3rd Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to human services; changing nursing home 1.3 moratorium conditions; authorizing the commissioner of 1.4 public safety to issue certain cards to program 1.5 clients; authorizing therapy providers to represent 1.6 clients at agency hearings; changing the state share 1.7 of certain program costs; authorizing assistance 1.8 transaction card fees; modifying ICF/MR client 1.9 classification requirements; authorizing an hourly 1.10 job-coach rate for day training services; modifying 1.11 the chemical dependency treatment fund allocation; 1.12 establishing an Indian elders coordinator position; 1.13 authorizing mental retardation waivered services in an 1.14 unlicensed facility under certain conditions; 1.15 authorizing children's mental health transition 1.16 services to persons over 18 years of age under certain 1.17 conditions; modifying allocation procedures for the 1.18 child care funds; establishing a public assistance 1.19 lien under certain circumstances; making Minnesota 1.20 family investment plan participants subject to fraud 1.21 statutes; modifying program disqualification 1.22 requirements; strengthening lien enforcement 1.23 provisions; modifying income and asset allowance 1.24 provisions and other provisions relating to medical 1.25 assistance; requiring a plan to restructure 1.26 alternative care and otherwise modifying alternative 1.27 care and waivered service programs; modifying the 1.28 traumatic brain injury program; making technical 1.29 modifications in nursing facility reimbursement and 1.30 reporting; requiring recommendations on a new ICF/MR 1.31 reimbursement system; modifying asset allowances under 1.32 general assistance medical care; requiring various 1.33 studies and reports; providing MA payment for persons 1.34 with special needs in state operated services; 1.35 providing elderly housing with supportive services; 1.36 amending Minnesota Statutes 1994, sections 16B.08, 1.37 subdivision 5; 144.0723, subdivisions 1, 2, 3, 4, and 1.38 6; 144A.071, subdivisions 2, 4a, and by adding a 1.39 subdivision; 144A.073, subdivisions 1, 2, 3, 4, 8, and 1.40 by adding a subdivision; 144B.01, subdivision 5; 1.41 171.07, by adding a subdivision; 245.4871, by adding a 1.42 subdivision; 245.4875, by adding a subdivision; 1.43 246.56, by adding a subdivision; 252.27, subdivision 1.44 1a; 252.275, subdivisions 3, 4, and 8; 252.46, 1.45 subdivisions 1, 3, and 17; 254B.02, subdivision 1; 1.46 254B.05, subdivision 1; 256.014, subdivision 1; 2.1 256.015, subdivisions 1 and 2; 256.034, subdivision 1; 2.2 256.045, subdivisions 3, 4, and 5; 256.73, subdivision 2.3 2; 256.9353, subdivision 8; 256.969, subdivisions 10 2.4 and 16; 256.975, by adding a subdivision; 256.98, 2.5 subdivisions 1 and 8; 256B.042, subdivision 2; 2.6 256B.056, subdivision 4; 256B.0575; 256B.059, 2.7 subdivisions 1, 3, and 5; 256B.0595, subdivisions 1, 2.8 2, 3, and 4; 256B.06, subdivision 4; 256B.0625, 2.9 subdivisions 5, 13a, and 18; 256B.0628, subdivision 2; 2.10 256B.0911, subdivisions 2, 2a, and 3; 256B.0913, 2.11 subdivisions 4, 5, 8, 12, and 14; 256B.0915, 2.12 subdivisions 3, 5, and by adding a subdivision; 2.13 256B.092, by adding a subdivision; 256B.093, 2.14 subdivisions 1, 2, 3, and by adding a subdivision; 2.15 256B.431, subdivision 15, and by adding a subdivision; 2.16 256B.432, subdivisions 1, 2, 3, 5, and 6; 256B.501, 2.17 subdivisions 1, 3g, 8, and by adding subdivisions; 2.18 256B.69, subdivision 4; 256D.03, subdivision 3; 2.19 256D.05, subdivision 7; 256D.46, subdivisions 1 and 2; 2.20 256F.09; 256H.01, subdivisions 9 and 12; 256H.02; 2.21 256H.03, subdivisions 1, 2a, 6, and by adding a 2.22 subdivision; 256H.08; 256H.11, subdivision 1; 256H.12, 2.23 subdivision 1, and by adding a subdivision; 256H.15, 2.24 subdivision 1; 256H.18; 256I.03, subdivision 5, and by 2.25 adding a subdivision; 256I.04, subdivision 2b; 2.26 256I.05, subdivisions 1 and 5; 256I.06, subdivisions 2 2.27 and 6; 524.6-207; and 550.37, subdivision 14; Laws 2.28 1993, First Special Session chapter 1, article 8, 2.29 section 30, subdivision 2; proposing coding for new 2.30 law in Minnesota Statutes, chapter 256B; proposing 2.31 coding for new law as Minnesota Statutes, chapter 2.32 144D; repealing Minnesota Statutes 1994, sections 2.33 144.0723, subdivision 5; 144A.073, subdivision 3a; 2.34 252.275, subdivisions 4a and 10; and 256H.03, 2.35 subdivisions 2 and 5. 2.36 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 2.37 ARTICLE 1 2.38 DEPARTMENT OF HUMAN SERVICES FINANCE AND MANAGEMENT POLICY 2.39 Section 1. Minnesota Statutes 1994, section 16B.08, 2.40 subdivision 5, is amended to read: 2.41 Subd. 5. [FEDERALGENERAL SERVICES ADMINISTRATIONAGENCY 2.42 PRICE SCHEDULES.] Notwithstanding anything in this chapter to 2.43 the contrary, the commissioner may, instead of soliciting bids, 2.44 contract for purchases with suppliers who have published 2.45 schedules of prices effective for sales tothe General Services2.46Administrationany federal agency of the United States. These 2.47 contracts may be entered into, regardless of the amount of the 2.48 purchase price, if the commissioner considers them advantageous 2.49 and if the purchase price of all the commodities purchased under 2.50 the contract do not exceed the price specified by the schedule. 2.51 Sec. 2. Minnesota Statutes 1994, section 171.07, is 2.52 amended by adding a subdivision to read: 2.53 Subd. 10. [AGREEMENTS WITH OTHER AGENCIES.] The 3.1 commissioner of public safety is authorized to enter into 3.2 agreements with other agencies to issue cards to clients of 3.3 those agencies for use in their programs. The cards may be 3.4 issued to persons who do not qualify for a Minnesota driver's 3.5 license or do not provide evidence of name and identity as 3.6 required by rule for a Minnesota identification card. Persons 3.7 issued cards under this subdivision will meet the identification 3.8 verification requirements of the contracting agency. 3.9 The interagency agreement may include provisions for the 3.10 payment of the county fee provided in section 171.06, 3.11 subdivision 4, and the actual cost to manufacture the card. 3.12 Cards issued under this subdivision are not Minnesota 3.13 identification cards for the purposes defined in sections 3.14 48.512, 201.061, 201.161, 332.50, and 340A.503. 3.15 Sec. 3. Minnesota Statutes 1994, section 256.014, 3.16 subdivision 1, is amended to read: 3.17 Subdivision 1. [ESTABLISHMENT OF SYSTEMS.] The 3.18 commissioner of human services shall establish and enhance 3.19 computer systems necessary for the efficient operation of the 3.20 programs the commissioner supervises, including: 3.21 (1) management and administration of the food stamp and 3.22 income maintenance programs, including the electronic 3.23 distribution of benefits; 3.24 (2) management and administration of the child support 3.25 enforcement program; and 3.26 (3) administration of medical assistance and general 3.27 assistance medical care. 3.28 The commissioner shall distribute the nonfederal share of 3.29 the costs of operating and maintaining the systems to the 3.30 commissioner and to the counties participating in the system in 3.31 a manner that reflects actual system usage, except that the 3.32 nonfederal share of the costs of the MAXIS computer system and 3.33 child support enforcement systems shall be borne entirely by the 3.34 commissioner. Development costs must not be assessed against 3.35 county agencies. 