HF 3222

3rd Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; amending health care services provisions;
making changes to general assistance medical care, medical assistance, and
MinnesotaCare; modifying claims, liens, and treatment of assets; establishing a
statewide information exchange; amending Minnesota Statutes 2006, sections
245.462, subdivision 18; 245.470, subdivision 1; 245.4871, subdivision
27; 245.488, subdivision 1; 256B.056, subdivisions 2, 4a, 11, by adding a
subdivision; 256B.057, subdivision 1; 256B.0571, subdivisions 8, 9, 15, by
adding a subdivision; 256B.058; 256B.059, subdivisions 1, 1a; 256B.0594;
256B.0595, subdivisions 1, 2, 3, 4, by adding subdivisions; 256B.0624,
subdivisions 5, 8; 256B.0625, subdivision 13g; 256B.075, subdivision 2;
256B.0943, subdivision 1; 256B.15, subdivision 4; 256B.69, subdivisions 6, 27,
28; 256J.08, subdivision 73a; 524.3-803; Minnesota Statutes 2007 Supplement,
sections 256.01, subdivision 2b; 256B.055, subdivision 14; 256B.0623,
subdivision 5; 256B.0625, subdivision 49; 256D.03, subdivision 3; proposing
coding for new law in Minnesota Statutes, chapter 256B.

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

ARTICLE 1

HEALTH CARE SERVICES

Section 1.

Minnesota Statutes 2007 Supplement, section 256.01, subdivision 2b,
is amended to read:

Subd. 2b.

Performance payments new text begin ; performance measurement new text end .

(a) The
commissioner shall develop and implement a pay-for-performance system to provide
performance payments to eligible medical groups and clinics that demonstrate optimum
care in serving individuals with chronic diseases who are enrolled in health care
programs administered by the commissioner under chapters 256B, 256D, and 256L.
The commissioner may receive any federal matching money that is made available
through the medical assistance program for managed care oversight contracted through
vendors, including consumer surveys, studies, and external quality reviews as required
by the federal Balanced Budget Act of 1997, Code of Federal Regulations, title 42, part
438-managed care, subpart E-external quality review. Any federal money received
for managed care oversight is appropriated to the commissioner for this purpose. The
commissioner may expend the federal money received in either year of the biennium.

(b) Effective July 1, 2009, or upon federal approval, whichever is later, the
commissioner shall develop and implement a patient incentive health program to provide
incentives and rewards to patients who are enrolled in health care programs administered
by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and
have met personal health goals established with the patients' primary care providers to
manage a chronic disease or condition, including but not limited to diabetes, high blood
pressure, and coronary artery disease.

new text begin (c) The commissioner, in consultation with the Health Services Policy Committee,
shall develop and provide to the legislature by December 15, 2008, a methodology and
any draft legislation necessary to allow for the release, upon request, of summary data as
defined in section 13.02, subdivision 19, on claims and utilization for medical assistance,
general assistance medical care, and MinnesotaCare enrollees at no charge to the
University of Minnesota Medical School, the Mayo Medical School, Northwestern Health
Sciences University, the Institute for Clinical Systems Improvement, and other research
institutions, to conduct analyses of health care outcomes and treatment effectiveness,
provided the research institutions do not release private or nonpublic data, or data for
which dissemination is prohibited by law.
new text end

Sec. 2.

Minnesota Statutes 2007 Supplement, section 256B.055, subdivision 14,
is amended to read:

Subd. 14.

Persons detained by law.

(a) Medical assistance may be paid for an
inmate of a correctional facility who is conditionally released as authorized under section
241.26, 244.065, or 631.425, if the individual does not require the security of a public
detention facility and is housed in a halfway house or community correction center, or
under house arrest and monitored by electronic surveillance in a residence approved
by the commissioner of corrections, and if the individual meets the other eligibility
requirements of this chapter.

(b) An individual who is enrolled in medical assistance, and who is charged with a
crime and incarcerated for less than 12 months shall be suspended from eligibility at the
time of incarceration until the individual is released. Upon release, medical assistance
eligibility is reinstated without reapplication using a reinstatement process and form, if the
individual is otherwise eligible.

(c) An individual, regardless of age, who is considered an inmate of a public
institution as defined in Code of Federal Regulations, title 42, section deleted text begin 435.1009 deleted text end new text begin 435.1010 new text end ,
is not eligible for medical assistance.

Sec. 3.

Minnesota Statutes 2006, section 256B.056, subdivision 2, is amended to read:

Subd. 2.

Homestead exclusion deleted text begin and homestead equity limit deleted text end for deleted text begin institutionalized deleted text end
persons new text begin residing in a long-term care facility new text end .

deleted text begin (a) deleted text end The homestead shall be excluded
for the first six calendar months of a person's stay in a long-term care facility and shall
continue to be excluded for as long as the recipient can be reasonably expected to return to
the homestead. For purposes of this subdivision, "reasonably expected to return to the
homestead" means the recipient's attending physician has certified that the expectation
is reasonable, and the recipient can show that the cost of care upon returning home will
be met through medical assistance or other sources. The homestead shall continue to
be excluded for persons residing in a long-term care facility if it is used as a primary
residence by one of the following individuals:

(1) the spouse;

(2) a child under age 21;

(3) a child of any age who is blind or permanently and totally disabled as defined in
the supplemental security income program;

(4) a sibling who has equity interest in the home and who resided in the home for at
least one year immediately before the date of the person's admission to the facility; or

(5) a child of any age deleted text begin , deleted text end or deleted text begin , subject to federal approval, deleted text end a grandchild of any age deleted text begin , deleted text end who
resided in the home for at least two years immediately before the date of the person's
admission to the facility, and who provided care to the person that permitted the person to
reside at home rather than in an institution.

deleted text begin (b) Effective for applications filed on or after July 1, 2006, and for renewals after
July 1, 2006, for persons who first applied for payment of long-term care services on
or after January 2, 2006, the equity interest in the homestead of an individual whose
eligibility for long-term care services is determined on or after January 1, 2006, shall not
exceed $500,000, unless it is the lawful residence of the individual's spouse or child
who is under age 21, blind, or disabled. The amount specified in this paragraph shall be
increased beginning in year 2011, from year to year based on the percentage increase in
the Consumer Price Index for all urban consumers (all items; United States city average),
rounded to the nearest $1,000. This provision may be waived in the case of demonstrated
hardship by a process to be determined by the secretary of health and human services
pursuant to section 6014 of the Deficit Reduction Act of 2005, Public Law 109-171.
deleted text end

Sec. 4.

Minnesota Statutes 2006, section 256B.056, is amended by adding a
subdivision to read:

new text begin Subd. 2a. new text end

new text begin Home equity limit for medical assistance payment of long-term
care services. new text end

new text begin (a) Effective for requests of medical assistance payment of long-term
care services filed on or after July 1, 2006, and for renewals on or after July 1, 2006,
for persons who received payment of long-term care services under a request filed on
or after January 1, 2006, the equity interest in the home of a person whose eligibility
for long-term care services is determined on or after January 1, 2006, shall not exceed
$500,000, unless it is the lawful residence of the person's spouse or child who is under
age 21, or a child of any age who is blind or permanently and totally disabled as defined
in the Supplemental Security Income program. The amount specified in this paragraph
shall be increased beginning in year 2011, from year to year based on the percentage
increase in the Consumer Price Index for all urban consumers (all items; United States city
average), rounded to the nearest $1,000.
new text end

new text begin (b) For purposes of this subdivision, a "home" means any real or personal property
interest, including an interest in an agricultural homestead as defined under section
273.124, subdivision 1, that, at the time of the request for medical assistance payment of
long-term care services, is the primary dwelling of the person or was the primary dwelling
of the person before receipt of long-term care services began outside of the home.
new text end

new text begin (c) A person denied or terminated from medical assistance payment of long-term
care services because the person's home equity exceeds the home equity limit may seek
a waiver based upon a hardship by filing a written request with the county agency.
Hardship is an imminent threat to the person's health and well-being that is demonstrated
by documentation of no alternatives for payment of long-term care services. The county
agency shall make a decision regarding the written request to waive the home equity limit
within 30 days if all necessary information has been provided. The county agency shall
send the person and the person's representative a written notice of decision on the request
for a demonstrated hardship waiver that also advises the person of appeal rights under the
fair hearing process of section 256.045.
new text end

Sec. 5.

Minnesota Statutes 2006, section 256B.056, subdivision 4a, is amended to read:

Subd. 4a.

Asset verification.

For purposes of verification, deleted text begin the value of deleted text end new text begin an individual
is not required to make a good faith effort to sell new text end a life estate new text begin that is not excluded under
subdivision 2 and the life estate new text end shall be deleted text begin considered deleted text end new text begin deemed new text end not salable unless the owner
of the remainder interest intends to purchase the life estate, or the owner of the life estate
and the owner of the remainder sell the entire property. new text begin This subdivision applies only for
the purpose of determining eligibility for medical assistance, and does not apply to the
valuation of assets owned by either the institutional spouse or the community spouse
under section 256B.059, subdivision 2.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256B.056, subdivision 11, is amended to read:

Subd. 11.

Treatment of annuities.

(a) Any deleted text begin individual applying for or seeking
recertification of eligibility for deleted text end new text begin person requesting new text end medical assistance payment of long-term
care services shall provide a complete description of any interest either the deleted text begin individual deleted text end
new text begin person new text end or the deleted text begin individual's deleted text end new text begin person's new text end spouse has in annuities new text begin on a form designated by the
department. The form shall include a statement that the state becomes a preferred
remainder beneficiary of annuities or similar financial instruments by virtue of the receipt
of medical assistance payment of long-term care services new text end . The deleted text begin individual deleted text end new text begin person new text end and the
deleted text begin individual's deleted text end new text begin person's new text end spouse shall furnish the agency responsible for determining eligibility
with complete current copies of their annuities and related documents deleted text begin for review as part
of the application process on disclosure forms provided by the department as part of
their application deleted text end new text begin and complete the form designating the state as the preferred remainder
beneficiary for each annuity in which the person or the person's spouse has an interest new text end .

