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HF 1233

as introduced - 88th Legislature (2013 - 2014) Posted on 06/21/2017 11:01am

KEY: stricken = removed, old language. underscored = added, new language.

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A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions related to health care, continuing care, nursing facility
admission, children and family services, human services licensing, chemical and
mental health, program integrity, managed care organizations, waiver provider
standards, home care, and the Department of Health; redesigning home and
community-based services; establishing community first services and supports
and Northstar Care for Children; providing for fraud investigations in the
child care assistance program; establishing autism early intensive intervention
benefits; creating a human services performance council; making technical
changes; requiring a study; requiring reports; appropriating money; repealing
MinnesotaCare; amending Minnesota Statutes 2012, sections 16C.10, subdivision
5; 16C.155, subdivision 1; 103I.005, by adding a subdivision; 103I.521;
119B.011, by adding a subdivision; 119B.02, by adding a subdivision; 119B.025,
subdivision 1; 119B.03, subdivision 4; 119B.05, subdivision 1; 119B.13,
subdivisions 1, 1a, 6, by adding subdivisions; 144.051, by adding subdivisions;
144.0724, subdivision 4; 144.123, subdivision 1; 144.125, subdivision 1; 144.98,
subdivisions 3, 5, by adding subdivisions; 144.99, subdivision 4; 144A.351;
144A.43; 144A.44; 144A.45; 144D.01, subdivision 4; 145.986; 145C.01,
subdivision 7; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5,
16, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding
subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4;
149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions
1, 2, 4; 149A.74; 149A.90, subdivision 8; 149A.91, subdivision 9; 149A.92,
subdivision 1; 149A.93, subdivisions 3, 6; 149A.94; 149A.96, subdivision
9; 174.30, subdivision 1; 243.166, subdivisions 4b, 7; 245.4682, subdivision
2; 245A.02, subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 9; 245A.04,
subdivision 13; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08,
subdivision 2a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435;
245A.144; 245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5;
245A.50; 245C.04, by adding a subdivision; 245C.08, subdivision 1; 245C.33,
subdivision 1; 245D.02; 245D.03; 245D.04; 245D.05; 245D.06; 245D.07;
245D.09; 245D.10; 246.18, subdivision 8, by adding a subdivision; 246.54;
254B.04, subdivision 1; 256.01, subdivisions 2, 24, 34, by adding subdivisions;
256.0112, by adding a subdivision; 256.82, subdivisions 2, 3; 256.969,
subdivision 3a; 256.975, subdivision 7, by adding subdivisions; 256.9754,
subdivision 5, by adding subdivisions; 256.98, subdivision 8; 256B.02, by
adding subdivisions; 256B.021, by adding subdivisions; 256B.04, subdivisions
18, 21, by adding a subdivision; 256B.055, subdivisions 3a, 6, 10, 15, by adding
subdivisions; 256B.056, subdivisions 1, 1a, 1c, 3, 3c, 4, 5c, 10, by adding a
subdivision; 256B.057, subdivisions 1, 8, 10, by adding a subdivision; 256B.059,
subdivision 1; 256B.06, subdivision 4; 256B.0625, subdivisions 13e, 17a, 19c,
58, by adding subdivisions; 256B.0659, subdivision 21; 256B.0911, subdivisions
1, 1a, 3a, 4d, 6, 7, by adding a subdivision; 256B.0913, subdivision 4, by adding a
subdivision; 256B.0915, subdivisions 3a, 5, by adding a subdivision; 256B.0916,
by adding a subdivision; 256B.0917, subdivisions 6, 13, by adding subdivisions;
256B.092, subdivisions 11, 12, by adding subdivisions; 256B.434, subdivision
4; 256B.437, subdivision 6; 256B.439, subdivisions 1, 2, 3, 4, by adding a
subdivision; 256B.441, subdivisions 13, 53, by adding subdivisions; 256B.49,
subdivisions 11a, 12, 14, 15, by adding subdivisions; 256B.4912, subdivisions 1,
7, by adding subdivisions; 256B.493, subdivision 2; 256B.5011, subdivision 2;
256B.69, subdivisions 5c, 31; 256B.76, subdivisions 1, 2; 256B.761; 256B.766;
256I.05, by adding a subdivision; 256J.08, subdivision 24; 256J.21, subdivisions
2, 3; 256J.24, subdivisions 3, 7; 256J.621; 256J.626, subdivision 7; 257.85,
subdivisions 2, 5, 6; 260C.446; 402A.10; 402A.18; 471.59, subdivision 1;
626.556, subdivisions 2, 3, 10d; 626.557, subdivisions 4, 9, 9a, 9e; 626.5572,
subdivision 13; Laws 1998, chapter 407, article 6, section 116; proposing coding
for new law in Minnesota Statutes, chapters 144; 144A; 149A; 245; 245A;
245D; 256; 256B; 256J; 259A; 260C; 402A; proposing coding for new law
as Minnesota Statutes, chapters 245E; 256N; repealing Minnesota Statutes
2012, sections 103I.005, subdivision 20; 144.123, subdivision 2; 144A.46;
144A.461; 149A.025; 149A.20, subdivision 8; 149A.30, subdivision 2; 149A.40,
subdivision 8; 149A.45, subdivision 6; 149A.50, subdivision 6; 149A.51,
subdivision 7; 149A.52, subdivision 5a; 149A.53, subdivision 9; 245A.655;
245B.01; 245B.02; 245B.03; 245B.031; 245B.04; 245B.05, subdivisions 1, 2, 3,
5, 6, 7; 245B.055; 245B.06; 245B.07; 245B.08; 245D.08; 256.82, subdivision
4; 256B.055, subdivisions 3, 5, 10b; 256B.056, subdivision 5b; 256B.057,
subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b, 4c; 256B.0917, subdivisions
1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.092, subdivision 11; 256B.49,
subdivisions 16a, 22; 256J.24, subdivision 10; 256L.01, subdivisions 1, 1a, 2, 3,
3a, 4a, 5; 256L.02, subdivisions 1, 2, 3; 256L.03, subdivisions 1, 1a, 1b, 2, 3,
3a, 3b, 4, 5, 6; 256L.031; 256L.04, subdivisions 1, 1a, 1b, 2, 2a, 7, 7a, 7b, 8, 9,
10, 10a, 12, 13; 256L.05; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2,
3, 4, 5, 8, 9; 256L.09, subdivisions 1, 2, 4, 5, 6, 7; 256L.10; 256L.11; 256L.12;
256L.15, subdivisions 1, 1a, 1b, 2; 256L.17, subdivisions 1, 2, 3, 4, 5; 256L.18;
256L.22; 256L.24; 256L.26; 256L.28; 260C.441; 485.14; Minnesota Rules, parts
3400.0130, subpart 8; 4668.0002; 4668.0003; 4668.0005; 4668.0008; 4668.0012;
4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040;
4668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080;
4668.0100; 4668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150;
4668.0160; 4668.0170; 4668.0180; 4668.0190; 4668.0200; 4668.0218;
4668.0220; 4668.0230; 4668.0240; 4668.0800; 4668.0805; 4668.0810;
4668.0815; 4668.0820; 4668.0825; 4668.0830; 4668.0835; 4668.0840;
4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870; 4669.0001;
4669.0010; 4669.0020; 4669.0030; 4669.0040; 4669.0050; 9502.0355, subpart
4; 9560.0650, subparts 1, 3, 6; 9560.0651; 9560.0655.

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

ARTICLE 1

AFFORDABLE CARE ACT IMPLEMENTATION; BETTER HEALTH
CARE FOR MORE MINNESOTANS

Section 1.

Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
the income standards of section 256B.056, subdivision 4, and persons eligible for general
assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
dependency fund services. State money appropriated for this paragraph must be placed in
a separate account established for this purpose.

Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county
shall pay for out-of-home placement costs, if applicable.

(b) A person not entitled to services under paragraph (a), but with family income
that is less than 215 percent of the federal poverty guidelines for the applicable family
size, shall be eligible to receive chemical dependency fund services within the limit
of funds appropriated for this group for the fiscal year. If notified by the state agency
of limited funds, a county must give preferential treatment to persons with dependent
children who are in need of chemical dependency treatment pursuant to an assessment
under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
6
, or 260C.212. A county may spend money from its own sources to serve persons under
this paragraph. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.

(c) Persons whose income is between 215 percent and 412 percent of the federal
poverty guidelines for the applicable family size shall be eligible for chemical dependency
services on a sliding fee basis, within the limit of funds appropriated for this group for the
fiscal year. Persons eligible under this paragraph must contribute to the cost of services
according to the sliding fee scale established under subdivision 3. A county may spend
money from its own sources to provide services to persons under this paragraph. State
money appropriated for this paragraph must be placed in a separate account established
for this purpose.

Sec. 2.

[256.0131] FEDERAL APPROVAL OF HEALTH CARE COVERAGE
WAIVER.

(a) The commissioner of human services shall pursue federal funding to provide
health care coverage to certain individuals with incomes above 133 percent of the federal
poverty guidelines effective January 1, 2014. The waiver request shall specify that
reimbursement is requested for providing health care coverage to:

(1) parents and caretaker relatives of children ages birth up to a child's 19th birthday,
children who are 19 years old or older and up to the child's 21st birthday, and adults without
children with household incomes above 133 percent of federal poverty guidelines, and at
or below the lowest income standard for the advance premium tax credit program offered
by the Minnesota Insurance Marketplace, who meet all other eligibility requirements; and

(2) lawfully present noncitizens ineligible for Medicaid by reason of immigration
status with income at or below the lowest income standard for the advance premium
tax credit program offered by the Minnesota Insurance Marketplace who meet all other
eligibility requirements.

(b) The commissioner shall request that federal funding for health care coverage
as described in paragraph (a) continue until Minnesota receives federal approval for, and
implements, a Basic Health Plan option as described in section 1331 of the Affordable
Care Act (Public Law 111-148).

(c) The waiver request must be consistent with provisions of the Affordable Care
Act so that it will operate in conjunction with other insurance affordability programs
defined in that law.

Sec. 3.

Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
to read:


Subd. 17.

Affordable Care Act or ACA.

"Affordable Care Act" or "ACA" means
Public Law 111-148, as amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance
issued under, those acts.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 4.

Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
to read:


Subd. 18.

Caretaker relative.

"Caretaker relative" means a relative, by blood,
adoption, or marriage, of a child under age 19 with whom the child is living and who
assumes primary responsibility for the child's care.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 5.

Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
to read:


Subd. 19.

Insurance affordability program.

"Insurance affordability program"
means one of the following programs:

(1) medical assistance under this chapter;

(2) a program that provides advance payments of the premium tax credits established
under section 36B of the Internal Revenue Code or cost-sharing reductions established
under section 1402 of the Affordable Care Act;

(3) MinnesotaCare as defined in chapter 256L; and

(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:


Subd. 18.

Applications for medical assistance.

(a) The state agency may take
shall accept applications for medical assistance and conduct eligibility determinations for
MinnesotaCare enrollees
by telephone, via mail, in-person, online via an Internet Web
site, and through other commonly available electronic means
.

(b) The commissioner of human services shall modify the Minnesota health care
programs application form to add a question asking applicants whether they have ever
served in the United States military.

(c) For each individual who submits an application or whose eligibility is subject to
renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
if the agency determines the individual is not eligible for medical assistance, the agency
shall determine potential eligibility for other insurance affordability programs.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 7.

Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:


Subd. 3a.

Families with children.

Beginning July 1, 2002, Medical assistance may
be paid for a person who is a child under the age of 18, or age 18 if a full-time student
in a secondary school, or in the equivalent level of vocational or technical training, and
reasonably expected to complete the program before reaching age
19; the parent or
stepparent
of a dependent child under the age of 19, including a pregnant woman; or a
caretaker relative of a dependent child under the age of 19.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 8.

Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:


Subd. 6.

Pregnant women; needy unborn child.

Medical assistance may be paid
for a pregnant woman who has written verification of a positive pregnancy test from a
physician or licensed registered nurse, who
meets the other eligibility criteria of this
section and whose unborn child would be eligible as a needy child under subdivision 10 if
born and living with the woman. In accordance with Code of Federal Regulations, title
42, section 435.956, the commissioner must accept self-attestation of pregnancy unless
the agency has information that is not reasonably compatible with such attestation.
For
purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 9.

Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:


Subd. 10.

Infants.

Medical assistance may be paid for an infant less than one year
of age, whose mother was eligible for and receiving medical assistance at the time of birth
or who is less than two years of age and is in a family with countable income that is equal
to or less than the income standard established under section 256B.057, subdivision 1.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 10.

Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:


Subd. 15.

Adults without children.

Medical assistance may be paid for a person
who is:

(1) at least age 21 and under age 65;

(2) not pregnant;

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

(4) not an adult in a family with children as defined in section 256L.01, subdivision
3a
; and
not otherwise eligible under subdivision 7 as a person who meets the categorical
eligibility requirements of the supplemental security income program;

(5) not enrolled under subdivision 7 as a person who would meet the categorical
eligibility requirements of the supplemental security income program except for excess
income or assets; and

(5) (6) not described in another subdivision of this section.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 11.

Minnesota Statutes 2012, section 256B.055, is amended by adding a
subdivision to read:


Subd. 16.

Children ages 19 and 20.

Medical assistance may be paid for children
who are 19 to 20 years of age.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 12.

Minnesota Statutes 2012, section 256B.055, is amended by adding a
subdivision to read:


Subd. 17.

Adults who were in foster care at the age of 18.

Medical assistance may
be paid for a person under 26 years of age who was in foster care under the commissioner's
responsibility on the date of attaining 18 years of age, and who was enrolled in medical
assistance under the state plan or a waiver of the plan while in foster care, in accordance
with section 2004 of the Affordable Care Act.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 13.

Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:


Subdivision 1.

Residency.

To be eligible for medical assistance, a person must
reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
in accordance with the rules of the state agency Code of Federal Regulations, title 42,
section 435.403
.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 14.

Minnesota Statutes 2012, section 256B.056, subdivision 1a, is amended to read:


Subd. 1a.

Income and assets generally.

(a)(1) Unless specifically required by
state law or rule or federal law or regulation, the methodologies used in counting income
and assets to determine eligibility for medical assistance for persons whose eligibility
category is based on blindness, disability, or age of 65 or more years, the methodologies
for the supplemental security income program shall be used, except as provided under
subdivision 3, paragraph (a), clause (6).

(2) Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments
made by an obligor in satisfaction of or in addition to a temporary or permanent order
for child support, and Social Security payments are not counted as income. For families
and children, which includes all other eligibility categories, the methodologies under the
state's AFDC plan in effect as of July 16, 1996, as required by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193,
shall be used, except that effective October 1, 2003, the earned income disregards and
deductions are limited to those in subdivision 1c.

(b)(1) The modified adjusted gross income methodology as defined in the Affordable
Care Act shall be used for eligibility categories based on:

(i) children under age 19 and their parents and relative caretakers as defined in
section 256B.055, subdivision 3a;

(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;

(iii) pregnant women as defined in section 256B.055, subdivision 6;

(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057,
subdivision 8; and

(v) adults without children as defined in section 256B.055, subdivision 15.

For these purposes, a "methodology" does not include an asset or income standard,
or accounting method, or method of determining effective dates.

(2) For individuals whose income eligibility is determined using the modified
adjusted gross income methodology in clause (1), the commissioner shall subtract from
the individual's modified adjusted gross income an amount equivalent to five percent
of the federal poverty guidelines.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 15.

Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:


Subd. 1c.

Families with children income methodology.

(a)(1) [Expired, 1Sp2003
c 14 art 12 s 17]

(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 July 1, 2003, 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.

(3) For children ages one through 18 whose eligibility is determined under section
256B.057, subdivision 2
, the following deductions shall be applied to income counted
toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
16, 1996: $90 work expense, dependent care, and child support paid under court order.
This clause is effective October 1, 2003.

(b) For families with children whose eligibility is determined using the standard
specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
earned income shall be disregarded for up to four months and the following deductions
shall be applied to each individual's income counted toward eligibility as allowed under
the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
under court order.

(c) If the four-month disregard in paragraph (b) has been applied to the wage
earner's income for four months, the disregard shall not be applied again until the wage
earner's income has not been considered in determining medical assistance eligibility for
12 consecutive months.

(d) 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 except that the income standards
shall not go below those in effect on July 1, 2009.

(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
organization to or for the benefit of the child with a life-threatening illness must be
disregarded from income.

Sec. 16.

Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:


Subd. 3.

Asset limitations for certain individuals and families.

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

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

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

(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income program;

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

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

(6) when a person enrolled in medical assistance under section 256B.057, subdivision
9
, is age 65 or older and has been enrolled during each of the 24 consecutive months
before the person's 65th birthday, the assets owned by the person and the person's spouse
must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
when determining eligibility for medical assistance under section 256B.055, subdivision
7
. The income of a spouse of a person enrolled in medical assistance under section
256B.057, subdivision 9, during each of the 24 consecutive months before the person's
65th birthday must be disregarded when determining eligibility for medical assistance
under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
is required to have qualified for medical assistance under section 256B.057, subdivision 9,
prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and

(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 17.

Minnesota Statutes 2012, section 256B.056, subdivision 3c, is amended to read:


Subd. 3c.

Asset limitations for families and children.

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

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

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

(3) one motor vehicle is excluded for each person of legal driving age who is
employed or seeking employment;

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

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

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

(7) assets owned by children are not considered; and

(8) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

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

(b) Beginning January 1, 2014, this subdivision applies only to parents and caretaker
relatives who qualify for medical assistance under subdivision 5.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 18.

Minnesota Statutes 2012, section 256B.056, subdivision 4, is amended to read:


Subd. 4.

Income.

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

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

(c) Effective July 1, 2002 January 1, 2014, to be eligible for medical assistance,
families and children under section 256B.055, subdivision 3a, a parent or caretaker
relative
may have an income up to 100 133 percent of the federal poverty guidelines for
the family household size.

(d) To be eligible for medical assistance under section 256B.055, subdivision 15,
a person may have an income up to 75 133 percent of federal poverty guidelines for
the family household size.

(e) In computing income to determine eligibility of persons under paragraphs (a) to
(d) who are not residents of long-term care facilities, the commissioner shall disregard
increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
Veterans aid and attendance benefits and Veterans Administration unusual medical
expense payments are considered income to the recipient
To be eligible for medical
assistance under section 256B.055, subdivision 16, a child may have an income up to 133
percent of the federal poverty guidelines for the household size
.

(f) In computing income to determine eligibility of persons under paragraphs (a) to
(e) who are not residents of long-term care facilities, the commissioner shall disregard
increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
Administration unusual medical expense payments are considered income to the recipient.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 19.

Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:


Subd. 5c.

Excess income standard.

(a) The excess income standard for families
with children
parents and caretaker relatives, pregnant women, infants, and children ages
two through 20
is the standard specified in subdivision 4, paragraph (b).

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
family size. Effective July 1, 2002, the excess income standard for this paragraph
shall
equal 75 percent of the federal poverty guidelines.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 20.

Minnesota Statutes 2012, section 256B.056, is amended by adding a
subdivision to read:


Subd. 7a.

Periodic renewal of eligibility.

(a) The commissioner shall make an
annual redetermination of eligibility based on information contained in the enrollee's case
file and other information available to the agency, including but not limited to information
accessed through an electronic database, without requiring the enrollee to submit any
information when sufficient data is available for the agency to renew eligibility.

(b) If the commissioner cannot renew eligibility in accordance with paragraph (a),
the commissioner must provide the enrollee with a prepopulated renewal form containing
eligibility information available to the agency and permit the enrollee to submit the form
with any corrections or additional information to the agency and sign the renewal form via
any of the modes of submission specified in section 256B.04, subdivision 18.

(c) An enrollee who is terminated for failure to complete the renewal process may
subsequently submit the renewal form and required information within four months after
the date of termination and have coverage reinstated without a lapse, if otherwise eligible
under this chapter.

(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
required to renew eligibility every six months.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 21.

Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:


Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10
, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.

(d) The commissioner shall utilize information obtained through the electronic
service established by the secretary of the United States Department of Health and Human
Services and other available electronic data sources in Code of Federal Regulations, title
42, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
shall establish standards to define when information obtained electronically is reasonably
compatible with information provided by applicants and enrollees, including use of
self-attestation, to accomplish real-time eligibility determinations and maintain program
integrity.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 22.

Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:


Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year
two years of age or 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 the
individual's
countable family household income is equal to or less than 275 percent of the
federal poverty guideline for the same family household size or an equivalent standard
when converted using modified adjusted gross income methodology as required under
the Affordable Care Act
. 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.

(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.

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

(d) (b) An infant born 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.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 23.

Minnesota Statutes 2012, section 256B.057, subdivision 8, is amended to read:


Subd. 8.

Children under age two.

Medical assistance may be paid for a child under
two years of age whose countable family income is above 275 percent of the federal poverty
guidelines for the same size family but less than or equal to 280 percent of the federal
poverty guidelines for the same size family or an equivalent standard when converted using
modified adjusted gross income methodology as required under the Affordable Care Act
.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 24.

Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:


Subd. 10.

Certain persons needing treatment for breast or cervical cancer.

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

(1) has been screened for breast or cervical cancer by the Minnesota breast and
cervical cancer control program, and program funds have been used to pay for the person's
screening;

(2) according to the person's treating health professional, needs treatment, including
diagnostic services necessary to determine the extent and proper course of treatment, for
breast or cervical cancer, including precancerous conditions and early stage cancer;

(3) meets the income eligibility guidelines for the Minnesota breast and cervical
cancer control program;

(4) is under age 65;

(5) is not otherwise eligible for medical assistance under United States Code, title
42, section 1396a(a)(10)(A)(i); and

(6) is not otherwise covered under creditable coverage, as defined under United
States Code, title 42, section 1396a(aa).

(b) Medical assistance provided for an eligible person under this subdivision shall
be limited to services provided during the period that the person receives treatment for
breast or cervical cancer.

(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
without meeting the eligibility criteria relating to income and assets in section 256B.056,
subdivisions 1a to 5b 5a.

Sec. 25.

Minnesota Statutes 2012, section 256B.057, is amended by adding a
subdivision to read:


Subd. 12.

Presumptive eligibility determinations made by qualified hospitals.

The commissioner shall establish a process to qualify hospitals that are participating
providers under the medical assistance program to determine presumptive eligibility for
medical assistance for applicants who may have a basis of eligibility using the modified
adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
paragraph (b), clause (1).

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 26.

Minnesota Statutes 2012, section 256B.059, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For purposes of this section and sections 256B.058
and 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 the first continuous period of 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, 256B.092, or 256B.49 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, 256B.092, 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.

(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
section 256B.0913, 256B.0915,
256B.092, or 256B.49
. 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:

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

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

(3) the services are paid by the EW program under section 256B.0915 or the AC
program under section
256B.0913 , 256B.0915, 256B.092, or 256B.49 or would qualify
for payment under the EW or AC programs those sections 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

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

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 27.

Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:


Subd. 4.

Citizenship requirements.

(a) Eligibility for medical assistance is limited
to citizens of the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States. Citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or
nationality according to the requirements of the federal Deficit Reduction Act of 2005,
Public Law 109-171.

(b) "Qualified noncitizen" means a person who meets one of the following
immigration criteria:

(1) admitted for lawful permanent residence according to United States Code, title 8;

(2) admitted to the United States as a refugee according to United States Code,
title 8, section 1157;

(3) granted asylum according to United States Code, title 8, section 1158;

(4) granted withholding of deportation according to United States Code, title 8,
section 1253(h);

(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);

(6) granted conditional entrant status according to United States Code, title 8,
section 1153(a)(7);

(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;

(8) is a child of a noncitizen determined to be a battered noncitizen by the United
States Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
Public Law 104-200; or

(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.

(c) All qualified noncitizens who were residing in the United States before August
22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation.

(d) Beginning December 1, 1996, qualified noncitizens who entered the United
States on or after August 22, 1996, and who otherwise meet the eligibility requirements
of this chapter are eligible for medical assistance with federal participation for five years
if they meet one of the following criteria:

(1) refugees admitted to the United States according to United States Code, title 8,
section 1157;

(2) persons granted asylum according to United States Code, title 8, section 1158;

(3) persons granted withholding of deportation according to United States Code,
title 8, section 1253(h);

(4) veterans of the United States armed forces with an honorable discharge for
a reason other than noncitizen status, their spouses and unmarried minor dependent
children; or

(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.

Beginning July 1, 2010, children and pregnant women who are noncitizens
described in paragraph (b) or who are lawfully present in the United States as defined
in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
eligibility requirements of this chapter, are eligible for medical assistance with federal
financial participation as provided by the federal Children's Health Insurance Program
Reauthorization Act of 2009, Public Law 111-3.

(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
Code, title 8, section 1101(a)(15).

(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of
this chapter, if such care and services are necessary for the treatment of an emergency
medical condition.

(g) For purposes of this subdivision, the term "emergency medical condition" means
a medical condition that meets the requirements of United States Code, title 42, section
1396b(v).

(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
of an emergency medical condition are limited to the following:

(i) services delivered in an emergency room or by an ambulance service licensed
under chapter 144E that are directly related to the treatment of an emergency medical
condition;

(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and

(iii) follow-up services that are directly related to the original service provided
to treat the emergency medical condition and are covered by the global payment made
to the provider.

(2) Services for the treatment of emergency medical conditions do not include:

(i) services delivered in an emergency room or inpatient setting to treat a
nonemergency condition;

(ii) organ transplants, stem cell transplants, and related care;

(iii) services for routine prenatal care;

(iv) continuing care, including long-term care, nursing facility services, home health
care, adult day care, day training, or supportive living services;

(v) elective surgery;

(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
part of an emergency room visit;

(vii) preventative health care and family planning services;

(viii) dialysis;

(ix) chemotherapy or therapeutic radiation services;

(x) rehabilitation services;

(xi) physical, occupational, or speech therapy;

(xii) transportation services;

(xiii) case management;

(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;

(xv) dental services;

(xvi) hospice care;

(xvii) audiology services and hearing aids;

(xviii) podiatry services;

(xix) chiropractic services;

(xx) immunizations;

(xxi) vision services and eyeglasses;

(xxii) waiver services;

(xxiii) individualized education programs; or

(xxiv) chemical dependency treatment.

(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
nonimmigrants, or lawfully present in the United States as defined in Code of Federal
Regulations, title 8, section 103.12,
ineligible for federally funded medical assistance
are not covered by a group health plan or health insurance coverage according to Code
of Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility
requirements of this chapter, are eligible for medical assistance through the period of
pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal
funds are available under title XXI of the Social Security Act, and the state children's
health insurance program.

(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
services from a nonprofit center established to serve victims of torture and are otherwise
ineligible for medical assistance under this chapter are eligible for medical assistance
without federal financial participation. These individuals are eligible only for the period
during which they are receiving services from the center. Individuals eligible under this
paragraph shall not be required to participate in prepaid medical assistance.