3.36 Sec. 4. Minnesota Statutes 1994, section 256.045, 4.1 subdivision 4, is amended to read: 4.2 Subd. 4. [CONDUCT OF HEARINGS.] All hearings held pursuant 4.3 to subdivision 3, 3a, or 4a shall be conducted according to the 4.4 provisions of the federal Social Security Act and the 4.5 regulations implemented in accordance with that act to enable 4.6 this state to qualify for federal grants-in-aid, and according 4.7 to the rules and written policies of the commissioner of human 4.8 services. County agencies shall install equipment necessary to 4.9 conduct telephone hearings. A state human services referee may 4.10 schedule a telephone conference hearing when the distance or 4.11 time required to travel to the county agency offices will cause 4.12 a delay in the issuance of an order, or to promote efficiency, 4.13 or at the mutual request of the parties. Hearings may be 4.14 conducted by telephone conferences unless the applicant, 4.15 recipient, or former recipient objects. The hearing shall not 4.16 be held earlier than five days after filing of the required 4.17 notice with the county or state agency. The state human 4.18 services referee shall notify all interested persons of the 4.19 time, date, and location of the hearing at least five days 4.20 before the date of the hearing. Interested persons may be 4.21 represented by legal counsel or other representative of their 4.22 choice, including a provider of therapy services, at the hearing 4.23 and may appear personally, testify and offer evidence, and 4.24 examine and cross-examine witnesses. The applicant, recipient, 4.25 or former recipient shall have the opportunity to examine the 4.26 contents of the case file and all documents and records to be 4.27 used by the county or state agency at the hearing at a 4.28 reasonable time before the date of the hearing and during the 4.29 hearing. Upon request, the county agency shall provide 4.30 reimbursement for transportation, child care, photocopying, 4.31 medical assessment, witness fee, and other necessary and 4.32 reasonable costs incurred by the applicant, recipient, or former 4.33 recipient in connection with the appeal. All evidence, except 4.34 that privileged by law, commonly accepted by reasonable people 4.35 in the conduct of their affairs as having probative value with 4.36 respect to the issues shall be submitted at the hearing and such 5.1 hearing shall not be "a contested case" within the meaning of 5.2 section 14.02, subdivision 3. The agency must present its 5.3 evidence prior to or at the hearing, and may not submit evidence 5.4 after the hearing except by agreement of the parties at the 5.5 hearing, provided the recipient has the opportunity to respond. 5.6 Sec. 5. Minnesota Statutes 1994, section 256.045, 5.7 subdivision 5, is amended to read: 5.8 Subd. 5. [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] A 5.9 state human services referee shall conduct a hearing on the 5.10 appeal and shall recommend an order to the commissioner of human 5.11 services. The recommended order must be based on all relevant 5.12 evidence and must not be limited to a review of the propriety of 5.13 the state or county agency's action. A referee may take 5.14 official notice of adjudicative facts. The commissioner of 5.15 human services may accept the recommended order of a state human 5.16 services referee and issue the order to the county agency and 5.17 the applicant, recipient, former recipient, or prepaid health 5.18 plan. The commissioner on refusing to accept the recommended 5.19 order of the state human services referee, shall notify the 5.20 county agency and the applicant, recipient, former recipient, or 5.21 prepaid health plan of that fact and shall state reasons 5.22 therefor and shall allow each party ten days' time to submit 5.23 additional written argument on the matter. After the expiration 5.24 of the ten-day period, the commissioner shall issue an order on 5.25 the matter to the county agency and the applicant, recipient, 5.26 former recipient, or prepaid health plan. 5.27 A party aggrieved by an order of the commissioner may 5.28 appeal under subdivision 7, or request reconsideration by the 5.29 commissioner within 30 days after the date the commissioner 5.30 issues the order. The commissioner may reconsider an order upon 5.31 request of any party or on the commissioner's own motion. A 5.32 request for reconsideration does not stay implementation of the 5.33 commissioner's order. Upon reconsideration, the commissioner 5.34 may issue an amended order or an order affirming the original 5.35 order. 5.36 Any order of the commissioner issued under this subdivision 6.1 shall be conclusive upon the parties unless appeal is taken in 6.2 the manner provided by subdivision 7. Any order of the 6.3 commissioner is binding on the parties and must be implemented 6.4 by the state agency or a county agency until the order is 6.5 reversed by the district court, or unless the commissioner or a 6.6 district court orders monthly assistance or aid or services paid 6.7 or provided under subdivision 10. 6.8 Except for a prepaid health plan, a vendor of medical care 6.9 as defined in section 256B.02, subdivision 7, or a vendor under 6.10 contract with a county agency to provide social services under 6.11 section 256E.08, subdivision 4, is not a party and may not 6.12 request a hearing or seek judicial review of an order issued 6.13 under this section, unless assisting a recipient as provided in 6.14 subdivision 4. 6.15 ARTICLE 2 6.16 LIFE SKILLS SELF-SUFFICIENCY POLICY 6.17 Section 1. Minnesota Statutes 1994, section 144.0723, 6.18 subdivision 1, is amended to read: 6.19 Subdivision 1. [CLIENTREIMBURSEMENTCLASSIFICATIONS.] The 6.20 commissioner of health shall establishreimbursement6.21 classifications based upon the assessment of each client in 6.22 intermediate care facilities for the mentally retarded conducted 6.23 after December 31,19881993, under section 256B.501, 6.24 subdivision 3g, or under rules established by the commissioner6.25of human services under section 256B.501, subdivision 3j. 6.26 Thereimbursementclassifications established by the 6.27 commissioner must conform tothesection 256B.501, subdivision 6.28 3g, and subsequent rules established by the commissioner of 6.29 human services to set payment rates for intermediate care 6.30 facilities for the mentally retardedbeginning on or after6.31October 1, 1990. 6.32 Sec. 2. Minnesota Statutes 1994, section 144.0723, 6.33 subdivision 2, is amended to read: 6.34 Subd. 2. [NOTICE OF CLIENTREIMBURSEMENTCLASSIFICATION.] 