(b) deleted text begin The disclosure form shall include a statement that the department becomes the
remainder beneficiary under the annuity or similar financial instrument by virtue of the
receipt of medical assistance. deleted text end The deleted text begin disclosure form deleted text end new text begin department new text end shall deleted text begin include a deleted text end new text begin provide new text end
notice to the issuer of the department's right under this section as a preferred remainder
beneficiary under the annuity or similar financial instrument for medical assistance
furnished to the deleted text begin individual deleted text end new text begin person new text end or the deleted text begin individual's deleted text end new text begin person's new text end spouse, and deleted text begin require the
issuer to provide confirmation that a remainder beneficiary designation has been made
and to notify the county agency when there is a change in the amount of the income or
principal being withdrawn from the annuity or other similar financial instrument at the
time of the most recent disclosure required under this section. The individual and the
individual's spouse shall execute separate disclosure forms for each annuity or similar
financial instrument that they are required to disclose under this section and in which they
have an interest. deleted text end new text begin provide notice of the issuer's responsibilities as provided in paragraph (c).
new text end

(c) An issuer of an annuity or similar financial instrument who receives notice
deleted text begin on a disclosure form deleted text end new text begin of the state's right to be named a preferred remainder beneficiary new text end
as described in paragraph (b) shall provide confirmation to the requesting agency that
deleted text begin a remainder beneficiary designating deleted text end the state has been made deleted text begin and deleted text end new text begin a preferred remainder
beneficiary. The issuer new text end shall new text begin also new text end notify the county agency when deleted text begin there is deleted text end a change in the
amount of income or principal being withdrawn from the annuity or other similar financial
instrument new text begin or a change in the state's preferred remainder beneficiary designation under
the annuity or other similar financial instrument occurs new text end . The county agency shall provide
the issuer with the name, address, and telephone number of a unit within the department
that the issuer can contact to comply with this paragraph.

new text begin (d) "Preferred remainder beneficiary" for purposes of this subdivision and sections
256B.0594 and 256B.0595 means the state is a remainder beneficiary in the first position in
an amount equal to the amount of medical assistance paid on behalf of the institutionalized
person, or is a remainder beneficiary in the second position if the institutionalized person
designates and is survived by a remainder beneficiary who is (1) a spouse who does not
reside in a medical institution, (2) a minor child, or (3) a child of any age who is blind or
permanently and totally disabled as defined in the Supplemental Security Income program.
Notwithstanding this paragraph, the state is the remainder beneficiary in the first position
if the spouse or child disposes of the remainder for less than fair market value.
new text end

new text begin (e) For purposes of this subdivision, "institutionalized person" and "long-term care
services" have the meanings given in section 256B.0595, subdivision 1, paragraph (h).
new text end

new text begin (f) For purposes of this subdivision, "medical institution" means a skilled
nursing facility, intermediate care facility, intermediate care facility for persons with
developmental disabilities, nursing facility, or inpatient hospital.
new text end

Sec. 7.

Minnesota Statutes 2006, section 256B.057, subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year of
age new text begin or a pregnant woman who has written verification of a positive pregnancy test from a
physician or licensed registered nurse new text end is eligible for medical assistance if countable family
income is equal to or less than 275 percent of the federal poverty guideline for the same
family size. deleted text begin A pregnant woman who has written verification of a positive pregnancy test
from a physician or licensed registered nurse is eligible for medical assistance if countable
family income is equal to or less than 200 percent of the federal poverty guideline for the
same family size. deleted text end For purposes of this subdivision, "countable family income" means the
amount of income considered available using the methodology of the AFDC program
under the state's AFDC plan as of July 16, 1996, as required by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193,
except for the earned income disregard and employment deductions.

(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to the effective date for any months in the six-month budget period before
that date and the income standards and methodologies in effect on the effective date for
any months in the six-month budget period on or after that date. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
2003, and the income standards and methodologies in effect on the expiration date for any
months in the six-month budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

new text begin (3) An amount equal to the amount of earned income exceeding 275 percent of
the federal poverty guideline, up to a maximum of the amount by which the combined
total of 185 percent of the federal poverty guideline plus the earned income disregards
and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
pregnant women and infants less than one year of age.
new text end

(c) Dependent care and child support paid under court order shall be deducted from
the countable income of pregnant women.

(d) An infant born on or after January 1, 1991, to a woman who was eligible for and
receiving medical assistance on the date of the child's birth shall continue to be eligible for
medical assistance without redetermination until the child's first birthday, as long as the
child remains in the woman's household.

Sec. 8.

Minnesota Statutes 2006, section 256B.0571, subdivision 8, is amended to read:

Subd. 8.

Program established.

(a) The commissioner, in cooperation with the
commissioner of commerce, shall establish the Minnesota partnership for long-term care
program to provide for the financing of long-term care through a combination of private
insurance and medical assistance.

(b) An individual who meets the requirements in this paragraph is eligible to
participate in the partnership program. The individual must:

(1) be a Minnesota resident at the time coverage first became effective under the
partnership policy;

(2) be a beneficiary of a partnership policy that (i) is issued on or after the effective
date of the state plan amendment implementing the partnership program in Minnesota,
deleted text begin or deleted text end (ii) qualifies as a partnership policy under the provisions of subdivision 8a new text begin , or (iii) if
permitted under subdivision 17, qualifies for a partnership program established by another
state under United States Code, title 42, section 1396p(b)(1)(C), and is either issued on
or after the effective date of the state plan amendment implementing the partnership
program in the state of issuance or qualifies for an exchange under the requirements of
the partnership program in that state new text end ; and

(3) have exhausted all of the benefits under the partnership policy as described in this
section. Benefits received under a long-term care insurance policy before July 1, 2006, do
not count toward the exhaustion of benefits required in this subdivision.

Sec. 9.

Minnesota Statutes 2006, section 256B.0571, subdivision 9, is amended to read:

Subd. 9.

Medical assistance eligibility.

(a) Upon deleted text begin application deleted text end new text begin request new text end for medical
assistance program payment of long-term care services by an individual who meets the
requirements described in subdivision 8, the commissioner shall determine the individual's
eligibility for medical assistance according to paragraphs (b) to (i).

(b) After determining assets subject to the asset limit under section 256B.056,
subdivision 3 or 3c, or 256B.057, subdivision 9 or 10, the commissioner shall allow
the individual to designate assets to be protected from recovery under subdivisions 13
and 15 up to the dollar amount of the benefits utilized under the partnership policy.
Designated assets shall be disregarded for purposes of determining eligibility for payment
of long-term care services.

(c) The individual shall identify the designated assets and the full fair market value
of those assets and designate them as assets to be protected at the time of initial application
for medical assistance. The full fair market value of real property or interests in real
property shall be based on the most recent full assessed value for property tax purposes
for the real property, unless the individual provides a complete professional appraisal by
a licensed appraiser to establish the full fair market value. The extent of a life estate in
real property shall be determined using the life estate table in the health care program's
manual. Ownership of any asset in joint tenancy shall be treated as ownership as tenants
in common for purposes of its designation as a disregarded asset. The unprotected value
of any protected asset is subject to estate recovery according to subdivisions 13 and 15.

(d) The right to designate assets to be protected is personal to the individual and
ends when the individual dies, except as otherwise provided in subdivisions 13 and
15. It does not include the increase in the value of the protected asset and the income,
dividends, or profits from the asset. It may be exercised by the individual or by anyone
with the legal authority to do so on the individual's behalf. It shall not be sold, assigned,
transferred, or given away.

(e) If the dollar amount of the benefits utilized under a partnership policy is greater
than the full fair market value of all assets protected at the time of the application for
medical assistance long-term care services, the individual may designate additional assets
that become available during the individual's lifetime for protection under this section.
The individual must make the designation in writing deleted text begin to the county agency deleted text end no later than
deleted text begin the last date on which the individual must report a change in circumstances to the county
agency, as provided for under the medical assistance program deleted text end new text begin ten days from the date the
designation is requested by the county agency new text end . Any excess used for this purpose shall not
be available to the individual's estate to protect assets in the estate from recovery under
section 256B.15 or 524.3-1202, or otherwise.

(f) This section applies only to estate recovery under United States Code, title 42,
section 1396p, subsections (a) and (b), and does not apply to recovery authorized by other
provisions of federal law, including, but not limited to, recovery from trusts under United
States Code, title 42, section 1396p, subsection (d)(4)(A) and (C), or to recovery from
annuities, or similar legal instruments, subject to section 6012, subsections (a) and (b), of
the Deficit Reduction Act of 2005, Public Law 109-171.

(g) An individual's protected assets owned by the individual's spouse who applies
for payment of medical assistance long-term care services shall not be protected assets or
disregarded for purposes of eligibility of the individual's spouse solely because they were
protected assets of the individual.

(h) Assets designated under this subdivision shall not be subject to penalty under
section 256B.0595.

(i) The commissioner shall otherwise determine the individual's eligibility
for payment of long-term care services according to medical assistance eligibility
requirements.

Sec. 10.

Minnesota Statutes 2006, section 256B.0571, subdivision 15, is amended to
read:

Subd. 15.

Limitation on liens.

(a) An individual's interest in real property shall not
be subject to a medical assistance lien new text begin under sections 514.980 to 514.985 new text end or a deleted text begin notice of
potential claim deleted text end new text begin lien arising under section 256B.15 new text end while and to the extent it is protected
under subdivision 9. new text begin An individual's interest in real property that exceeds the value
protected under subdivision 9 is subject to a lien for recovery.
new text end

(b) Medical assistance liens new text begin under sections 514.980 to 514.985 new text end or liens arising
under deleted text begin notices of potential claims deleted text end new text begin section 256B.15 new text end against an individual's interests in real
property in the individual's estate that are designated as protected under subdivision 13,
paragraph (b), shall be released to the extent of the dollar value of the protection applied
to the interest.