(k) Noncitizens who are lawfully present in the United States as defined in Code
of Federal Regulations, title 8, section 103.12, who are not children or pregnant women
as defined in paragraph (d), and who otherwise meet the eligibility requirements of this
chapter, are eligible for medical assistance without federal financial participation. These
individuals must cooperate with the United States Citizenship and Immigration Services to
pursue any applicable immigration status, including citizenship, that would qualify them
for medical assistance with federal financial participation.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 28. REPEALER.

Subdivision 1.

Repeal; certain health care provisions.

Minnesota Statutes 2012,
sections 256B.055, subdivisions 3, 5, and 10b; 256B.056, subdivision 5b; and 256B.057,
subdivisions 1c and 2,
are repealed.

Subd. 2.

Repeal of MinnesotaCare.

Minnesota Statutes 2012, sections 256L.01,
subdivisions 1, 1a, 2, 3, 3a, 4a, and 5; 256L.02, subdivisions 1, 2, and 3; 256L.03,
subdivisions 1, 1a, 1b, 2, 3, 3a, 3b, 4, 5, and 6; 256L.031; 256L.04, subdivisions 1, 1a,
1b, 2, 2a, 7, 7a, 7b, 8, 9, 10, 10a, 12, and 13; 256L.05; 256L.06, subdivision 3; 256L.07,
subdivisions 1, 2, 3, 4, 5, 8, and 9; 256L.09, subdivisions 1, 2, 4, 5, 6, and 7; 256L.10;
256L.11; 256L.12; 256L.15, subdivisions 1, 1a, 1b, and 2; 256L.17, subdivisions 1, 2,
3, 4, and 5; 256L.18; 256L.22; 256L.24; 256L.26; and 256L.28,
are repealed effective
January 1, 2014.

ARTICLE 2

REFORM 2020; REDESIGNING HOME AND COMMUNITY-BASED SERVICES

Section 1.

Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:


Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 3.0, and subsequent updates when issued by the
Centers for Medicare and Medicaid Services. The commissioner of health may substitute
successor manuals or question and answer documents published by the United States
Department of Health and Human Services, Centers for Medicare and Medicaid Services,
to replace or supplement the current version of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment must be completed by day 14 following admission;

(2) an annual assessment which must have an assessment reference date (ARD)
within 366 days of the ARD of the last comprehensive assessment;

(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and

(4) all quarterly assessments must have an assessment reference date (ARD) within
92 days of the ARD of the previous assessment.

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
county, tribe, or managed care organization under contract with the Department of Human
Services
256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
or other organization under contract with the Minnesota Board on Aging
; and

(2) a nursing facility level of care determination as provided for under section
256B.0911, subdivision 4e, as part of
a face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2012, section 144A.351, is amended to read:


144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
REPORT AND STUDY REQUIRED.

Subdivision 1.

Report requirements.

The commissioners of health and human
services, with the cooperation of counties and in consultation with stakeholders, including
persons who need or are using long-term care services and supports, lead agencies,
regional entities, senior, disability, and mental health organization representatives, service
providers, and community members shall prepare a report to the legislature by August 15,
2013, and biennially thereafter, regarding the status of the full range of long-term care
services and supports for the elderly and children and adults with disabilities and mental
illnesses in Minnesota. The report shall address:

(1) demographics and need for long-term care services and supports in Minnesota;

(2) summary of county and regional reports on long-term care gaps, surpluses,
imbalances, and corrective action plans;

(3) status of long-term care services and related mental health services, housing
options, and supports by county and region including:

(i) changes in availability of the range of long-term care services and housing options;

(ii) access problems, including access to the least restrictive and most integrated
services and settings, regarding long-term care services; and

(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and

(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.

Subd. 2.

Critical access study.

The commissioner shall conduct a onetime study
to assess local capacity and availability of home and community-based services for
older adults and people with disabilities. The study must assess critical access at the
community level and identify potential strategies to build home and community-based
service capacity in critical access areas.

Sec. 3.

Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:


Subd. 4a.

City, county, and state social workers.

(a) Beginning July 1, 2016, the
licensure of city, county, and state agency social workers is voluntary, except an individual
who is newly employed by a city or state agency after July 1, 2016, must be licensed
if the individual who provides social work services, as those services are defined in
section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
incorporating the words "social work" or "social worker."

(b) City, county, and state agencies employing social workers and staff who are
designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
256.01, subdivision 24,
are not required to employ licensed social workers.

Sec. 4.

Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:


Subd. 2.

Specific powers.

Subject to the provisions of section 241.021, subdivision
2
, the commissioner of human services shall carry out the specific duties in paragraphs (a)
through (cc) (dd):

(a) Administer and supervise all forms of public assistance provided for by state law
and other welfare activities or services as are vested in the commissioner. Administration
and supervision of human services activities or services includes, but is not limited to,
assuring timely and accurate distribution of benefits, completeness of service, and quality
program management. In addition to administering and supervising human services
activities vested by law in the department, the commissioner shall have the authority to:

(1) require county agency participation in training and technical assistance programs
to promote compliance with statutes, rules, federal laws, regulations, and policies
governing human services;

(2) monitor, on an ongoing basis, the performance of county agencies in the
operation and administration of human services, enforce compliance with statutes, rules,
federal laws, regulations, and policies governing welfare services and promote excellence
of administration and program operation;

(3) develop a quality control program or other monitoring program to review county
performance and accuracy of benefit determinations;

(4) require county agencies to make an adjustment to the public assistance benefits
issued to any individual consistent with federal law and regulation and state law and rule
and to issue or recover benefits as appropriate;

(5) delay or deny payment of all or part of the state and federal share of benefits and
administrative reimbursement according to the procedures set forth in section 256.017;

(6) make contracts with and grants to public and private agencies and organizations,
both profit and nonprofit, and individuals, using appropriated funds; and

(7) enter into contractual agreements with federally recognized Indian tribes with
a reservation in Minnesota to the extent necessary for the tribe to operate a federally
approved family assistance program or any other program under the supervision of the
commissioner. The commissioner shall consult with the affected county or counties in
the contractual agreement negotiations, if the county or counties wish to be included,
in order to avoid the duplication of county and tribal assistance program services. The
commissioner may establish necessary accounts for the purposes of receiving and
disbursing funds as necessary for the operation of the programs.

(b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
regulation, and policy necessary to county agency administration of the programs.

(c) Administer and supervise all child welfare activities; promote the enforcement of
laws protecting disabled, dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the times of the conception
nor at the births of the children; license and supervise child-caring and child-placing
agencies and institutions; supervise the care of children in boarding and foster homes or
in private institutions; and generally perform all functions relating to the field of child
welfare now vested in the State Board of Control.

(d) Administer and supervise all noninstitutional service to disabled persons,
including those who are visually impaired, hearing impaired, or physically impaired
or otherwise disabled. The commissioner may provide and contract for the care and
treatment of qualified indigent children in facilities other than those located and available
at state hospitals when it is not feasible to provide the service in state hospitals.

(e) Assist and actively cooperate with other departments, agencies and institutions,
local, state, and federal, by performing services in conformity with the purposes of Laws
1939, chapter 431.

(f) Act as the agent of and cooperate with the federal government in matters of
mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
431, including the administration of any federal funds granted to the state to aid in the
performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
and including the promulgation of rules making uniformly available medical care benefits
to all recipients of public assistance, at such times as the federal government increases its
participation in assistance expenditures for medical care to recipients of public assistance,
the cost thereof to be borne in the same proportion as are grants of aid to said recipients.

(g) Establish and maintain any administrative units reasonably necessary for the
performance of administrative functions common to all divisions of the department.

(h) Act as designated guardian of both the estate and the person of all the wards of
the state of Minnesota, whether by operation of law or by an order of court, without any
further act or proceeding whatever, except as to persons committed as developmentally
disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
recognized by the Secretary of the Interior whose interests would be best served by
adoptive placement, the commissioner may contract with a licensed child-placing agency
or a Minnesota tribal social services agency to provide adoption services. A contract
with a licensed child-placing agency must be designed to supplement existing county
efforts and may not replace existing county programs or tribal social services, unless the
replacement is agreed to by the county board and the appropriate exclusive bargaining
representative, tribal governing body, or the commissioner has evidence that child
placements of the county continue to be substantially below that of other counties. Funds
encumbered and obligated under an agreement for a specific child shall remain available
until the terms of the agreement are fulfilled or the agreement is terminated.

(i) Act as coordinating referral and informational center on requests for service for
newly arrived immigrants coming to Minnesota.

(j) The specific enumeration of powers and duties as hereinabove set forth shall in no
way be construed to be a limitation upon the general transfer of powers herein contained.

(k) Establish county, regional, or statewide schedules of maximum fees and charges
which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
nursing home care and medicine and medical supplies under all programs of medical
care provided by the state and for congregate living care under the income maintenance
programs.

(l) Have the authority to conduct and administer experimental projects to test methods
and procedures of administering assistance and services to recipients or potential recipients
of public welfare. To carry out such experimental projects, it is further provided that the
commissioner of human services is authorized to waive the enforcement of existing specific
statutory program requirements, rules, and standards in one or more counties. The order
establishing the waiver shall provide alternative methods and procedures of administration,
shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
in no event shall the duration of a project exceed four years. It is further provided that no
order establishing an experimental project as authorized by the provisions of this section
shall become effective until the following conditions have been met:

(1) the secretary of health and human services of the United States has agreed, for
the same project, to waive state plan requirements relative to statewide uniformity; and

(2) a comprehensive plan, including estimated project costs, shall be approved by
the Legislative Advisory Commission and filed with the commissioner of administration.

(m) According to federal requirements, establish procedures to be followed by
local welfare boards in creating citizen advisory committees, including procedures for
selection of committee members.

(n) Allocate federal fiscal disallowances or sanctions which are based on quality
control error rates for the aid to families with dependent children program formerly
codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
following manner:

(1) one-half of the total amount of the disallowance shall be borne by the county
boards responsible for administering the programs. For the medical assistance and the
AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
shared by each county board in the same proportion as that county's expenditures for the
sanctioned program are to the total of all counties' expenditures for the AFDC program
formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
food stamp program, sanctions shall be shared by each county board, with 50 percent of
the sanction being distributed to each county in the same proportion as that county's
administrative costs for food stamps are to the total of all food stamp administrative costs
for all counties, and 50 percent of the sanctions being distributed to each county in the
same proportion as that county's value of food stamp benefits issued are to the total of
all benefits issued for all counties. Each county shall pay its share of the disallowance
to the state of Minnesota. When a county fails to pay the amount due hereunder, the
commissioner may deduct the amount from reimbursement otherwise due the county, or
the attorney general, upon the request of the commissioner, may institute civil action
to recover the amount due; and

(2) notwithstanding the provisions of clause (1), if the disallowance results from
knowing noncompliance by one or more counties with a specific program instruction, and
that knowing noncompliance is a matter of official county board record, the commissioner
may require payment or recover from the county or counties, in the manner prescribed in
clause (1), an amount equal to the portion of the total disallowance which resulted from the
noncompliance, and may distribute the balance of the disallowance according to clause (1).

(o) Develop and implement special projects that maximize reimbursements and
result in the recovery of money to the state. For the purpose of recovering state money,
the commissioner may enter into contracts with third parties. Any recoveries that result
from projects or contracts entered into under this paragraph shall be deposited in the
state treasury and credited to a special account until the balance in the account reaches
$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
transferred and credited to the general fund. All money in the account is appropriated to
the commissioner for the purposes of this paragraph.

(p) Have the authority to make direct payments to facilities providing shelter
to women and their children according to section 256D.05, subdivision 3. Upon
the written request of a shelter facility that has been denied payments under section
256D.05, subdivision 3, the commissioner shall review all relevant evidence and make
a determination within 30 days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days shall be considered a
determination not to issue direct payments.

(q) Have the authority to establish and enforce the following county reporting
requirements:

(1) the commissioner shall establish fiscal and statistical reporting requirements
necessary to account for the expenditure of funds allocated to counties for human
services programs. When establishing financial and statistical reporting requirements, the
commissioner shall evaluate all reports, in consultation with the counties, to determine if
the reports can be simplified or the number of reports can be reduced;

(2) the county board shall submit monthly or quarterly reports to the department
as required by the commissioner. Monthly reports are due no later than 15 working days
after the end of the month. Quarterly reports are due no later than 30 calendar days after
the end of the quarter, unless the commissioner determines that the deadline must be
shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
or risking a loss of federal funding. Only reports that are complete, legible, and in the
required format shall be accepted by the commissioner;

(3) if the required reports are not received by the deadlines established in clause (2),
the commissioner may delay payments and withhold funds from the county board until
the next reporting period. When the report is needed to account for the use of federal
funds and the late report results in a reduction in federal funding, the commissioner shall
withhold from the county boards with late reports an amount equal to the reduction in
federal funding until full federal funding is received;

(4) a county board that submits reports that are late, illegible, incomplete, or not
in the required format for two out of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant, the commissioner
shall notify the county board of the reason the county board is considered noncompliant
and request that the county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective action plan must be submitted
to the commissioner within 45 days after the date the county board received notice
of noncompliance;

(5) the final deadline for fiscal reports or amendments to fiscal reports is one year
after the date the report was originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding associated with the report for
that reporting period and the county board must repay any funds associated with the
report received for that reporting period;

(6) the commissioner may not delay payments, withhold funds, or require repayment
under clause (3) or (5) if the county demonstrates that the commissioner failed to
provide appropriate forms, guidelines, and technical assistance to enable the county to
comply with the requirements. If the county board disagrees with an action taken by the
commissioner under clause (3) or (5), the county board may appeal the action according
to sections 14.57 to 14.69; and

(7) counties subject to withholding of funds under clause (3) or forfeiture or
repayment of funds under clause (5) shall not reduce or withhold benefits or services to
clients to cover costs incurred due to actions taken by the commissioner under clause
(3) or (5).

(r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
federal fiscal disallowances or sanctions are based on a statewide random sample in direct
proportion to each county's claim for that period.

(s) Be responsible for ensuring the detection, prevention, investigation, and
resolution of fraudulent activities or behavior by applicants, recipients, and other
participants in the human services programs administered by the department.

(t) Require county agencies to identify overpayments, establish claims, and utilize
all available and cost-beneficial methodologies to collect and recover these overpayments
in the human services programs administered by the department.

(u) Have the authority to administer a drug rebate program for drugs purchased
pursuant to the prescription drug program established under section 256.955 after the
beneficiary's satisfaction of any deductible established in the program. The commissioner
shall require a rebate agreement from all manufacturers of covered drugs as defined in
section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
or after July 1, 2002, must include rebates for individuals covered under the prescription
drug program who are under 65 years of age. For each drug, the amount of the rebate shall
be equal to the rebate as defined for purposes of the federal rebate program in United
States Code, title 42, section 1396r-8. The manufacturers must provide full payment
within 30 days of receipt of the state invoice for the rebate within the terms and conditions
used for the federal rebate program established pursuant to section 1927 of title XIX of
the Social Security Act. The manufacturers must provide the commissioner with any
information necessary to verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate program established pursuant to
section 1927 of title XIX of the Social Security Act.

(v) Have the authority to administer the federal drug rebate program for drugs
purchased under the medical assistance program as allowed by section 1927 of title XIX
of the Social Security Act and according to the terms and conditions of section 1927.
Rebates shall be collected for all drugs that have been dispensed or administered in an
outpatient setting and that are from manufacturers who have signed a rebate agreement
with the United States Department of Health and Human Services.

(w) Have the authority to administer a supplemental drug rebate program for drugs
purchased under the medical assistance program. The commissioner may enter into
supplemental rebate contracts with pharmaceutical manufacturers and may require prior
authorization for drugs that are from manufacturers that have not signed a supplemental
rebate contract. Prior authorization of drugs shall be subject to the provisions of section
256B.0625, subdivision 13.

(x) Operate the department's communication systems account established in Laws
1993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
communication costs necessary for the operation of the programs the commissioner
supervises. A communications account may also be established for each regional
treatment center which operates communications systems. Each account must be used
to manage shared communication costs necessary for the operations of the programs the
commissioner supervises. The commissioner may distribute the costs of operating and
maintaining communication systems to participants in a manner that reflects actual usage.
Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
other costs as determined by the commissioner. Nonprofit organizations and state, county,
and local government agencies involved in the operation of programs the commissioner
supervises may participate in the use of the department's communications technology and
share in the cost of operation. The commissioner may accept on behalf of the state any
gift, bequest, devise or personal property of any kind, or money tendered to the state for
any lawful purpose pertaining to the communication activities of the department. Any
money received for this purpose must be deposited in the department's communication
systems accounts. Money collected by the commissioner for the use of communication
systems must be deposited in the state communication systems account and is appropriated
to the commissioner for purposes of this section.

(y) Receive any federal matching money that is made available through the medical
assistance program for the consumer satisfaction survey. Any federal money received for
the survey is appropriated to the commissioner for this purpose. The commissioner may
expend the federal money received for the consumer satisfaction survey in either year of
the biennium.

(z) Designate community information and referral call centers and incorporate
cost reimbursement claims from the designated community information and referral
call centers into the federal cost reimbursement claiming processes of the department
according to federal law, rule, and regulations. Existing information and referral centers
provided by Greater Twin Cities United Way or existing call centers for which Greater
Twin Cities United Way has legal authority to represent, shall be included in these
designations upon review by the commissioner and assurance that these services are
accredited and in compliance with national standards. Any reimbursement is appropriated
to the commissioner and all designated information and referral centers shall receive
payments according to normal department schedules established by the commissioner
upon final approval of allocation methodologies from the United States Department of
Health and Human Services Division of Cost Allocation or other appropriate authorities.

(aa) Develop recommended standards for foster care homes that address the
components of specialized therapeutic services to be provided by foster care homes with
those services.

(bb) Authorize the method of payment to or from the department as part of the
human services programs administered by the department. This authorization includes the
receipt or disbursement of funds held by the department in a fiduciary capacity as part of
the human services programs administered by the department.

(cc) Have the authority to administer a drug rebate program for drugs purchased for
persons eligible for general assistance medical care under section 256D.03, subdivision 3.
For manufacturers that agree to participate in the general assistance medical care rebate
program, the commissioner shall enter into a rebate agreement for covered drugs as
defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
United States Code, title 42, section 1396r-8. The manufacturers must provide payment
within the terms and conditions used for the federal rebate program established under
section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
the terms and conditions used for the federal rebate program established under section
1927 of title XIX of the Social Security Act.

Effective January 1, 2006, drug coverage under general assistance medical care shall
be limited to those prescription drugs that:

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

(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with such agreements.
Prescription drug coverage under general assistance medical care shall conform to
coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g
.

The rebate revenues collected under the drug rebate program are deposited in the
general fund.

(dd) Designate the agencies that operate the Senior LinkAge Line under section
256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
of Minnesota Aging and the Disability Resource Centers under United States Code, title
42, section 3001, the Older Americans Act Amendments of 2006 and incorporate cost
reimbursement claims from the designated centers into the federal cost reimbursement
claiming processes of the department according to federal law, rule, and regulations. Any
reimbursement must be appropriated to the commissioner and all Aging and Disability
Resource Center designated agencies shall receive payments of grant funding that supports
the activity and generates the federal financial participation according to Board on Aging
administrative granting mechanisms.

Sec. 5.

Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:


Subd. 24.

Disability Linkage Line.

The commissioner shall establish the Disability
Linkage Line, to who shall serve people with disabilities as the designated Aging and
Disability Resource Center under United States Code, title 42, section 3001, the Older
Americans Act Amendments of 2006 in partnership with the Senior LinkAge Line and
shall
serve as Minnesota's neutral access point for statewide disability information and
assistance and must be available during business hours through a statewide toll-free
number and the internet
. The Disability Linkage Line shall:

(1) deliver information and assistance based on national and state standards;

(2) provide information about state and federal eligibility requirements, benefits,
and service options;

(3) provide benefits and options counseling;

(4) make referrals to appropriate support entities;

(5) educate people on their options so they can make well-informed choices and link
them to quality profiles
;

(6) help support the timely resolution of service access and benefit issues;

(7) inform people of their long-term community services and supports;

(8) provide necessary resources and supports that can lead to employment and
increased economic stability of people with disabilities; and

(9) serve as the technical assistance and help center for the Web-based tool,
Minnesota's Disability Benefits 101.org. ; and

(10) provide preadmission screening for individuals under 60 years of age who are
admitted to a nursing facility from a hospital using the procedures as defined in section
256.975, subdivisions 7a to 7c, and 256B.0911, subdivision 4d.

Sec. 6.

Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:


Subd. 7.

Consumer information and assistance and long-term care options
counseling; Senior LinkAge Line.

(a) The Minnesota Board on Aging shall operate a
statewide service to aid older Minnesotans and their families in making informed choices
about long-term care options and health care benefits. Language services to persons
with limited English language skills may be made available. The service, known as
Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
Resource Center under United States Code, title 42, section 3001, the Older Americans
Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
256.01, subdivision 24, and
must be available during business hours through a statewide
toll-free number and must also be available through the Internet. The Minnesota Board
on Aging shall consult with, and when appropriate work through, the area agencies on
aging to provide and maintain the telephony infrastructure and related support for the
Aging and Disability Resource Center partners which agree by memorandum to access
the infrastructure, including the designated providers of the Senior LinkAge Line and the
Disability Linkage Line.

(b) The service must provide long-term care options counseling by assisting older
adults, caregivers, and providers in accessing information and options counseling about
choices in long-term care services that are purchased through private providers or available
through public options. The service must:

(1) develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;

(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;

(3) link callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;

(4) develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;

(5) conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;

(6) implement a messaging system for overflow callers and respond to these callers
by the next business day;

(7) link callers with county human services and other providers to receive more
in-depth assistance and consultation related to long-term care options;

(8) link callers with quality profiles for nursing facilities and other home and
community-based services
providers developed by the commissioner commissioners of
health and human services;

(9) incorporate information about the availability of housing options, as well as
registered housing with services and consumer rights within the MinnesotaHelp.info
network long-term care database to facilitate consumer comparison of services and costs
among housing with services establishments and with other in-home services and to
support financial self-sufficiency as long as possible. Housing with services establishments
and their arranged home care providers shall provide information that will facilitate price
comparisons, including delineation of charges for rent and for services available. The
commissioners of health and human services shall align the data elements required by
section 144G.06, the Uniform Consumer Information Guide, and this section to provide
consumers standardized information and ease of comparison of long-term care options.
The commissioner of human services shall provide the data to the Minnesota Board on
Aging for inclusion in the MinnesotaHelp.info network long-term care database;

(10) provide long-term care options counseling. Long-term care options counselors
shall:

(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;

(ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;

(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and

(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs;

(11) using risk management and support planning protocols, provide long-term care
options counseling to current residents of nursing homes deemed appropriate for discharge
by the commissioner and older adults who request service after consultation with the
Senior LinkAge Line under clause (12)
. In order to meet this requirement, The Senior
LinkAge Line shall also receive referrals from the residents or staff of nursing homes. The
Senior LinkAge Line shall identify and contact residents deemed appropriate for discharge
by developing targeting criteria in consultation with
the commissioner who shall provide
designated Senior LinkAge Line contact centers with a list of nursing home residents that
meet the criteria as being
appropriate for discharge planning via a secure Web portal.
Senior LinkAge Line shall provide these residents, if they indicate a preference to
receive long-term care options counseling, with initial assessment, review of risk factors,
independent living support consultation, or
and, if appropriate, a referral to:

(i) long-term care consultation services under section 256B.0911;

(ii) designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or

(iii) the long-term care consultation team for those who are appropriate eligible
for relocation service coordination due to high-risk factors or psychological or physical
disability; and

(12) develop referral protocols and processes that will assist certified health care
homes and hospitals to identify at-risk older adults and determine when to refer these
individuals to the Senior LinkAge Line for long-term care options counseling under this
section. The commissioner is directed to work with the commissioner of health to develop
protocols that would comply with the health care home designation criteria and protocols
available at the time of hospital discharge. The commissioner shall keep a record of the
number of people who choose long-term care options counseling as a result of this section.

Sec. 7.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7a.

Preadmission screening activities related to nursing facility
admissions.

(a) All individuals seeking admission to Medicaid certified nursing facilities,
including certified boarding care facilities, must be screened prior to admission regardless
of income, assets, or funding sources for nursing facility care, except as described in
subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
need for nursing facility level of care as described in section 256B.0911, subdivision
4e, and to complete activities required under federal law related to mental illness and
developmental disability as outlined in paragraph (b).

(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
the need for further evaluation and specialized services, unless the admission prior to
screening is authorized by the local mental health authority or the local developmental
disabilities case manager, or unless authorized by the county agency according to Public
Law 101-508.

(c) The following criteria apply to the preadmission screening:

(1) requests for preadmission screenings must be submitted via an online form
developed by the commissioner;

(2) the Senior LinkAge Line must use forms and criteria developed by the
commissioner to identify persons who require referral for further evaluation and
determination of the need for specialized services; and

(3) the evaluation and determination of the need for specialized services must be
done by:

(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or

(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.

(d) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440(a)(1).

(e) In assessing a person's needs, the screener shall:

(1) use an automated system designated by the commissioner;

(2) consult with care transitions coordinators or physician; and

(3) consider the assessment of the individual's physician.

Other personnel may be included in the level of care determination as deemed
necessary by the screener.

Sec. 8.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7b.

Exemptions and emergency admissions.

(a) Exemptions from the federal
screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:

(1) a person who, having entered an acute care facility from a certified nursing
facility, is returning to a certified nursing facility; or

(2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota.

(b) Persons who are exempt from preadmission screening for purposes of level of
care determination include:

(1) persons described in paragraph (a);

(2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the Veterans' Administration;

(3) an individual enrolled in a demonstration project under section 256B.69,
subdivision 8, at the time of application to a nursing facility; and

(4) an individual currently being served under the alternative care program or under
a home and community-based services waiver authorized under section 1915(c) of the
federal Social Security Act.

(c) Persons admitted to a Medicaid-certified nursing facility from the community
on an emergency basis as described in paragraph (d) or from an acute care facility on a
nonworking day must be screened the first working day after admission.

(d) Emergency admission to a nursing facility prior to screening is permitted when
all of the following conditions are met:

(1) a person is admitted from the community to a certified nursing or certified
boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
older and Disability Linkage Line nonworking hours for under age 60;

(2) a physician has determined that delaying admission until preadmission screening
is completed would adversely affect the person's health and safety;

(3) there is a recent precipitating event that precludes the client from living safely in
the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
inability to continue to provide care;

(4) the attending physician has authorized the emergency placement and has
documented the reason that the emergency placement is recommended; and

(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
working day following the emergency admission.

Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care and from whom admission is being
sought on a nonworking day.

(e) A nursing facility must provide written information to all persons admitted
regarding the person's right to request and receive long-term care consultation services as
defined in section 256B.0911, subdivision 1a. The information must be provided prior to
the person's discharge from the facility and in a format specified by the commissioner.

Sec. 9.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7c.

Screening requirements.