6.35 The commissioner of health shall notify eachclient and6.36 intermediate care facility for the mentally retardedin which7.1the client residesof thereimbursement classification7.2 classifications established under subdivision 1 for each client 7.3 residing in the facility. The notice must inform the 7.4clientintermediate care facility for the mentally retarded of 7.5 theclassificationclassifications thatwasare assigned, the7.6opportunity to review the documentation supporting the7.7classification, the opportunity to obtain clarification from the7.8commissioner,and the opportunity to request a reconsideration 7.9 ofthe classificationany classifications assigned. The notice 7.10 of classification must be sent by first-class mail.The7.11individual client notices may be sent to the client's7.12intermediate care facility for the mentally retarded for7.13distribution to the client. The facility must distribute the7.14notice to the client's case manager and to the client or to the7.15client's representative. This notice must be distributed within7.16three working days after the facility receives the notices from7.17the department. For the purposes of this section,7.18"representative" includes the client's legal representative as7.19defined in Minnesota Rules, part 9525.0015, subpart 18, the7.20person authorized to pay the client's facility expenses, or any7.21other individual designated by the client.7.22 Sec. 3. Minnesota Statutes 1994, section 144.0723, 7.23 subdivision 3, is amended to read: 7.24 Subd. 3. [REQUEST FOR RECONSIDERATION.] Theclient,7.25client's representative, or theintermediate care facility for 7.26 the mentally retarded may request that the commissioner 7.27 reconsider the assigned classification. The request for 7.28 reconsideration must be submitted in writing to the commissioner 7.29 within 30 days after the receipt of the notice of client 7.30 classification. The request for reconsideration must include 7.31 the name of the client, the name and address of the facility in 7.32 which the client resides, the reasons for the reconsideration, 7.33 the requested classification changes, and documentation 7.34 supporting the requested classification. The documentation 7.35 accompanying the reconsideration request is limited to 7.36 documentation establishing that the needs of the client and 8.1 services provided to the client at the time of the assessment 8.2 resulting in the disputed classification justify a change of 8.3 classification. 8.4 Sec. 4. Minnesota Statutes 1994, section 144.0723, 8.5 subdivision 4, is amended to read: 8.6 Subd. 4. [ACCESS TO INFORMATION.] Annually, at the 8.7 interdisciplinary team meeting, the intermediate care facility 8.8 for the mentally retarded shall inform the client or the 8.9 client's representative and case manager of the client's most 8.10 recent classification as determined by the department of 8.11 health. Upon written request, the intermediate care facility 8.12 for the mentally retarded must give the client's case manager, 8.13 the client, or the client's representative a copy of the 8.14 assessment form and the other documentation that was given to 8.15 the department to support the assessment findings.The facility8.16shall also provide access to and a copy of other information8.17from the client's record that has been requested by or on behalf8.18of the client to support a client's reconsideration request. A8.19copy of any requested material must be provided within three8.20working days after the facility receives a written request for8.21the information. If the facility fails to provide the material8.22within this time, it is subject to the issuance of a correction8.23order and penalty assessment. Notwithstanding this section, any8.24order issued by the commissioner under this subdivision must8.25require that the facility immediately comply with the request8.26for information and that as of the date the order is issued, the8.27facility shall forfeit to the state a $100 fine the first day of8.28noncompliance, and an increase in the $100 fine by $508.29increments for each day the noncompliance continues.8.30 Sec. 5. Minnesota Statutes 1994, section 144.0723, 8.31 subdivision 6, is amended to read: 8.32 Subd. 6. [RECONSIDERATION.] The commissioner's 8.33 reconsideration must be made by individuals not involved in 8.34 reviewing the assessment that established the disputed 8.35 classification. The reconsideration must be based upon the 8.36 initial assessment and upon the information provided to the 9.1 commissioner undersubdivisionssubdivision 3and 5.If9.2necessary for evaluating the reconsideration request, the9.3commissioner may conduct on-site reviews. At the commissioner's9.4discretion, the commissioner may review the reimbursement9.5classifications assigned to all clients in the facility.Within 9.6 15 working days after receiving the request for reconsideration, 9.7 the commissioner shall affirm or modify the original client 9.8 classification. The original classification must be modified if 9.9 the commissioner determines that the assessment resulting in the 9.10 classification did not accurately reflect the status of the 9.11 client at the time of the assessment. Theclient and the9.12 intermediate care facility for the mentally retarded shall be 9.13 notified within five working days after the decision is made. 9.14 The commissioner's decision under this subdivision is the final 9.15 administrative decision of the agency. 9.16 Sec. 6. Minnesota Statutes 1994, section 252.27, 9.17 subdivision 1a, is amended to read: 9.18 Subd. 1a. [DEFINITIONS.] Aperson has a"related 9.19 condition"if that person hasis a condition that is found to be 9.20 closely related to mental retardation, including, but not 9.21 limited to, cerebral palsy, epilepsy, autism, and Prader-Willi 9.22 syndrome and that meets all of the following criteria: (a) is 9.23 severe,and chronicdisability that meets all of the following9.24conditions: (a) is attributable to cerebral palsy, epilepsy,9.25autism, Prader-Willi syndrome, or any other condition, other9.26than mental illness as defined under section 245.462,9.27subdivision 20, or an emotional disturbance, as defined under9.28section 245.4871, subdivision 15, found to be closely related to9.29mental retardation because the condition; (b) results in 9.30 impairment of general intellectual functioning or adaptive 9.31 behavior similar to that of persons with mental retardationand; 9.32 (c) requires treatment or services similar to those required for 9.33 persons with mental retardation;(b)(d) is manifested before 9.34 the person reaches 22 years of age;(c)(e) is likely to 9.35 continue indefinitely;and (d)(f) results in substantial 9.36 functional limitations in three or more of the following areas 10.1 of major life activity: (1) self-care, (2) understanding and 10.2 use of language, (3) learning, (4) mobility, (5) self-direction, 10.3 (6) capacity for independent living; and (g) is not attributable 10.4 to mental illness as defined in section 245.462, subdivision 20, 10.5 or an emotional disturbance as defined in section 245.4871, 10.6 subdivision 15. For purposes of clause (g), notwithstanding 10.7 section 245.462, subdivision 20, or 245.4871, subdivision 15, 10.8 "mental illness" does not include autism or other pervasive 10.9 developmental disorders. 10.10 Sec. 7. Minnesota Statutes 1994, section 252.275, 10.11 subdivision 3, is amended to read: 10.12 Subd. 3. [REIMBURSEMENT.] Counties shall be reimbursed for 10.13 all expenditures made pursuant to subdivision 1 at a rate of 70 10.14 percent, up to the allocation determined pursuant to 10.15 subdivisions 4, 4a,and 4b. However, the commissioner shall not 10.16 reimburse costs of services for any person if the costs exceed 10.17 the state share of the average medical assistance costs for 10.18 services provided by intermediate care facilities for a person 10.19 with mental retardation or a related condition for the same 10.20 fiscal year, and shall not reimburse costs of a one-time living 10.21 allowance for any person if the costs exceed $1,500 in a state 10.22 fiscal year.For the biennium ending June 30, 1993, the10.23commissioner shall not reimburse costs in excess of the 85th10.24percentile of hourly service costs based upon the cost10.25information supplied to the legislature in the proposed budget10.26for the biennium.The commissioner may make payments to each 10.27 county in quarterly installments. The commissioner may certify 10.28 an advance of up to 25 percent of the allocation. Subsequent 10.29 payments shall be made on a reimbursement basis for reported 10.30 expenditures and may be adjusted for anticipated spending 10.31 patterns. 