(c) If an interest in real property is protected from a lien for recovery of medical
assistance paid on behalf of the individual under paragraph (a) or (b), no lien for recovery
of medical assistance paid on behalf of that individual shall be filed against the protected
interest in real property after it is distributed to the individual's heirs or devisees.

Sec. 11.

Minnesota Statutes 2006, section 256B.0571, is amended by adding a
subdivision to read:

new text begin Subd. 17. new text end

new text begin Reciprocal agreements. new text end

new text begin The commissioner may enter into an agreement
with any other state with a partnership program under United States Code, title 42,
section 1396p(b)(1)(C), for reciprocal recognition of qualified long-term care insurance
policies purchased under each state's partnership program. The commissioner shall notify
the secretary of the United States Department of Health and Human Services if the
commissioner declines to enter into a national reciprocal agreement.
new text end

Sec. 12.

Minnesota Statutes 2006, section 256B.058, is amended to read:

256B.058 TREATMENT OF INCOME OF INSTITUTIONALIZED SPOUSE.

Subdivision 1.

Income not available.

The income described in subdivisions 2 and 3
shall be deducted from an institutionalized spouse's monthly income and is not considered
available for payment of the monthly costs of an institutionalized deleted text begin person deleted text end new text begin spouse new text end in the
institution after deleted text begin the person has been deleted text end determined eligible for medical assistance.

Subd. 2.

Monthly income allowance for community spouse.

(a) For an
institutionalized spouse deleted text begin with a spouse residing in the community deleted text end , monthly income may be
allocated to the community spouse as a monthly income allowance for the community
spouse. Beginning with the first full calendar month the institutionalized spouse is
in the institution, the monthly income allowance is not considered available to the
institutionalized spouse for monthly payment of costs of care in the institution as long as
the income is made available to the community spouse.

(b) The monthly income allowance is the amount by which the community spouse's
monthly maintenance needs allowance under paragraphs (c) and (d) exceeds the amount
of monthly income otherwise available to the community spouse.

(c) The community spouse's monthly maintenance needs allowance is the lesser of
$1,500 or 122 percent of the monthly federal poverty guideline for a family of two plus
an excess shelter allowance. The excess shelter allowance is for the amount of shelter
expenses that exceed 30 percent of 122 percent of the federal poverty guideline line for a
family of two. Shelter expenses are the community spouse's expenses for rent, mortgage
payments including principal and interest, taxes, insurance, required maintenance charges
for a cooperative or condominium that is the community spouse's principal residence,
and the standard utility allowance under section 5(e) of the federal Food Stamp Act of
1977. If the community spouse has a required maintenance charge for a cooperative or
condominium, the standard utility allowance must be reduced by the amount of utility
expenses included in the required maintenance charge.

If the community or institutionalized spouse establishes that the community spouse
needs income greater than the monthly maintenance needs allowance determined in this
paragraph due to exceptional circumstances resulting in significant financial duress, the
monthly maintenance needs allowance may be increased to an amount that provides
needed additional income.

(d) The percentage of the federal poverty guideline used to determine the monthly
maintenance needs allowance in paragraph (c) is increased to 133 percent on July 1,
1991, and to 150 percent on July 1, 1992. Adjustments in the income limits due to annual
changes in the federal poverty guidelines shall be implemented the first day of July
following publication of the annual changes. The $1,500 maximum must be adjusted
January 1, 1990, and every January 1 after that by the same percentage increase in the
Consumer Price Index for all urban consumers (all items; United States city average)
between the two previous Septembers.

(e) If a court has entered an order against an institutionalized spouse for monthly
income for support of the community spouse, the community spouse's monthly income
allowance under this subdivision shall not be less than the amount of the monthly income
ordered.

Subd. 3.

Family allowance.

(a) A family allowance determined under paragraph
(b) is not considered available to the institutionalized spouse for monthly payment of costs
of care in the institution.

(b) The family allowance is equal to one-third of the amount by which 122 percent
of the monthly federal poverty guideline for a family of two exceeds the monthly income
for that family member.

(c) For purposes of this subdivision, the term family member only includes a
minor or dependent child new text begin as defined in the Internal Revenue Code new text end , dependent parent, or
dependent sibling of the institutionalized or community spouse if the sibling resides with
the community spouse.

(d) The percentage of the federal poverty guideline used to determine the family
allowance in paragraph (b) is increased to 133 percent on July 1, 1991, and to 150 percent
on July 1, 1992. Adjustments in the income limits due to annual changes in the federal
poverty guidelines shall be implemented the first day of July following publication of
the annual changes.

Subd. 4.

Treatment of income.

(a) No income of the community spouse will
be considered available to an eligible institutionalized spouse, beginning the first full
calendar month of institutionalization, except as provided in this subdivision.

(b) In determining the income of an institutionalized spouse or community spouse,
after the institutionalized spouse has been determined eligible for medical assistance,
the following rules apply.

(1) For income that is not from a trust, availability is determined according to items
(i) to (v), unless the instrument providing the income otherwise specifically provides:

(i) if payment is made solely in the name of one spouse, the income is considered
available only to that spouse;

(ii) if payment is made in the names of both spouses, one-half of the income is
considered available to each;

(iii) if payment is made in the names of one or both spouses together with one or
more other persons, the income is considered available to each spouse according to the
spouse's interest, or one-half of the joint interest is considered available to each spouse
if each spouse's interest is not specified;

(iv) if there is no instrument that establishes ownership, one-half of the income is
considered available to each spouse; and

(v) either spouse may rebut the determination of availability of income by showing
by a preponderance of the evidence that ownership interests are different than provided
above.

(2) For income from a trust, income is considered available to each spouse as
provided in the trust. If the trust does not specify an amount available to either or both
spouses, availability will be determined according to items (i) to (iii):

(i) if payment of income is made only to one spouse, the income is considered
available only to that spouse;

(ii) if payment of income is made to both spouses, one-half is considered available to
each; and

(iii) if payment is made to either or both spouses and one or more other persons,
the income is considered available to each spouse in proportion to each spouse's interest,
or if no such interest is specified, one-half of the joint interest is considered available
to each spouse.

Sec. 13.

Minnesota Statutes 2006, section 256B.059, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section and deleted text begin section deleted text end new text begin sections
256B.058 and new text end 256B.0595, the terms defined in this subdivision have the meanings given
them.

(b) "Community spouse" means the spouse of an institutionalized spouse.

(c) "Spousal share" means one-half of the total value of all assets, to the extent that
either the institutionalized spouse or the community spouse had an ownership interest at
the time of new text begin the first continuous period of new text end institutionalization.

(d) "Assets otherwise available to the community spouse" means assets individually
or jointly owned by the community spouse, other than assets excluded by subdivision 5,
paragraph (c).

(e) "Community spouse asset allowance" is the value of assets that can be transferred
under subdivision 3.

(f) "Institutionalized spouse" means a person who is:

(1) in a hospital, nursing facility, or intermediate care facility for persons with
developmental disabilities, or receiving home and community-based services under
section 256B.0915 deleted text begin or 256B.49 deleted text end , and is expected to remain in the facility or institution or
receive the home and community-based services for at least 30 consecutive days; and

(2) married to a person who is not in a hospital, nursing facility, or intermediate
care facility for persons with developmental disabilities, and is not receiving home and
community-based services under section 256B.0915 or 256B.49.

(g) "For the sole benefit of" means no other individual or entity can benefit in any
way from the assets or income at the time of a transfer or at any time in the future.

new text begin (h) "Continuous period of institutionalization" means a 30-consecutive-day period
of time in which a person is expected to stay in a medical or long-term care facility,
or receive home and community-based services that would qualify for coverage under
the elderly waiver (EW) or alternative care (AC) programs. For a stay in a facility, the
30-consecutive-day period begins on the date of entry into a medical or long-term care
facility. For receipt of home and community-based services, the 30-consecutive-day
period begins on the date that the following conditions are met:
new text end

new text begin (1) the person is receiving services that meet the nursing facility level of care
determined by a long-term care consultation;
new text end

new text begin (2) the person has received the long-term care consultation within the past 60 days;
new text end

new text begin (3) the services are paid by the EW program under section 256B.0915 or the AC
program under section 256B.0913 or would qualify for payment under the EW or AC
programs if the person were otherwise eligible for either program, and but for the receipt
of such services the person would have resided in a nursing facility; and
new text end

new text begin (4) the services are provided by a licensed provider qualified to provide home and
community-based services.
new text end

Sec. 14.

Minnesota Statutes 2006, section 256B.059, subdivision 1a, is amended to
read:

Subd. 1a.

Institutionalized spouse.

The provisions of this section apply only
when a spouse deleted text begin is institutionalized for a deleted text end new text begin begins the first new text end continuous period deleted text begin beginning deleted text end new text begin of
institutionalization new text end on or after October 1, 1989.

Sec. 15.

Minnesota Statutes 2006, section 256B.0594, is amended to read:

256B.0594 PAYMENT OF BENEFITS FROM AN ANNUITY.

When payment becomes due under an annuity that names the department a
remainder beneficiary deleted text begin as described in section 256B.056, subdivision 11 deleted text end , the issuer shall
request and the department shall, within 45 days after receipt of the request, provide
a written statement of the total amount of the medical assistance paid new text begin or confirmation
that any family member designated as a remainder beneficiary meets requirements for
qualification as a beneficiary in the first position new text end . Upon timely receipt of the written
statement of the amount of medical assistance paid, the issuer shall pay the department an
amount equal to the lesser of the amount due the department under the annuity or the total
amount of medical assistance paid on behalf of the individual or the individual's spouse.
Any amounts remaining after the issuer's payment to the department shall be payable
according to the terms of the annuity or similar financial instrument. The county agency
or the department shall provide the issuer with the name, address, and telephone number
of a unit within the department the issuer can contact to comply with this section. The
requirements of section 72A.201, subdivision 4, clause (3), shall not apply to payments
made under this section until the issuer has received final payment information from the
department, if the issuer has notified the beneficiary of the requirements of this section at
the time it initially requests payment information from the department.