(a) A person may be screened for nursing
facility admission by telephone or in a face-to-face screening interview. The Senior
LinkAge Line shall identify each individual's needs using the following categories:

(1) the person needs no face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services to
determine the need for nursing facility level of care based on information obtained from
other health care professionals;

(2) the person needs an immediate face-to-face long-term care consultation
assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
tribe, or managed care organization under contract with the Department of Human
Services to determine the need for nursing facility level of care and complete activities
required under subdivision 7a; or

(3) the person may be exempt from screening requirements as outlined in subdivision
7b, but will need transitional assistance after admission or in-person follow-along after
a return home.

(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
with only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission as described in
section 256B.0911, subdivision 4d, paragraph (c).

(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
facility must be screened prior to admission.

(d) Screenings provided by the Senior LinkAge Line must include processes
to identify persons who may require transition assistance described in subdivision 7,
paragraph (b), clause (12), and section 256B.0911, subdivision 3b.

Sec. 10.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7d.

Payment for preadmission screening.

Funding for preadmission
screening shall be provided to the Minnesota Board on Aging for the population 60
years of age and older by the Department of Human Services to cover screener salaries
and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
Board on Aging shall employ, or contract with other agencies to employ, within the limits
of available funding, sufficient personnel to provide preadmission screening and level of
care determination services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (dd).

Sec. 11.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:


Subd. 3a.

Priority for other grants.

The commissioner of health shall give
priority to a grantee selected under subdivision 3 when awarding technology-related
grants, if the grantee is using technology as a part of a proposal. The commissioner
of transportation shall give priority to a grantee selected under subdivision 3 when
distributing transportation-related funds to create transportation options for older adults.

Sec. 12.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:


Subd. 3b.

State waivers.

The commissioner of health may waive applicable state
laws and rules on a time-limited basis if the commissioner of health determines that a
participating grantee requires a waiver in order to achieve demonstration project goals.

Sec. 13.

Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:


Subd. 5.

Grant preference.

The commissioner of human services shall give
preference when awarding grants under this section to areas where nursing facility
closures have occurred or are occurring or areas with service needs identified by section
144A.351
. The commissioner may award grants to the extent grant funds are available
and to the extent applications are approved by the commissioner. Denial of approval of an
application in one year does not preclude submission of an application in a subsequent
year. The maximum grant amount is limited to $750,000.

Sec. 14.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 4a.

Evaluation.

The commissioner shall evaluate the projects contained in
subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:

(1) an impact assessment focusing on program outcomes, especially those
experienced directly by the person receiving services;

(2) study samples drawn from the population of interest for each project; and

(3) a time series analysis to examine aggregate trends in average monthly
utilization, expenditures, and other outcomes in the targeted populations before and after
implementation of the initiatives.

Sec. 15.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 6.

Work, empower, and encourage independence.

As provided under
subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
demonstration project to provide navigation, employment supports, and benefits planning
services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
This demonstration shall promote economic stability, increase independence, and reduce
applications for disability benefits while providing a positive impact on the health and
future of participants.

Sec. 16.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 7.

Housing stabilization.

As provided under subdivision 4, paragraph (e),
upon federal approval, the commissioner shall establish a demonstration project to provide
service coordination, outreach, in-reach, tenancy support, and community living assistance
to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
demonstration shall promote housing stability, reduce costly medical interventions, and
increase opportunities for independent community living.

Sec. 17.

Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:


Subdivision 1.

Purpose and goal.

(a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making care
decisions and selecting support and service options that meet their needs and reflect
their preferences. The availability of, and access to, information and other types of
assistance, including assessment and support planning, is also intended to prevent or delay
institutional placements and to provide access to transition assistance after admission.
Further, the goal of these services is to contain costs associated with unnecessary
institutional admissions. Long-term consultation services must be available to any person
regardless of public program eligibility. The commissioner of human services shall seek
to maximize use of available federal and state funds and establish the broadest program
possible within the funding available.

(b) These services must be coordinated with long-term care options counseling
provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
section 256.01, subdivision 24. The lead agency providing long-term care consultation
services shall encourage the use of volunteers from families, religious organizations, social
clubs, and similar civic and service organizations to provide community-based services.

Sec. 18.

Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
read:


Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) Until additional requirements apply under paragraph (b), "long-term care
consultation services" means:

(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;

(2) providing recommendations for and referrals to cost-effective community
services that are available to the individual;

(3) development of an individual's person-centered community support plan;

(4) providing information regarding eligibility for Minnesota health care programs;

(5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;

(6) federally mandated preadmission screening activities described under
subdivisions 4a and 4b;

(7) (6) determination of home and community-based waiver and other service
eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
of care determination for individuals who need an institutional level of care as determined
under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
community support plan development, appropriate referrals to obtain necessary diagnostic
information, and including an eligibility determination for consumer-directed community
supports;

(8) (7) providing recommendations for institutional placement when there are no
cost-effective community services available;

(9) (8) providing access to assistance to transition people back to community settings
after institutional admission; and

(10) (9) providing information about competitive employment, with or without
supports, for school-age youth and working-age adults and referrals to the Disability
Linkage Line and Disability Benefits 101 to ensure that an informed choice about
competitive employment can be made. For the purposes of this subdivision, "competitive
employment" means work in the competitive labor market that is performed on a full-time
or part-time basis in an integrated setting, and for which an individual is compensated at or
above the minimum wage, but not less than the customary wage and level of benefits paid
by the employer for the same or similar work performed by individuals without disabilities.

(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
2c, and 3a, "long-term care consultation services" also means:

(1) service eligibility determination for state plan home care services identified in:

(i) section 256B.0625, subdivisions 7, 19a, and 19c;

(ii) section 256B.0657; or

(iii) consumer support grants under section 256.476;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections
256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
9525.0016;

(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination
of eligibility for family support grants under section 252.32, semi-independent living
services under section 252.275, and day training and habilitation services under section
256B.092; and

(4) obtaining necessary diagnostic information to determine eligibility under clauses
(2) and (3).

(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
also includes telephone assistance and follow up once a long-term care consultation
assessment has been completed.

(d) "Minnesota health care programs" means the medical assistance program under
chapter 256B and the alternative care program under section 256B.0913.

(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.

Sec. 19.

Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and
private duty nursing. The commissioner shall provide at least a 90-day notice to lead
agencies prior to the effective date of this requirement. Face-to-face assessments must be
conducted according to paragraphs (b) to (i).

(b) The lead agency may utilize a team of either the social worker or public health
nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
use certified assessors to conduct the assessment. The consultation team members must
confer regarding the most appropriate care for each individual screened or assessed. For
a person with complex health care needs, a public health or registered nurse from the
team must be consulted.

(c) The assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a community support plan that
meets the consumers needs, using an assessment form provided by the commissioner.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, and other individuals as requested by
the person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a community support plan that ensures the person's health and
safety, but who is not a provider of service or has any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living
services under section 256B.0915, with the permission of the person being assessed or
the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment.

(e) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan within 40
calendar days of the assessment visit, regardless of whether the individual is eligible for
Minnesota health care programs. The written community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.

(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to long-term care options
counseling services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).

(h) The lead agency must give the person receiving assessment or support planning,
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening conducted by long-term
care options counselors according to section 256.975, subdivisions 7a to 7c, and section
256.01, subdivision 24,
if the person selects nursing facility placement. If the individual
selects nursing facility placement, the lead agency shall forward information needed to
complete the level of care determinations and screening for developmental disability and
mental illness collected during the assessment to the long-term care options counselor
using forms provided by the commissioner
;

(4) the role of long-term care consultation assessment and support planning in
eligibility determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a, paragraphs (a),
clause (7), and (b);

(5) information about Minnesota health care programs;

(6) the person's freedom to accept or reject the recommendations of the team;

(7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(8) the certified assessor's decision regarding the person's need for institutional level
of care as determined under criteria established in section 256B.0911, subdivision 4a,
paragraph (d)
4e, and the certified assessor's decision regarding eligibility for all services
and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
(b), and incorporating the decision regarding the need for institutional level of care or the
lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and brain injury waiver programs under sections 256B.0913,
256B.0915, and 256B.49 is valid to establish service eligibility for no more than 60
calendar days after the date of assessment.

(j) The effective eligibility start date for programs in paragraph (i) can never be
prior to the date of assessment. If an assessment was completed more than 60 days
before the effective waiver or alternative care program eligibility start date, assessment
and support plan information must be updated in a face-to-face visit and documented in
the department's Medicaid Management Information System (MMIS). Notwithstanding
retroactive medical assistance coverage of state plan services, the effective date of
eligibility for programs included in paragraph (i) cannot be prior to the date the most
recent updated assessment is completed.

Sec. 20.

Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
read:


Subd. 4d.

Preadmission screening of individuals under 65 60 years of age.

(a)
It is the policy of the state of Minnesota to ensure that individuals with disabilities or
chronic illness are served in the most integrated setting appropriate to their needs and have
the necessary information to make informed choices about home and community-based
service options.

(b) Individuals under 65 60 years of age who are admitted to a nursing facility
from a hospital must be screened prior to admission as outlined in subdivisions 4a
through 4c
according to the requirements outlined in section 256.975, subdivisions 7a
to 7c. This shall be provided by the Disability Linkage Line as required under section
256.01, subdivision 24
.

(c) Individuals under 65 years of age who are admitted to nursing facilities with
only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission.

(d) Individuals under 65 years of age who are admitted to a nursing facility
without preadmission screening according to the exemption described in subdivision 4b,
paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
a face-to-face assessment within 40 days of admission.

(e) (d) At the face-to-face assessment, the long-term care consultation team member
or county case manager must perform the activities required under subdivision 3b.

(f) (e) For individuals under 21 years of age, a screening interview which
recommends nursing facility admission must be face-to-face and approved by the
commissioner before the individual is admitted to the nursing facility.

(g) (f) In the event that an individual under 65 60 years of age is admitted to a
nursing facility on an emergency basis, the county Disability Linkage Line must be
notified of the admission on the next working day, and a face-to-face assessment as
described in paragraph (c) must be conducted within 40 calendar days of admission.

(h) (g) At the face-to-face assessment, the long-term care consultation team member
or the case manager must present information about home and community-based options,
including consumer-directed options, so the individual can make informed choices. If the
individual chooses home and community-based services, the long-term care consultation
team member or case manager must complete a written relocation plan within 20 working
days of the visit. The plan shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.

(i) (h) An individual under 65 years of age residing in a nursing facility shall receive
a face-to-face assessment at least every 12 months to review the person's service choices
and available alternatives unless the individual indicates, in writing, that annual visits are
not desired. In this case, the individual must receive a face-to-face assessment at least
once every 36 months for the same purposes.

(j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments for individuals under 65 years of age
who are being considered for placement or residing in a nursing facility.

(j) Funding for preadmission screening shall be provided to the Disability Linkage
Line for the under 60 population by the Department of Human Services to cover screener
salaries and expenses to provide the services described in subdivisions 7a to 7c. The
Disability Linkage Line shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provider preadmission screening
and level of care determination services and shall seek to maximize federal funding for the
service as provided under section 256.01, subdivision 2, paragraph (dd).

Sec. 21.

Minnesota Statutes 2012, section 256B.0911, is amended by adding a
subdivision to read:


Subd. 4e.

Determination of institutional level of care.

The determination of the
need for nursing facility, hospital, and intermediate care facility levels of care must be
made according to criteria developed by the commissioner, and in section 256B.092,
using forms developed by the commissioner. Effective January 1, 2014, for individuals
age 21 and older, the determination of need for nursing facility level of care shall be
based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
determination of the need for nursing facility level of care must be made according to
criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
becomes effective on or after October 1, 2019.

Sec. 22.

Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:


Subd. 7.

Reimbursement for certified nursing facilities.

(a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
mental illness is approved by the local mental health authority or an admission for a
recipient with developmental disability is approved by the state developmental disability
authority.

(b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities
as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
facility must include unreimbursed resident days in the nursing facility resident day totals
reported to the commissioner.

Sec. 23.

Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:


Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
the provision of services under the alternative care program;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other
state or federal funding, or other health insurance or other third-party insurance such as
long-term care insurance;

(6) except for individuals described in clause (7), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
does not prohibit the alternative care client from payment for additional services, but in no
case may the cost of additional services purchased under this section exceed the difference
between the client's monthly service limit defined under section 256B.0915, subdivision
3
, and the alternative care program monthly service limit defined in this paragraph. If
care-related supplies and equipment or environmental modifications and adaptations are or
will be purchased for an alternative care services recipient, the costs may be prorated on a
monthly basis for up to 12 consecutive months beginning with the month of purchase.
If the monthly cost of a recipient's other alternative care services exceeds the monthly
limit established in this paragraph, the annual cost of the alternative care services shall be
determined. In this event, the annual cost of alternative care services shall not exceed 12
times the monthly limit described in this paragraph;

(7) for individuals assigned a case mix classification A as described under section
256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily
living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
when the dependency score in eating is three or greater as determined by an assessment
performed under section 256B.0911, the monthly cost of alternative care services funded
by the program cannot exceed $593 per month for all new participants enrolled in
the program on or after July 1, 2011. This monthly limit shall be applied to all other
participants who meet this criteria at reassessment. This monthly limit shall be increased
annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (6)
for case mix classification A; and

(8) the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person who
is a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by
medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
pay a medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 24.

Minnesota Statutes 2012, section 256B.0913, is amended by adding a
subdivision to read:


Subd. 17.

Essential community supports grants.

(a) Notwithstanding subdivisions
1 to 14, the purpose of the essential community supports grant program is to provide
targeted services to persons age 65 and older who need essential community support, but
whose needs do not meet the level of care required for nursing facility placement under
section 144.0724, subdivision 11.

(b) Essential community supports grants are available not to exceed $400 per person
per month. Essential community supports service grants may be used as authorized within
an authorization period not to exceed 12 months. Grants must be available to a person who:

(1) is age 65 or older;

(2) is not eligible for medical assistance;

(3) would otherwise be financially eligible for the alternative care program under
subdivision 4;

(4) has received a community assessment under section 256B.0911, subdivision 3a
or 3b, and does not require the level of care provided in a nursing facility;

(5) has a community support plan; and

(6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain
their community residence:

(i) caregiver support;

(ii) homemaker support;

(iii) chores; or

(iv) a personal emergency response device or system.

(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their community support plan.

(d) A person who has been determined to be eligible for an essential community
supports grant must be reassessed at least annually and continue to meet the criteria in
paragraph (b) to remain eligible for an essential community supports grant.

(e) The commissioner is authorized to use federal matching funds for essential
community supports as necessary and to meet demand for essential community supports
grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
appropriated to the commissioner for this purpose.

(f) Upon federal approval and following a reasonable implementation period
determined by the commissioner, essential community supports are available to an
individual who:

(1) is receiving nursing facility services or home and community-based long-term
services and supports under section 256B.0915 or 256B.49 on the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;

(2) meets one of the following criteria:

(i) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of nursing facility services at the
first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
after the effective date of the revised nursing facility level of care criteria under section
144.0724, subdivision 11; or

(ii) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of home and community-based
long-term services and supports under section 256B.0915 or 256B.49 at the first
reassessment required under those sections that occurs on or after the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;

(3) is not eligible for personal care attendant services; and

(4) has an assessed need for one or more of the supportive services offered under
essential community supports.

Individuals eligible under this paragraph includes individuals who continue to be
eligible for medical assistance state plan benefits and those who are not or are no longer
financially eligible for medical assistance.

(g) Upon federal approval and following a reasonable implementation period
determined by the commissioner, the services available through essential community
supports include the services and grants provided in paragraphs (b) and (c), home-delivered
meals, and community living assistance as defined by the commissioner. These services
are available to all eligible recipients including those outlined in paragraphs (b) and (f).
Recipients are eligible if they have a need for any of these services and meet all other
eligibility criteria.

Sec. 25.

Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
read:


Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of
waivered services to an individual elderly waiver client except for individuals described in
paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility
rate of the case mix resident class to which the elderly waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
state fiscal year in which the resident assessment system as described in section 256B.438
for nursing home rate determination is implemented. Effective on the first day of the state
fiscal year in which the resident assessment system as described in section 256B.438 for
nursing home rate determination is implemented and the first day of each subsequent state
fiscal year, the monthly limit for the cost of waivered services to an individual elderly
waiver client shall be the rate of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
the last day of the previous state fiscal year, adjusted by any legislatively adopted home
and community-based services percentage rate adjustment.

(b) The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with:

(1) no dependencies in activities of daily living; or

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
when the dependency score in eating is three or greater as determined by an assessment
performed under section 256B.0911

shall be $1,750 per month effective on July 1, 2011, for all new participants enrolled in
the program on or after July 1, 2011. This monthly limit shall be applied to all other
participants who meet this criteria at reassessment. This monthly limit shall be increased
annually as described in paragraph (a).

(c) If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a) or
(b), the annual cost of all waivered services shall be determined. In this event, the annual
cost of all waivered services shall not exceed 12 times the monthly limit of waivered
services as described in paragraph (a) or (b).

(d) Effective July 1, 2013, the monthly cost limit of waiver services, including
any necessary home care services described in section 256B.0651, subdivision 2, for
individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
amount established for home care services as described in section 256B.0652, subdivision
7, and the annual average contracted amount established by the commissioner for nursing
facility services for ventilator-dependent individuals. This monthly limit shall be increased
annually as described in paragraph (a).

Sec. 26.

Minnesota Statutes 2012, section 256B.0915, is amended by adding a
subdivision to read:


Subd. 3j.

Individual community living support.

Upon federal approval, there
is established a new service called individual community living support (ICLS) that is
available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
have any interest in the recipient's housing. ICLS must be delivered in a single-family
home or apartment where the service recipient or their family owns or rents, as
demonstrated by a lease agreement, and maintains control over the individual unit. Case
managers or care coordinators must develop individual ICLS plans in consultation with
the client using a tool developed by the commissioner. The commissioner shall establish
payment rates and mechanisms to align payments with the type and amount of service
provided, assure statewide uniformity, and assure cost-effectiveness. ICLS shall not be
considered home care services for purposes of section 144A.43.

Sec. 27.

Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:


Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client
shall receive an initial assessment of strengths, informal supports, and need for services
in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and at
other times when the case manager determines that there has been significant change in
the client's functioning. This may include instances where the client is discharged from
the hospital. There must be a determination that the client requires nursing facility level
of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.

(b) Regardless of other assessments identified in section 144.0724, subdivision
4, as appropriate to determine nursing facility level of care for purposes of medical
assistance payment for nursing facility services, only face-to-face assessments conducted
according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.

Sec. 28.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1a.

Home and community-based services for older adults.

(a) The purpose
of projects selected by the commissioner of human services under this section is to
make strategic changes in the long-term services and supports system for older adults
including statewide capacity for local service development and technical assistance, and
statewide availability of home and community-based services for older adult services,
caregiver support and respite care services, and other supports in the state of Minnesota.
These projects are intended to create incentives for new and expanded home and
community-based services in Minnesota in order to:

(1) reach older adults early in the progression of their need for long-term services
and supports, providing them with low-cost, high-impact services that will prevent or
delay the use of more costly services;

(2) support older adults to live in the most integrated, least restrictive community
setting;

(3) support the informal caregivers of older adults;

(4) develop and implement strategies to integrate long-term services and supports
with health care services, in order to improve the quality of care and enhance the quality
of life of older adults and their informal caregivers;

(5) ensure cost-effective use of financial and human resources;

(6) build community-based approaches and community commitment to delivering
long-term services and supports for older adults in their own homes;

(7) achieve a broad awareness and use of lower-cost in-home services as an
alternative to nursing homes and other residential services;

(8) strengthen and develop additional home and community-based services and
alternatives to nursing homes and other residential services; and

(9) strengthen programs that use volunteers.

(b) The services provided by these projects are available to older adults who are
eligible for medical assistance and the elderly waiver under section 256B.0915, the
alternative care program under section 256B.0913, or essential community supports grant
under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
services.

Sec. 29.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1b.

Definitions.

(a) For purposes of this section, the following terms have
the meanings given.

(b) "Community" means a town; township; city; or targeted neighborhood within a
city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.

(c) "Core home and community-based services provider" means a Faith in Action,
Living at Home Block Nurse, Congregational Nurse, or similar community-based program
that organizes and uses volunteers and paid staff to deliver nonmedical services intended
to assist older adults to identify and manage risks and to maintain their community living
and integration in the community.

(d) "Eldercare development partnership" means a team of representatives of county
social service and public health agencies, the area agency on aging, local nursing home
providers, local home care providers, and other appropriate home and community-based
providers in the area agency's planning and service area.

(e) "Long-term services and supports" means any service available under the
elderly waiver program or alternative care grant programs; nursing facility services;
transportation services; caregiver support and respite care services; and other home and
community-based services identified as necessary either to maintain lifestyle choices for
older adults or to support them to remain in their own home.

(f) "Older adult" refers to an individual who is 65 years of age or older.

Sec. 30.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1c.

Eldercare development partnerships.

The commissioner of human
services shall select and contract with eldercare development partnerships sufficient to
provide statewide availability of service development and technical assistance using a
request for proposals process. Eldercare development partnerships shall:

(1) develop a local long-term services and supports strategy consistent with state
goals and objectives;

(2) identify and use existing local skills, knowledge and relationships, and build
on these assets;

(3) coordinate planning for funds to provide services to older adults, including funds
received under Title III of the Older Americans Act, Title XX of the Social Security Act,
and the Local Public Health Act;

(4) target service development and technical assistance where nursing facility
closures have occurred or are occurring or in areas where service needs have been
identified through activities under section 144A.351;

(5) provide sufficient staff for development and technical support in its designated
area; and

(6) designate a single public or nonprofit member of the eldercare development
partnerships to apply grant funding and manage the project.

Sec. 31.

Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:


Subd. 6.

Caregiver support and respite care projects.

(a) The commissioner
shall establish up to 36 projects to expand the respite care network in the state and to
support caregivers in their responsibilities for care. The purpose of each project shall
be to
availability of caregiver support and respite care services for family and other
caregivers. The commissioner shall use a request for proposals to select nonprofit entities
to administer the projects. Projects shall
:

(1) establish a local coordinated network of volunteer and paid respite workers;

(2) coordinate assignment of respite workers care services to clients and care
receivers and assure the health and safety of the client; and
caregivers of older adults;

(3) provide training for caregivers and ensure that support groups are available
in the community.

(3) assure the health and safety of the older adults;

(4) identify at-risk caregivers;

(5) provide information, education, and training for caregivers in the designated
community; and

(6) demonstrate the need in the proposed service area particularly where nursing
facility closures have occurred or are occurring or areas with service needs identified
by section 144A.351. Preference must be given for projects that reach underserved
populations.

(b) The caregiver support and respite care funds shall be available to the four to six
local long-term care strategy projects designated in subdivisions 1 to 5.

(c) The commissioner shall publish a notice in the State Register to solicit proposals
from public or private nonprofit agencies for the projects not included in the four to six
local long-term care strategy projects defined in subdivision 2. A county agency may,
alone or in combination with other county agencies, apply for caregiver support and
respite care project funds. A public or nonprofit agency within a designated SAIL project
area may apply for project funds if the agency has a letter of agreement with the county
or counties in which services will be developed, stating the intention of the county or
counties to coordinate their activities with the agency requesting a grant.

(d) The commissioner shall select grantees based on the following criteria (b)
Projects must clearly describe
:

(1) the ability of the proposal to demonstrate need in the area served, as evidenced
by a community needs assessment or other demographic data;

(2) the ability of the proposal to clearly describe how the project (1) how they will
achieve the their purpose defined in paragraph (b);

(3) the ability of the proposal to reach underserved populations;

(4) the ability of the proposal to demonstrate community commitment to the project,
as evidenced by letters of support and cooperation as well as formation of a community
task force;

(5) the ability of the proposal to clearly describe (2) the process for recruiting,
training, and retraining volunteers; and

(6) the inclusion in the proposal of the (3) their plan to promote the project in the
designated community, including outreach to persons needing the services.

(e) (c) Funds for all projects under this subdivision may be used to:

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
care services and assign workers to clients;

(2) recruit and train volunteer providers;

(3) train provide information, training, and education to caregivers;

(4) ensure the development of support groups for caregivers;

(5) (4) advertise the availability of the caregiver support and respite care project; and

(6) (5) purchase equipment to maintain a system of assigning workers to clients.

(f) (d) Project funds may not be used to supplant existing funding sources.

Sec. 32.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 7a.

Core home and community-based services.

The commissioner shall
select and contract with core home and community-based services providers for projects
to provide services and supports to older adults both with and without family and other
informal caregivers using a request for proposals process. Projects must:

(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
support;

(2) have a specific, clearly defined geographic service area;

(3) use a practice framework designed to identify high-risk older adults and help them
take action to better manage their chronic conditions and maintain their community living;

(4) have a team approach to coordination and care, ensuring that the older adult
participants, their families, and the formal and informal providers are all part of planning
and providing services;

(5) provide information, support services, homemaking services, counseling, and
training for the older adults and family caregivers;

(6) encourage service area or neighborhood residents and local organizations to
collaborate in meeting the needs of older adults in their geographic service areas;

(7) recruit, train, and direct the use of volunteers to provide informal services and
other appropriate support to older adults and their caregivers; and

(8) provide coordination and management of formal and informal services to older
adults and their families using less expensive alternatives.

Sec. 33.

Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
read:


Subd. 13.

Community service grants.

The commissioner shall award contracts
for grants to public and private nonprofit agencies to establish services that strengthen
a community's ability to provide a system of home and community-based services
for elderly persons. The commissioner shall use a request for proposal process. The
commissioner shall give preference when awarding grants under this section to areas
where nursing facility closures have occurred or are occurring or to areas with service
needs identified under section 144A.351
. The commissioner shall consider grants for:

(1) caregiver support and respite care projects under subdivision 6;

(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and

(3) services identified as needed for community transition.

Sec. 34.

Minnesota Statutes 2012, section 256B.092, is amended by adding a
subdivision to read:


Subd. 14.

Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions.

(a) Persons receiving
home and community-based services authorized under this section who have had two
or more admissions within a calendar year to an emergency room, psychiatric unit,
or institution must receive consultation from a mental health professional as defined in
section 245.462, subdivision 18, or a behavioral professional as defined in the home and
community-based services state plan within 30 days of discharge. The mental health
professional or behavioral professional must:

(1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;

(2) use the results of the functional assessment to amend the coordinated service and
support plan set forth in section 245D.02, subdivision 4b, to address the potential need
for additional staff training, increased staffing, access to crisis mobility services, mental
health services, use of technology, and crisis stabilization services in section 256B.0624,
subdivision 7; and

(3) identify the need for additional consultation, testing, and mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.

(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

Sec. 35.

Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:


Subdivision 1.

Development and implementation of quality profiles.