10.32 Sec. 8. Minnesota Statutes 1994, section 252.275, 10.33 subdivision 4, is amended to read: 10.34 Subd. 4. [FORMULA.]Effective January 1, 1992,The 10.35 commissioner shall allocate funds on a calendar year basis.For10.36calendar year 1992, funds shall be allocated based on each11.1county's portion of the statewide reimbursement received under11.2this section for state fiscal year 1991. For subsequent11.3calendar years, funds shall beBeginning with the calendar year 11.4 in the 1996 grant period, funds shall be allocated first in 11.5 amounts equal to each county's guaranteed floor according to 11.6 subdivision 4b, with any remaining available funds allocated 11.7 based on each county's portion of the statewide expenditures 11.8 eligible for reimbursement under this section during the 12 11.9 months ending on June 30 of the preceding calendar year. 11.10 If the legislature appropriates funds for special purposes, 11.11 the commissioner may allocate the funds based on proposals 11.12 submitted by the counties to the commissioner in a format 11.13 prescribed by the commissioner. Nothing in this section 11.14 prevents a county from using other funds to pay for additional 11.15 costs of semi-independent living services. 11.16 Sec. 9. Minnesota Statutes 1994, section 252.275, 11.17 subdivision 8, is amended to read: 11.18 Subd. 8. [USE OF FEDERAL FUNDS AND TRANSFER OF FUNDS TO 11.19 MEDICAL ASSISTANCE.] (a) The commissioner shall make every 11.20 reasonable effort to maximize the use of federal funds for 11.21 semi-independent living services. 11.22 (b) The commissioner shall reduce the payments to be made 11.23 under this section to each county from January 1, 1994 to June 11.24 30, 1996, by the amount of the state share of medical assistance 11.25 reimbursement for services other than residential services 11.26 provided under the home and community-based waiver program under 11.27 section 256B.092 from January 1, 1994 to June 30, 1996, for 11.28 clients for whom the county is financially responsible and who 11.29 have been transferred by the county from the semi-independent 11.30 living services program to the home and community-based waiver 11.31 program. Unless otherwise specified, all reduced amounts shall 11.32 be transferred to the medical assistance state account. 11.33 (c) For fiscal year 1997, the base appropriation available 11.34 under this section shall be reduced by the amount of the state 11.35 share of medical assistance reimbursement for services other 11.36 than residential services provided under the home and 12.1 community-based waiver program authorized in section 256B.092 12.2 from January 1, 1995 to December 31, 1995, for persons who have 12.3 been transferred from the semi-independent living services 12.4 program to the home and community-based waiver program. The 12.5 base appropriation for the medical assistance state account 12.6 shall be increased by the same amount. 12.7 (d) For purposes of calculating the guaranteed floor under 12.8 subdivision 4b and to establish the calendar year 1996 12.9 allocations, each county's original allocation for calendar year 12.10 1995 shall be reduced by the amount transferred to the state 12.11 medical assistance account under paragraph (b) during the six 12.12 months ending on June 30, 1995. For purposes of calculating the 12.13 guaranteed floor under subdivision 4b and to establish the 12.14 calendar year 1997 allocations, each county's original 12.15 allocation for calendar year 1996 shall be reduced by the amount 12.16 transferred to the state medical assistance account under 12.17 paragraph (b) during the six months ending onJune 30, 199612.18 December 31, 1995. 12.19 Sec. 10. Minnesota Statutes 1994, section 252.46, 12.20 subdivision 1, is amended to read: 12.21 Subdivision 1. [RATES.] Payment rates to vendors, except 12.22 regional centers, for county-funded day training and 12.23 habilitation services and transportation provided to persons 12.24 receiving day training and habilitation services established by 12.25 a county board are governed by subdivisions 2 to 19. The 12.26 commissioner shall approve the following three payment rates for 12.27 services provided by a vendor: 12.28 (1) a full-day service rate for persons who receive at 12.29 least six service hours a day, including the time it takes to 12.30 transport the person to and from the service site; 12.31 (2) a partial-day service rate that must not exceed 75 12.32 percent of the full-day service rate for persons who receive 12.33 less than a full day of service;and12.34 (3) a transportation rate for providing, or arranging and 12.35 paying for, transportation of a person to and from the person's 12.36 residence to the service site. 13.1 The commissioner may also approve an hourly job-coach, 13.2 follow-along rate for services provided by one employee en route 13.3 to or from community locations to supervise, support, and assist 13.4 one person receiving the vendor's services to learn job-related 13.5 skills necessary to obtain or retain employment when and where 13.6 no other persons receiving services are present and when all the 13.7 following criteria are met: 13.8 (1) the vendor requests and the county recommends an 13.9 optional rate; 13.10 (2) the service is prior authorized by the county on the 13.11 medicaid management information system for no more than 414 13.12 hours in a 12-month period and the daily per person charge to 13.13 medical assistance does not exceed the vendor's approved full 13.14 day plus transportation rates; 13.15 (3) separate full day, partial day, and transportation 13.16 rates are not billed for the same person on the same day; 13.17 (4) the approved hourly rate does not exceed the sum of the 13.18 vendor's current average hourly direct service wage, including 13.19 fringe benefits and taxes, plus a component equal to the 13.20 vendor's average hourly nondirect service wage expenses; and 13.21 (5) the actual revenue received for provision of hourly 13.22 job-coach, follow-along services is subtracted from the vendor's 13.23 total expenses for the same time period and those adjusted 13.24 expenses are used for determining recommended full day and 13.25 transportation payment rates under subdivision 5 in accordance 13.26 with the limitations in subdivision 3. 13.27 Medical assistance rates for home and community-based 13.28 service provided under section 256B.501, subdivision 4, by 13.29 licensed vendors of day training and habilitation services must 13.30 not be greater than the rates for the same services established 13.31 by counties under sections 252.40 to 252.47. For very dependent 13.32 persons with special needs the commissioner may approve an 13.33 exception to the approved payment rate under section 256B.501, 13.34 subdivision 4 or 8. 