Sec. 16.

Minnesota Statutes 2006, section 256B.0595, subdivision 1, is amended to
read:

Subdivision 1.

Prohibited transfers.

(a) For transfers of assets made on or before
August 10, 1993, if deleted text begin a deleted text end new text begin an institutionalized new text end person or the new text begin institutionalized new text end person's spouse
has given away, sold, or disposed of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are excluded under the supplemental
security program, within 30 months before or any time after the date of institutionalization
if the person has been determined eligible for medical assistance, or within 30 months
before or any time after the date of the first approved application for medical assistance
if the person has not yet been determined eligible for medical assistance, the person is
ineligible for long-term care services for the period of time determined under subdivision
2.

(b) Effective for transfers made after August 10, 1993, deleted text begin a deleted text end new text begin an institutionalized new text end person,
deleted text begin a deleted text end new text begin an institutionalized new text end person's spouse, or any person, court, or administrative body with
legal authority to act in place of, on behalf of, at the direction of, or upon the request of the
new text begin institutionalized new text end person or new text begin institutionalized new text end person's spouse, may not give away, sell, or
dispose of, for less than fair market value, any asset or interest therein, except assets other
than the homestead that are excluded under the supplemental security income program,
for the purpose of establishing or maintaining medical assistance eligibility. This applies
to all transfers, including those made by a community spouse after the month in which
the institutionalized spouse is determined eligible for medical assistance. For purposes of
determining eligibility for long-term care services, any transfer of such assets within 36
months before or any time after an institutionalized person deleted text begin applies for deleted text end new text begin requests new text end medical
assistance new text begin payment of long-term care services new text end , or 36 months before or any time after a
medical assistance recipient becomes new text begin an new text end institutionalized new text begin person new text end , for less than fair market
value may be considered. Any such transfer is presumed to have been made for the purpose
of establishing or maintaining medical assistance eligibility and the new text begin institutionalized new text end
person is ineligible for long-term care services for the period of time determined under
subdivision 2, unless the new text begin institutionalized new text end person furnishes convincing evidence to
establish that the transaction was exclusively for another purpose, or unless the transfer is
permitted under subdivision 3 or 4. In the case of payments from a trust or portions of a
trust that are considered transfers of assets under federal law, or in the case of any other
disposal of assets made on or after February 8, 2006, any transfers made within 60 months
before or any time after an institutionalized person deleted text begin applies for deleted text end new text begin requests new text end medical assistance
new text begin payment of long-term care services new text end and within 60 months before or any time after a
medical assistance recipient becomes new text begin an new text end institutionalized new text begin person new text end , may be considered.

(c) This section applies to transfers, for less than fair market value, of income
or assets, including assets that are considered income in the month received, such as
inheritances, court settlements, and retroactive benefit payments or income to which the new text begin
institutionalized new text end person or the new text begin institutionalized new text end person's spouse is entitled but does not
receive due to action by the new text begin institutionalized new text end person, the new text begin institutionalized new text end person's spouse,
or any person, court, or administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of the new text begin institutionalized new text end person or the new text begin
institutionalized new text end person's spouse.

(d) This section applies to payments for care or personal services provided by a
relative, unless the compensation was stipulated in a notarized, written agreement which
was in existence when the service was performed, the care or services directly benefited
the person, and the payments made represented reasonable compensation for the care
or services provided. A notarized written agreement is not required if payment for the
services was made within 60 days after the service was provided.

(e) This section applies to the portion of any asset or interest that deleted text begin a deleted text end new text begin an institutionalized new text end
person, deleted text begin a deleted text end new text begin an institutionalized new text end person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the direction of, or upon the request
of the new text begin institutionalized new text end person or the new text begin institutionalized new text end person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the new text begin institutionalized
new text end person or new text begin institutionalized person's new text end spouse while alive, based on estimated life expectancy
deleted text begin using the life expectancy tables employed by the supplemental security income program
to determine the value of an agreement for services for life deleted text end new text begin as determined according to the
current actuarial tables published by the Office of the Chief Actuary of the Social Security
Administration new text end . The commissioner may adopt rules reducing life expectancies based on
the need for long-term care. This section applies to an annuity deleted text begin described in this paragraph deleted text end
purchased on or after March 1, 2002, that:

(1) is not purchased from an insurance company or financial institution that is
subject to licensing or regulation by the Minnesota Department of Commerce or a similar
regulatory agency of another state;

(2) does not pay out principal and interest in equal monthly installments; or

(3) does not begin payment at the earliest possible date after annuitization.

(f) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, deleted text begin the purchase of an annuity deleted text end by or on behalf of an deleted text begin individual deleted text end new text begin
institutionalized person new text end who has applied for or is receiving long-term care services or the
deleted text begin individual's deleted text end new text begin institutionalized person's new text end spouse shall be treated as the disposal of an asset for
less than fair market value unless the department is named deleted text begin as the deleted text end new text begin a preferred new text end remainder
beneficiary deleted text begin in first position for an amount equal to at least the total amount of medical
assistance paid on behalf of the individual or the individual's spouse; or the department
is named as the remainder beneficiary in second position for an amount equal to at least
the total amount of medical assistance paid on behalf of the individual or the individual's
spouse after the individual's community spouse or minor or disabled child and is named as
the remainder beneficiary in the first position if the community spouse or a representative
of the minor or disabled child disposes of the remainder for less than fair market value deleted text end new text begin as
described in section 256B.056, subdivision 11 new text end . Any subsequent change to the designation
of the department as a new text begin preferred new text end remainder beneficiary shall result in the annuity being
treated as a disposal of assets for less than fair market value. The amount of such transfer
shall be the maximum amount the deleted text begin individual deleted text end new text begin institutionalized person new text end or the deleted text begin individual's deleted text end new text begin
institutionalized person's new text end spouse could receive from the annuity or similar financial
instrument. Any change in the amount of the income or principal being withdrawn
from the annuity or other similar financial instrument at the time of the most recent
disclosure shall be deemed to be a transfer of assets for less than fair market value unless
the deleted text begin individual deleted text end new text begin institutionalized person new text end or the deleted text begin individual's deleted text end new text begin institutionalized person's new text end spouse
demonstrates that the transaction was for fair market value. new text begin In the event a distribution
of income or principal has been improperly distributed or disbursed from an annuity or
other retirement planning instrument of an institutionalized person or the institutionalized
person's spouse, a cause of action exists against the individual receiving the improper
distribution for the cost of medical assistance services provided or the amount of the
improper distribution, whichever is less.
new text end

(g) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, deleted text begin the purchase of an annuity deleted text end by or on behalf of an deleted text begin individual deleted text end new text begin
institutionalized person new text end applying for or receiving long-term care services shall be treated
as a disposal of assets for less than fair market value unless it is:

(i) an annuity described in subsection (b) or (q) of section 408 of the Internal
Revenue Code of 1986; or

(ii) purchased with proceeds from:

(A) an account or trust described in subsection (a), (c), or (p) of section 408 of the
Internal Revenue Code;

(B) a simplified employee pension within the meaning of section 408(k) of the
Internal Revenue Code; or

(C) a Roth IRA described in section 408A of the Internal Revenue Code; or

(iii) an annuity that is irrevocable and nonassignable; is actuarially sound as
determined in accordance with actuarial publications of the Office of the Chief Actuary of
the Social Security Administration; and provides for payments in equal amounts during
the term of the annuity, with no deferral and no balloon payments made.

(h) For purposes of this section, long-term care services include services in a nursing
facility, services that are eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care facility for persons with
developmental disabilities, and home and community-based services provided pursuant
to sections 256B.0915, 256B.092, and 256B.49. For purposes of this subdivision and
subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient
in a nursing facility or in a swing bed, or intermediate care facility for persons with
developmental disabilities or who is receiving home and community-based services under
sections 256B.0915, 256B.092, and 256B.49.

(i) This section applies to funds used to purchase a promissory note, loan, or
mortgage unless the note, loan, or mortgage:

(1) has a repayment term that is actuarially sound;

(2) provides for payments to be made in equal amounts during the term of the loan,
with no deferral and no balloon payments made; and

(3) prohibits the cancellation of the balance upon the death of the lender.

In the case of a promissory note, loan, or mortgage that does not meet an exception
in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding
balance due as of the date of the deleted text begin individual's application deleted text end new text begin institutionalized person's request
new text end for new text begin medical assistance payment of new text end long-term care services.

(j) This section applies to the purchase of a life estate interest in another deleted text begin individual's deleted text end
new text begin person's new text end home unless the purchaser resides in the home for a period of at least one year
after the date of purchase.

Sec. 17.

Minnesota Statutes 2006, section 256B.0595, subdivision 2, is amended to
read:

Subd. 2.

Period of ineligibility.

(a) For any uncompensated transfer occurring on or
before August 10, 1993, the number of months of ineligibility for long-term care services
shall be the lesser of 30 months, or the uncompensated transfer amount divided by the
average medical assistance rate for nursing facility services in the state in effect on the
date of application. The amount used to calculate the average medical assistance payment
rate shall be adjusted each July 1 to reflect payment rates for the previous calendar year.
The period of ineligibility begins with the month in which the assets were transferred.
If the transfer was not reported to the local agency at the time of application, and the
applicant received long-term care services during what would have been the period of
ineligibility if the transfer had been reported, a cause of action exists against the transferee
for the cost of long-term care services provided during the period of ineligibility, or for the
uncompensated amount of the transfer, whichever is less. deleted text begin The action may be brought by
deleted text end deleted text begin the state or the local agency responsible for providing medical assistance under chapter
deleted text end deleted text begin 256G. deleted text end The uncompensated transfer amount is the fair market value of the asset at the time
it was given away, sold, or disposed of, less the amount of compensation received.

