approved by the commissioner. The commissioner 38.31 may establish, for each contract, various levels of achievement 38.32 within an outcome. After the outcomes have been specified the 38.33 commissioner shall assign various levels of payment associated 38.34 with achieving the outcome. Any incentive-based payment cancels 38.35 if there is a termination of the contract. In establishing the 38.36 specified outcomes and related criteria the commissioner shall 39.1 consider the following state policy objectives: 39.2 (1) improved cost effectiveness and quality of life as 39.3 measured by improved clinical outcomes; 39.4 (2) successful diversion or discharge to community 39.5 alternatives; 39.6 (3) decreased acute care costs; 39.7 (4) improved consumer satisfaction; 39.8 (5) the achievement of quality; or 39.9 (6) any additional outcomes proposed by a nursing facility 39.10 that the commissioner finds desirable. 39.11 Sec. 17. [REPEALER.] 39.12 Minnesota Statutes 1998, sections 256B.03, subdivision 2; 39.13 256B.431, subdivisions 2, 2a, 2f, 2h, 2m, 2p, 2q, 3, 3b, 3d, 3h, 39.14 3j, 4, 5, 7, 8, 9, 9a, 12, and 24; 256B.48, subdivision 9; 39.15 256B.50, subdivision 3; and 256B.74, subdivision 3, are repealed 39.16 effective July 1, 2000. 39.17 Sec. 18. [REVISOR INSTRUCTIONS.] 39.18 In the next and subsequent editions of Minnesota Statutes 39.19 and Minnesota Rules, the revisor of statutes shall make any 39.20 necessary statutory cross-reference changes required as a result 39.21 of the provisions in this bill. 39.22 Sec. 19. [EFFECTIVE DATE.] 39.23 The amendment in section 3 to Minnesota Statutes, section 39.24 256B.0913, subdivision 5, paragraph (g), is effective July 1, 39.25 2000, or upon federal approval of amendments to Minnesota's home 39.26 and community-based waiver for elderly persons at risk of 39.27 nursing home level of care, Health Care Financing Administration 39.28 control number 0025.91.R3, whichever occurs later. The 39.29 remainder of section 3, and sections 4 to 17 are effective July 39.30 1, 2000.