13.35 Sec. 11. Minnesota Statutes 1994, section 252.46, 13.36 subdivision 3, is amended to read: 14.1 Subd. 3. [RATE MAXIMUM.] Unless a variance is granted 14.2 under subdivision 6, the maximum payment rates for each vendor 14.3 for a calendar year must be equal to the payment rates approved 14.4 by the commissioner for that vendor in effect December 1 of the 14.5 previous calendar year. The commissioner of finance shall 14.6 include as a budget change request in each biennial detailed 14.7 expenditure budget submitted to the legislature under section 14.8 16A.11 annual inflation adjustments in reimbursement rates for 14.9 each vendor, based upon the projected percentage change in the 14.10 urban consumer price index, all items, published by the United 14.11 States Department of Labor, for the upcoming calendar year over 14.12 the current calendar year.The commissioner shall not provide14.13an annual inflation adjustment for the biennium ending June 30,14.141993.14.15 Sec. 12. Minnesota Statutes 1994, section 252.46, 14.16 subdivision 17, is amended to read: 14.17 Subd. 17. [HOURLY RATE STRUCTURE.] Counties participating 14.18 as host counties under the pilot study of hourly rates 14.19 established under Laws 1988, chapter 689, article 2, section 14.20 117, may recommend continuation of the hourly rates for 14.21 participating vendors. The recommendation must be made annually 14.22 under subdivision 5 and according to the methods and standards 14.23 provided by the commissioner. The commissioner shall approve 14.24 the hourly rates when service authorization, billing, and 14.25 payment for services is possible through the Medicaid management 14.26 information system and the other criteria in this subdivision 14.27 are met. Counties and vendors operating under the pilot study 14.28 of hourly rates established under Laws 1988, chapter 689, 14.29 article 2, section 117, shall work with the commissioner to 14.30 translate the hourly rates and actual expenditures into rates 14.31 meeting the criteria in subdivisions 1 to 16 unless hourly rates 14.32 are approved under this subdivision. If the rates meeting the 14.33 criteria in subdivisions 1 to 16 are lower than the county's or 14.34 vendor's current rate, the county or vendor must continue to 14.35 receive the current rate. 14.36 Sec. 13. Minnesota Statutes 1994, section 254B.02, 15.1 subdivision 1, is amended to read: 15.2 Subdivision 1. [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 15.3 The chemical dependency funds appropriated for allocation shall 15.4 be placed in a special revenue account. For the fiscal year 15.5 beginning July 1, 1987, funds shall be transferred to operate 15.6 the vendor payment, invoice processing, and collections system 15.7 for one year. The commissioner shall annually transfer funds 15.8 from the chemical dependency fund to pay for operation of the 15.9 drug and alcohol abuse normative evaluation system and to pay 15.10 for all costs incurred by adding two positions for licensing of 15.11 chemical dependency treatment and rehabilitation programs 15.12 located in hospitals for which funds are not otherwise 15.13 appropriated. The commissioner shall annually divide the money 15.14 available in the chemical dependency fund that is not held in 15.15 reserve by counties from a previous allocation. Twelve percent 15.16 of the remaining money must be reserved for treatment of 15.17 American Indians by eligible vendors under section 254B.05. The 15.18 remainder of the money must be allocated among the counties 15.19 according to the following formula, using state demographer data 15.20 and other data sources determined by the commissioner: 15.21(a) The county non-Indian and over age 14 per capita-months15.22of eligibility for aid to families with dependent children,15.23general assistance, and medical assistance is divided by the15.24total state non-Indian and over age 14 per capita-months of15.25eligibility to determine the caseload factor for each county.15.26(b) The average median married couple income for the15.27previous three years for the state is divided by the average15.28median married couple income for the previous three years for15.29each county to determine the income factor.15.30(c) The non-Indian and over age 14 population of the county15.31is multiplied by the sum of the income factor and the caseload15.32factor to determine the adjusted population.15.33 (a) For purposes of this formula, American Indians and 15.34 children under age 14 are subtracted from the population of each 15.35 county to determine the restricted population. 15.36 (b) The amount of chemical dependency fund expenditures for 16.1 entitled persons for services not covered by prepaid plans 16.2 governed by section 256B.69 in the previous year is divided by 16.3 the amount of chemical dependency fund expenditures for entitled 16.4 persons for all services to determine the proportion of exempt 16.5 service expenditures for each county. 16.6 (c) The prepaid plan months of eligibility is multiplied by 16.7 the proportion of exempt service expenditures to determine the 16.8 adjusted prepaid plan months of eligibility for each county. 16.9 (d) The adjusted prepaid plan months of eligibility is 16.10 added to the number of restricted population fee for service 16.11 months of eligibility for aid to families with dependent 16.12 children, general assistance, and medical assistance and divided 16.13 by the county restricted population to determine county per 16.14 capita months of covered service eligibility. 16.15 (e) The number of adjusted prepaid plan months of 16.16 eligibility for the state is added to the number of fee for 16.17 service months of eligibility for aid to families with dependent 16.18 children, general assistance, and medical assistance for the 16.19 state restricted population and divided by the state restricted 16.20 population to determine state per capita months of covered 16.21 service eligibility. 16.22 (f) The county per capita months of covered service 16.23 eligibility is divided by the state per capita months of covered 16.24 service eligibility to determine the county welfare caseload 16.25 factor. 16.26 (g) The median married couple income for the most recent 16.27 three-year period available for the state is divided by the 16.28 median married couple income for the same period for each county 16.29 to determine the income factor for each county. 16.30 (h) The county restricted population is multiplied by the 16.31 sum of the county welfare caseload factor and the county income 16.32 factor to determine the adjusted population. 16.33(d)(i) $15,000 shall be allocated to each county. 16.34(e)(j) The remaining funds shall be allocated proportional 16.35 to the county adjusted population. 