(b) For uncompensated transfers made after August 10, 1993, the number of months
of ineligibility for long-term care services shall be the total uncompensated value of the
resources transferred divided by the average medical assistance rate for nursing facility
services in the state in effect on the date of application. The amount used to calculate the
average medical assistance payment rate shall be adjusted each July 1 to reflect payment
rates for the previous calendar year. The period of ineligibility begins with the first day
of the month after the month in which the assets were transferred except that if one or
more uncompensated transfers are made during a period of ineligibility, the total assets
transferred during the ineligibility period shall be combined and a penalty period calculated
to begin on the first day of the month after the month in which the first uncompensated
transfer was made. If the transfer was reported to the local agency after the date that
advance notice of a period of ineligibility that affects the next month could be provided to
the recipient and the recipient received medical assistance services or the transfer was not
reported to the local agency, and the applicant or recipient received medical assistance
services during what would have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for deleted text begin the cost of medical assistance deleted text end
new text begin that portion of long-term care new text end services provided during the period of ineligibility, or for
the uncompensated amount of the transfer, whichever is less. deleted text begin The action may be brought
by the state or the local agency responsible for providing medical assistance under chapter
256G. deleted text end The uncompensated transfer amount is the fair market value of the asset at the
time it was given away, sold, or disposed of, less the amount of compensation received.
Effective for transfers made on or after March 1, 1996, involving persons who apply for
medical assistance on or after April 13, 1996, no cause of action exists for a transfer unless:

(1) the transferee knew or should have known that the transfer was being made by a
person who was a resident of a long-term care facility or was receiving that level of care in
the community at the time of the transfer;

(2) the transferee knew or should have known that the transfer was being made to
assist the person to qualify for or retain medical assistance eligibility; or

(3) the transferee actively solicited the transfer with intent to assist the person to
qualify for or retain eligibility for medical assistance.

(c) For uncompensated transfers made on or after February 8, 2006, the period
of ineligibility new text begin :
new text end

new text begin (1) for uncompensated transfers by or on behalf of individuals receiving medical
assistance payment of long-term care services, new text end begins deleted text begin on deleted text end the first day of the month
deleted text begin in which deleted text end new text begin following new text end advance notice deleted text begin can be given following deleted text end new text begin of the penalty period, but no
later than the first day of new text end the month deleted text begin in which assets have been transferred for less than
fair market value, deleted text end new text begin that follows three full calendar months from the date of the report
or discovery of the transfer; new text end or

new text begin (2) for uncompensated transfers by individuals requesting medical assistance
payment of long-term care services, begins new text end the date on which the individual is eligible
for medical assistance under the Medicaid state plan and would otherwise be receiving
long-term care services based on an approved application for such care but for the
application of the penalty period, deleted text begin whichever is later, deleted text end new text begin ; new text end and deleted text begin which does not occur deleted text end

new text begin (3) cannot begin new text end during any other period of ineligibility.

(d) If a calculation of a penalty period results in a partial month, payments for
long-term care services shall be reduced in an amount equal to the fraction.

(e) In the case of multiple fractional transfers of assets in more than one month for
less than fair market value on or after February 8, 2006, the period of ineligibility is
calculated by treating the total, cumulative, uncompensated value of all assets transferred
during all months on or after February 8, 2006, as one transfer.

Sec. 18.

Minnesota Statutes 2006, section 256B.0595, subdivision 3, is amended to
read:

Subd. 3.

Homestead exception to transfer prohibition.

(a) An institutionalized
person is not ineligible for long-term care services due to a transfer of assets for less than
fair market value if the asset transferred was a homestead and:

(1) title to the homestead was transferred to the individual's:

(i) spouse;

(ii) child who is under age 21;

(iii) blind or permanently and totally disabled child as defined in the supplemental
security income program;

(iv) sibling who has equity interest in the home and who was residing in the home
for a period of at least one year immediately before the date of the individual's admission
to the facility; or

(v) son or daughter who was residing in the individual's home for a period of at least
two years immediately before the date deleted text begin of the individual's admission to the facility deleted text end new text begin the
individual became an institutionalized person new text end , and who provided care to the individual
that, as certified by the individual's attending physician, permitted the individual to reside
at home rather than new text begin receive care new text end in an institution or facility;

(2) a satisfactory showing is made that the individual intended to dispose of the
homestead at fair market value or for other valuable consideration; or

(3) the local agency grants a waiver of a penalty resulting from a transfer for less
than fair market value because denial of eligibility would cause undue hardship for the
individual, based on imminent threat to the individual's health and well-being. Whenever
an applicant or recipient is denied eligibility because of a transfer for less than fair market
value, the local agency shall notify the applicant or recipient that the applicant or recipient
may request a waiver of the penalty if the denial of eligibility will cause undue hardship.
With the written consent of the individual or the personal representative of the individual,
a long-term care facility in which an individual is residing may file an undue hardship
waiver request, on behalf of the individual who is denied eligibility for long-term care
services on or after July 1, 2006, due to a period of ineligibility resulting from a transfer on
or after February 8, 2006. In evaluating a waiver, the local agency shall take into account
whether the individual was the victim of financial exploitation, whether the individual has
made reasonable efforts to recover the transferred property or resource, and other factors
relevant to a determination of hardship. If the local agency does not approve a hardship
waiver, the local agency shall issue a written notice to the individual stating the reasons
for the denial and the process for appealing the local agency's decision.

(b) When a waiver is granted under paragraph (a), clause (3), a cause of action exists
against the person to whom the homestead was transferred for that portion of long-term
care services deleted text begin granted deleted text end new text begin provided new text end within:

(1) 30 months of a transfer made on or before August 10, 1993;

(2) 60 months if the homestead was transferred after August 10, 1993, to a trust or
portion of a trust that is considered a transfer of assets under federal law;

(3) 36 months if transferred in any other manner after August 10, 1993, but prior
to February 8, 2006; or

(4) 60 months if the homestead was transferred on or after February 8, 2006,

or the amount of the uncompensated transfer, whichever is less, together with the
costs incurred due to the action. deleted text begin The action shall be brought by the state unless the
deleted text end deleted text begin state delegates this responsibility to the local agency responsible for providing medical
deleted text end deleted text begin assistance under chapter 256G.
deleted text end

Sec. 19.

Minnesota Statutes 2006, section 256B.0595, subdivision 4, is amended to
read:

Subd. 4.

Other exceptions to transfer prohibition.

An institutionalized person
who has made, or whose spouse has made a transfer prohibited by subdivision 1, is not
ineligible for long-term care services if one of the following conditions applies:

(1) the assets were transferred to the individual's spouse or to another for the sole
benefit of the spouse; or

(2) the institutionalized spouse, prior to being institutionalized, transferred assets
to a spouse, provided that the spouse to whom the assets were transferred does not then
transfer those assets to another person for less than fair market value. (At the time when
one spouse is institutionalized, assets must be allocated between the spouses as provided
under section 256B.059); or

(3) the assets were transferred to the individual's child who is blind or permanently
and totally disabled as determined in the supplemental security income program; or

(4) a satisfactory showing is made that the individual intended to dispose of the
assets either at fair market value or for other valuable consideration; or

(5) the local agency determines that denial of eligibility for long-term care services
would work an undue hardship and grants a waiver of a penalty resulting from a transfer
for less than fair market value based on an imminent threat to the individual's health
and well-being. Whenever an applicant or recipient is denied eligibility because of a
transfer for less than fair market value, the local agency shall notify the applicant or
recipient that the applicant or recipient may request a waiver of the penalty if the denial of
eligibility will cause undue hardship. With the written consent of the individual or the
personal representative of the individual, a long-term care facility in which an individual
is residing may file an undue hardship waiver request, on behalf of the individual who
is denied eligibility for long-term care services on or after July 1, 2006, due to a period
of ineligibility resulting from a transfer on or after February 8, 2006. In evaluating a
waiver, the local agency shall take into account whether the individual was the victim of
financial exploitation, whether the individual has made reasonable efforts to recover the
transferred property or resource, whether the individual has taken any action to prevent
the designation of the department as a remainder beneficiary on an annuity as described
in section 256B.056, subdivision 11, and other factors relevant to a determination of
hardship. new text begin The local agency shall make a determination within 30 days of the receipt of all
necessary information needed to make such a determination. new text end If the local agency does not
approve a hardship waiver, the local agency shall issue a written notice to the individual
stating the reasons for the denial and the process for appealing the local agency's decision.
When a waiver is granted, a cause of action exists against the person to whom the assets
were transferred for that portion of long-term care services deleted text begin granted deleted text end new text begin provided new text end within:

(i) 30 months of a transfer made on or before August 10, 1993;

(ii) 60 months of a transfer if the assets were transferred after August 30, 1993, to a
trust or portion of a trust that is considered a transfer of assets under federal law;

(iii) 36 months of a transfer if transferred in any other manner after August 10, 1993,
but prior to February 8, 2006; or

(iv) 60 months of any transfer made on or after February 8, 2006,

or the amount of the uncompensated transfer, whichever is less, together with the
costs incurred due to the action deleted text begin . The action shall be brought by the state unless the
deleted text end deleted text begin state delegates this responsibility to the local agency responsible for providing medical
deleted text end deleted text begin assistance under this chapter deleted text end ; or

(6) for transfers occurring after August 10, 1993, the assets were transferred by
the person or person's spouse: (i) into a trust established for the sole benefit of a son or
daughter of any age who is blind or disabled as defined by the Supplemental Security
Income program; or (ii) into a trust established for the sole benefit of an individual who is
under 65 years of age who is disabled as defined by the Supplemental Security Income
program.