(a) The
commissioner of human services, in cooperation with the commissioner of health,
shall develop and implement a quality profile system profiles for nursing facilities and,
beginning not later than July 1, 2004 2014, other providers of long-term care services,
except when the quality profile system would duplicate requirements under section
256B.5011, 256B.5012, or 256B.5013. The system quality profiles must be developed
and implemented to the extent possible without the collection of significant amounts of
new data. To the extent possible, the system
using existing data sets maintained by the
commissioners of health and human services to the extent possible. The profiles
must
incorporate or be coordinated with information on quality maintained by area agencies on
aging, long-term care trade associations, the ombudsman offices, counties, tribes, health
plans,
and other entities and the long-term care database maintained under section 256.975,
subdivision 7
. The system profiles must be designed to provide information on quality to:

(1) consumers and their families to facilitate informed choices of service providers;

(2) providers to enable them to measure the results of their quality improvement
efforts and compare quality achievements with other service providers; and

(3) public and private purchasers of long-term care services to enable them to
purchase high-quality care.

(b) The system profiles must be developed in consultation with the long-term care
task force, area agencies on aging, and representatives of consumers, providers, and labor
unions. Within the limits of available appropriations, the commissioners may employ
consultants to assist with this project.

Sec. 36.

Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:


Subd. 2.

Quality measurement tools.

The commissioners shall identify and apply
existing quality measurement tools to:

(1) emphasize quality of care and its relationship to quality of life; and

(2) address the needs of various users of long-term care services, including, but not
limited to, short-stay residents, persons with behavioral problems, persons with dementia,
and persons who are members of minority groups.

The tools must be identified and applied, to the extent possible, without requiring
providers to supply information beyond current state and federal requirements.

Sec. 37.

Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:


Subd. 3.

Consumer surveys of nursing facilities residents.

Following
identification of the quality measurement tool, the commissioners shall conduct surveys
of long-term care service consumers of nursing facilities to develop quality profiles
of providers. To the extent possible, surveys must be conducted face-to-face by state
employees or contractors. At the discretion of the commissioners, surveys may be
conducted by telephone or by provider staff. Surveys must be conducted periodically to
update quality profiles of individual service nursing facilities providers.

Sec. 38.

Minnesota Statutes 2012, section 256B.439, is amended by adding a
subdivision to read:


Subd. 3a.

Home and community-based services report card in cooperation with
the commissioner of health.

The profiles developed for home and community-based
services providers under this section shall be incorporated into a report card and
maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
7, paragraph (b), clause (2), as data becomes available. The commissioner, in
cooperation with the commissioner of health, shall use consumer choice, quality of life,
care approaches, and cost or flexible purchasing categories to organize the consumer
information in the profiles. The final categories used shall include consumer input and
survey data to the extent that is available through the state agencies. The commissioner
shall develop and disseminate the qualify profiles for a limited number of provider types
initially, and develop quality profiles for additional provider types as measurement tools
are developed and data becomes available. This includes providers of services to older
adults and people with disabilities, regardless of payor source.

Sec. 39.

Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:


Subd. 4.

Dissemination of quality profiles.

By July 1, 2003 2014, the
commissioners shall implement a system public awareness effort to disseminate the quality
profiles developed from consumer surveys using the quality measurement tool. Profiles
may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
to consumers, providers, and purchasers of long-term care services through all feasible
printed and electronic outlets. The commissioners may conduct a public awareness
campaign to inform potential users regarding profile contents and potential uses
.

Sec. 40.

Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:


Subd. 12.

Informed choice.

Persons who are determined likely to require the level
of care provided in a nursing facility as determined under section 256B.0911, subdivision
4e,
or a hospital shall be informed of the home and community-based support alternatives
to the provision of inpatient hospital services or nursing facility services. Each person
must be given the choice of either institutional or home and community-based services
using the provisions described in section 256B.77, subdivision 2, paragraph (p).

Sec. 41.

Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:


Subd. 14.

Assessment and reassessment.

(a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
With the permission of the recipient or the recipient's designated legal representative,
the recipient's current provider of services may submit a written report outlining their
recommendations regarding the recipient's care needs prepared by a direct service
employee with at least 20 hours of service to that client. The person conducting the
assessment or reassessment must notify the provider of the date by which this information
is to be submitted. This information shall be provided to the person conducting the
assessment and the person or the person's legal representative and must be considered
prior to the finalization of the assessment or reassessment.

(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
(d)
4e, at initial and subsequent assessments to initiate and maintain participation in the
waiver program.

(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for
purposes of initial and ongoing access to waiver services payment.

(d) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their
65th birthday if they continue to meet all other eligibility factors.

(e) The commissioner shall develop criteria to identify recipients whose level of
functioning is reasonably expected to improve and reassess these recipients to establish
a baseline assessment. Recipients who meet these criteria must have a comprehensive
transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the recipient's
functioning for at least 12 months. After there has been no significant change in the
recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
informal support systems, and need for services shall be conducted at least every 12
months and at other times when there has been a significant change in the recipient's
functioning. Counties, case managers, and service providers are responsible for
conducting these reassessments and shall complete the reassessments out of existing funds.

Sec. 42.

Minnesota Statutes 2012, section 256B.49, is amended by adding a
subdivision to read:


Subd. 25.

Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions.

(a) Persons receiving
home and community-based services authorized under this section who have two or more
admissions within a calendar year to an emergency room, psychiatric unit, or institution
must receive consultation from a mental health professional as defined in section 245.462,
subdivision 18, or a behavioral professional as defined in the home and community-based
services state plan within 30 days of discharge. The mental health professional or
behavioral professional must:

(1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;

(2) use the results of the functional assessment to amend the coordinated service and
support plan in section 245D.02, subdivision 4b, to address the potential need for additional
staff training, increased staffing, access to crisis mobility services, mental health services,
use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and

(3) identify the need for additional consultation, testing, mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.

(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

Sec. 43.

[256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.

Subdivision 1.

Basis and scope.

(a) Upon federal approval, the commissioner
shall establish a medical assistance state plan option for the provision of home and
community-based personal assistance service and supports called "community first
services and supports (CFSS)."

(b) CFSS is a participant-controlled method of selecting and providing services
and supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports
by choosing to have a significant and meaningful role in the management of services
and supports including acting as the employer of record with the necessary supports
to perform that function.

(c) CFSS is available statewide to eligible individuals to assist with accomplishing
activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
health-related procedures and tasks through hands-on assistance to complete the task or
supervision and cueing to complete the task; and to assist with acquiring, maintaining, and
enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures
and tasks. CFSS allows payment for certain supports and goods such as environmental
modifications and technology that are intended to replace or decrease the need for human
assistance.

(d) Upon federal approval, CFSS will replace the personal care assistance program
under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.

Subd. 2.

Definitions.

(a) For the purposes of this section, the terms defined in
this subdivision have the meanings given.

(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
dressing, bathing, mobility, positioning, and transferring.

(c) "Agency-provider model" means a method of CFSS under which a qualified
agency provides services and supports through the agency's own employees and policies.
The agency must allow the participant to have a significant role in the selection and
dismissal of support workers of their choice for the delivery of their specific services and
supports including employing workers specifically selected by the participant.

(d) "Behavior" means a category to determine the home care rating and is based on the
criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
others, or destruction of property that requires the immediate response of another person.

(e) "Complex health-related needs" means a category to determine the home care
rating and is based on the criteria in section 256B.0659.

(f) "Community first services and supports" or "CFSS" means the assistance and
supports program under this section needed for accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through hands-on assistance
to complete the task or supervision and cueing to complete the task, or the purchase of
goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
human assistance.

(g) "Community first services and supports service delivery plan" or "service delivery
plan" means a written summary of the services and supports, that is based on the community
support plan identified in section 256B.0911 and coordinated services and support plan
and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
by the participant to meet the assessed needs, using a person-centered planning process.

(h) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.

(i) "Dependency" in activities of daily living means a person requires assistance to
begin and complete one or more of the activities of daily living.

(j) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary
to use the flexible spending model under subdivision 13, that include but are not limited
to: participant education and technical assistance; CFSS service delivery planning and
budgeting; billing, making payments, and monitoring of spending; and assisting the
participant in fulfilling regulatory requirements when acting as an employer of record for
support workers or employer agent, that are in accordance with Section 3504 of the IRS
code and the IRS Revenue Procedure 70-6.

(k) "Flexible spending model" means a service delivery method of CFSS that uses
an individualized CFSS service delivery plan and service budget and assistance from the
financial management services contractor for the employment of support workers and the
acquisition of supports and goods.

(l) "Health-related procedures and tasks" means procedures and tasks related to
the specific needs of an individual that can be delegated or assigned by a state-licensed
healthcare or behavioral health professional and performed by a support worker.

(m) "Instrumental activities of daily living" means activities related to living
independently in the community, including but not limited to: meal planning, preparation,
and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
assistance with medications; managing money; communicating needs, preferences, and
activities; arranging supports; and assistance with traveling around and participating
in the community.

(n) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include
but are not limited to a health care agent or an attorney-in-fact authorized through a health
care directive or power of attorney.

(o) "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication and includes any of the following supports:

(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;

(2) organizing medications as directed by the participant or the participant's
representative; and

(3) providing verbal or visual reminders to perform regularly scheduled medications.

(p) "Participant's representative" means a parent, family member, advocate, or
other adult authorized by the participant to serve as a representative in connection with
the provision of CFSS. This authorization must be in writing or by another method
that clearly indicates the participant's free choice. The participant's representative must
have no financial interest in the provision of any services included in the participant's
service delivery plan and must be capable of providing the support necessary to assist
the participant in the use of CFSS. If through the assessment process described in
subdivision 5 a participant is determined to be in need of a participant's representative, one
must be selected. If the participant is unable to assist in the selection of a participant's
representative, the legal representative shall appoint one. Two persons may be designated
as a participant's representative for reasons such as divided households and court-ordered
custodies. Duties of a participant's representatives may include:

(1) being available while care is provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;

(2) monitoring CFSS services to ensure the participant's CFSS service delivery
plan is being followed; and

(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.

(q) "Person-centered planning process" means a process that is driven by the
participant for discovering and planning services and supports that ensures the participant
makes informed choices and decisions. The person-centered planning process must:

(1) include people chosen by the participant;

(2) provide necessary information and support to ensure that the participant directs
the process to the maximum extent possible, and is enabled to make informed choices
and decisions;

(3) be timely and occur at time and locations of convenience to the participant;

(4) reflect cultural considerations of the participant;

(5) include strategies for solving conflict or disagreement within the process,
including clear conflict-of-interest guidelines for all planning;

(6) offers choices to the participant regarding the services and supports they receive
and from whom;

(7) include a method for the participant to request updates to the plan; and

(8) record the alternative home and community-based settings that were considered
by the participant.

(r) "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same provider.

(s) "Support specialist" means a professional with the skills and ability to assist the
participant using either the agency provider model under subdivision 11 or the flexible
spending model under subdivision 13, in services including, but not limited to:

(1) the development, implementation, and evaluation of the CFSS service delivery
plan under subdivision 6;

(2) recruitment, training, or supervision, including supervision of health-related
tasks or behavioral supports appropriately delegated by a health care professional, and
evaluation of support workers; and

(3) facilitating the use of informal and community supports, goods, or resources.

(t) "Support worker" means a regular or temporary employee of the agency-provider,
the financial management services contractor, or the participant who has direct contact
with the participant and provides services as specified within the participant's service
delivery plan.

(u) "Wages and benefits" means the hourly wages and salaries, the employer's
share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
compensation, mileage reimbursement, health and dental insurance, life insurance,
disability insurance, long-term care insurance, uniform allowance, and contributions to
employee retirement accounts.

Subd. 3.

Eligibility.

CFSS is available to a person who meets one of the following:

(1) is a recipient of medical assistance as determined under section 256B.055,
256B.056, or 256B.057, subdivisions 5 and 9;

(2) is a recipient of the alternative care program under section 256B.0913;

(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
or 256B.49; or

(4) has medical services identified in a participant's individualized education
program and is eligible for services as determined in section 256B.0625, subdivision 26.

(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:

(1) is determined eligible based on assessment under section 256B.0911;

(2) is not a recipient under the family support grant under section 252.32;

(3) lives in the person's own apartment or home including a family foster care setting
licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
noncertified boarding care or boarding and lodging establishments under chapter 157;
unless transitioning into the community from an institution; and

(4) has not been excluded or disenrolled from the flexible spending model.

(c) The commissioner shall disenroll or exclude participants from the flexible
spending model and transfer them to the agency-provider model under the following
circumstances that include but are not limited to:

(1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period;

(2) when a participant exits the flexible spending service delivery model during the
participant's service plan year. Upon transfer, the participant shall not access the flexible
spending model for the remainder of that service plan year; or

(3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the service
delivery model. The commissioner must develop policies for determining if a participant
is unable to manage responsibilities under a service model.

(d) A participant may appeal in writing to the department to contest the department's
decision under paragraph (c), clause (3), to remove or exclude the participant from the
flexible spending model.

Subd. 4.

Eligibility for other services.

Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state
plan medical assistance benefit or other services available through alternative care.

Subd. 5.

Assessment requirements.

(a) The assessment of functional need must:

(1) be conducted by a certified assessor according to the criteria established in
section 256B.0911;

(2) be conducted face-to-face, initially and at least annually thereafter, or when there
is a significant change in the participant's condition or a change in the need for services
and supports; and

(3) be completed using the format established by the commissioner.

(b) A participant who is residing in a facility may be assessed and choose CFSS for
the purpose of using CFSS to return to the community as described in subdivisions 3
and 7, paragraph (a), clause (5).

(c) The results of the assessment and any recommendations and authorizations for
CFSS must be determined and communicated in writing by the lead agency's certified
assessor as defined in section 256B.0911 to the participant and the agency-provider or
financial management services provider chosen by the participant within 40 calendar days
and must include the participant's right to appeal under section 256.045.

Subd. 6.

Community first services and support service delivery plan.

(a) The
CFSS service delivery plan must be developed, implemented, and evaluated through a
person-centered planning process by the participant, or the participant's representative
or legal representative who may be assisted by a support specialist. The CFSS service
delivery plan must reflect the services and supports that are important to the participant
and for the participant to meet the needs assessed by the certified assessor and identified
in the community support plan under section 256B.0911 or the coordinated services and
support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
service delivery plan must be reviewed by the participant and the agency-provider or
financial management services contractor at least annually upon reassessment, or when
there is a significant change in the participant's condition, or a change in the need for
services and supports.

(b) The commissioner shall establish the format and criteria for the CFSS service
delivery plan.

(c) The CFSS service delivery plan must be person-centered and:

(1) specify the agency-provider or financial management services contractor selected
by the participant;

(2) reflect the setting in which the participant resides that is chosen by the participant;

(3) reflect the participant's strengths and preferences;

(4) include the means to address the clinical and support needs as identified through
an assessment of functional needs;

(5) include individually identified goals and desired outcomes;

(6) reflect the services and supports, paid and unpaid, that will assist the participant
to achieve identified goals, and the providers of those services and supports, including
natural supports;

(7) identify the amount and frequency of face-to-face supports and amount and
frequency of remote supports and technology that will be used;

(8) identify risk factors and measures in place to minimize them, including
individualized backup plans;

(9) be understandable to the participant and the individuals providing support;

(10) identify the individual or entity responsible for monitoring the plan;

(11) be finalized and agreed to in writing by the participant and signed by all
individuals and providers responsible for its implementation;

(12) be distributed to the participant and other people involved in the plan; and

(13) prevent the provision of unnecessary or inappropriate care.

(d) The total units of agency-provider services or the budget allocation amount for
the flexible spending model include both annual totals and a monthly average amount
that cover the number of months of the service authorization. The amount used each
month may vary, but additional funds must not be provided above the annual service
authorization amount unless a change in condition is assessed and authorized by the
certified assessor and documented in the community support plan, coordinated services
and supports plan, and service delivery plan.

Subd. 7.

Community first services and supports; covered services.

(a) Services
and supports covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
of daily living (IADLs), and health-related procedures and tasks through hands-on
assistance to complete the task or supervision and cueing to complete the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
to accomplish activities of daily living, instrumental activities of daily living, or
health-related tasks;

(3) expenditures for items, services, supports, environmental modifications, or
goods, including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan; and

(ii) increase independence or substitute for human assistance to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;

(4) observation and redirection for episodes where there is a need for redirection
due to participant behaviors. An assessment of behaviors must meet the criteria in this
clause. A recipient qualifies as having a need for assistance due to behaviors if the
recipient's behavior requires assistance at least four times per week and shows one or
more of the following behaviors:

(i) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;

(ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or

(iii) increased need for assistance for recipients who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic
devices, to ensure continuity of the participant's services and supports;

(6) transition costs, including:

(i) deposits for rent and utilities;

(ii) first month's rent and utilities;

(iii) bedding;

(iv) basic kitchen supplies;

(v) other necessities, to the extent that these necessities are not otherwise covered
under any other funding that the participant is eligible to receive; and

(vi) other required necessities for an individual to make the transition from a nursing
facility, institution for mental diseases, or intermediate care facility for persons with
developmental disabilities to a community-based home setting where the participant
resides; and

(7) services by a support specialist defined under subdivision 2 that are chosen
by the participant.

(b) Services and supports received under this section are not home care services for
the purposes of section 144A.43.

Subd. 8.

Determination of CFSS service methodology.

(a) All community first
services and supports must be authorized by the commissioner or the commissioner's
designee before services begin except for the assessments established in section
256B.0911. The authorization for CFSS must be completed within 30 days after receiving
a complete request.

(b) The amount of CFSS authorized must be based on the recipient's home
care rating. The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner identifying
the following for a recipient:

(1) the total number of dependencies of activities of daily living as defined in
subdivision 2;

(2) the presence of complex health-related needs as defined in subdivision 2; and

(3) the presence of Level I behavior as defined in subdivision 2.

(c) For purposes meeting the criteria in paragraph (b), the methodology to determine
the total minutes for CFSS for each home care rating is based on the median paid units per
day for each home care rating from fiscal year 2007 data for the CFSS program. Each
home care rating has a base number of minutes assigned. Additional minutes are added
through the assessment and identification of the following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in subdivision 2;

(2) 30 additional minutes per day for each complex health-related function as
defined in subdivision 2; and

(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.

Subd. 9.

Noncovered services.

(a) Services or supports that are not eligible for
payment under this section include those that:

(1) are not authorized by the certified assessor or included in the written service
delivery plan;

(2) are provided prior to the authorization of services and the approval of the written
CFSS service delivery plan;

(3) are duplicative of other paid services in the written service delivery plan;

(4) supplant natural unpaid supports that are provided voluntarily to the participant
and are selected by the participant in lieu of a support worker and appropriately meeting
the participant's needs;

(5) are not effective means to meet the participant's needs; and

(6) are available through other funding sources, including, but not limited to, funding
through Title IV-E of the Social Security Act.

(b) Additional services, goods, or supports that are not covered include:

(1) those that are not for the direct benefit of the participant;

(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;

(3) insurance, except for insurance costs related to employee coverage;

(4) room and board costs for the participant with the exception of allowable
transition costs in subdivision 7, clause (6);

(5) services, supports, or goods that are not related to the assessed needs;

(6) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;

(7) assistive technology devices and assistive technology services other than those
for back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;

(8) medical supplies and equipment;

(9) environmental modifications, except as specified in subdivision 7;

(10) expenses for travel, lodging, or meals related to training the participant, the
participant's representative, legal representative, or paid or unpaid caregivers that exceed
$500 in a 12-month period;

(11) experimental treatments;

(12) any service or good covered by other medical assistance state plan services,
including prescription and over-the-counter medications, compounds, and solutions and
related fees, including premiums and co-payments;

(13) membership dues or costs, except when the service is necessary and appropriate
to treat a physical condition or to improve or maintain the participant's physical condition.
The condition must be identified in the participant's CFSS plan and monitored by a
physician enrolled in a Minnesota health care program;

(14) vacation expenses other than the cost of direct services;

(15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need; and

(16) tickets and related costs to attend sporting or other recreational or entertainment
events.

Subd. 10.

Provider qualifications and general requirements.

(a)
Agency-providers delivering services under the agency-provider model under subdivision
11 or financial management service (FMS) contractors under subdivision 13 shall:

(1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standards;

(2) comply with medical assistance provider enrollment requirements;

(3) demonstrate compliance with law and policies of CFSS as determined by the
commissioner;

(4) comply with background study requirements under chapter 245C;

(5) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers and support specialists;

(6) not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family member
or participants' representatives;

(7) pay support workers and support specialists based upon actual hours of services
provided;

(8) withhold and pay all applicable federal and state payroll taxes;

(9) make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(10) enter into a written agreement with the participant, participant's representative,
or legal representative that assigns roles and responsibilities to be performed before
services, supports, or goods are provided using a format established by the commissioner;

(11) report suspected neglect and abuse to the common entry point according to
sections 256B.0651 and 626.557; and

(12) provide the participant with a copy of the service-related rights under
subdivision 19 at the start of services and supports.

(b) The commissioner shall develop policies and procedures designed to ensure
program integrity and fiscal accountability for goods and services provided in this section.

Subd. 11.

Agency-provider model.

(a) The agency-provider model is limited to
the services provided by support workers and support specialists who are employed by
an agency-provider that is licensed according to chapter 245A or meets other criteria
established by the commissioner, including required training.

(b) The agency-provider shall allow the participant to retain the ability to have a
significant role in the selection and dismissal of the support workers for the delivery of the
services and supports specified in the service delivery plan.

(c) A participant may use authorized units of CFSS services as needed within
a service authorization that is not greater than 12 months. Using authorized units
agency-provider services or the budget allocation amount for the flexible spending model
flexibly does not increase the total amount of services and supports authorized for a
participant or included in the participant's service delivery plan.

(d) A participant may share CFSS services. Two or three CFSS participants may
share services at the same time provided by the same support worker.

(e) The agency-provider must use a minimum of 72.5 percent of the revenue
generated by the medical assistance payment for CFSS for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist must not be used in making this calculation.

(f) The agency-provider model must be used by individuals who have been restricted
by the Minnesota restricted recipient program.

Subd. 12.

Requirements for initial enrollment of CFSS provider agencies.

(a)
All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
agency in a format determined by the commissioner, information and documentation that
includes, but is not limited to, the following:

(1) the CFSS provider agency's current contact information including address,
telephone number, and e-mail address;

(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;

(3) proof of fidelity bond coverage in the amount of $20,000;

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the CFSS provider agency's organization identifying the names
or all owners, managing employees, staff, board of directors, and the affiliations of the
directors, owners, or staff to other service providers;

(7) a copy of the CFSS provider agency's written policies and procedures including:
hiring of employees; training requirements; service delivery; and employee and consumer
safety including process for notification and resolution of consumer grievances,
identification and prevention of communicable diseases, and employee misconduct;

(8) copies of all other forms the CFSS provider agency uses in the course of daily
business including, but not limited to:

(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
the standard time sheet for CFSS services approved by the commissioner, and a letter
requesting approval of the CFSS provider agency's nonstandard time sheet;

(ii) the CFSS provider agency's template for the CFSS care plan; and

(iii) the CFSS provider agency's template for the written agreement in subdivision
21 for recipients using the CFSS choice option, if applicable;

(9) a list of all training and classes that the CFSS provider agency requires of its
staff providing CFSS services;

(10) documentation that the CFSS provider agency and staff have successfully
completed all the training required by this section;

(11) documentation of the agency's marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;

(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for CFSS services for employee personal
care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist shall not be used in making this calculation; and

(14) documentation that the agency does not burden recipients' free exercise of their
right to choose service providers by requiring personal care assistants to sign an agreement
not to work with any particular CFSS recipient or for another CFSS provider agency after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.

(b) CFSS provider agencies shall provide the information specified in paragraph
(a) to the commissioner.

(c) All CFSS provider agencies shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day
management and operations of the agency to complete mandatory training as determined
by the commissioner. Employees in management and supervisory positions and owners
who are active in the day-to-day operations of an agency who have completed the required
training as an employee with a CFSS provider agency do not need to repeat the required
training if they are hired by another agency, if they have completed the training within
the past three years. CFSS provider agency billing staff shall complete training about
CFSS program financial management. Any new owners or employees in management
and supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. CFSS provider agencies
certified for participation in Medicare as home health agencies are exempt from the
training required in this subdivision.

Subd. 13.

Flexible spending model.

(a) Under the flexible spending model
participants accept more responsibility and control over the services and supports
described and budgeted within the CFSS service delivery plan. Under this model:

(1) using a budget allocation, participants may directly employ and pay support
workers and obtain other supports and goods as defined in subdivision 7; and

(2) from the financial management services (FMS) contractor the participant may
choose a range of support assistance for:

(i) planning, budgeting, and management of services and support;

(ii) the employment, training, supervision, and evaluation of workers;

(iii) acquisition and payment and supports and goods; and

(iv) evaluation of individual service outcomes as needed for the scope of the
participant's degree of control and responsibility.

(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
may authorize a legal representative or participant's representative to do so on their behalf.

(c) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model. The FMS contractor shall provide service functions as
determined by the commissioner that include but are not limited to:

(1) information and consultation about CFSS;

(2) assistance with the development of the service delivery plan and flexible
spending model as requested by the participant;

(3) billing and making payments for flexible spending model expenditures;

(4) employer and employer agent functions according to Internal Revenue Code
Procedure 70-6, section 3504, Agency Employer Tax Liability, regulation 137036-08,
which includes assistance with filing and paying payroll taxes, and obtaining worker
compensation coverage;

(5) data recording and reporting of participant spending; and

(6) other duties established in the contract with the department.

(d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use flexible spending model
with a service delivery plan that specifies the amount of services to be authorized to the
agency-provider and the expenditures to be paid by the FMS contractor.

(e) The FMS contractor shall:

(1) not limit or restrict the participant's choice of service or support providers,
including the use of any available employment models;

(2) provide the participant and the targeted case manager, if applicable, with a
monthly written summary of the spending for services and supports that were billed
against the spending budget;

(3) be knowledgeable of state and federal employment regulations under the Fair
Labor Standards Act of 1938, and comply with the requirements under the Internal
Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
Liability for vendor or fiscal employer agent, and any requirements necessary to process
employer and employee deductions, provide appropriate and timely submission of
employer tax liabilities, and maintain documentation to support medical assistance claims;

(4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commission and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;

(5) assume fiscal accountability for state funds designated for the program; and

(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support
workers. The documentation and time records must be maintained for a minimum of
five years from the claim date and be available for audit or review upon request by the
commissioner. Claims submitted by the FMS contractor to the commissioner for payment
must correspond with services, amounts, and time periods as authorized in the participant's
spending budget and service plan.

(f) The commissioner of human services shall:

(1) establish rates and payment methodology for the FMS contractor;

(2) identify a process to ensure quality and performance standards for the FMS
contractor and ensure statewide access to FMS contractors; and

(3) establish a uniform protocol for delivering and administering CFSS services
to be used by eligible FMS contractors.

(g) Participants who are disenrolled from the model shall be transferred to the
agency-provider model.

Subd. 14.

Participant's responsibilities under flexible spending model.

(a) A
participant using the flexible spending model must use a FMS contractor or vendor that is
under contract with the department. Upon a determination of eligibility and completion of
the assessment and community support plan, the participant shall choose a FMS contractor
from a list of eligible vendors maintained by the department.