16.36 Sec. 14. Minnesota Statutes 1994, section 254B.05, 17.1 subdivision 1, is amended to read: 17.2 Subdivision 1. [LICENSURE REQUIRED.] Programs licensed by 17.3 the commissioner are eligible vendors. Hospitals may apply for 17.4 and receive licenses to be eligible vendors, notwithstanding the 17.5 provisions of section 245A.03. American Indian programs located 17.6 on federally recognized tribal lands that provide chemical 17.7 dependency primary treatment, extended care, transitional 17.8 residence, or outpatient treatment services, and are licensed by 17.9 tribal government are eligible vendors. Detoxification programs 17.10 are not eligible vendors. Programs that are not licensed as a 17.11 chemical dependency residential or nonresidential treatment 17.12 program by the commissioner or by tribal government are not 17.13 eligible vendors. To be eligible for payment under the 17.14 Consolidated Chemical Dependency Treatment Fund, a vendor must 17.15 participate in the Drug and Alcohol Abuse Normative Evaluation 17.16 System and the treatment accountability plan. 17.17 Sec. 15. Minnesota Statutes 1994, section 256.975, is 17.18 amended by adding a subdivision to read: 17.19 Subd. 6. [INDIAN ELDERS POSITION.] The Minnesota board on 17.20 aging shall create an Indian elders coordinator position, and 17.21 shall hire staff as appropriations permit for the purposes of 17.22 coordinating efforts with the National Indian Council on Aging 17.23 and developing a comprehensive statewide service system for 17.24 Indian elders. An Indian elder is defined for purposes of this 17.25 subdivision as an Indian enrolled in a band or tribe who is 55 17.26 years or older. The statewide service system must include the 17.27 following components: 17.28 (1) an assessment of the program eligibility, examining the 17.29 need to change the age-based eligibility criteria to need-based 17.30 eligibility criteria; 17.31 (2) a planning system that would grant or make 17.32 recommendations for granting federal and state funding for 17.33 services; 17.34 (3) a plan for service focal points, senior centers, or 17.35 community centers for socialization and service accessibility 17.36 for Indian elders; 18.1 (4) a plan to develop and implement education and public 18.2 awareness campaigns including awareness programs, sensitivity 18.3 cultural training, and public education on Indian elder needs; 18.4 (5) a plan for information and referral services including 18.5 trained advocates and an Indian elder newsletter; 18.6 (6) a plan for a coordinated health care system including 18.7 health promotion/prevention, in-home service, long-term care 18.8 service, and health care services; 18.9 (7) a plan for ongoing research involving Indian elders 18.10 including needs assessment and needs analysis; 18.11 (8) information and referral services for legal advice or 18.12 legal counsel; and 18.13 (9) a plan to coordinate services with existing 18.14 organizations including the council of Indian affairs, the 18.15 Minnesota Indian council of elders, the Minnesota board on 18.16 aging, and tribal governments. 18.17 Sec. 16. Minnesota Statutes 1994, section 256B.092, is 18.18 amended by adding a subdivision to read: 18.19 Subd. 4c. [LIVING ARRANGEMENTS BASED ON A 24-HOUR PLAN OF 18.20 CARE.] (a) Notwithstanding the requirements for licensure under 18.21 Minnesota Rules, part 9525.1860, subpart 6, item D, and upon 18.22 federal approval of an amendment to the home- and 18.23 community-based services waiver for persons with mental 18.24 retardation or related conditions, a person receiving home- and 18.25 community-based services may choose to live in their own home 18.26 without requiring that the living arrangement be licensed under 18.27 Minnesota Rules, parts 9555.5050 to 9555.6265, provided the 18.28 following conditions are met: 18.29 (1) the person receiving home- and community-based services 18.30 has chosen to live in their own home; 18.31 (2) home- and community-based services are provided by a 18.32 qualified vendor who meets the provider standards as approved in 18.33 the Minnesota home- and community-based services waiver plan for 18.34 persons with mental retardation or related conditions; 18.35 (3) the person, or their legal representative, individually 18.36 or with others has purchased or rents the home and the person's 19.1 service provider has no financial interest in the home; and 19.2 (4) the service planning team, as defined in Minnesota 19.3 Rules, part 9525.0004, subpart 24, has determined that the 19.4 planned services, the 24-hour plan of care, and the housing 19.5 arrangement are appropriate to address the health, safety, and 19.6 welfare of the person. 19.7 (b) The county agency may require safety inspections of the 19.8 selected housing as part of their determination of the adequacy 19.9 of the living arrangement. 19.10 Sec. 17. [REPEALER.] 19.11 Minnesota Statutes 1994, sections 144.0723, subdivision 5; 19.12 and 252.275, subdivisions 4a and 10, are repealed. 19.13 ARTICLE 3 19.14 CHILDREN'S PROGRAMS POLICY 19.15 Section 1. Minnesota Statutes 1994, section 245.4871, is 19.16 amended by adding a subdivision to read: 19.17 Subd. 35. [TRANSITION SERVICES.] "Transition services" 19.18 means mental health services, designed within an outcome 19.19 oriented process that promotes movement from school to 19.20 postschool activities, including post-secondary education, 19.21 vocational training, integrated employment including supported 19.22 employment, continuing and adult education, adult mental health 19.23 and social services, other adult services, independent living, 19.24 or community participation. 19.25 Sec. 2. Minnesota Statutes 1994, section 245.4875, is 19.26 amended by adding a subdivision to read: 19.27 Subd. 8. [TRANSITION SERVICES.] The county board may 19.28 continue to provide mental health services as defined in 19.29 sections 245.487 to 245.4888 to persons over 18 years of age, 19.30 but under 21 years of age, if the person was receiving case 19.31 management or family community support services prior to age 18, 19.32 and if one of the following conditions is met: 19.33 (1) the person is receiving special education services 19.34 through the local school district; or 19.35 (2) it is in the best interest of the person to continue 19.36 services defined in sections 245.487 to 245.4888. 20.1 Sec. 3. Minnesota Statutes 1994, section 256F.09, is 20.2 amended to read: 20.3 256F.09 [GRANTS FORCHILDREN'S SAFETYFAMILY VISITATION 20.4 CENTERS.] 20.5 Subdivision 1. [PURPOSE.] The commissioner shall issue a 20.6 request for proposals from existing local nonprofit, 20.7 nongovernmental organizations, to use existing local facilities 20.8 aspilot children's safetyfamily visitation centers. The 20.9 commissioner shall award grants in amounts up to $50,000 for the 20.10 purpose of creatingchildren's safetyor maintaining family 20.11 visitation centers to reduce children's vulnerability to 20.12 violence and trauma related to family visitation, where there 20.13 has been a history of domestic violence or abuse within the 20.14 family. At least one of the pilot projects shall be located in 20.15 the seven-county metropolitan area and at least one of the 20.16 projects shall be located outside the seven-county metropolitan 20.17 area, and the commissioner shall award the grants to provide the 20.18 greatest possible number of safety centers and to locate them to 20.19 provide for the broadest possible geographic distribution of the 20.20 centers throughout the state. 20.21 Eachchildren's safetyfamily visitation center must use 20.22 existing local facilities to provide a healthy interactive 20.23 environment for parents who are separated or divorced and for 20.24 parents with children in foster homes to visit with their 20.25 children. The centers must be available for use by district 20.26 courts who may order visitation to occur at asafetyvisitation 20.27 center. The centers may also be used as drop-off sites, so that 20.28 parents who are under court order to have no contact with each 20.29 other can exchange children for visitation at a neutral site. 20.30 Each center must provide sufficient security to ensure a safe 20.31 visitation environment for children and their parents. A 20.32 grantee must demonstrate the ability to provide a local match, 20.33 which may include in-kind contributions. 