"For the sole benefit of" has the meaning found in section 256B.059, subdivision 1.

Sec. 20.

Minnesota Statutes 2006, section 256B.0595, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin Cause of action; transfer prior to death. new text end

new text begin (a) A cause of action exists
against a transferee who receives assets for less than fair market value, either:
new text end

new text begin (1) from a person who was a recipient of medical assistance and who made an
uncompensated transfer that was known to the county agency but a penalty period could
not be implemented under this section due to the death of the person; or
new text end

new text begin (2) from a person who was a recipient of medical assistance who made an
uncompensated transfer that was not known to the county agency and the transfer was
made with the intent to hinder, delay, or defraud the state or local agency from recovering
as allowed under section 256B.15. In determining intent under this clause consideration
may be given, among other factors, to whether:
new text end

new text begin (i) the transfer was to a family member;
new text end

new text begin (ii) the transferor retained possession or control of the property after the transfer;
new text end

new text begin (iii) the transfer was concealed;
new text end

new text begin (iv) the transfer included the majority of the transferor's assets;
new text end

new text begin (v) the value of the consideration received was not reasonably equivalent to the fair
market value of the property; and
new text end

new text begin (vi) the transfer occurred shortly before the death of the transferor.
new text end

new text begin (b) No cause of action exists under this subdivision unless:
new text end

new text begin (1) the transferee knew or should have known that the transfer was being made by a
person who was receiving medical assistance as described in section 256B.15, subdivision
1, paragraph (b); and
new text end

new text begin (2) the transferee received the asset without providing a reasonable equivalent fair
market value in exchange for the transfer.
new text end

new text begin (c) The cause of action is for the uncompensated amount of the transfer or the
amount of medical assistance paid on behalf of the person, whichever is less. The
uncompensated transfer amount is the fair market value of the asset at the time it was
given away, sold, or disposed of, less the amount of the compensation received.
new text end

Sec. 21.

Minnesota Statutes 2006, section 256B.0595, is amended by adding a
subdivision to read:

new text begin Subd. 9. new text end

new text begin Filing cause of action; limitation. new text end

new text begin (a) The county of financial
responsibility under chapter 256G may bring a cause of action under any or all of the
following:
new text end

new text begin (1) subdivision 1, paragraph (f);
new text end

new text begin (2) subdivision 2, paragraphs (a) and (b);
new text end

new text begin (3) subdivision 3, paragraph (b);
new text end

new text begin (4) subdivision 4, clause (5); and
new text end

new text begin (5) subdivision 8
new text end

new text begin on behalf of the claimant who must be the commissioner.
new text end

new text begin (b) Notwithstanding any other law to the contrary, a cause of action under
subdivision 2, paragraph (a) or (b) or subdivision 8, must be commenced within six years
of the date the local agency determines that a transfer was made for less than fair market
value. Notwithstanding any other law to the contrary, a cause of action under subdivision
3, paragraph (b), or subdivision 4, clause (5), must be commenced within six years of the
date of approval of a waiver of the penalty period for a transfer for less than fair market
value based on undue hardship.
new text end

Sec. 22.

Minnesota Statutes 2006, section 256B.0625, subdivision 13g, is amended to
read:

Subd. 13g.

Preferred drug list.

(a) The commissioner shall adopt and implement a
preferred drug list by January 1, 2004. The commissioner may enter into a contract with
a vendor deleted text begin or one or more states deleted text end for the purpose of participating in a deleted text begin multistate deleted text end preferred
drug list and supplemental rebate program. The commissioner shall ensure that any
contract meets all federal requirements and maximizes federal financial participation. The
commissioner shall publish the preferred drug list annually in the State Register and shall
maintain an accurate and up-to-date list on the agency Web site.

(b) The commissioner may add to, delete from, and otherwise modify the preferred
drug list, after consulting with the Formulary Committee and appropriate medical
specialists and providing public notice and the opportunity for public comment.

(c) The commissioner shall adopt and administer the preferred drug list as part of the
administration of the supplemental drug rebate program. Reimbursement for prescription
drugs not on the preferred drug list may be subject to prior authorization, unless the drug
manufacturer signs a supplemental rebate contract.

(d) For purposes of this subdivision, "preferred drug list" means a list of prescription
drugs within designated therapeutic classes selected by the commissioner, for which prior
authorization based on the identity of the drug or class is not required.

(e) The commissioner shall seek any federal waivers or approvals necessary to
implement this subdivision.

Sec. 23.

Minnesota Statutes 2007 Supplement, section 256B.0625, subdivision 49,
is amended to read:

Subd. 49.

Community health worker.

(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if
the community health worker has:

(1) received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculum; or

(2) at least five years of supervised experience with an enrolled physician, registered
nurse, or advanced practice registered nurse new text begin , or at least five years of supervised experience
by a certified public health nurse operating under the direct authority of an enrolled unit
of government new text end .

Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.

(b) Community health workers must work under the supervision of a medical
assistance enrolled physician, registered nurse, or advanced practice registered nurse new text begin , or
work under the supervision of a certified public health nurse operating under the direct
authority of an enrolled unit of government new text end .

Sec. 24.

Minnesota Statutes 2006, section 256B.075, subdivision 2, is amended to read:

Subd. 2.

Fee-for-service.

(a) The commissioner shall develop and implement
a disease management program for medical assistance and general assistance medical
care recipients who are not enrolled in the prepaid medical assistance or prepaid general
assistance medical care programs and who are receiving services on a fee-for-service basis.
The commissioner may contract with an outside organization to provide these services.

(b) The commissioner shall seek any federal approval necessary to implement this
section and to obtain federal matching funds.

(c) The commissioner shall develop and implement a pilot intensive care
management program for medical assistance children with complex and chronic medical
issues deleted text begin who are not able to participate in the metro-based U Special Kids program due
to geographic distance deleted text end .

Sec. 25.

new text begin [256B.0948] STATEWIDE HEALTH INFORMATION EXCHANGE.
new text end

new text begin Subdivision 1. new text end

new text begin Commissioner's authority to join and participate. new text end

new text begin The
commissioner of human services has the authority to join and participate as a member
in a legal entity developing and operating a statewide health information exchange that
shall meet the following criteria:
new text end

new text begin (1) the legal entity must meet all constitutional and statutory requirements to allow
the commissioner to participate including, without limitation, the Minnesota Constitution,
article X, section 1; and
new text end

new text begin (2) the commissioner or the commissioner's designated representative must have
the right to participate in the governance of the legal entity under the same terms and
conditions and subject to the same requirements as any other member in the legal entity
and in that role shall act to advance state interests and lessen the burdens of government.
new text end

new text begin Subd. 2. new text end

new text begin Development expenses. new text end

new text begin Notwithstanding chapter 16C, the commissioner
may pay the state's prorated share of development-related expenses of the legal entity
retroactively from October 29, 2007, regardless of the date the commissioner joins the
legal entity as a member.
new text end

Sec. 26.

Minnesota Statutes 2006, section 256B.15, subdivision 4, is amended to read:

Subd. 4.

Other survivors.

new text begin (a) new text end If the decedent who was single or the surviving
spouse of a married couple is survived by one of the following persons, a claim exists
against the estate payable first from the value of the nonhomestead property included in
the estate and the personal representative shall make, execute, and deliver to the county
agency a lien against the homestead property in the estate for any unpaid balance of the
claim to the claimant as provided under this section:

deleted text begin (a) deleted text end new text begin (1) new text end a sibling who resided in the decedent medical assistance recipient's home at
least one year before the decedent's institutionalization and continuously since the date
of institutionalization; or

deleted text begin (b) deleted text end new text begin (2) new text end a son or daughter or a grandchild who resided in the decedent medical
assistance recipient's home for at least two years immediately before the parent's or
grandparent's institutionalization and continuously since the date of institutionalization,
and who establishes by a preponderance of the evidence having provided care to the
parent or grandparent who received medical assistance, that the care was provided before
institutionalization, and that the care permitted the parent or grandparent to reside at
home rather than in an institution.

new text begin (b) For purposes of this subdivision, "institutionalization" means receiving care:
(1) in a nursing facility or swing bed, or intermediate care facility for persons with
developmental disabilities; or (2) through home and community-based services under
section 256B.0915, 256B.092, or 256B.49.
new text end

Sec. 27.

Minnesota Statutes 2006, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) Each demonstration provider shall be responsible for
the health care coordination for eligible individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered
to enrollees new text begin , notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over new text end ;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for eligible
individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

Sec. 28.

Minnesota Statutes 2006, section 256B.69, subdivision 27, is amended to read:

Subd. 27.

Information for persons with limited English-language proficiency.

Managed care contracts entered into under this section and sections 256D.03, subdivision
4, paragraph (c), and 256L.12 must require demonstration providers to deleted text begin inform enrollees
that upon request the enrollee can obtain a certificate of coverage in the following
languages: Spanish, Hmong, Laotian, Russian, Somali, Vietnamese, or Cambodian.
Upon request, the demonstration provider must provide the enrollee with a certificate of
coverage in the specified language of preference deleted text end new text begin provide language assistance to enrollees
that ensures meaningful access to its programs and services according to Title VI of the
Civil Rights Act and federal regulations adopted under that law or any guidance from the
United States Department of Health and Human Services new text end .

Sec. 29.

Minnesota Statutes 2006, section 256B.69, subdivision 28, is amended to read:

Subd. 28.

Medicare special needs plans; medical assistance basic health care.

(a) The commissioner may contract with qualified Medicare-approved special needs
plans to provide medical assistance basic health care services to persons with disabilities,
including those with developmental disabilities. Basic health care services include:

(1) those services covered by the medical assistance state plan except for ICF/MR
services, home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care
and certain home care services defined by the commissioner in consultation with the
stakeholder group established under paragraph (d); and

(2) basic health care services may also include risk for up to 100 days of nursing
facility services for persons who reside in a noninstitutional setting and home health
services related to rehabilitation as defined by the commissioner after consultation with
the stakeholder group.