(b) When the participant, participant's representative, or legal representative chooses
to be the employer of record for the support worker, they are responsible for recruiting,
interviewing, hiring, training, scheduling, supervising, and discharging direct support
workers.

(c) In addition to the employer responsibilities in paragraph (b), the participant,
participant's representative, or legal representative is responsible for:

(1) tracking the services provided and all expenditures for goods or other supports;

(2) preparing and submitting time sheets, signed by both the participant and support
worker, to the FMS contractor on a regular basis and in a timely manner according to
the FMS contractor's procedures;

(3) notifying the FMS contractor within ten days of any changes in circumstances
affecting the CFSS service plan or in the participant's place of residence including, but
not limited to, any hospitalization of the participant or change in the participant's address,
telephone number, or employment;

(4) notifying the FMS contractor of any changes in the employment status of each
participant support worker; and

(5) reporting any problems resulting from the quality of services rendered by the
support worker to the FMS contractor. If the participant is unable to resolve any problems
resulting from the quality of service rendered by the support worker with the FMS
contractor, the participant shall report the situation to the department.

Subd. 15.

Documentation of support services provided.

(a) Support services
provided to a participant by a support worker employed by either an agency-provider
or the participant acting as the employer must be documented daily by each support
worker, on a time sheet form approved by the commissioner. All documentation may be
Web-based, electronic, or paper documentation. The completed form must be submitted
on a monthly basis to the provider or the participant and the FMS contractor selected by
the participant to provide assistance with meeting the participant's employer obligations
and kept in the recipient's health record.

(b) The activity documentation must correspond to the written service delivery plan
and be reviewed by the agency provider or the participant and the FMS contractor when
the participant is acting as the employer of the support worker.

(c) The time sheet must be on a form approved by the commissioner documenting
time the support worker provides services in the home. The following criteria must be
included in the time sheet:

(1) full name of the support worker and individual provider number;

(2) provider name and telephone numbers, if an agency-provider is responsible for
delivery services under the written service plan;

(3) full name of the participant;

(4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;

(5) signatures of the participant or the participant's representative;

(6) personal signature of the support worker;

(7) any shared care provided, if applicable;

(8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and

(9) dates and location of recipient stays in a hospital, care facility, or incarceration.

Subd. 16.

Support workers requirements.

(a) Support workers shall:

(1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:

(i) the support worker is not disqualified under section 245C.14; or

(ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;

(2) have the ability to effectively communicate with the participant or the
participant's representative;

(3) have the skills and ability to provide the services and supports according to the
person's CFSS service delivery plan and respond appropriately to the participant's needs;

(4) not be a participant of CFSS;

(5) complete the basic standardized training as determined by the commissioner
before completing enrollment. The training must be available in languages other than
English and to those who need accommodations due to disabilities. Support worker
training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of support workers including information about basic body
mechanics, emergency preparedness, orientation to positive behavioral practices, fraud
issues, time cards and documentation, and an overview of person-centered planning and
self-direction. Upon completion of the training components, the support worker must pass
the certification test to provide assistance to participants;

(6) complete training and orientation on the participant's individual needs; and

(7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.

(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:

(1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;

(2) fails to provide the authorized services required by the participant employer;

(3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;

(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or

(5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.

(c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.

Subd. 17.

Support specialist requirements and payments.

The commissioner
shall develop qualifications, scope of functions, and payment rates and service limits for a
support specialist that may provide additional or specialized assistance necessary to plan,
implement, arrange, augment, or evaluate services and supports.

Subd. 18.

Service unit and budget allocation requirements.

(a) For the
agency-provider model, services will be authorized in units of service. The total service
unit amount must be established based upon the assessed need for CFSS services, and
must not exceed the maximum number of units available as determined by section
256B.0652, subdivision 6. The unit rate established by the commissioner is used with
assessed units to determine the maximum available CFSS allocation.

(b) For the flexible spending model, services and supports are authorized under
a budget limit.

(c) The maximum available CFSS participant budget allocation shall be established
by multiplying the number of units authorized under subdivision 8 by the payment rate
established by the commissioner.

Subd. 19.

Support system.

(a) The commissioner shall provide information,
consultation, training, and assistance to ensure the participant is able to manage the
services and supports and budgets, if applicable. This support shall include individual
consultation on how to select and employ workers, manage responsibilities under CFSS,
and evaluate personal outcomes.

(b) The commissioner shall provide assistance with the development of risk
management agreements.

Subd. 20.

Service-related rights.

Participants must be provided with adequate
information, counseling, training, and assistance, as needed, to ensure that the participant
is able to choose and manage services, models, and budgets. This support shall include
information regarding: (1) person-centered planning; (2) the range and scope of individual
choices; (3) the process for changing plans, services and budgets; (4) the grievance
process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
and responsibilities; and (8) risk management. A participant who appeals a reduction in
previously authorized CFSS services may continue previously authorized services pending
an appeal under section 256.045. The commissioner must ensure that the participant
has a copy of the most recent service delivery plan that contains a detailed explanation
of which areas of covered CFSS are reduced, and provide notice of the amount of the
budget reduction, and the reasons for the reduction in the participant's notice of denial,
termination, or reduction.

Subd. 21.

Development and Implementation Council.

The commissioner
shall establish a Development and Implementation Council of which the majority of
members are individuals with disabilities, elderly individuals, and their representatives.
The commissioner shall consult and collaborate with the council when developing and
implementing this section.

Subd. 22.

Quality assurance and risk management system.

(a) The commissioner
shall establish quality assurance and risk management measures for use in developing and
implementing CFSS including those that (1) recognize the roles and responsibilities of those
involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
based upon a recipient's resources and capabilities. Risk management measures must
include background studies, and backup and emergency plans, including disaster planning.

(b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for CFSS participants.

(c) Performance assessment measures, such as a participant's satisfaction with the
services and supports, and ongoing monitoring of health and well-being shall be identified
in consultation with the council established in subdivision 21.

Subd. 23.

Commissioner's access.

When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate
access without prior notice to the agency provider or FMS contractor's office during
regular business hours and to documentation and records related to services provided and
submission of claims for services provided. Denying the commissioner access to records
is cause for immediate suspension of payment and terminating the agency provider's
enrollment according to section 256B.064 or terminating the FMS contract.

Subd. 24.

CFSS agency-providers; background studies.

CFSS agency-providers
enrolled to provide personal care assistance services under the medical assistance program
shall comply with the following:

(1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
agency-provider. "Managing employee" has the same meaning as Code of Federal
Regulations, title 42, section 455. An organization is barred from enrollment if:

(i) the organization has not initiated background studies on owners managing
employees; or

(ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14, and
the owner or managing employee has not received a set-aside of the disqualification
under section 245C.22;

(2) a background study must be initiated and completed for all support specialists; and

(3) a background study must be initiated and completed for all support workers.

EFFECTIVE DATE.

This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when this occurs.

Sec. 44.

Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1o.

Supplementary service rate; exemptions.

A county agency shall not
negotiate a supplementary service rate under this section for any individual that has been
determined to be eligible for Housing Stability Services as approved by the Centers
for Medicare and Medicaid Services, and who resides in an establishment voluntarily
registered under section 144D.025, as a supportive housing establishment or participates
in the Minnesota supportive housing demonstration program under section 256I.04,
subdivision 3, paragraph (a), clause (4).

Sec. 45.

Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:


Subd. 4.

Reporting.

(a) Except as provided in paragraph (b), a mandated reporter
shall immediately make an oral report to the common entry point. The common entry
point may accept electronic reports submitted through a Web-based reporting system
established by the commissioner.
Use of a telecommunications device for the deaf or other
similar device shall be considered an oral report. The common entry point may not require
written reports. To the extent possible, the report must be of sufficient content to identify
the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
any evidence of previous maltreatment, the name and address of the reporter, the time,
date, and location of the incident, and any other information that the reporter believes
might be helpful in investigating the suspected maltreatment. A mandated reporter may
disclose not public data, as defined in section 13.02, and medical records under sections
144.291 to 144.298, to the extent necessary to comply with this subdivision.

(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
certified under Title 19 of the Social Security Act, a nursing home that is licensed under
section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
to the common entry point instead of submitting an oral report. The report may be a
duplicate of the initial report the facility submits electronically to the commissioner of
health to comply with the reporting requirements under Code of Federal Regulations, title
42, section 483.13. The commissioner of health may modify these reporting requirements
to include items required under paragraph (a) that are not currently included in the
electronic reporting form.

EFFECTIVE DATE.

This section is effective July 1, 2014.

Sec. 46.

Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:


Subd. 9.

Common entry point designation.

(a) Each county board shall designate
a common entry point for reports of suspected maltreatment. Two or more county boards
may jointly designate a single
The commissioner of human services shall establish a
common entry point effective July 1, 2014. The common entry point is the unit responsible
for receiving the report of suspected maltreatment under this section.

(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:

(1) the time and date of the report;

(2) the name, address, and telephone number of the person reporting;

(3) the time, date, and location of the incident;

(4) the names of the persons involved, including but not limited to, perpetrators,
alleged victims, and witnesses;

(5) whether there was a risk of imminent danger to the alleged victim;

(6) a description of the suspected maltreatment;

(7) the disability, if any, of the alleged victim;

(8) the relationship of the alleged perpetrator to the alleged victim;

(9) whether a facility was involved and, if so, which agency licenses the facility;

(10) any action taken by the common entry point;

(11) whether law enforcement has been notified;

(12) whether the reporter wishes to receive notification of the initial and final
reports; and

(13) if the report is from a facility with an internal reporting procedure, the name,
mailing address, and telephone number of the person who initiated the report internally.

(c) The common entry point is not required to complete each item on the form prior
to dispatching the report to the appropriate lead investigative agency.

(d) The common entry point shall immediately report to a law enforcement agency
any incident in which there is reason to believe a crime has been committed.

(e) If a report is initially made to a law enforcement agency or a lead investigative
agency, those agencies shall take the report on the appropriate common entry point intake
forms and immediately forward a copy to the common entry point.

(f) The common entry point staff must receive training on how to screen and
dispatch reports efficiently and in accordance with this section.

(g) The commissioner of human services shall maintain a centralized database
for the collection of common entry point data, lead investigative agency data including
maltreatment report disposition, and appeals data. The common entry point shall
have access to the centralized database and must log the reports into the database and
immediately identify and locate prior reports of abuse, neglect, or exploitation.

(h) When appropriate, the common entry point staff must refer calls that do not
allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
that might resolve the reporter's concerns.

(i) a common entry point must be operated in a manner that enables the
commissioner of human services to:

(1) track critical steps in the reporting, evaluation, referral, response, disposition,
and investigative process to ensure compliance with all requirements for all reports;

(2) maintain data to facilitate the production of aggregate statistical reports for
monitoring patterns of abuse, neglect, or exploitation;

(3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect,
or exploitation;

(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and

(5) track and manage consumer complaints related to the common entry point.

(j) The commissioners of human services and health shall collaborate on the creation
of a triage system for investigations. This system shall enable the commissioner of human
services to track critical steps in the reporting, evaluation, referral, response, disposition,
investigation, notification, determination, and appeal processes.

Sec. 47.

Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:


Subd. 9e.

Education requirements.

(a) The commissioners of health, human
services, and public safety shall cooperate in the development of a joint program for
education of lead investigative agency investigators in the appropriate techniques for
investigation of complaints of maltreatment. This program must be developed by July
1, 1996. The program must include but need not be limited to the following areas: (1)
information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
conclusions based on evidence; (5) interviewing skills, including specialized training to
interview people with unique needs; (6) report writing; (7) coordination and referral
to other necessary agencies such as law enforcement and judicial agencies; (8) human
relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
systems and the appropriate methods for interviewing relatives in the course of the
assessment or investigation; (10) the protective social services that are available to protect
alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
which lead investigative agency investigators and law enforcement workers cooperate in
conducting assessments and investigations in order to avoid duplication of efforts; and
(12) data practices laws and procedures, including provisions for sharing data.

(b) The commissioner of human services shall conduct an outreach campaign to
promote the common entry point for reporting vulnerable adult maltreatment. This
campaign shall assist potential reporters, mandated reporters, and vulnerable adults in
finding information on reporting to the common entry point. This campaign shall use the
Internet and other means of communication.

(b) (c) The commissioners of health, human services, and public safety shall offer at
least annual education to others on the requirements of this section, on how this section is
implemented, and investigation techniques.

(c) (d) The commissioner of human services, in coordination with the commissioner
of public safety shall provide training for the common entry point staff as required in this
subdivision and the program courses described in this subdivision, at least four times
per year. At a minimum, the training shall be held twice annually in the seven-county
metropolitan area and twice annually outside the seven-county metropolitan area. The
commissioners shall give priority in the program areas cited in paragraph (a) to persons
currently performing assessments and investigations pursuant to this section.

(d) (e) The commissioner of public safety shall notify in writing law enforcement
personnel of any new requirements under this section. The commissioner of public
safety shall conduct regional training for law enforcement personnel regarding their
responsibility under this section.

(e) (f) Each lead investigative agency investigator must complete the education
program specified by this subdivision within the first 12 months of work as a lead
investigative agency investigator.

A lead investigative agency investigator employed when these requirements take
effect must complete the program within the first year after training is available or as soon
as training is available.

All lead investigative agency investigators having responsibility for investigation
duties under this section must receive a minimum of eight hours of continuing education
or in-service training each year specific to their duties under this section.

Sec. 48. REPEALER.

Minnesota Statutes 2012, sections 245A.655; 256B.0911, subdivisions 4a, 4b, and
4c; and 256B.0917, subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, and 14,
are repealed.

Sec. 49. EFFECTIVE DATE; CONTINGENT SYSTEMS MODERNIZATION
APPROPRIATION.

Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms in this
subdivision have the meanings given.

(b) Unless otherwise indicated, "commissioner" means the commissioner of human
services.

(c) "Contingent systems modernization appropriation" refers to the appropriation in
article 14, section 3, subdivision 4, paragraph (a).

(d) "Department" means the Department of Human Services.

(e) "Plan" means the plan that outlines how the provisions in this article, and the
contingent appropriation for systems modernization, are implemented once federal action
on Reform 2020 has occurred.

(f) Unless otherwise indicated, "Reform 2020" means the commissioner's request
for any necessary federal approval of provisions in this article that modify or provide
new medical assistance services, or that otherwise modify the federal role in the state's
long-term care system.

Subd. 2.

Intent; effective dates generally.

(a) Because the changes contained in
this article generate savings that are contingent on federal approval of Reform 2020,
the legislature has also made an appropriation for systems modernization contingent on
federal approval of Reform 2020. The purpose of this section is to outline how this article
and the contingent systems modernization appropriation are implemented if Reform 2020
is fully, partially, or incrementally approved or denied.

(b) In order for sections 1 to 48 of this article to be effective, the commissioner must
follow the provisions of subdivisions 3 and 4, as applicable, notwithstanding any other
effective dates for those sections.

Subd. 3.

Federal approval.

(a) The implementation of this article is contingent
on federal approval.

(b) Upon full or partial approval of the waiver application, the commissioner shall
develop a plan for implementing the provisions in this article that received federal
approval as well as any that do not require federal approval. The plan must:

(1) include fiscal estimates for the 2014-2015 and 2016-2017 biennia;

(2) include the contingent systems modernization appropriation, which cannot
exceed $18,814,000 for the biennium ending June 30, 2015; and

(3) include spending estimates that, with federal administrative reimbursement, do
not exceed the department's net general fund appropriations for the 2014-2015 biennium.

(c) Upon approval by the commissioner of management and budget, the department
may implement the plan.

(d) The commissioner may follow this plan and implement parts of Reform 2020
consistent with federal law if federal approval is denied, received incrementally, or
significantly delayed.

(e) The commissioner must notify the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services funding of the
plan. The plan must be made publicly available online.

Subd. 4.

Disbursement; implementation.

The commissioner of management and
budget shall disburse the appropriations in article 14, section 3, subdivision 4, paragraphs
(a), (b), and (d); subdivision 5, paragraphs (e), (g), and (h); and subdivision 6, paragraphs
(f), (i), and (k), to the commissioner to allow for implementation of the approved plan
and make necessary adjustments in the accounting system to reflect any modified funding
levels. Notwithstanding Minnesota Statutes, section 16A.11, subdivision 3, paragraph (b),
these fiscal estimates must be considered in establishing the appropriation base for the
biennium ending June 30, 2017. The commissioner of management and budget shall reflect
the modified funding levels in the first fund balance following the approval of the plan.

ARTICLE 3

SAFE AND HEALTHY DEVELOPMENT OF CHILDREN

Section 1.

Minnesota Statutes 2012, section 119B.011, is amended by adding a
subdivision to read:


Subd. 19b.

Student parent.

"Student parent" means a person who is:

(1) under 21 years of age and has a child;

(2) pursuing a high school or general equivalency diploma;

(3) residing within a county that has a basic sliding fee waiting list under section
119B.03, subdivision 4; and

(4) not an MFIP participant.

EFFECTIVE DATE.

This section is effective November 11, 2013.

Sec. 2.

Minnesota Statutes 2012, section 119B.02, is amended by adding a subdivision
to read:


Subd. 7.

Child care market rate survey.

Biennially, the commissioner shall survey
prices charged by child care providers in Minnesota to determine the 75th percentile for
like-care arrangements in county price clusters.

EFFECTIVE DATE.

This section is effective September 16, 2013.

Sec. 3.

Minnesota Statutes 2012, section 119B.025, subdivision 1, is amended to read:


Subdivision 1.

Factors which must be verified.

(a) The county shall verify the
following at all initial child care applications using the universal application:

(1) identity of adults;

(2) presence of the minor child in the home, if questionable;

(3) relationship of minor child to the parent, stepparent, legal guardian, eligible
relative caretaker, or the spouses of any of the foregoing;

(4) age;

(5) immigration status, if related to eligibility;

(6) Social Security number, if given;

(7) income;

(8) spousal support and child support payments made to persons outside the
household;

(9) residence; and

(10) inconsistent information, if related to eligibility.

(b) If a family did not use the universal application or child care addendum to apply
for child care assistance, the family must complete the universal application or child care
addendum at its next eligibility redetermination and the county must verify the factors
listed in paragraph (a) as part of that redetermination. Once a family has completed a
universal application or child care addendum, the county shall use the redetermination
form described in paragraph (c) for that family's subsequent redeterminations. Eligibility
must be redetermined at least every six months. A family is considered to have met the
eligibility redetermination requirement if a complete redetermination form and all required
verifications are received within 30 days after the date the form was due. Assistance shall
be payable retroactively from the redetermination due date.
For a family where at least
one parent is under the age of 21, does not have a high school or general equivalency
diploma, and is a student in a school district or another similar program that provides or
arranges for child care, as well as parenting, social services, career and employment
supports, and academic support to achieve high school graduation, the redetermination of
eligibility shall be deferred beyond six months, but not to exceed 12 months, to the end of
the student's school year. If a family reports a change in an eligibility factor before the
family's next regularly scheduled redetermination, the county must recalculate eligibility
without requiring verification of any eligibility factor that did not change.

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

EFFECTIVE DATE.

This section is effective August 4, 2014.

Sec. 4.

Minnesota Statutes 2012, section 119B.03, subdivision 4, is amended to read:


Subd. 4.

Funding priority.

(a) First priority for child care assistance under the
basic sliding fee program must be given to eligible non-MFIP families who do not have a
high school or general equivalency diploma or who need remedial and basic skill courses
in order to pursue employment or to pursue education leading to employment and who
need child care assistance to participate in the education program. This includes student
parents as defined under section 119B.011, subdivision 19b.
Within this priority, the
following subpriorities must be used:

(1) child care needs of minor parents;

(2) child care needs of parents under 21 years of age; and

(3) child care needs of other parents within the priority group described in this
paragraph.

(b) Second priority must be given to parents who have completed their MFIP or
DWP transition year, or parents who are no longer receiving or eligible for diversionary
work program supports.

(c) Third priority must be given to families who are eligible for portable basic sliding
fee assistance through the portability pool under subdivision 9.

(d) Fourth priority must be given to families in which at least one parent is a veteran
as defined under section 197.447.

(e) Families under paragraph (b) must be added to the basic sliding fee waiting list
on the date they begin the transition year under section 119B.011, subdivision 20, and
must be moved into the basic sliding fee program as soon as possible after they complete
their transition year.

EFFECTIVE DATE.

This section is effective November 11, 2013.

Sec. 5.

Minnesota Statutes 2012, section 119B.05, subdivision 1, is amended to read:


Subdivision 1.

Eligible participants.

Families eligible for child care assistance
under the MFIP child care program are:

(1) MFIP participants who are employed or in job search and meet the requirements
of section 119B.10;

(2) persons who are members of transition year families under section 119B.011,
subdivision 20
, and meet the requirements of section 119B.10;

(3) families who are participating in employment orientation or job search, or
other employment or training activities that are included in an approved employability
development plan under section 256J.95;

(4) MFIP families who are participating in work job search, job support,
employment, or training activities as required in their employment plan, or in appeals,
hearings, assessments, or orientations according to chapter 256J;

(5) MFIP families who are participating in social services activities under chapter
256J as required in their employment plan approved according to chapter 256J;

(6) families who are participating in services or activities that are included in an
approved family stabilization plan under section 256J.575;

(7) families who are participating in programs as required in tribal contracts under
section 119B.02, subdivision 2, or 256.01, subdivision 2; and

(8) families who are participating in the transition year extension under section
119B.011, subdivision 20a . ; and

(9) student parents as defined under section 119B.011, subdivision 19b.

EFFECTIVE DATE.

This section is effective November 11, 2013.

Sec. 6.

Minnesota Statutes 2012, section 119B.13, subdivision 1, is amended to read:


Subdivision 1.

Subsidy restrictions.

(a) Beginning October 31, 2011 September 16,
2013
, the maximum rate paid for child care assistance in any county or multicounty region
county price cluster under the child care fund shall be the rate for like-care arrangements in
the county effective July 1, 2006, decreased by 2.5 percent
greater of the 25th percentile of
the 2011 child care provider rate survey or the maximum rate effective November 28, 2011.
The commissioner may: (1) assign a county with no reported provider prices to a similar
price cluster; and (2) consider county level access when determining final price clusters
.

(b) Biennially, beginning in 2012, the commissioner shall survey rates charged
by child care providers in Minnesota to determine the 75th percentile for like-care
arrangements in counties. When the commissioner determines that, using the
commissioner's established protocol, the number of providers responding to the survey is
too small to determine the 75th percentile rate for like-care arrangements in a county or
multicounty region, the commissioner may establish the 75th percentile maximum rate
based on like-care arrangements in a county, region, or category that the commissioner
deems to be similar.

(c) (b) A rate which includes a special needs rate paid under subdivision 3 or under a
school readiness service agreement paid under section 119B.231, may be in excess of the
maximum rate allowed under this subdivision.

(d) (c) The department shall monitor the effect of this paragraph on provider rates.
The county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care
on an hourly, full-day, and weekly basis, including special needs and disability care. The
maximum payment to a provider for one day of care must not exceed the daily rate. The
maximum payment to a provider for one week of care must not exceed the weekly rate.

(e) (d) Child care providers receiving reimbursement under this chapter must not
be paid activity fees or an additional amount above the maximum rates for care provided
during nonstandard hours for families receiving assistance.

(f) (e) When the provider charge is greater than the maximum provider rate allowed,
the parent is responsible for payment of the difference in the rates in addition to any
family co-payment fee.

(g) (f) All maximum provider rates changes shall be implemented on the Monday
following the effective date of the maximum provider rate.

(g) Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum
registration fees in effect on January 1, 2013, shall remain in effect.

Sec. 7.

Minnesota Statutes 2012, section 119B.13, subdivision 1a, is amended to read:


Subd. 1a.

Legal nonlicensed family child care provider rates.

(a) Legal
nonlicensed family child care providers receiving reimbursement under this chapter must
be paid on an hourly basis for care provided to families receiving assistance.

(b) The maximum rate paid to legal nonlicensed family child care providers must be
68 percent of the county maximum hourly rate for licensed family child care providers. In
counties or county price clusters where the maximum hourly rate for licensed family child
care providers is higher than the maximum weekly rate for those providers divided by 50,
the maximum hourly rate that may be paid to legal nonlicensed family child care providers
is the rate equal to the maximum weekly rate for licensed family child care providers
divided by 50 and then multiplied by 0.68. The maximum payment to a provider for one
day of care must not exceed the maximum hourly rate times ten. The maximum payment
to a provider for one week of care must not exceed the maximum hourly rate times 50.

(c) A rate which includes a special needs rate paid under subdivision 3 may be in
excess of the maximum rate allowed under this subdivision.

(d) Legal nonlicensed family child care providers receiving reimbursement under
this chapter may not be paid registration fees for families receiving assistance.

EFFECTIVE DATE.

This section is effective September 16, 2013.

Sec. 8.

Minnesota Statutes 2012, section 119B.13, is amended by adding a subdivision
to read:


Subd. 3b.

Provider rate differential for Parent Aware.

A family child care
provider or child care center shall be paid a 15 percent differential if they hold a three-star
Parent Aware rating or a 20 percent differential if they hold a four-star Parent Aware
rating. A 15 percent or 20 percent rate differential must be paid above the maximum rate
established in subdivision 1, up to the actual provider rate.

EFFECTIVE DATE.

This section is effective March 3, 2014.

Sec. 9.

Minnesota Statutes 2012, section 119B.13, is amended by adding a subdivision
to read:


Subd. 3c.

Weekly rate paid for children attending high-quality care.

A licensed
child care provider or license-exempt center may be paid up to the applicable weekly
maximum rate, not to exceed the provider's actual charge, when the following conditions
are met:

(1) the child is age birth to five years, but not yet in kindergarten;

(2) the child attends a child care provider that qualifies for the rate differential
identified in subdivision 3a or 3b; and

(3) the applicant's activities qualify for at least 30 hours of care per week under
sections 119B.03, 119B.05, 119B.10, and Minnesota Rules, chapter 3400.

EFFECTIVE DATE.

This section is effective August 4, 2014.

Sec. 10.

Minnesota Statutes 2012, section 119B.13, subdivision 6, is amended to read:


Subd. 6.

Provider payments.

(a) The provider shall bill for services provided
within ten days of the end of the service period. If bills are submitted within ten days of
the end of the service period, payments under the child care fund shall be made within 30
days of receiving a bill from the provider. Counties or the state may establish policies that
make payments on a more frequent basis.

(b) If a provider has received an authorization of care and been issued a billing form
for an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be paid.

(c) If a provider provided care for a time period without receiving an authorization
of care and a billing form for an eligible family, payment of child care assistance may only
be made retroactively for a maximum of six months from the date the provider is issued
an authorization of care and billing form.