20.34 Subd. 2. [PRIORITIES.] In awarding grants under the 20.35 program, the commissioner shall give priority to: 20.36 (1) areas of the state where nochildren's safetyother 21.1 family visitation center or similar facility exists; 21.2 (2) applicants who demonstrate that private funding for the 21.3 center is available and will continue; and 21.4 (3) facilities that are adapted for use to care for 21.5 children, such as day care centers, religious institutions, 21.6 community centers, schools, technical colleges, parenting 21.7 resource centers, and child care referral services. 21.8 Subd. 3. [ADDITIONAL SERVICES.] Each center may provide 21.9 parenting and child development classes, and offer support 21.10 groups to participating custodial parents and hold regular 21.11 classes designed to assist children who have experienced 21.12 domestic violence and abuse. 21.13 Subd. 4. [REPORT.] The commissioner shall evaluate the 21.14 operation of thepilot children's safetyfamily visitation 21.15 centers and report to the legislature by February 1, 1994, with 21.16 recommendations. 21.17 Sec. 4. Minnesota Statutes 1994, section 256H.01, 21.18 subdivision 9, is amended to read: 21.19 Subd. 9. [FAMILY.] "Family" means parents, stepparents, 21.20 guardians and their spouses, or other eligible relative 21.21 caretakers and their spouses, and their blood related dependent 21.22 children and adoptive siblings under the age of 18 years living 21.23 in the same home including children temporarily absent from the 21.24 household in settings such as schools, foster care, and 21.25 residential treatment facilities. When a minor parent or 21.26 parents and his, her, or their child or children are living with 21.27 other relatives, and the minor parent or parents apply for a 21.28 child care subsidy, "family" means only the minor parent or 21.29 parents and the child or children. An adult may be considered a 21.30 dependent member of the family unit if 50 percent of the adult's 21.31 support is being provided by the parents, stepparents, guardians 21.32 and their spouses, or eligible relative caretakers and their 21.33 spouses, residing in the same household. An adult age 18 who is 21.34 a full-time high school student and can reasonably be expected 21.35 to graduate before age 19 may be considered a dependent member 21.36 of the family unit. 22.1 Sec. 5. Minnesota Statutes 1994, section 256H.01, 22.2 subdivision 12, is amended to read: 22.3 Subd. 12. [PROVIDER.] "Provider" means a child care 22.4 license holder who operates a family day care home, a group 22.5 family day care home, a day care center, a nursery school, a day 22.6 nursery, an extended day school age child care program; aperson22.7exempt from licensure who meets child care standards established22.8 legal nonlicensed extended day school age child care program 22.9 which operates under the auspices of a local school board that 22.10 has adopted school age child care standards which meet or exceed 22.11 standards recommended by the stateboarddepartment of 22.12 education; or a legal nonlicensed caregiver who is at least 18 22.13 years of age, and who is not a member of the AFDC assistance 22.14 unit. 22.15 Sec. 6. Minnesota Statutes 1994, section 256H.02, is 22.16 amended to read: 22.17 256H.02 [DUTIES OF COMMISSIONER.] 22.18 The commissioner shall develop standards for county and 22.19 human services boards to provide child care services to enable 22.20 eligible families to participate in employment, training, or 22.21 education programs. Within the limits of available 22.22 appropriations, the commissioner shall distribute money to 22.23 counties to reduce the costs of child care for eligible 22.24 families. The commissioner shall adopt rules to govern the 22.25 program in accordance with this section. The rules must 22.26 establish a sliding schedule of fees for parents receiving child 22.27 care services. In the rules adopted under this section, county 22.28 and human services boards shall be authorized to establish 22.29 policies for payment of child care spaces for absent children, 22.30 when the payment is required by the child's regular provider. 22.31 The rules shall not set a maximum number of days for which 22.32 absence payments can be made, but instead shall direct the 22.33 county agency to set limits and pay for absences according to 22.34 the prevailing market practice in the county. County policies 22.35 for payment of absences shall be subject to the approval of the 22.36 commissioner. The commissioner shall maximize the use of 23.1 federal moneyunder the AFDC employment special needs programin 23.2 section 256.736,subdivision 8,and other programs that provide 23.3 federal reimbursement for child care services for recipients of 23.4 aid to families with dependent children who are in education, 23.5 training, job search, or other activities allowed under those 23.6 programs. Money appropriated under this section must be 23.7 coordinated with theAFDC employment special needs program and23.8otherprograms that provide federal reimbursement for child care 23.9 services to accomplish this purpose. Federal reimbursement 23.10 obtained must be allocated to the county that spent money for 23.11 child care that is federally reimbursable under programs that 23.12 provide federal reimbursement for child care services. The 23.13 counties shall use the federal money to expand child care 23.14 services. The commissioner may adopt rules under chapter 14 to 23.15 implement and coordinate federal program requirements. 23.16 Sec. 7. Minnesota Statutes 1994, section 256H.03, 23.17 subdivision 1, is amended to read: 23.18 Subdivision 1. [ALLOCATION PERIOD; NOTICE OF ALLOCATION.] 23.19 When the commissioner notifies county and human service boards 23.20 of the forms and instructions they are to follow in the 23.21 development of their biennial community social services plans 23.22 required under section 256E.08, the commissioner shall also 23.23 notify county and human services boards of their estimated child 23.24 care fund program allocation for the two years covered by the 23.25 plan. ByJuneOctober 1 of each year, the commissioner shall 23.26 notify all counties of their final child care fund program 23.27 allocation. 23.28 Sec. 8. Minnesota Statutes 1994, section 256H.03, 23.29 subdivision 2a, is amended to read: 23.30 Subd. 2a. [ELIGIBLE RECIPIENTS.] Families that meet the 23.31 eligibility requirements under sections 256H.10, except AFDC 23.32 recipients, MFIP recipients, and transition year families, and 23.33 256H.11 are eligible for child care assistance under the basic 23.34 sliding fee program.From July 1, 1990, to June 30, 1991, a23.35county may not accept new applications for the basic sliding fee23.36program unless the county can demonstrate that its state money24.1expenditures for the basic sliding fee program for this period24.2will not exceed 95 percent of the county's allocation of state24.3money for the fiscal year ending June 30, 1990. As basic24.4sliding fee program money becomes available to serve new24.5families, eligible families whose benefits were terminated24.6during the fiscal year ending June 30, 1990, for reasons other24.7than loss of eligibility shall be reinstated.Families enrolled 24.8 in the basic sliding fee program as of July 1, 1990, shall be 24.9 continued until they are no longer eligible. Counties shall 24.10 make vendor payments to the child care provider or pay the 24.11 parent directly for eligible child care expenses on a 24.12 reimbursement basis. Child care assistance provided through the 24.13 child care fund is considered assistance to the parent. 