The commissioner may exclude other medical assistance services from the basic
health care benefit set. Enrollees in these plans can access any excluded services on the
same basis as other medical assistance recipients who have not enrolled.

Unless a person is otherwise required to enroll in managed care, enrollment in these
plans for Medicaid services must be voluntary. For purposes of this subdivision, automatic
enrollment with an option to opt out is not voluntary enrollment.

(b) Beginning January 1, 2007, the commissioner may contract with qualified
Medicare special needs plans to provide basic health care services under medical
assistance to persons who are dually eligible for both Medicare and Medicaid and those
Social Security beneficiaries eligible for Medicaid but in the waiting period for Medicare.
The commissioner shall consult with the stakeholder group under paragraph (d) in
developing program specifications for these services. The commissioner shall report to
the chairs of the house and senate committees with jurisdiction over health and human
services policy and finance by February 1, 2007, on implementation of these programs and
the need for increased funding for the ombudsman for managed care and other consumer
assistance and protections needed due to enrollment in managed care of persons with
disabilities. Payment for Medicaid services provided under this subdivision for the months
of May and June will be made no earlier than July 1 of the same calendar year.

(c) Beginning January 1, 2008, the commissioner may expand contracting under this
subdivision to all persons with disabilities not otherwise required to enroll in managed
care.

(d) The commissioner shall establish a state-level stakeholder group to provide
advice on managed care programs for persons with disabilities, including both MnDHO
and contracts with special needs plans that provide basic health care services as described
in paragraphs (a) and (b). The stakeholder group shall provide advice on program
expansions under this subdivision and subdivision 23, including:

(1) implementation efforts;

(2) consumer protections; and

(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.

(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the
counties covered by the plan, members, consumer advocates, and providers, for advice on
issues that arise in the local or regional area.

new text begin (f) The commissioner is prohibited from providing the names of potential enrollees
to health plans for marketing purposes. The commissioner may mail marketing materials
to potential enrollees on behalf of health plans, in which case the health plans shall cover
any costs incurred by the commissioner for mailing marketing materials.
new text end

Sec. 30.

Minnesota Statutes 2007 Supplement, section 256D.03, subdivision 3, is
amended to read:

Subd. 3.

General assistance medical care; eligibility.

(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section 256B.056, subdivision 5, or MinnesotaCare as defined in
paragraph (b), except as provided in paragraph (c), and:

(1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, subdivision 3, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the beneficiary by
the trustee, assuming the full exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum;

(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the
family size, using a six-month budget period, whose equity in assets is not in excess
of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient
hospitalization; or

(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7, with covered services as provided in section 256L.03 for the rest of the
six-month general assistance medical care eligibility period, until their six-month renewal.

(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
application.

(e) Applicants and recipients eligible under paragraph (a), clause (1) deleted text begin ; who deleted text end new text begin are
exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
new text end

new text begin (1) new text end have applied for and are awaiting a determination of blindness or disability by
the state medical review team or a determination of eligibility for Supplemental Security
Income or Social Security Disability Insurance by the Social Security Administration; deleted text begin who
deleted text end

new text begin (2) new text end fail to meet the requirements of section 256L.09, subdivision 2; deleted text begin who
deleted text end

new text begin (3) new text end are homeless as defined by United States Code, title 42, section 11301, et seq.;
deleted text begin who
deleted text end

new text begin (4) new text end are classified as end-stage renal disease beneficiaries in the Medicare program;
deleted text begin who
deleted text end

new text begin (5) new text end are enrolled in private health care coverage as defined in section 256B.02,
subdivision 9; deleted text begin who
deleted text end

new text begin (6) new text end are eligible under paragraph (j); deleted text begin or who
deleted text end

new text begin (7) new text end receive treatment funded pursuant to section 254B.02 deleted text begin are exempt from the
MinnesotaCare enrollment requirements of this subdivision deleted text end new text begin ; or
new text end

new text begin (8) reside in the Minnesota sex offender program defined in chapter 246B new text end .

(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).

(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.

(i) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.

(j) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.

(k) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.

(l) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.

(m) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.

(n) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services.

(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.

(p) Effective July 1, 2003, general assistance medical care emergency services end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 31.

Minnesota Statutes 2006, section 524.3-803, is amended to read:

524.3-803 LIMITATIONS ON PRESENTATION OF CLAIMS.

(a) All claims as defined in section 524.1-201(6), against a decedent's estate which
arose before the death of the decedent, including claims of the state and any subdivision
thereof, whether due or to become due, absolute or contingent, liquidated or unliquidated,
if not barred earlier by other statute of limitations, are barred against the estate, the personal
representative, and the heirs and devisees of the decedent, unless presented as follows:

(1) in the case of a creditor who is only entitled, under the United States Constitution
and under the Minnesota Constitution, to notice by publication under section 524.3-801,
within four months after the date of the court administrator's notice to creditors which
is subsequently published pursuant to section 524.3-801;

(2) in the case of a creditor who was served with notice under section 524.3-801(c),
within the later to expire of four months after the date of the first publication of notice to
creditors or one month after the service;

(3) within the later to expire of one year after the decedent's death, or one year after
June 16, 1989, whether or not notice to creditors has been published or served under
section 524.3-801, provided, however, that in the case of a decedent who died before June
16, 1989, no claim which was then barred by any provision of law may be deemed to have
been revived by the amendment of this section. new text begin Claims authorized by section 246.53,
256B.15, or 256D.16 must not be barred after one year as provided in this clause.
new text end

(b) All claims against a decedent's estate which arise at or after the death of the
decedent, including claims of the state and any subdivision thereof, whether due or to
become due, absolute or contingent, liquidated or unliquidated, are barred against the
estate, the personal representative, and the heirs and devisees of the decedent, unless
presented as follows:

(1) a claim based on a contract with the personal representative, within four months
after performance by the personal representative is due;

(2) any other claim, within four months after it arises.

(c) Nothing in this section affects or prevents:

(1) any proceeding to enforce any mortgage, pledge, or other lien upon property
of the estate;

(2) any proceeding to establish liability of the decedent or the personal representative
for which there is protection by liability insurance, to the limits of the insurance protection
only;

(3) the presentment and payment at any time within one year after the decedent's
death of any claim arising before the death of the decedent that is referred to in section
524.3-715, clause (18), although the same may be otherwise barred under this section; or

(4) the presentment and payment at any time before a petition is filed in compliance
with section 524.3-1001 or 524.3-1002 or a closing statement is filed under section
524.3-1003, of:

(i) any claim arising after the death of the decedent that is referred to in section
524.3-715, clause (18), although the same may be otherwise barred hereunder;

(ii) any other claim, including claims subject to clause (3), which would otherwise be
barred hereunder, upon allowance by the court upon petition of the personal representative
or the claimant for cause shown on notice and hearing as the court may direct.

Sec. 32. new text begin HOME MODIFICATIONS.
new text end

new text begin Effective upon federal approval, the costs associated with home modifications that
add to the square footage of an unlicensed private residence when necessary to complete a
modification to configure a bathroom to accommodate a wheelchair may be allowed
expenses for home and community-based waiver services provided under Minnesota
Statutes, sections 256B.0916 and 256B.49 for persons with disabilities when the following
conditions are met:
new text end

new text begin (1) the annual cost of the care and modifications for the waiver recipient does not
exceed the cost of care that would otherwise be incurred for the recipient without the
modification, as determined by the local lead agency;
new text end

new text begin (2) the modification is based on the assessed needs, goals, and best interest of the
recipient as identified in the plan of care;
new text end

new text begin (3) the modification has been found to be the least costly appropriate alternative after
other alternatives have been explored through an evaluation by the local lead agency; and
new text end

new text begin (4) the modification is reasonable given the value and size of the home.
new text end

Sec. 33. new text begin WAIVER AMENDMENT.
new text end

new text begin The commissioner of human services shall submit an amendment to the Centers for
Medicare and Medicaid Services consistent with section 32 by October 1, 2008.
new text end

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 2

HEALTH OCCUPATIONS

Section 1.

Minnesota Statutes 2006, section 245.462, subdivision 18, is amended to
read:

Subd. 18.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the treatment of mental illness who is qualified in at
least one of the following ways:

(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171
to 148.285; and:

(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or

(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;

(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;

(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;

(4) in psychiatry: a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry;

(5) in marriage and family therapy: the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness; deleted text begin or
deleted text end

new text begin (6) in licensed professional clinical counseling, the mental health professional shall,
subject to approval of the commissioner, be a licensed professional clinical counselor
under section 148B.5301; or
new text end

deleted text begin (6) deleted text end new text begin (7) new text end in allied fields: a person with a master's degree from an accredited college or
university in one of the behavioral sciences or related fields, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness.

Sec. 2.

Minnesota Statutes 2006, section 245.470, subdivision 1, is amended to read:

Subdivision 1.

Availability of outpatient services.

(a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of adults
with mental illness residing in the county. Services may be provided directly by the
county through county-operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with privately
operated mental health centers or mental health clinics approved by the commissioner
under section 245.69, subdivision 2; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a licensed mental health professional as defined in section 245.462,
subdivision 18, clauses (1) to deleted text begin (4) deleted text end new text begin (6) new text end . Clients may be required to pay a fee according to
section 245.481. Outpatient services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating an adult's mental health needs through therapy;

(6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication; and

(7) preventing placement in settings that are more intensive, costly, or restrictive
than necessary and appropriate to meet client needs.

(b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the client can best be served outside the
county.

Sec. 3.

Minnesota Statutes 2006, section 245.4871, subdivision 27, is amended to read:

Subd. 27.

Mental health professional.