(d) A county may refuse to issue a child care authorization to a licensed or legal
nonlicensed provider, revoke an existing child care authorization to a licensed or legal
nonlicensed provider, stop payment issued to a licensed or legal nonlicensed provider, or
refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:

(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;

(2) a county finds by a preponderance of the evidence that the provider intentionally
gave the county materially false information on the provider's billing forms;

(3) the provider is in violation of child care assistance program rules, until the
agency determines those violations have been corrected;

(4) the provider is operating after receipt of an order of suspension or an order
of revocation of the provider's license, or the provider has been issued an order citing
violations of licensing standards that affect the health and safety of children in care due to
the nature, chronicity, or severity of the licensing violations, until the licensing agency
determines those violations have been corrected;

(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request; or

(6) the provider gives false child care price information.

The county may withhold the provider's authorization or payment for a period of
time not to exceed three months beyond the time the condition has been corrected.

(e) A county's payment policies must be included in the county's child care plan
under section 119B.08, subdivision 3. If payments are made by the state, in addition to
being in compliance with this subdivision, the payments must be made in compliance
with section 16A.124.

EFFECTIVE DATE.

This section is effective February 3, 2014.

Sec. 11.

Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:


Subd. 2a.

Immediate suspension expedited hearing.

(a) Within five working days
of receipt of the license holder's timely appeal, the commissioner shall request assignment
of an administrative law judge. The request must include a proposed date, time, and place
of a hearing. A hearing must be conducted by an administrative law judge within 30
calendar days of the request for assignment, unless an extension is requested by either
party and granted by the administrative law judge for good cause. The commissioner shall
issue a notice of hearing by certified mail or personal service at least ten working days
before the hearing. The scope of the hearing shall be limited solely to the issue of whether
the temporary immediate suspension should remain in effect pending the commissioner's
final order under section 245A.08, regarding a licensing sanction issued under subdivision
3 following the immediate suspension. The burden of proof in expedited hearings under
this subdivision shall be limited to the commissioner's demonstration that reasonable
cause exists to believe that the license holder's actions or failure to comply with applicable
law or rule poses, or if the actions of other individuals or conditions in the program poses
an imminent risk of harm to the health, safety, or rights of persons served by the program.
"Reasonable cause" means there exist specific articulable facts or circumstances which
provide the commissioner with a reasonable suspicion that there is an imminent risk of harm
to the health, safety, or rights of persons served by the program. When the commissioner
has determined there is reasonable cause to order the temporary immediate suspension of
a license based on a violation of safe sleep requirements, the commissioner is not required
to demonstrate that an infant died or was injured as a result of the safe sleep violations.

(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The
record shall close at the end of the ten-day period for submission of exceptions. The
commissioner's final order shall be issued within ten working days from the close of the
record. Within 90 calendar days after a final order affirming an immediate suspension, the
commissioner shall make a determination regarding whether a final licensing sanction
shall be issued under subdivision 3. The license holder shall continue to be prohibited
from operation of the program during this 90-day period.

(c) When the final order under paragraph (b) affirms an immediate suspension, and a
final licensing sanction is issued under subdivision 3 and the license holder appeals that
sanction, the license holder continues to be prohibited from operation of the program
pending a final commissioner's order under section 245A.08, subdivision 5, regarding the
final licensing sanction.

Sec. 12.

Minnesota Statutes 2012, section 245A.1435, is amended to read:


245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT
DEATH SYNDROME IN LICENSED PROGRAMS.

(a) When a license holder is placing an infant to sleep, the license holder must
place the infant on the infant's back, unless the license holder has documentation from
the infant's parent physician directing an alternative sleeping position for the infant. The
parent physician directive must be on a form approved by the commissioner and must
include a statement that the parent or legal guardian has read the information provided by
the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance
of placing an infant or child on its back to sleep to reduce the risk of SIDS
remain on file
at the licensed location
. An infant who independently rolls onto its stomach after being
placed to sleep on its back may be allowed to remain sleeping on its stomach.

(b) The license holder must place the infant in a crib directly on a firm mattress with
a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be
dislodged by pulling on the corner of the sheet. The license holder must not place pillows,
quilts, comforters, sheepskin, pillow-like stuffed toys, any loose bedding including but
not limited to blankets and sheets,
or other soft products in the crib with the infant. The
requirements of this section apply to license holders serving infants up to and including
12 months of age. Licensed child care providers must meet the crib requirements under
section 245A.146.

(c) If an infant falls asleep before being placed in a crib, the license holder must
move the infant to a crib as soon as practicable, and must keep the infant within sight of
the license holder until the infant is placed in a crib. When an infant falls asleep while
being held, the license holder must consider the supervision needs of other children in
care when determining how long to hold the infant before placing the infant in a crib to
sleep. The sleeping infant must not be in a position where the airway may be blocked or
with anything covering the infant's face.

Sec. 13.

Minnesota Statutes 2012, section 245A.144, is amended to read:


245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR
CHILD FOSTER CARE PROVIDERS.

(a) Licensed child foster care providers that care for infants or children through five
years of age must document that before staff persons and caregivers assist in the care
of infants or children through five years of age, they are instructed on the standards in
section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome for abusive head trauma from shaking infants
and young children. This section does not apply to emergency relative placement under
section 245A.035. The training on reducing the risk of sudden unexpected infant death
syndrome and shaken baby syndrome abusive head trauma may be provided as:

(1) orientation training to child foster care providers, who care for infants or children
through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or

(2) in-service training to child foster care providers, who care for infants or children
through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.

(b) Training required under this section must be at least one hour in length and must
be completed at least once every five years. At a minimum, the training must address
the risk factors related to sudden unexpected infant death syndrome and shaken baby
syndrome
abusive head trauma, means of reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome abusive head trauma, and license holder
communication with parents regarding reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome abusive head trauma.

(c) Training for child foster care providers must be approved by the county or
private licensing agency that is responsible for monitoring the child foster care provider
under section 245A.16. The approved training fulfills, in part, training required under
Minnesota Rules, part 2960.3070.

Sec. 14.

Minnesota Statutes 2012, section 245A.1444, is amended to read:


245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD
TRAUMA
BY OTHER PROGRAMS.

A licensed chemical dependency treatment program that serves clients with infants
or children through five years of age, who sleep at the program and a licensed children's
residential facility that serves infants or children through five years of age, must document
that before program staff persons or volunteers assist in the care of infants or children
through five years of age, they are instructed on the standards in section 245A.1435 and
receive training on reducing the risk of sudden unexpected infant death syndrome and
shaken baby syndrome abusive head trauma from shaking infants and young children. The
training conducted under this section may be used to fulfill training requirements under
Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.

This section does not apply to child care centers or family child care programs
governed by sections 245A.40 and 245A.50.

Sec. 15.

[245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
REQUIREMENTS.

Subdivision 1.

In-person checks on infants.

(a) License holders that serve infants
must monitor sleeping infants by conducting in-person checks on each infant in their care
every 30 minutes.

(b) Upon enrollment of an infant in a family child care program, the license holder
must conduct in-person checks on the infant every 15 minutes, during the first four
months of care.

(c) When an infant has an upper respiratory infection, the license holder must
conduct in-person checks on the infant every 15 minutes throughout the hours of care.

Subd. 2.

Use of audio or visual monitoring devices.

In addition to conducting
the in-person checks required under subdivision 1, license holders serving infants must
use and maintain an audio or visual monitoring device to monitor each infant in care
during all hours of care.

Sec. 16.

[245A.152] CHILD CARE LICENSE HOLDER INSURANCE.

Subdivision 1.

Insurance coverage required for child care licensure.

(a) All
licensed family child care providers and child care centers shall maintain insurance
coverage for personal injury, death, or property damage resulting from any act or omission
related to the provision of services under the license. The coverage limits shall be at least
$100,000 per person and $250,000 per occurrence.

(b) No license to provide child care shall take effect before the insurance coverage
required under this section becomes effective. A license shall be suspended or revoked
any time the insurance coverage required under this section lapses or is terminated and
replacement coverage has not taken effect.

(c) A license holder shall immediately notify the commissioner if the insurance
coverage required under this section lapses or is terminated and no replacement coverage
has taken effect.

Subd. 2.

Evidence of insurance.

(a) A current certificate of coverage for insurance
required under this section shall be posted in a place in the licensed family child care
home or center that is conspicuous to all visitors and parents of children receiving services
from the program.

(b) A license holder shall, upon request, provide a copy of the current certificate of
coverage for insurance required under this section to the commissioner or to any parent
of a child receiving services from the licensed program.

Sec. 17.

Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:


Subd. 5.

Sudden unexpected infant death syndrome and shaken baby syndrome
abusive head trauma training.

(a) License holders must document that before staff
persons and volunteers care for infants, they are instructed on the standards in section
245A.1435 and receive training on reducing the risk of sudden unexpected infant death
syndrome. In addition, license holders must document that before staff persons care for
infants or children under school age, they receive training on the risk of shaken baby
syndrome
abusive head trauma from shaking infants and young children. The training
in this subdivision may be provided as orientation training under subdivision 1 and
in-service training under subdivision 7.

(b) Sudden unexpected infant death syndrome reduction training required under
this subdivision must be at least one-half hour in length and must be completed at least
once every five years year. At a minimum, the training must address the risk factors
related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
unexpected infant death syndrome in child care, and license holder communication with
parents regarding reducing the risk of sudden unexpected infant death syndrome.

(c) Shaken baby syndrome Abusive head trauma training under this subdivision
must be at least one-half hour in length and must be completed at least once every five
years
year. At a minimum, the training must address the risk factors related to shaken
baby syndrome for
shaking infants and young children, means to reduce the risk of shaken
baby syndrome
abusive head trauma in child care, and license holder communication with
parents regarding reducing the risk of shaken baby syndrome abusive head trauma.

(d) The commissioner shall make available for viewing a video presentation on the
dangers associated with shaking infants and young children. The video presentation must
be part of the orientation and annual in-service training of licensed child care center
staff persons caring for children under school age. The commissioner shall provide to
child care providers and interested individuals, at cost, copies of a video approved by the
commissioner of health under section 144.574 on the dangers associated with shaking
infants and young children.

Sec. 18.

Minnesota Statutes 2012, section 245A.50, is amended to read:


245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.

Subdivision 1.

Initial training.

(a) License holders, caregivers, and substitutes must
comply with the training requirements in this section.

(b) Helpers who assist with care on a regular basis must complete six hours of
training within one year after the date of initial employment.

Subd. 2.

Child growth and development and behavior guidance training.

(a) For
purposes of family and group family child care, the license holder and each adult caregiver
who provides care in the licensed setting for more than 30 days in any 12-month period
shall complete and document at least two four hours of child growth and development
and behavior guidance training within the first year of prior to initial licensure, and before
caring for children
. For purposes of this subdivision, "child growth and development
training" means training in understanding how children acquire language and develop
physically, cognitively, emotionally, and socially. "Behavior guidance training" means
training in the understanding of the functions of child behavior and strategies for managing
challenging situations. Child growth and development and behavior guidance training
must be repeated annually. Training curriculum shall be developed by the commissioner
of human services by January 1, 2014.

(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if
they:

(1) have taken a three-credit course on early childhood development within the
past five years;

(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;

(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood
educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early
childhood special education teacher, or an elementary teacher with a kindergarten
endorsement; or

(4) have received a baccalaureate degree with a Montessori certificate within the
past five years.

Subd. 3.

First aid.

(a) When children are present in a family child care home
governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person
must be present in the home who has been trained in first aid. The first aid training must
have been provided by an individual approved to provide first aid instruction. First aid
training may be less than eight hours and persons qualified to provide first aid training
include individuals approved as first aid instructors. First aid training must be repeated
every two years.

(b) A family child care provider is exempt from the first aid training requirements
under this subdivision related to any substitute caregiver who provides less than 30 hours
of care during any 12-month period.

(c) Video training reviewed and approved by the county licensing agency satisfies
the training requirement of this subdivision.

Subd. 4.

Cardiopulmonary resuscitation.

(a) When children are present in a family
child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least
one staff person must be present in the home who has been trained in cardiopulmonary
resuscitation (CPR) and in the treatment of obstructed airways that includes CPR
techniques for infants and children
. The CPR training must have been provided by an
individual approved to provide CPR instruction, must be repeated at least once every three
two years, and must be documented in the staff person's records.

(b) A family child care provider is exempt from the CPR training requirement in
this subdivision related to any substitute caregiver who provides less than 30 hours of
care during any 12-month period.

(c) Video training reviewed and approved by the county licensing agency satisfies
the training requirement of this subdivision.
Persons providing CPR training must use
CPR training that has been developed:

(1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or

(2) using nationally recognized, evidence-based guidelines for CPR training and
incorporates psychomotor skills to support the instruction.

Subd. 5.

Sudden unexpected infant death syndrome and shaken baby syndrome
abusive head trauma training.

(a) License holders must document that before staff
persons, caregivers, and helpers assist in the care of infants, they are instructed on the
standards in section 245A.1435 and receive training on reducing the risk of sudden
unexpected infant death syndrome. In addition, license holders must document that before
staff persons, caregivers, and helpers assist in the care of infants and children under
school age, they receive training on reducing the risk of shaken baby syndrome abusive
head trauma from shaking infants and young children
. The training in this subdivision
may be provided as initial training under subdivision 1 or ongoing annual training under
subdivision 7.

(b) Sudden unexpected infant death syndrome reduction training required under
this subdivision must be at least one-half hour in length and must be completed at least
once every five years year. At a minimum, the training must address the risk factors
related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
unexpected infant death syndrome in child care, and license holder communication with
parents regarding reducing the risk of sudden unexpected infant death syndrome.

(c) Shaken baby syndrome Abusive head trauma training required under this
subdivision must be at least one-half hour in length and must be completed at least once
every five years year. At a minimum, the training must address the risk factors related
to shaken baby syndrome shaking infants and young children, means of reducing the
risk of shaken baby syndrome abusive head trauma in child care, and license holder
communication with parents regarding reducing the risk of shaken baby syndrome abusive
head trauma
.

(d) Training for family and group family child care providers must be approved
by the county licensing agency.

(e) The commissioner shall make available for viewing by all licensed child care
providers a video presentation on the dangers associated with shaking infants and young
children. The video presentation shall be part of the initial and ongoing annual training of
licensed child care providers, caregivers, and helpers caring for children under school age.
The commissioner shall provide to child care providers and interested individuals, at cost,
copies of a video approved by the commissioner of health under section 144.574 on the
dangers associated with shaking infants and young children.

Subd. 6.

Child passenger restraint systems; training requirement.

(a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685.

(b) Family and group family child care programs licensed by the Department of
Human Services that serve a child or children under nine years of age must document
training that fulfills the requirements in this subdivision.

(1) Before a license holder, staff person, caregiver, or helper transports a child or
children under age nine in a motor vehicle, the person placing the child or children in a
passenger restraint must satisfactorily complete training on the proper use and installation
of child restraint systems in motor vehicles. Training completed under this subdivision may
be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.

(2) Training required under this subdivision must be at least one hour in length,
completed at initial training, and repeated at least once every five years. At a minimum,
the training must address the proper use of child restraint systems based on the child's
size, weight, and age, and the proper installation of a car seat or booster seat in the motor
vehicle used by the license holder to transport the child or children.

(3) Training under this subdivision must be provided by individuals who are certified
and approved by the Department of Public Safety, Office of Traffic Safety. License holders
may obtain a list of certified and approved trainers through the Department of Public
Safety Web site or by contacting the agency.

(c) Child care providers that only transport school-age children as defined in section
245A.02, subdivision 19, paragraph (f), in child care buses as defined in section 169.448,
subdivision 1, paragraph (e), are exempt from this subdivision.

Subd. 7.

Training requirements for family and group family child care.

For
purposes of family and group family child care, the license holder and each primary
caregiver must complete eight 16 hours of ongoing training each year. For purposes
of this subdivision, a primary caregiver is an adult caregiver who provides services in
the licensed setting for more than 30 days in any 12-month period. Repeat of topical
training requirements in subdivisions 2 to 7 shall count toward the annual 16-hour training
requirement. Additional
ongoing training subjects to meet the annual 16-hour training
requirement
must be selected from the following areas:

(1) "child growth and development training" has the meaning given in under
subdivision 2, paragraph (a);

(2) "learning environment and curriculum" includes , including training in
establishing an environment and providing activities that provide learning experiences to
meet each child's needs, capabilities, and interests;

(3) "assessment and planning for individual needs" includes , including training in
observing and assessing what children know and can do in order to provide curriculum
and instruction that addresses their developmental and learning needs, including children
with special needs and bilingual children or children for whom English is not their
primary language;

(4) "interactions with children" includes , including training in establishing
supportive relationships with children, guiding them as individuals and as part of a group;

(5) "families and communities" includes , including training in working
collaboratively with families and agencies or organizations to meet children's needs and to
encourage the community's involvement;

(6) "health, safety, and nutrition" includes , including training in establishing and
maintaining an environment that ensures children's health, safety, and nourishment,
including child abuse, maltreatment, prevention, and reporting; home and fire safety; child
injury prevention; communicable disease prevention and control; first aid; and CPR; and

(7) "program planning and evaluation" includes , including training in establishing,
implementing, evaluating, and enhancing program operations.

Subd. 8.

Other required training requirements.

(a) The training required of
family and group family child care providers and staff must include training in the cultural
dynamics of early childhood development and child care. The cultural dynamics and
disabilities training and skills development of child care providers must be designed to
achieve outcomes for providers of child care that include, but are not limited to:

(1) an understanding and support of the importance of culture and differences in
ability in children's identity development;

(2) understanding the importance of awareness of cultural differences and
similarities in working with children and their families;

(3) understanding and support of the needs of families and children with differences
in ability;

(4) developing skills to help children develop unbiased attitudes about cultural
differences and differences in ability;

(5) developing skills in culturally appropriate caregiving; and

(6) developing skills in appropriate caregiving for children of different abilities.

The commissioner shall approve the curriculum for cultural dynamics and disability
training.

(b) The provider must meet the training requirement in section 245A.14, subdivision
11
, paragraph (a), clause (4), to be eligible to allow a child cared for at the family child
care or group family child care home to use the swimming pool located at the home.

Subd. 9.

Supervising for safety; training requirement.

Effective July 1, 2014,
all family child care license holders and each adult caregiver who provides care in the
licensed family child care home for more than 30 days in any 12-month period shall
complete and document at least six hours approved training on supervising for safety
prior to initial licensure, and before caring for children. At least two hours of training
on supervising for safety must be repeated annually. For purposes of this subdivision,
"supervising for safety" includes supervision basics, supervision outdoors, equipment and
materials, illness, injuries, and disaster preparedness. The commissioner shall develop
the supervising for safety curriculum by January 1, 2014.

Sec. 19.

Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:


Subdivision 1.

Background studies conducted by Department of Human
Services.

(a) For a background study conducted by the Department of Human Services,
the commissioner shall review:

(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);

(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;

(3) information from juvenile courts as required in subdivision 4 for individuals
listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;

(4) information from the Bureau of Criminal Apprehension;

(5) except as provided in clause (6), information from the national crime information
system when the commissioner has reasonable cause as defined under section 245C.05,
subdivision 5; and

(6) for a background study related to a child foster care application for licensure, a
transfer of permanent legal and physical custody under section 260C.515,
or adoptions,
the commissioner shall also review:

(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; and

(ii) information from national crime information databases, when the background
study subject is 18 years of age or older.

(b) Notwithstanding expungement by a court, the commissioner may consider
information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
received notice of the petition for expungement and the court order for expungement is
directed specifically to the commissioner.

Sec. 20.

Minnesota Statutes 2012, section 245C.33, subdivision 1, is amended to read:


Subdivision 1.

Background studies conducted by commissioner.

(a) Before
placement of a child for purposes of adoption, the commissioner shall conduct a
background study on individuals listed in section 259.41, subdivision 3, for county
agencies and private agencies licensed to place children for adoption.

(b) Before placement of a child for the purposes of a transfer of permanent legal and
physical custody to a relative under section 260C.515, the commissioner shall conduct a
background study on each person over the age of 13 living in the home. New background
studies do not need to be completed if the proposed relative custodian has a valid foster
care license, and background studies according to section 245C.08, subdivision 1, were
completed as part of the licensure process.

Sec. 21.

Minnesota Statutes 2012, section 256.0112, is amended by adding a
subdivision to read:


Subd. 10.

Contracts for child foster care services.

When local agencies negotiate
lead county contracts or purchase of service contracts for child foster care services, the
foster care maintenance payment made on behalf of the child shall follow the provisions of
Northstar Care for Children, chapter 256N. Foster care maintenance payments as defined
in section 256N.02, subdivision 15, represents costs for activities similar in nature to those
expected of parents and do not cover services rendered by the licensed or tribally approved
foster parent, facility, or administrative costs or fees. Payments made to foster parents
must follow the requirements of section 256N.26, subdivision 15. The legally responsible
agency must provide foster parents with the assessment and notice as specified in section
256N.24. The financially responsible agency is permitted to make additional payments for
specific services provided by the foster parents or facility, as permitted in section 256N.21,
subdivision 5. These additional payments are not considered foster care maintenance.

Sec. 22.

Minnesota Statutes 2012, section 256.82, subdivision 2, is amended to read:


Subd. 2.

Foster care maintenance payments.

Beginning January 1, 1986, For the
purpose of foster care maintenance payments under title IV-E of the Social Security Act,
United States Code, title 42, sections 670 to 676, the county paying the maintenance
costs must be reimbursed for the costs from the federal money available for the purpose.
Beginning July 1, 1997, for the purposes of determining a child's eligibility under title
IV-E of the Social Security Act, the placing agency shall use AFDC requirements in
effect on July 16, 1996.

Sec. 23.

Minnesota Statutes 2012, section 256.82, subdivision 3, is amended to read:


Subd. 3.

Setting foster care standard rates.

(a) The commissioner shall annually
establish minimum standard maintenance rates for foster care maintenance and including
supplemental
difficulty of care payments for all children in foster care eligible for
Northstar Care for Children under chapter 256N
.

(b) All children entering foster care on or after January 1, 2015, are eligible for
Northstar Care for Children under chapter 256N.
Any increase in rates shall in no case
exceed three percent per annum.

(c) All children in foster care on December 31, 2014, must remain in the
pre-Northstar Care for Children foster care program under sections 256N.21, subdivision
6, and 260C.4411, subdivision 1. The rates for the pre-Northstar Care for Children foster
care program shall remain those in effect on January 1, 2013.

Sec. 24.

Minnesota Statutes 2012, section 256.98, subdivision 8, is amended to read:


Subd. 8.

Disqualification from program.

(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the
work participation cash benefit program, the food stamp or food support program, the
general assistance program, the group residential housing program, or the Minnesota
supplemental aid program shall be disqualified from that program. In addition, any person
disqualified from the Minnesota family investment program shall also be disqualified from
the food stamp or food support program. The needs of that individual shall not be taken
into consideration in determining the grant level for that assistance unit:

(1) for one year after the first offense;

(2) for two years after the second offense; and

(3) permanently after the third or subsequent offense.

The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution
for, any other sanctions that may be provided for by law for the offense involved. A
disqualification established through hearing or waiver shall result in the disqualification
period beginning immediately unless the person has become otherwise ineligible for
assistance. If the person is ineligible for assistance, the disqualification period begins
when the person again meets the eligibility criteria of the program from which they were
disqualified and makes application for that program.

(b) A family receiving assistance through child care assistance programs under
chapter 119B with a family member who is found to be guilty of wrongfully obtaining child
care assistance by a federal court, state court, or an administrative hearing determination
or waiver, through a disqualification consent agreement, as part of an approved diversion
plan under section 401.065, or a court-ordered stay with probationary or other conditions,
is disqualified from child care assistance programs. The disqualifications must be for
periods of three months, six months, and one year and two years for the first, and
second, and third offenses, respectively. Subsequent violations must result in permanent
disqualification. During the disqualification period, disqualification from any child care
program must extend to all child care programs and must be immediately applied.

(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care
services from the child care assistance program under chapter 119B when the provider is
found to have wrongfully obtained child care assistance by a federal court, state court,
or an administrative hearing determination or waiver under section 256.046, through
a disqualification consent agreement, as part of an approved diversion plan under
section 401.065, or a court-ordered stay with probationary or other conditions. The
disqualification must be for a period of one year for the first offense and two years for
the second offense. Any subsequent violation must result in permanent disqualification.
The disqualification period must be imposed immediately after a determination is made
under this paragraph. During the disqualification period, the provider is disqualified from
receiving payment from any child care program under chapter 119B.

(d) Any person found to be guilty of wrongfully obtaining general assistance
medical care, MinnesotaCare for adults without children, and upon federal approval, all
categories of medical assistance and remaining categories of MinnesotaCare, except
for children through age 18, by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, is disqualified from that program. The
period of disqualification is one year after the first offense, two years after the second
offense, and permanently after the third or subsequent offense. The period of program
disqualification shall begin on the date stipulated on the advance notice of disqualification
without possibility of postponement for administrative stay or administrative hearing
and shall continue through completion unless and until the findings upon which the
sanctions were imposed are reversed by a court of competent jurisdiction. The period for
which sanctions are imposed is not subject to review. The sanctions provided under this
subdivision are in addition to, and not in substitution for, any other sanctions that may be
provided for by law for the offense involved.

EFFECTIVE DATE.

This section is effective February 3, 2014.

Sec. 25.

Minnesota Statutes 2012, section 256J.08, subdivision 24, is amended to read:


Subd. 24.

Disregard.

"Disregard" means earned income that is not counted when
determining initial eligibility
in the initial income test in section 256J.21, subdivision 3,
or income that is not counted when determining ongoing eligibility and calculating the
amount of the assistance payment for participants. The commissioner shall determine
the amount of the
disregard according to section 256J.24, subdivision 10 for ongoing
eligibility shall be 50 percent of gross earned income
.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 26.

Minnesota Statutes 2012, section 256J.21, subdivision 2, is amended to read:


Subd. 2.

Income exclusions.

The following must be excluded in determining a
family's available income:

(1) payments for basic care, difficulty of care, and clothing allowances received for
providing family foster care to children or adults under Minnesota Rules, parts 9555.5050
to 9555.6265, 9560.0521, and 9560.0650 to 9560.0655, payments for family foster care to
children under chapter 256N,
and payments received and used for care and maintenance of
a third-party beneficiary who is not a household member;

(2) reimbursements for employment training received through the Workforce
Investment Act of 1998, United States Code, title 20, chapter 73, section 9201;

(3) reimbursement for out-of-pocket expenses incurred while performing volunteer
services, jury duty, employment, or informal carpooling arrangements directly related to
employment;

(4) all educational assistance, except the county agency must count graduate student
teaching assistantships, fellowships, and other similar paid work as earned income and,
after allowing deductions for any unmet and necessary educational expenses, shall
count scholarships or grants awarded to graduate students that do not require teaching
or research as unearned income;

(5) loans, regardless of purpose, from public or private lending institutions,
governmental lending institutions, or governmental agencies;

(6) loans from private individuals, regardless of purpose, provided an applicant or
participant documents that the lender expects repayment;

(7)(i) state income tax refunds; and

(ii) federal income tax refunds;

(8)(i) federal earned income credits;

(ii) Minnesota working family credits;

(iii) state homeowners and renters credits under chapter 290A; and

(iv) federal or state tax rebates;

(9) funds received for reimbursement, replacement, or rebate of personal or real
property when these payments are made by public agencies, awarded by a court, solicited
through public appeal, or made as a grant by a federal agency, state or local government,
or disaster assistance organizations, subsequent to a presidential declaration of disaster;

(10) the portion of an insurance settlement that is used to pay medical, funeral, and
burial expenses, or to repair or replace insured property;

(11) reimbursements for medical expenses that cannot be paid by medical assistance;

(12) payments by a vocational rehabilitation program administered by the state
under chapter 268A, except those payments that are for current living expenses;

(13) in-kind income, including any payments directly made by a third party to a
provider of goods and services;

(14) assistance payments to correct underpayments, but only for the month in which
the payment is received;

(15) payments for short-term emergency needs under section 256J.626, subdivision 2;

(16) funeral and cemetery payments as provided by section 256.935;

(17) nonrecurring cash gifts of $30 or less, not exceeding $30 per participant in
a calendar month;

(18) any form of energy assistance payment made through Public Law 97-35,
Low-Income Home Energy Assistance Act of 1981, payments made directly to energy
providers by other public and private agencies, and any form of credit or rebate payment
issued by energy providers;

(19) Supplemental Security Income (SSI), including retroactive SSI payments and
other income of an SSI recipient, except as described in section 256J.37, subdivision 3b;

(20) Minnesota supplemental aid, including retroactive payments;

(21) proceeds from the sale of real or personal property;

(22) state adoption assistance payments under section 259.67, and up to an equal
amount of county adoption assistance payments
adoption assistance payments under
chapter 259A and Minnesota Permanency Demonstration, Title IV-E waiver payments
under section 256.01, subdivision 14a
;

(23) state-funded family subsidy program payments made under section 252.32 to
help families care for children with developmental disabilities, consumer support grant
funds under section 256.476, and resources and services for a disabled household member
under one of the home and community-based waiver services programs under chapter 256B;

(24) interest payments and dividends from property that is not excluded from and
that does not exceed the asset limit;

(25) rent rebates;

(26) income earned by a minor caregiver, minor child through age 6, or a minor
child who is at least a half-time student in an approved elementary or secondary education
program;

(27) income earned by a caregiver under age 20 who is at least a half-time student in
an approved elementary or secondary education program;

(28) MFIP child care payments under section 119B.05;

(29) all other payments made through MFIP to support a caregiver's pursuit of
greater economic stability;

(30) income a participant receives related to shared living expenses;

(31) reverse mortgages;

(32) benefits provided by the Child Nutrition Act of 1966, United States Code, title
42, chapter 13A, sections 1771 to 1790;

(33) benefits provided by the women, infants, and children (WIC) nutrition program,
United States Code, title 42, chapter 13A, section 1786;

(34) benefits from the National School Lunch Act, United States Code, title 42,
chapter 13, sections 1751 to 1769e;

(35) relocation assistance for displaced persons under the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, United States Code, title
42, chapter 61, subchapter II, section 4636, or the National Housing Act, United States
Code, title 12, chapter 13, sections 1701 to 1750jj;

(36) benefits from the Trade Act of 1974, United States Code, title 19, chapter
12, part 2, sections 2271 to 2322;

(37) war reparations payments to Japanese Americans and Aleuts under United
States Code, title 50, sections 1989 to 1989d;

(38) payments to veterans or their dependents as a result of legal settlements
regarding Agent Orange or other chemical exposure under Public Law 101-239, section
10405, paragraph (a)(2)(E);

(39) income that is otherwise specifically excluded from MFIP consideration in
federal law, state law, or federal regulation;

(40) security and utility deposit refunds;

(41) American Indian tribal land settlements excluded under Public Laws 98-123,
98-124, and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech
Lake, and Mille Lacs reservations and payments to members of the White Earth Band,
under United States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;

(42) all income of the minor parent's parents and stepparents when determining the
grant for the minor parent in households that include a minor parent living with parents or
stepparents on MFIP with other children;

(43) income of the minor parent's parents and stepparents equal to 200 percent of the
federal poverty guideline for a family size not including the minor parent and the minor
parent's child in households that include a minor parent living with parents or stepparents
not on MFIP when determining the grant for the minor parent. The remainder of income is
deemed as specified in section 256J.37, subdivision 1b;

(44) payments made to children eligible for relative custody assistance under section
257.85 and guardianship assistance under section 256N.20;

(45) vendor payments for goods and services made on behalf of a client unless the
client has the option of receiving the payment in cash;

(46) the principal portion of a contract for deed payment; and

(47) cash payments to individuals enrolled for full-time service as a volunteer under
AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps
National, and AmeriCorps NCCC.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 27.

Minnesota Statutes 2012, section 256J.21, subdivision 3, is amended to read:


Subd. 3.

Initial income test.

The county agency shall determine initial eligibility
by considering all earned and unearned income that is not excluded under subdivision 2.
To be eligible for MFIP, the assistance unit's countable income minus the disregards in
paragraphs (a) and (b) must be below the transitional standard of assistance family wage
level
according to section 256J.24 for that size assistance unit.

(a) The initial eligibility determination must disregard the following items:

(1) the employment disregard is 18 percent of the gross earned income whether or
not the member is working full time or part time;

(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older under
this chapter and chapter 119B;

(3) all payments made according to a court order for spousal support or the support
of children not living in the assistance unit's household shall be disregarded from the
income of the person with the legal obligation to pay support, provided that, if there has
been a change in the financial circumstances of the person with the legal obligation to pay
support since the support order was entered, the person with the legal obligation to pay
support has petitioned for a modification of the support order; and

(4) an allocation for the unmet need of an ineligible spouse or an ineligible child
under the age of 21 for whom the caregiver is financially responsible and who lives with
the caregiver according to section 256J.36.

(b) Notwithstanding paragraph (a), when determining initial eligibility for applicant
units when at least one member has received MFIP in this state within four months of
the most recent application for MFIP, apply the disregard as defined in section 256J.08,
subdivision 24
, for all unit members.

After initial eligibility is established, the assistance payment calculation is based on
the monthly income test.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 28.

Minnesota Statutes 2012, section 256J.24, subdivision 3, is amended to read:


Subd. 3.

Individuals who must be excluded from an assistance unit.

(a) The
following individuals who are part of the assistance unit determined under subdivision 2
are ineligible to receive MFIP:

(1) individuals who are recipients of Supplemental Security Income or Minnesota
supplemental aid;

(2) individuals disqualified from the food stamp or food support program or MFIP,
until the disqualification ends;

(3) children on whose behalf federal, state or local foster care payments are made,
except as provided in sections 256J.13, subdivision 2, and 256J.74, subdivision 2;

(4) children receiving ongoing guardianship assistance payments under chapter 256N;

(4) (5) children receiving ongoing monthly adoption assistance payments under
section 259.67 chapter 259A or 256N; and

(5) (6) individuals disqualified from the work participation cash benefit program
until that disqualification ends.

(b) The exclusion of a person under this subdivision does not alter the mandatory
assistance unit composition.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 29.

Minnesota Statutes 2012, section 256J.24, subdivision 7, is amended to read:


Subd. 7.

Family wage level.

The family wage level is 110 percent of the transitional
standard under subdivision 5 or 6, when applicable, and is the standard used when there is
earned income in the assistance unit. As specified in section 256J.21
. If there is earned
income in the assistance unit
, earned income is subtracted from the family wage level to
determine the amount of the assistance payment, as specified in section 256J.21. The
assistance payment may not exceed the transitional standard under subdivision 5 or 6,
or the shared household standard under subdivision 9, whichever is applicable, for the
assistance unit.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 30.

Minnesota Statutes 2012, section 256J.621, is amended to read:


256J.621 WORK PARTICIPATION CASH BENEFITS.

Subdivision 1.

Program characteristics.

(a) Effective October 1, 2009, upon
exiting the diversionary work program (DWP) or upon terminating the Minnesota family
investment program with earnings, a participant who is employed may be eligible for work
participation cash benefits of $25 per month to assist in meeting the family's basic needs
as the participant continues to move toward self-sufficiency.

(b) To be eligible for work participation cash benefits, the participant shall not
receive MFIP or diversionary work program assistance during the month and the
participant or participants must meet the following work requirements:

(1) if the participant is a single caregiver and has a child under six years of age, the
participant must be employed at least 87 hours per month;

(2) if the participant is a single caregiver and does not have a child under six years of
age, the participant must be employed at least 130 hours per month; or

(3) if the household is a two-parent family, at least one of the parents must be
employed 130 hours per month.

Whenever a participant exits the diversionary work program or is terminated from
MFIP and meets the other criteria in this section, work participation cash benefits are
available for up to 24 consecutive months.

(c) Expenditures on the program are maintenance of effort state funds under
a separate state program for participants under paragraph (b), clauses (1) and (2).
Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
funds. Months in which a participant receives work participation cash benefits under this
section do not count toward the participant's MFIP 60-month time limit.

Subd. 2.

Program suspension.

(a) Effective December 1, 2013, the work
participation cash benefits program shall be suspended.

(b) The commissioner of human services may reinstate the work participation cash
benefits program if the United States Department of Human Services determines that the
state of Minnesota did not meet the federal TANF work participation rate, and sends a
notice of penalty to reduce Minnesota's federal TANF block grant authorized under title I
of Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996, and under Public Law 109-171, the Deficit Reduction Act of 2005.

(c) The commissioner shall notify the chairs of the legislative committees with
jurisdiction over human services policy and funding of the potential penalty and the
commissioner's plans to reinstate the work participation cash benefit program within 30
days of the date the commissioner receives notification that the state failed to meet the
federal work participation rate.

Sec. 31.

Minnesota Statutes 2012, section 256J.626, subdivision 7, is amended to read:


Subd. 7.

Performance base funds.

(a) For the purpose of this section, the following
terms have the meanings given.

(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota
TANF and separate state program caseload has fallen relative to federal fiscal year 2005
based on caseload data from October 1 to September 30.

(2) "TANF participation rate target" means a 50 percent participation rate reduced by
the CRC for the previous year.

(b) (a) For calendar year 2010 2016 and yearly thereafter, each county and tribe will
must be allocated 95 100 percent of their initial calendar year allocation. Allocations for
counties and tribes will must be allocated additional funds adjusted based on performance
as follows:

(1) a county or tribe that achieves the TANF participation rate target or a five
percentage point improvement over the previous year's TANF participation rate under
section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive months for
the most recent year for which the measurements are available, will receive an additional
allocation equal to 2.5 percent of its initial allocation;

(2) (1) a county or tribe that performs within or above its range of expected
performance on the annualized three-year self-support index under section 256J.751,
subdivision 2
, clause (6), will must receive an additional allocation equal to 2.5 percent of
its initial allocation; and

(3) a county or tribe that does not achieve the TANF participation rate target or
a five percentage point improvement over the previous year's TANF participation rate
under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will not
receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear
improvement plan with the commissioner; or

(4) (2) a county or tribe that does not perform within or above performs below its
range of expected performance on the annualized three-year self-support index under
section 256J.751, subdivision 2, clause (6), will not receive an additional allocation equal
to 2.5 percent of its initial allocation until after negotiating
for two consecutive years must
negotiate
a multiyear improvement plan with the commissioner. If no improvement is
shown by the end of the multiyear plan, the county's or tribe's allocation must be decreased
by 2.5 percent. The decrease must remain in effect until the tribe performs within or
above its range of expected performance.

(c) (b) For calendar year 2009 2016 and yearly thereafter, performance-based funds
for a federally approved tribal TANF program in which the state and tribe have in place a
contract under section 256.01, addressing consolidated funding, will must be allocated
as follows:

(1) a tribe that achieves the participation rate approved in its federal TANF plan
using the average of 12 consecutive months for the most recent year for which the
measurements are available, will receive an additional allocation equal to 2.5 percent of
its initial allocation; and

(2) (1) a tribe that performs within or above its range of expected performance on the
annualized three-year self-support index under section 256J.751, subdivision 2, clause (6),
will must receive an additional allocation equal to 2.5 percent of its initial allocation; or

(3) a tribe that does not achieve the participation rate approved in its federal TANF
plan using the average of 12 consecutive months for the most recent year for which the
measurements are available, will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner; or

(4) (2) a tribe that does not perform within or above performs below its range of
expected performance on the annualized three-year self-support index under section
256J.751, subdivision 2, clause (6), will not receive an additional allocation equal to
2.5 percent until after negotiating
for two consecutive years must negotiate a multiyear
improvement plan with the commissioner. If no improvement is shown by the end of the
multiyear plan, the tribe's allocation must be decreased by 2.5 percent. The decrease must
remain in effect until the tribe performs within or above its range of expected performance.

(d) (c) Funds remaining unallocated after the performance-based allocations
in paragraph (b) (a) are available to the commissioner for innovation projects under
subdivision 5.

(1) (d) If available funds are insufficient to meet county and tribal allocations under
paragraph paragraphs (a) and (b), the commissioner may make available for allocation
funds that are unobligated and available from the innovation projects through the end of
the current biennium
shall proportionally prorate funds to counties and tribes that qualify
for a bonus under paragraphs (a), clause (1), and (b), clause (2)
.

(2) If after the application of clause (1) funds remain insufficient to meet county and
tribal allocations under paragraph (b), the commissioner must proportionally reduce the
allocation of each county and tribe with respect to their maximum allocation available
under paragraph (b).

Sec. 32.

[256J.78] TANF DEMONSTRATION PROJECTS OR WAIVER FROM
FEDERAL RULES AND REGULATIONS.

Subdivision 1.

Duties of the commissioner.

The commissioner of human services
may pursue TANF demonstration projects or waivers of TANF requirements from the
United States Department of Health and Human Services as needed to allow the state to
build a more results-oriented Minnesota Family Investment Program to better meet the
needs of Minnesota families.

Subd. 2.

Purpose.

The purpose of the TANF demonstration projects or waivers is to:

(1) replace the federal TANF process measure and its complex administrative
requirements with state-developed outcomes measures that track adult employment and
exits from MFIP cash assistance;

(2) simplify programmatic and administrative requirements; and

(3) make other policy or programmatic changes that improve the performance of the
program and the outcomes for participants.

Subd. 3.

Report to legislature.

The commissioner shall report to the members of
the legislative committees having jurisdiction over human services issues by March 1,
2014, regarding the progress of this waiver or demonstration project.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 33.

[256N.001] CITATION.

Sections 256N.001 to 256N.28 may be cited as the "Northstar Care for Children Act."
Sections 256N.001 to 256N.28 establish Northstar Care for Children, which authorizes
certain benefits to support a child in need who is served by the Minnesota child welfare
system and who is the responsibility of the state, local county social service agencies, or
tribal social service agencies authorized under section 256.01, subdivision 14b, or are
otherwise eligible for federal adoption assistance. A child eligible under this chapter
has experienced a child welfare intervention that has resulted in the child being placed
away from the child's parents' care and is receiving foster care services consistent with
chapter 260B, 260C, or 260D, or is in the permanent care of relatives through a transfer of
permanent legal and physical custody, or in the permanent care of adoptive parents.

Sec. 34.

[256N.01] PUBLIC POLICY.

(a) The legislature declares that the public policy of this state is to keep children safe
from harm and to ensure that when children suffer harmful or injurious experiences in
their lives, appropriate services are immediately available to keep them safe.

(b) Children do best in permanent, safe, nurturing homes where they can maintain
lifelong relationships with adults. Whenever safely possible, children are best served
when they can be nurtured and raised by their parents. Where services cannot be provided
to allow a child to remain safely at home, an out-of-home placement may be required.
When this occurs, reunification should be sought if it can be accomplished safely. When
it is not possible for parents to provide safety and permanency for their children, an
alternative permanent home must quickly be made available to the child, drawing from
kinship sources whenever possible.

(c) Minnesota understands the importance of having a comprehensive approach to
temporary out-of-home care and to permanent homes for children who cannot be reunited
with their families. It is critical that stable benefits be available to caregivers to ensure
that the child's needs can be met whether the child's situation and best interests call for
temporary foster care, transfer of permanent legal and physical custody to a relative, or
adoption. Northstar Care for Children focuses on the child's needs and strengths, and
the actual level of care provided by the caregiver, without consideration for the type of
placement setting. In this way caregivers are not faced with the burden of making specific
long-term decisions based upon competing financial incentives.

Sec. 35.

[256N.02] DEFINITIONS.

Subdivision 1.

Scope.

For the purposes of sections 256N.001 to 256N.28, the terms
defined in this section have the meanings given them.

Subd. 2.

Adoption assistance.

"Adoption assistance" means medical coverage as
allowable under section 256B.055 and reimbursement of nonrecurring expenses associated
with adoption and may include financial support provided under agreement with the
financially responsible agency, the commissioner, and the parents of an adoptive child
whose special needs would otherwise make it difficult to place the child for adoption to
assist with the cost of caring for the child. Financial support may include a basic rate
payment and a supplemental difficulty of care rate.

Subd. 3.

Assessment.

"Assessment" means the process under section 256N.24 that
determines the benefits an eligible child may receive under section 256N.26.

Subd. 4.

At-risk child.

"At-risk child" means a child who does not have a
documented disability but who is at risk of developing a physical, mental, emotional, or
behavioral disability based on being related within the first or second degree to persons
who have an inheritable physical, mental, emotional, or behavioral disabling condition,
or from a background which has the potential to cause the child to develop a physical,
mental, emotional, or behavioral disability that the child is at risk of developing. The
disability must manifest during childhood.

Subd. 5.

Basic rate.

"Basic rate" means the maintenance payment made on behalf
of a child to support the costs caregivers incur to provide for a child's needs consistent with
the care parents customarily provide, including: food, clothing, shelter, daily supervision,
school supplies, and a child's personal incidentals. It also supports typical travel to the
child's home for visitation, and reasonable travel for the child to remain in the school in
which the child is enrolled at the time of placement.

Subd. 6.

Caregiver.

"Caregiver" means the foster parent or parents of a child in
foster care who meet the requirements of emergency relative placement, licensed foster
parents under chapter 245A, or foster parents licensed or approved by a tribe; the relative
custodian or custodians; or the adoptive parent or parents who have legally adopted a child.

Subd. 7.

Commissioner.

"Commissioner" means the commissioner of human
services or any employee of the Department of Human Services to whom the
commissioner has delegated appropriate authority.

Subd. 8.

County board.

"County board" means the board of county commissioners
in each county.

Subd. 9.

Disability.

"Disability" means a physical, mental, emotional, or behavioral
impairment that substantially limits one or more major life activities. Major life activities
include, but are not limited to: thinking, walking, hearing, breathing, working, seeing,
speaking, communicating, learning, developing and maintaining healthy relationships,
safely caring for oneself, and performing manual tasks. The nature, duration, and severity
of the impairment must be considered in determining if the limitation is substantial.

Subd. 10.

Financially responsible agency.

"Financially responsible agency" means
the agency that is financially responsible for a child. These agencies include both local
social service agencies under section 393.07 and tribal social service agencies authorized
in section 256.01, subdivision 14b, as part of the American Indian Child Welfare Initiative,
and Minnesota tribes who assume financial responsibility of children from other states.
Under Northstar Care for Children, the agency that is financially responsible at the time of
placement for foster care continues to be responsible under section 256N.27 for the local
share of any maintenance payments, even after finalization of the adoption of transfer of
permanent legal and physical custody of a child.

Subd. 11.

Guardianship assistance.

"Guardianship assistance" means medical
coverage, as allowable under section 256B.055, and reimbursement of nonrecurring
expenses associated with obtaining permanent legal and physical custody of a child, and
may include financial support provided under agreement with the financially responsible
agency, the commissioner, and the relative who has received a transfer of permanent legal
and physical custody of a child. Financial support may include a basic rate payment and a
supplemental difficulty of care rate to assist with the cost of caring for the child.

Subd. 12.

Human services board.

"Human services board" means a board
established under section 402.02; Laws 1974, chapter 293; or Laws 1976, chapter 340.

Subd. 13.

Initial assessment.

"Initial assessment" means the assessment conducted
within the first 30 days of a child's initial placement into foster care under section
256N.24, subdivisions 4 and 5.

Subd. 14.

Legally responsible agency.

"Legally responsible agency" means the
Minnesota agency that is assigned responsibility for placement, care, and supervision
of the child through a court order, voluntary placement agreement, or voluntary
relinquishment. These agencies include local social service agencies under section 393.07,
tribal social service agencies authorized in section 256.01, subdivision 14b, and Minnesota
tribes that assume court jurisdiction when legal responsibility is transferred to the tribal
social service agency through a Minnesota district court order. A Minnesota local social
service agency is otherwise financially responsible.

Subd. 15.

Maintenance payments.

"Maintenance payments" means the basic
rate plus any supplemental difficulty of care rate under Northstar Care for Children. It
specifically does not include the cost of initial clothing allowance, payment for social
services, or administrative payments to a child-placing agency. Payments are paid
consistent with section 256N.26.

Subd. 16.

Permanent legal and physical custody.

"Permanent legal and physical
custody" means a transfer of permanent legal and physical custody to a relative ordered by
a Minnesota juvenile court under section 260C.515, subdivision 4, or for a child under
jurisdiction of a tribal court, a judicial determination under a similar provision in tribal
code which means that a relative will assume the duty and authority to provide care,
control, and protection of a child who is residing in foster care, and to make decisions
regarding the child's education, health care, and general welfare until adulthood.

Subd. 17.

Reassessment.

"Reassessment" means an update of a previous assessment
through the process under section 256N.24 for a child who has been continuously eligible
for Northstar Care for Children, or when a child identified as an at-risk child (Level A)
under guardianship or adoption assistance has manifested the disability upon which
eligibility for the agreement was based according to section 256N.25, subdivision 3,
paragraph (b). A reassessment may be used to update an initial assessment, a special
assessment, or a previous reassessment.

Subd. 18.

Relative.

"Relative," as described in section 260C.007, subdivision 27,
means a person related to the child by blood, marriage, or adoption, or an individual who
is an important friend with whom the child has resided or had significant contact. For an
Indian child, relative includes members of the extended family as defined by the law or
custom of the Indian child's tribe or, in the absence of law or custom, nieces, nephews,
or first or second cousins, as provided in the Indian Child Welfare Act of 1978, United
States Code, title 25, section 1903.

Subd. 19.

Relative custodian.

"Relative custodian" means a person to whom
permanent legal and physical custody of a child has been transferred under section
260C.515, subdivision 4, or for a child under jurisdiction of a tribal court, a judicial
determination under a similar provision in tribal code, which means that a relative will
assume the duty and authority to provide care, control, and protection of a child who is
residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood.

Subd. 20.

Special assessment.

"Special assessment" means an assessment
performed under section 256N.24 that determines the benefits that an eligible child may
receive under section 256N.26 at the time when a special assessment is required. A special
assessment is used in the following circumstances when a child's status within Northstar
Care is shifted from a pre-Northstar Care program into Northstar Care for Children when
the commissioner determines that a special assessment is appropriate instead of assigning
the transition child to a level under section 256N.28.

Subd. 21.

Supplemental difficulty of care rate.

"Supplemental difficulty of care
rate" means the supplemental payment under section 256N.26, if any, as determined by
the financially responsible agency or the state, based upon an assessment under section
256N.24. The rate must support activities consistent with the care a parent provides a child
with special needs and not the equivalent of a purchased service. The rate must consider
the capacity and intensity of the activities associated with parenting duties provided in
the home to nurture the child, preserve the child's connections, and support the child's
functioning in the home and community.

Sec. 36.

[256N.20] NORTHSTAR CARE FOR CHILDREN; GENERALLY.

Subdivision 1.

Eligibility.

A child is eligible for Northstar Care for Children if
the child is eligible for:

(1) foster care under section 256N.21;

(2) guardianship assistance under section 256N.22; or

(3) adoption assistance under section 256N.23.

Subd. 2.

Assessments.

Except as otherwise specified, a child eligible for Northstar
Care for Children shall receive an assessment under section 256N.24.

Subd. 3.

Agreements.

When a child is eligible for guardianship assistance or
adoption assistance, negotiations with caregivers and the development of a written,
binding agreement must be conducted under section 256N.25.

Subd. 4.

Benefits and payments.

A child eligible for Northstar Care for Children is
entitled to benefits specified in section 256N.26, based primarily on assessments under
section 256N.24, and, if appropriate, negotiations and agreements under section 256N.25.
Although paid to the caregiver, these benefits must be considered benefits of the child
rather than of the caregiver.

Subd. 5.

Federal, state, and local shares.

The cost of Northstar Care for Children
must be shared among the federal government, state, counties of financial responsibility,
and certain tribes as specified in section 256N.27.

Subd. 6.

Administration and appeals.

The commissioner and financially
responsible agency, or other agency designated by the commissioner, shall administer
Northstar Care for Children according to section 256N.28. The notification and fair
hearing process applicable to this chapter is defined in section 256N.28.

Subd. 7.

Transition.

A child in foster care, relative custody assistance, or adoption
assistance prior to January 1, 2015, who remains with the same caregivers continues
to receive benefits under programs preceding Northstar Care for Children, unless the
child moves to a new foster care placement, permanency is obtained for the child, or the
commissioner initiates transition of a child receiving pre-Northstar Care for Children
relative custody assistance, guardianship assistance, or adoption assistance under this
chapter. Provisions for the transition to Northstar Care for Children for certain children in
preceding programs are specified in section 256N.28, subdivisions 2 and 7. Additional
provisions for children in: foster care are specified in section 256N.21, subdivision
6; relative custody assistance under section 257.85 are specified in section 256N.22,
subdivision 12; and adoption assistance under chapter 259A are specified in section
256N.23, subdivision 13.

Sec. 37.

[256N.21] ELIGIBILITY FOR FOSTER CARE BENEFITS.

Subdivision 1.

General eligibility requirements.

(a) A child is eligible for foster
care benefits under this section if the child meets the requirements of subdivision 2 on
or after January 1, 2015.

(b) The financially responsible agency shall make a title IV-E eligibility determination
for all foster children meeting the requirements of subdivision 2, provided the agency has
such authority under the state title IV-E plan. To be eligible for title IV-E foster care, a child
must also meet any additional criteria specified in section 472 of the Social Security Act.

(c) Except as provided under section 256N.26, subdivision 1 or 6, the foster care
benefit to the child under this section must be determined under sections 256N.24 and
256N.26 through an individual assessment. Information from this assessment must be
used to determine a potential future benefit under guardianship assistance or adoption
assistance, if needed.

(d) When a child is eligible for additional services, subdivisions 3 and 4 govern
the co-occurrence of program eligibility.

Subd. 2.

Placement in foster care.

To be eligible for foster care benefits under this
section, the child must be in placement away from the child's legal parent or guardian and
all of the following criteria must be met:

(1) the legally responsible agency must have placement authority and care
responsibility, including for a child 18 years old or older and under age 21, who maintains
eligibility for foster care consistent with section 260C.451;

(2) the legally responsible agency must have authority to place the child with a
voluntary placement agreement or a court order, consistent with sections 260B.198,
260C.001, 260D.01, or continued eligibility consistent with section 260C.451; and

(3) the child must be placed in an emergency relative placement under section
245A.035, a licensed foster family setting, foster residence setting, or treatment foster
care setting licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, a family
foster home licensed or approved by a tribal agency or, for a child 18 years old or older
and under age 21, an unlicensed supervised independent living setting approved by the
agency responsible for the youth's care.