"Mental health professional" means a
person providing clinical services in the diagnosis and treatment of children's emotional
disorders. A mental health professional must have training and experience in working with
children consistent with the age group to which the mental health professional is assigned.
A mental health professional must be qualified in at least one of the following ways:

(1) in psychiatric nursing, the mental health professional must be a registered nurse
who is licensed under sections 148.171 to 148.285 and who is certified as a clinical
specialist in child and adolescent psychiatric or mental health nursing by a national nurse
certification organization or who has a master's degree in nursing or one of the behavioral
sciences or related fields from an accredited college or university or its equivalent, with
at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of mental illness;

(2) in clinical social work, the mental health professional must be a person licensed
as an independent clinical social worker under chapter 148D, or a person with a master's
degree in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders;

(3) in psychology, the mental health professional must be an individual licensed by
the board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;

(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American board of psychiatry and neurology or eligible
for board certification in psychiatry;

(5) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39 with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental disorders or emotional disturbances; deleted text begin or
deleted text end

new text begin (6) in licensed professional clinical counseling, the mental health professional shall,
subject to approval of the commissioner, be a licensed professional clinical counselor
under section 148B.5301; or
new text end

deleted text begin (6) deleted text end new text begin (7) new text end in allied fields, the mental health professional must be a person with a
master's degree from an accredited college or university in one of the behavioral sciences
or related fields, with at least 4,000 hours of post-master's supervised experience in the
delivery of clinical services in the treatment of emotional disturbances.

Sec. 4.

Minnesota Statutes 2006, section 245.488, subdivision 1, is amended to read:

Subdivision 1.

Availability of outpatient services.

(a) County boards must provide
or contract for enough outpatient services within the county to meet the needs of each
child with emotional disturbance residing in the county and the child's family. Services
may be provided directly by the county through county-operated mental health centers or
mental health clinics approved by the commissioner under section 245.69, subdivision 2;
by contract with privately operated mental health centers or mental health clinics approved
by the commissioner under section 245.69, subdivision 2; by contract with hospital
mental health outpatient programs certified by the Joint Commission on Accreditation
of Hospital Organizations; or by contract with a licensed mental health professional as
defined in section 245.4871, subdivision 27, clauses (1) to deleted text begin (4) deleted text end new text begin (6) new text end . A child or a child's
parent may be required to pay a fee based in accordance with section 245.481. Outpatient
services include:

(1) conducting diagnostic assessments;

(2) conducting psychological testing;

(3) developing or modifying individual treatment plans;

(4) making referrals and recommending placements as appropriate;

(5) treating the child's mental health needs through therapy; and

(6) prescribing and managing medication and evaluating the effectiveness of
prescribed medication.

(b) County boards may request a waiver allowing outpatient services to be provided
in a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.

(c) Outpatient services offered by the county board to prevent placement must be at
the level of treatment appropriate to the child's diagnostic assessment.

Sec. 5.

Minnesota Statutes 2007 Supplement, section 256B.0623, subdivision 5,
is amended to read:

Subd. 5.

Qualifications of provider staff.

Adult rehabilitative mental health
services must be provided by qualified individual provider staff of a certified provider
entity. Individual provider staff must be qualified under one of the following criteria:

(1) a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to (5). If the recipient has a current diagnostic assessment by a licensed mental
health professional as defined in section 245.462, subdivision 18, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end ,
recommending receipt of adult mental health rehabilitative services, the definition of
mental health professional for purposes of this section includes a person who is qualified
under section 245.462, subdivision 18, clause deleted text begin (6) deleted text end new text begin (7) new text end , and who holds a current and valid
national certification as a certified rehabilitation counselor or certified psychosocial
rehabilitation practitioner;

(2) a mental health practitioner as defined in section 245.462, subdivision 17. The
mental health practitioner must work under the clinical supervision of a mental health
professional;

(3) a certified peer specialist under section 256B.0615. The certified peer specialist
must work under the clinical supervision of a mental health professional; or

(4) a mental health rehabilitation worker. A mental health rehabilitation worker
means a staff person working under the direction of a mental health practitioner or mental
health professional and under the clinical supervision of a mental health professional in
the implementation of rehabilitative mental health services as identified in the recipient's
individual treatment plan who:

(i) is at least 21 years of age;

(ii) has a high school diploma or equivalent;

(iii) has successfully completed 30 hours of training during the past two years in all
of the following areas: recipient rights, recipient-centered individual treatment planning,
behavioral terminology, mental illness, co-occurring mental illness and substance abuse,
psychotropic medications and side effects, functional assessment, local community
resources, adult vulnerability, recipient confidentiality; and

(iv) meets the qualifications in subitem (A) or (B):

(A) has an associate of arts degree in one of the behavioral sciences or human
services, or is a registered nurse without a bachelor's degree, or who within the previous
ten years has:

(1) three years of personal life experience with serious and persistent mental illness;

(2) three years of life experience as a primary caregiver to an adult with a serious
mental illness or traumatic brain injury; or

(3) 4,000 hours of supervised paid work experience in the delivery of mental health
services to adults with a serious mental illness or traumatic brain injury; or

(B)(1) is fluent in the non-English language or competent in the culture of the
ethnic group to which at least 20 percent of the mental health rehabilitation worker's
clients belong;

(2) receives during the first 2,000 hours of work, monthly documented individual
clinical supervision by a mental health professional;

(3) has 18 hours of documented field supervision by a mental health professional
or practitioner during the first 160 hours of contact work with recipients, and at least six
hours of field supervision quarterly during the following year;

(4) has review and cosignature of charting of recipient contacts during field
supervision by a mental health professional or practitioner; and

(5) has 40 hours of additional continuing education on mental health topics during
the first year of employment.

Sec. 6.

Minnesota Statutes 2006, section 256B.0624, subdivision 5, is amended to read:

Subd. 5.

Mobile crisis intervention staff qualifications.

For provision of adult
mental health mobile crisis intervention services, a mobile crisis intervention team is
comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end , or a combination of at least one mental health
professional and one mental health practitioner as defined in section 245.462, subdivision
17, with the required mental health crisis training and under the clinical supervision of
a mental health professional on the team. The team must have at least two people with
at least one member providing on-site crisis intervention services when needed. Team
members must be experienced in mental health assessment, crisis intervention techniques,
and clinical decision-making under emergency conditions and have knowledge of local
services and resources. The team must recommend and coordinate the team's services
with appropriate local resources such as the county social services agency, mental health
services, and local law enforcement when necessary.

Sec. 7.

Minnesota Statutes 2006, section 256B.0624, subdivision 8, is amended to read:

Subd. 8.

Adult crisis stabilization staff qualifications.

(a) Adult mental health
crisis stabilization services must be provided by qualified individual staff of a qualified
provider entity. Individual provider staff must have the following qualifications:

(1) be a mental health professional as defined in section 245.462, subdivision 18,
clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end ;

(2) be a mental health practitioner as defined in section 245.462, subdivision 17.
The mental health practitioner must work under the clinical supervision of a mental health
professional; or

(3) be a mental health rehabilitation worker who meets the criteria in section
256B.0623, subdivision 5, clause (3); works under the direction of a mental health
practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professional.

(b) Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during
the past two years.

Sec. 8.

Minnesota Statutes 2006, section 256B.0943, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

For purposes of this section, the following terms have
the meanings given them.

(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.

(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.

(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).

(k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.

(l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

(m) "Mental health professional" means an individual as defined in section 245.4871,
subdivision 27, clauses (1) to deleted text begin (5) deleted text end new text begin (6) new text end , or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

(n) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

(o) "Skills training" means individual, family, or group training designed to improve
the basic functioning of the child with emotional disturbance and the child's family in the
activities of daily living and community living, and to improve the social functioning of the
child and the child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual, family, and group skills training must:

(1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;

(2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and

(3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.

Sec. 9.

Minnesota Statutes 2006, section 256J.08, subdivision 73a, is amended to read:

Subd. 73a.

Qualified professional.

(a) For physical illness, injury, or incapacity,
a "qualified professional" means a licensed physician, a physician's assistant, a nurse
practitioner, or a licensed chiropractor.

(b) For developmental disability and intelligence testing, a "qualified professional"
means an individual qualified by training and experience to administer the tests necessary
to make determinations, such as tests of intellectual functioning, assessments of adaptive
behavior, adaptive skills, and developmental functioning. These professionals include
licensed psychologists, certified school psychologists, or certified psychometrists working
under the supervision of a licensed psychologist.

(c) For learning disabilities, a "qualified professional" means a licensed psychologist
or school psychologist with experience determining learning disabilities.

(d) For mental health, a "qualified professional" means a licensed physician or a
qualified mental health professional. A "qualified mental health professional" means:

(1) for children, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in child
and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences
or related fields from an accredited college or university or its equivalent, with at least
4,000 hours of post-master's supervised experience in the delivery of clinical services in
the treatment of mental illness;

(2) for adults, in psychiatric nursing, a registered nurse who is licensed under
sections 148.171 to 148.285, and who is certified as a clinical specialist in adult psychiatric
and mental health nursing by a national nurse certification organization or who has a
master's degree in nursing or one of the behavioral sciences or related fields from an
accredited college or university or its equivalent, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness;

(3) in clinical social work, a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;

(4) in psychology, an individual licensed by the Board of Psychology under sections
148.88 to 148.98, who has stated to the Board of Psychology competencies in the
diagnosis and treatment of mental illness;

(5) in psychiatry, a physician licensed under chapter 147 and certified by the
American Board of Psychiatry and Neurology or eligible for board certification in
psychiatry; deleted text begin and
deleted text end

(6) in marriage and family therapy, the mental health professional must be a
marriage and family therapist licensed under sections 148B.29 to 148B.39, with at least
two years of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness deleted text begin . deleted text end new text begin ; and
new text end

new text begin (7) in licensed professional clinical counseling, the mental health professional shall,
subject to approval of the commissioner, be a licensed professional clinical counselor
under section 148B.5301.
new text end