Subd. 3.

Minor parent.

A child who is a minor parent in placement with the minor
parent's child in the same home is eligible for foster care benefits under this section. The
foster care benefit is limited to the minor parent, unless the legally responsible agency has
separate legal authority for placement of the minor parent's child.

Subd. 4.

Foster children ages 18 up to 21 placed in an unlicensed supervised
independent living setting.

A foster child 18 years old or older and under age 21 who
maintains eligibility consistent with section 260C.451 and who is placed in an unlicensed
supervised independent living setting shall receive the level of benefit under section
256N.26.

Subd. 5.

Excluded activities.

The basic and supplemental difficulty of care
payment represents costs for activities similar in nature to those expected of parents,
and does not cover services rendered by the licensed or tribally approved foster parent,
facility, or administrative costs or fees. The financially responsible agency may pay an
additional fee for specific services provided by the licensed foster parent or facility. A
foster parent or residence setting must distinguish such a service from the daily care of the
child as assessed through the process under section 256N.24.

Subd. 6.

Transition from pre-Northstar Care for Children program.

(a) Section
256.82 establishes the pre-Northstar Care for Children foster care program for all children
residing in family foster care on December 31, 2014. Unless transitioned under paragraph
(b), a child in foster care with the same caregiver receives benefits under this pre-Northstar
Care for Children foster care program.

(b) Transition from the pre-Northstar Care for Children foster care program to
Northstar Care for Children takes place on or after January 1, 2015, when the child:

(1) moves to a different foster home or unlicensed supervised independent living
setting;

(2) has permanent legal and physical custody transferred and, if applicable, meets
eligibility requirements in section 256N.22;

(3) is adopted and, if applicable, meets eligibility requirements in section 256N.23; or

(4) re-enters foster care after reunification or a trial home visit.

(c) Upon becoming eligible, a foster child must be assessed according to section
256N.24 and then transitioned into Northstar Care for Children according to section
256N.28.

Sec. 38.

[256N.22] GUARDIANSHIP ASSISTANCE ELIGIBILITY.

Subdivision 1.

General eligibility requirements.

(a) To be eligible for the
guardianship assistance under this section, there must be a judicial determination under
section 260C.515, subdivision 4, that a transfer of permanent legal and physical custody to
a relative is in the child's best interest. For a child under jurisdiction of a tribal court, a
judicial determination under a similar provision in tribal code indicating that a relative
will assume the duty and authority to provide care, control, and protection of a child who
is residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood, and that this is in the child's best interest is
considered equivalent. Additionally, a child must:

(1) have been removed from the child's home pursuant to a voluntary placement
agreement or court order;

(2)(i) have resided in foster care for at least six consecutive months in the home
of the prospective relative custodian; or

(ii) have received an exemption from the requirement in item (i) from the court
based on a determination that:

(A) an expedited move to permanency is in the child's best interest;

(B) expedited permanency cannot be completed without provision of guardianship
assistance; and

(C) the prospective relative custodian is uniquely qualified to meet the child's needs
on a permanent basis;

(3) meet the agency determinations regarding permanency requirements in
subdivision 2;

(4) meet the applicable citizenship and immigration requirements in subdivision
3; and

(5) have been consulted regarding the proposed transfer of permanent legal and
physical custody to a relative, if the child is at least 14 years of age or is expected to attain
14 years of age prior to the transfer of permanent legal and physical custody; and

(6) have a written, binding agreement under section 256N.25 among the caregiver or
caregivers, the financially responsible agency, and the commissioner established prior to
transfer of permanent legal and physical custody.

(b) In addition to the requirements in paragraph (a), the child's prospective relative
custodian or custodians must meet the applicable background study requirements in
subdivision 4.

(c) To be eligible for title IV-E guardianship assistance, a child must also meet any
additional criteria in section 473(d) of the Social Security Act. The sibling of a child
who meets the criteria for title IV-E guardianship assistance in section 473(d) of the
Social Security Act is eligible for title IV-E guardianship assistance if the child and
sibling are placed with the same prospective relative custodian or custodians, and the
legally responsible agency, relatives, and commissioner agree on the appropriateness of
the arrangement for the sibling. A child who meets all eligibility criteria except those
specific to title IV-E guardianship assistance is entitled to guardianship assistance paid
through funds other than title IV-E.

Subd. 2.

Agency determinations regarding permanency.

(a) To be eligible for
guardianship assistance, the legally responsible agency must complete the following
determinations regarding permanency for the child prior to the transfer of permanent
legal and physical custody:

(1) a determination that reunification and adoption are not appropriate permanency
options for the child; and

(2) a determination that the child demonstrates a strong attachment to the prospective
relative custodian and the prospective relative custodian has a strong commitment to
caring permanently for the child.

(b) The legally responsible agency shall document the determinations in paragraph
(a) and the supporting information for completing each determination in the case file and
make them available for review as requested by the financially responsible agency and the
commissioner during the guardianship assistance eligibility determination process.

Subd. 3.

Citizenship and immigration status.

A child must be a citizen of the
United States or otherwise be eligible for federal public benefits according to the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, as amended, in order
to be eligible for guardianship assistance.

Subd. 4.

Background study.

(a) A background study under section 245C.33 must
be completed on each prospective relative custodian and any other adult residing in the
home of the prospective relative custodian. A background study on the prospective
relative custodian or adult residing in the household previously completed under section
245C.04 for the purposes of foster care licensure may be used for the purposes of this
section, provided that the background study is current at the time of the application for
guardianship assistance.

(b) If the background study reveals:

(1) a felony conviction at any time for:

(i) child abuse or neglect;

(ii) spousal abuse;

(iii) a crime against a child, including child pornography; or

(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or

(2) a felony conviction within the past five years for:

(i) physical assault;

(ii) battery; or

(iii) a drug-related offense;

the prospective relative custodian is prohibited from receiving guardianship assistance
on behalf of an otherwise eligible child.

Subd. 5.

Responsibility for determining guardianship assistance eligibility.

The
commissioner shall determine eligibility for:

(1) a child under the legal custody or responsibility of a Minnesota county social
service agency who would otherwise remain in foster care;

(2) a Minnesota child under tribal court jurisdiction who would otherwise remain
in foster care; and

(3) an Indian child being placed in Minnesota who meets title IV-E eligibility defined
in section 473(d) of the Social Security Act. The agency or entity assuming responsibility
for the child is responsible for the nonfederal share of the guardianship assistance payment.

Subd. 6.

Exclusions.

(a) A child with a guardianship assistance agreement under
Northstar Care for Children is not eligible for the Minnesota family investment program
child-only grant under chapter 256J.

(b) The commissioner shall not enter into a guardianship assistance agreement with:

(1) a child's biological parent;

(2) an individual assuming permanent legal and physical custody of a child or the
equivalent under tribal code without involvement of the child welfare system; or

(3) an individual assuming permanent legal and physical custody of a child who was
placed in Minnesota by another state or a tribe outside of Minnesota.

Subd. 7.

Guardianship assistance eligibility determination.

The financially
responsible agency shall prepare a guardianship assistance eligibility determination
for review and final approval by the commissioner. The eligibility determination must
be completed according to requirements and procedures and on forms prescribed by
the commissioner. Supporting documentation for the eligibility determination must be
provided to the commissioner. The financially responsible agency and the commissioner
must make every effort to establish a child's eligibility for title IV-E guardianship
assistance. A child who is determined to be eligible for guardianship assistance must
have a guardianship assistance agreement negotiated on the child's behalf according to
section 256N.25.

Subd. 8.

Termination of agreement.

(a) A guardianship assistance agreement must
be terminated in any of the following circumstances:

(1) the child has attained the age of 18, or up to age 21 when the child meets a
condition for extension in subdivision 11;

(2) the child has not attained the age of 18 years of age, but the commissioner
determines the relative custodian is no longer legally responsible for support of the child;

(3) the commissioner determines the relative custodian is no longer providing
financial support to the child up to age 21;

(4) the death of the child; or

(5) the relative custodian requests in writing termination of the guardianship
assistance agreement.

(b) A relative custodian is considered no longer legally responsible for support of
the child in any of the following circumstances:

(1) permanent legal and physical custody or guardianship of the child is transferred
to another individual;

(2) death of the relative custodian under subdivision 9;

(3) child enlists in the military;

(4) child gets married; or

(5) child is determined an emancipated minor through legal action.

Subd. 9.

Death of relative custodian or dissolution of custody.

The guardianship
assistance agreement ends upon death or dissolution of permanent legal and physical
custody of both relative custodians in the case of assignment of custody to two individuals,
or the sole relative custodian in the case of assignment of custody to one individual.
Guardianship assistance eligibility may be continued according to subdivision 10.

Subd. 10.

Assigning a child's guardianship assistance to a court-appointed
guardian or custodian.

(a) Guardianship assistance may be continued with the written
consent of the commissioner to an individual who is a guardian or custodian appointed by
a court for the child upon the death of both relative custodians in the case of assignment
of custody to two individuals, or the sole relative custodian in the case of assignment
of custody to one individual, unless the child is under the custody of a county, tribal,
or child-placing agency.

(b) Temporary assignment of guardianship assistance may be approved for a
maximum of six consecutive months from the death of the relative custodian or custodians
as provided in paragraph (a) and must adhere to the policies and procedures prescribed by
the commissioner. If a court has not appointed a permanent legal guardian or custodian
within six months, the guardianship assistance must terminate and must not be resumed.

(c) Upon assignment of assistance payments under this subdivision, assistance must
be provided from funds other than title IV-E.

Subd. 11.

Extension of guardianship assistance after age 18.

(a) Under the
circumstances outlined in paragraph (e), a child may qualify for extension of the
guardianship assistance agreement beyond the date the child attains age 18, up to the
date the child attains the age of 21.

(b) A request for extension of the guardianship assistance agreement must be
completed in writing and submitted, including all supporting documentation, by the
relative custodian to the commissioner at least 60 calendar days prior to the date that the
current agreement will terminate.

(c) A signed amendment to the current guardianship assistance agreement must be
fully executed between the relative custodian and the commissioner at least ten business
days prior to the termination of the current agreement. The request for extension and
the fully executed amendment must be made according to requirements and procedures
prescribed by the commissioner, including documentation of eligibility, and on forms
prescribed by the commissioner.

(d) If an agency is certifying a child for guardianship assistance and the child will
attain the age of 18 within 60 calendar days of submission, the request for extension must
be completed in writing and submitted, including all supporting documentation, with
the guardianship assistance application.

(e) A child who has attained the age of 16 prior to the effective date of the
guardianship assistance agreement is eligible for extension of the agreement up to the
date the child attains age 21 if the child:

(1) is dependent on the relative custodian for care and financial support; and

(2) meets at least one of the following conditions:

(i) is completing a secondary education program or a program leading to an
equivalent credential;

(ii) is enrolled in an institution which provides postsecondary or vocational education;

(iii) is participating in a program or activity designed to promote or remove barriers
to employment;

(iv) is employed for at least 80 hours per month; or

(v) is incapable of doing any of the activities described in items (i) to (iv) due to
a medical condition where incapability is supported by professional documentation
according to the requirements and procedures prescribed by the commissioner.

(f) A child who has not attained the age of 16 prior to the effective date of the
guardianship assistance agreement is eligible for extension of the guardianship assistance
agreement up to the date the child attains the age of 21 if the child is:

(1) dependent on the relative custodian for care and financial support; and

(2) possesses a physical or mental disability which impairs the capacity for
independent living and warrants continuation of financial assistance, as determined by
the commissioner.

Subd. 12.

Beginning guardianship assistance component of Northstar Care for
Children.

Effective November 27, 2014, a child who meets the eligibility criteria for
guardianship assistance in subdivision 1 may have a guardianship assistance agreement
negotiated on the child's behalf according to section 256N.25. The effective date of the
agreement must be January 1, 2015, or the date of the court order transferring permanent
legal and physical custody, whichever is later. Except as provided under section 256N.26,
subdivision 1, paragraph (c), the rate schedule for an agreement under this subdivision
is determined under section 256N.26 based on the age of the child on the date that the
prospective relative custodian signs the agreement.

Subd. 13.

Transition to guardianship assistance under Northstar Care for
Children.

The commissioner may execute guardianship assistance agreements for a child
with a relative custody agreement under section 257.85 executed on the child's behalf
on or before November 26, 2014, in accordance with the priorities outlined in section
256N.28, subdivision 7, paragraph (b). To facilitate transition into the guardianship
assistance program, the commissioner may waive any guardianship assistance eligibility
requirements for a child with a relative custody agreement under section 257.85 executed
on the child's behalf on or before November 26, 2014. Agreements negotiated under
this subdivision must be done according to the process outlined in section 256N.28,
subdivision 7. The maximum rate used in the negotiation process for an agreement under
this subdivision must be as outlined in section 256N.28, subdivision 7.

Sec. 39.

[256N.23] ADOPTION ASSISTANCE ELIGIBILITY.

Subdivision 1.

General eligibility requirements.

(a) To be eligible for adoption
assistance under this section, a child must:

(1) be determined to be a child with special needs under subdivision 2;

(2) meet the applicable citizenship and immigration requirements in subdivision 3;

(3)(i) meet the criteria in section 473 of the Social Security Act; or

(ii) have had foster care payments paid on the child's behalf while in out-of-home
placement through the county or tribe and be either under the guardianship of the
commissioner or under the jurisdiction of a Minnesota tribe and adoption, according to
tribal law, is in the child's documented permanency plan; and

(4) have a written, binding agreement under section 256N.25 among the adoptive
parent, the financially responsible agency, or if there is no financially responsible agency,
the agency designated by the commissioner, and the commissioner established prior to
finalization of the adoption.

(b) In addition to the requirements in paragraph (a), an eligible child's adoptive parent
or parents must meet the applicable background study requirements in subdivision 4.

(c) A child who meets all eligibility criteria except those specific to title IV-E adoption
assistance shall receive adoption assistance paid through funds other than title IV-E.

Subd. 2.

Special needs determination.

(a) A child is considered a child with
special needs under this section if the requirements in paragraphs (b) to (g) are met.

(b) There must be a determination that the child must not or should not be returned
to the home of the child's parents as evidenced by:

(1) a court-ordered termination of parental rights;

(2) a petition to terminate parental rights;

(3) consent of parent to adoption accepted by the court under chapter 260C;

(4) in circumstances when tribal law permits the child to be adopted without a
termination of parental rights, a judicial determination by a tribal court indicating the valid
reason why the child cannot or should not return home;

(5) a voluntary relinquishment under section 259.25 or 259.47 or, if relinquishment
occurred in another state, the applicable laws in that state; or

(6) the death of the legal parent or parents if the child has two legal parents.

(c) There exists a specific factor or condition of which it is reasonable to conclude
that the child cannot be placed with adoptive parents without providing adoption
assistance as evidenced by:

(1) a determination by the Social Security Administration that the child meets all
medical or disability requirements of title XVI of the Social Security Act with respect to
eligibility for Supplemental Security Income benefits;

(2) a documented physical, mental, emotional, or behavioral disability not covered
under clause (1);

(3) a member of a sibling group being adopted at the same time by the same parent;

(4) an adoptive placement in the home of a parent who previously adopted a sibling
for whom they receive adoption assistance; or

(5) documentation that the child is an at-risk child.

(d) A reasonable but unsuccessful effort must have been made to place the child
with adoptive parents without providing adoption assistance as evidenced by:

(1) a documented search for an appropriate adoptive placement; or

(2) a determination by the commissioner that a search under clause (1) is not in the
best interests of the child.

(e) The requirement for a documented search for an appropriate adoptive placement
under paragraph (d), including the registration of the child with the state adoption
exchange and other recruitment methods under paragraph (f), must be waived if:

(1) the child is being adopted by a relative and it is determined by the child-placing
agency that adoption by the relative is in the best interests of the child;

(2) the child is being adopted by a foster parent with whom the child has developed
significant emotional ties while in the foster parent's care as a foster child and it is
determined by the child-placing agency that adoption by the foster parent is in the best
interests of the child; or

(3) the child is being adopted by a parent that previously adopted a sibling of the
child, and it is determined by the child-placing agency that adoption by this parent is
in the best interests of the child.

For an Indian child covered by the Indian Child Welfare Act, a waiver must not be
granted unless the child-placing agency has complied with the placement preferences
required by the Indian Child Welfare Act, United States Code, title 25, section 1915(a).

(f) To meet the requirement of a documented search for an appropriate adoptive
placement under paragraph (d), clause (1), the child-placing agency minimally must:

(1) conduct a relative search as required by section 260C.221 and give consideration
to placement with a relative, as required by section 260C.212, subdivision 2;

(2) comply with the placement preferences required by the Indian Child Welfare Act
when the Indian Child Welfare Act, United States Code, title 25, section 1915(a), applies;

(3) locate prospective adoptive families by registering the child on the state adoption
exchange, as required under section 259.75; and

(4) if registration with the state adoption exchange does not result in the identification
of an appropriate adoptive placement, the agency must employ additional recruitment
methods prescribed by the commissioner.

(g) Once the legally responsible agency has determined that placement with an
identified parent is in the child's best interests and made full written disclosure about the
child's social and medical history, the agency must ask the prospective adoptive parent if
the prospective adoptive parent is willing to adopt the child without receiving adoption
assistance under this section. If the identified parent is either unwilling or unable to
adopt the child without adoption assistance, the legally responsible agency must provide
documentation as prescribed by the commissioner to fulfill the requirement to make a
reasonable effort to place the child without adoption assistance. If the identified parent is
willing to adopt the child without adoption assistance, the parent must provide a written
statement to this effect to the legally responsible agency and the statement must be
maintained in the permanent adoption record of the legally responsible agency. For children
under guardianship of the commissioner, the legally responsible agency shall submit a copy
of this statement to the commissioner to be maintained in the permanent adoption record.

Subd. 3.

Citizenship and immigration status.

(a) A child must be a citizen of the
United States or otherwise eligible for federal public benefits according to the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, as amended, in order to
be eligible for the title IV-E adoption assistance program.

(b) A child must be a citizen of the United States or meet the qualified alien
requirements as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, as amended, in order to be eligible for adoption assistance
paid through funds other than title IV-E.

Subd. 4.

Background study.

A background study under section 259.41 must be
completed on each prospective adoptive parent. If the background study reveals:

(1) a felony conviction at any time for:

(i) child abuse or neglect;

(ii) spousal abuse;

(iii) a crime against a child, including child pornography; or

(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or

(2) a felony conviction within the past five years for:

(i) physical assault;

(ii) battery; or

(iii) a drug-related offense;

the adoptive parent is prohibited from receiving adoption assistance on behalf of an
otherwise eligible child.

Subd. 5.

Responsibility for determining adoption assistance eligibility.

The
commissioner must determine eligibility for:

(1) a child under the guardianship of the commissioner who would otherwise remain
in foster care;

(2) a child who is not under the guardianship of the commissioner who meets title
IV-E eligibility defined in section 473 of the Social Security Act and no state agency has
legal responsibility for placement and care of the child;

(3) a Minnesota child under tribal jurisdiction who would otherwise remain in foster
care; and

(4) an Indian child being placed in Minnesota who meets title IV-E eligibility defined
in section 473 of the Social Security Act. The agency or entity assuming responsibility for
the child is responsible for the nonfederal share of the adoption assistance payment.

Subd. 6.

Exclusions.

The commissioner must not enter into an adoption assistance
agreement with the following individuals:

(1) a child's biological parent or stepparent;

(2) a child's relative under section 260C.007, subdivision 27, with whom the child
resided immediately prior to child welfare involvement unless:

(i) the child was in the custody of a Minnesota county or tribal agency pursuant to
an order under chapter 260C or equivalent provisions of tribal code and the agency had
placement and care responsibility for permanency planning for the child; and

(ii) the child is under guardianship of the commissioner of human services according
to the requirements of section 260C.325, subdivision 1 or 3, or is a ward of a Minnesota
tribal court after termination of parental rights, suspension of parental rights, or a finding
by the tribal court that the child cannot safely return to the care of the parent;

(3) an individual adopting a child who is the subject of a direct adoptive placement
under section 259.47 or the equivalent in tribal code;

(4) a child's legal custodian or guardian who is now adopting the child; or

(5) an individual who is adopting a child who is not a citizen or resident of the
United States and was either adopted in another country or brought to the United States
for the purposes of adoption.

Subd. 7.

Adoption assistance eligibility determination.

(a) The financially
responsible agency shall prepare an adoption assistance eligibility determination for
review and final approval by the commissioner. When there is no financially responsible
agency, the adoption assistance eligibility determination must be completed by the
agency designated by the commissioner. The eligibility determination must be completed
according to requirements and procedures and on forms prescribed by the commissioner.
The financially responsible agency and the commissioner shall make every effort to
establish a child's eligibility for title IV-E adoption assistance. Documentation from a
qualified expert for the eligibility determination must be provided to the commissioner
to verify that a child meets the special needs criteria in subdivision 2. A child who
is determined to be eligible for adoption assistance must have an adoption assistance
agreement negotiated on the child's behalf according to section 256N.25.

(b) Documentation from a qualified expert of a disability is limited to evidence
deemed appropriate by the commissioner and must be submitted to the commissioner with
the eligibility determination. Examples of appropriate documentation include, but are not
limited to, medical records, psychological assessments, educational or early childhood
evaluations, court findings, and social and medical history.

(c) Documentation that the child is at risk of developing physical, mental, emotional,
or behavioral disabilities must be submitted according to policies and procedures
prescribed by the commissioner.

Subd. 8.

Termination of agreement.

(a) An adoption assistance agreement must
terminate in any of the following circumstances:

(1) the child has attained the age of 18, or up to age 21 when the child meets a
condition for extension in subdivision 12;

(2) the child has not attained the age of 18, but the commissioner determines the
adoptive parent is no longer legally responsible for support of the child;

(3) the commissioner determines the adoptive parent is no longer providing financial
support to the child up to age 21;

(4) the death of the child; or

(5) the adoptive parent requests in writing the termination of the adoption assistance
agreement.

(b) An adoptive parent is considered no longer legally responsible for support of the
child in any of the following circumstances:

(1) parental rights to the child are legally terminated or a court accepted the parent's
consent to adoption under chapter 260C;

(2) permanent legal and physical custody or guardianship of the child is transferred
to another individual;

(3) death of the adoptive parent under subdivision 9;

(4) the child enlists in the military;

(5) the child gets married; or

(6) the child is determined an emancipated minor through legal action.

Subd. 9.

Death of adoptive parent or adoption dissolution.

The adoption
assistance agreement ends upon death or termination of parental rights of both adoptive
parents in the case of a two-parent adoption, or the sole adoptive parent in the case of
a single-parent adoption. The child's adoption assistance eligibility may be continued
according to subdivision 10.

Subd. 10.

Continuing a child's title IV-E adoption assistance in a subsequent
adoption.

(a) The child maintains eligibility for title IV-E adoption assistance in a
subsequent adoption if the following criteria are met:

(1) the child is determined to be a child with special needs as outlined in subdivision
2; and

(2) the subsequent adoptive parent resides in Minnesota.

(b) If a child had a title IV-E adoption assistance agreement in effect prior to the
death of the adoptive parent or dissolution of the adoption, and the subsequent adoptive
parent resides outside of Minnesota, the commissioner is not responsible for determining
whether the child meets the definition of special needs, entering into the adoption
assistance agreement, and making any adoption assistance payments outlined in the new
agreement unless a state agency in Minnesota has responsibility for placement and care of
the child at the time of the subsequent adoption. If there is no state agency in Minnesota
that has responsibility for placement and care of the child at the time of the subsequent
adoption, the public child welfare agency in the subsequent adoptive parent's residence is
responsible for determining whether the child meets the definition of special needs and
entering into the adoption assistance agreement.

Subd. 11.

Assigning a child's adoption assistance to a court-appointed guardian
or custodian.

(a) State-funded adoption assistance may be continued with the written
consent of the commissioner to an individual who is a guardian appointed by a court for
the child upon the death of both the adoptive parents in the case of a two-parent adoption,
or the sole adoptive parent in the case of a single-parent adoption, unless the child is
under the custody of a state agency.

(b) Temporary assignment of adoption assistance may be approved by the
commissioner for a maximum of six consecutive months from the death of the adoptive
parent or parents under subdivision 9 and must adhere to the requirements and procedures
prescribed by the commissioner. If, within six months, the child has not been adopted by a
person agreed upon by the commissioner, or a court has not appointed a permanent legal
guardian under section 260C.325, 525.5-313, or similar law of another jurisdiction, the
adoption assistance must terminate.

(c) Upon assignment of payments under this subdivision, assistance must be from
funds other than title IV-E.

Subd. 12.

Extension of adoption assistance agreement.

(a) Under certain limited
circumstances a child may qualify for extension of the adoption assistance agreement
beyond the date the child attains age 18, up to the date the child attains the age of 21.

(b) A request for extension of the adoption assistance agreement must be completed
in writing and submitted, including all supporting documentation, by the adoptive parent
to the commissioner at least 60 calendar days prior to the date that the current agreement
will terminate.

(c) A signed amendment to the current adoption assistance agreement must be
fully executed between the adoptive parent and the commissioner at least ten business
days prior to the termination of the current agreement. The request for extension and the
fully executed amendment must be made according to the requirements and procedures
prescribed by the commissioner, including documentation of eligibility, on forms
prescribed by the commissioner.

(d) If an agency is certifying a child for adoption assistance and the child will attain
the age of 18 within 60 calendar days of submission, the request for extension must be
completed in writing and submitted, including all supporting documentation, with the
adoption assistance application.

(e) A child who has attained the age of 16 prior to the finalization of the child's
adoption is eligible for extension of the adoption assistance agreement up to the date the
child attains age 21 if the child is:

(1) dependent on the adoptive parent for care and financial support; and

(2)(i) completing a secondary education program or a program leading to an
equivalent credential;

(ii) enrolled in an institution that provides postsecondary or vocational education;

(iii) participating in a program or activity designed to promote or remove barriers to
employment;

(iv) employed for at least 80 hours per month; or

(v) incapable of doing any of the activities described in items (i) to (iv) due to
a medical condition where incapability is supported by documentation from an expert
according to the requirements and procedures prescribed by the commissioner.

(f) A child who has not attained the age of 16 prior to finalization of the child's
adoption is eligible for extension of the adoption assistance agreement up to the date the
child attains the age of 21 if the child is:

(1) dependent on the adoptive parent for care and financial support; and

(2)(i) enrolled in a secondary education program or a program leading to the
equivalent; or

(ii) possesses a physical or mental disability that impairs the capacity for independent
living and warrants continuation of financial assistance as determined by the commissioner.

Subd. 13.

Beginning adoption assistance under Northstar Care for Chi