24.14 Sec. 9. Minnesota Statutes 1994, section 256H.03, is 24.15 amended by adding a subdivision to read: 24.16 Subd. 4a. [SIX-MONTH ALLOCATION.] For the period from July 24.17 1, 1995, to December 31, 1995, every county shall receive an 24.18 allocation at least equal and proportionate to one-half of its 24.19 original allocation in state fiscal year 1995. This six-month 24.20 allocation shall be combined with the calendar year 1996 24.21 allocation and be administered as one 18-month allocation. 24.22 Sec. 10. Minnesota Statutes 1994, section 256H.03, 24.23 subdivision 6, is amended to read: 24.24 Subd. 6. [GUARANTEED FLOOR.] (a)Each county's guaranteed24.25floor shall equal the lesser of:24.26(1) the county's original allocation in the preceding state24.27fiscal year; or24.28(2) 110 percent of the county's basic sliding fee child24.29care program state and federal earnings for the 12-month period24.30ending on December 31 of the preceding state fiscal year. For24.31purposes of this clause, "state and federal earnings" means the24.32reported direct child care expenditures adjusted for the24.33administrative allowance and 15 percent required county24.34match.Beginning January 1, 1996, each county's guaranteed 24.35 floor shall equal 90 percent of the allocation received in the 24.36 preceding calendar year. For the calendar year 1996 allocation, 25.1 the preceding calendar year shall be considered to be double the 25.2 six-month allocation as provided for in subdivision 4a. 25.3 (b) When the amount of funds available for allocation is 25.4 less than the amount available in the previous year, each 25.5 county's previous year allocation shall be reduced in proportion 25.6 to the reduction in the statewide funding, for the purpose of 25.7 establishing the guaranteed floor. 25.8 Sec. 11. Minnesota Statutes 1994, section 256H.08, is 25.9 amended to read: 25.10 256H.08 [USE OF MONEY.] 25.11 Money for persons listed in sections 256H.03, subdivision 25.12 2a, and 256H.05, subdivision 1b, shall be used to reduce the 25.13 costs of child care for students, including the costs of child 25.14 care for students while employed if enrolled in an eligible 25.15 education program at the same time and making satisfactory 25.16 progress towards completion of the program. Counties may not 25.17 limit the duration of child care subsidies for a person in an 25.18 employment or educational program, except when the person is 25.19 found to be ineligible under the child care fund eligibility 25.20 standards. Any limitation must be based on a person's 25.21 employability plan in the case of an AFDC recipient, and county 25.22 policies included in the child care allocation plan. Time 25.23 limitations for child care assistance, as specified in Minnesota 25.24 Rules, parts 9565.5000 to 9565.5200, do not apply to basic or 25.25 remedial educational programs needed to prepare for 25.26 post-secondary education or employment. These programs 25.27 include: high school, general equivalency diploma, and English 25.28 as a second language. Programs exempt from this time limit must 25.29 not run concurrently with a post-secondary program. High school 25.30 students who are participating in a post-secondary options 25.31 program and who receive a high school diploma issued by the 25.32 school district are exempt from the time limitations while 25.33 pursuing a high school diploma. Financially eligible students 25.34 who have received child care assistance for one academic year 25.35 shall be provided child care assistance in the following 25.36 academic year if funds allocated under sections 256H.03 and 26.1 256H.05 are available. If an AFDC recipient who is receiving 26.2 AFDC child care assistance under this chapter moves to another 26.3 county, continues to participate in educational or training 26.4 programs authorized in their employability development plans, 26.5 and continues to be eligible for AFDC child care assistance 26.6 under this chapter, the AFDC caretaker must receive continued 26.7 child care assistance from the county responsible for their 26.8 current employability development plan, without interruption. 26.9 Sec. 12. Minnesota Statutes 1994, section 256H.11, 26.10 subdivision 1, is amended to read: 26.11 Subdivision 1. [ASSISTANCE FOR PERSONS SEEKING AND 26.12 RETAINING EMPLOYMENT.] Persons who are seeking employment and 26.13 who are eligible for assistance under this section are eligible 26.14 to receivethe equivalent of up to one month of child careup to 26.15 240 hours of child care assistance per calendar year. Employed 26.16 persons who work at least an average of ten hours a week and 26.17 receive at least a minimum wage for all hours worked are 26.18 eligible for continued child care assistance. 26.19 Sec. 13. Minnesota Statutes 1994, section 256H.12, 26.20 subdivision 1, is amended to read: 26.21 Subdivision 1. [COUNTY CONTRIBUTIONS REQUIRED.] Beginning 26.22 July 1, 1995, in addition to payments fromparentsbasic sliding 26.23 fee child care program participants, counties shall contribute 26.24 from county tax or other sourcesa minimum of 15 percent of the26.25cost of the basic sliding fee programat the local match 26.26 percentage calculated according to subdivision 1a. The 26.27 commissioner shall recover funds from the county as necessary to 26.28 bring county expenditures into compliance with this subdivision. 26.29 Sec. 14. Minnesota Statutes 1994, section 256H.12, is 26.30 amended by adding a subdivision to read: 26.31 Subd. 1a. [LOCAL MATCH PERCENTAGE.] The local match 26.32 percentage shall equal the lesser of either 15 percent of the 26.33 cost of the basic sliding fee program or the statewide required 26.34 local match in state fiscal year 1995, divided by the sum of the 26.35 current year's basic sliding fee allocation, plus the statewide 26.36 required local match in state fiscal year 1995. The resulting 27.1 local match percentage shall be adjusted to reflect a statewide 27.2 local match of five percent on any state and federal funding for 27.3 the basic sliding fee program above the initial state fiscal 27.4 year 1995 statewide allocation. For purposes of this 27.5 computation, the statewide required local match in state fiscal 27.6 year 1995 shall be equal to the initial state fiscal year 1995 27.7 basic sliding fee allocation, divided by 85 percent, and then 27.8 multiplied by 15 percent. The calendar year 1996 local match 27.9 percentage shall be in effect for the six-month allocation 27.10 period defined in section 256H.03. 27.11 Sec. 15. Minnesota Statutes 1994, section 256H.15, 27.12 subdivision 1, is amended to read: 27.13 Subdivision 1. [SUBSIDY RESTRICTIONS.](a) Until June 30,27.141991, the maximum child care rate is determined under this27.15paragraph. The county board may limit the subsidy allowed by27.16setting a maximum on the provider child care rate that the27.17county shall subsidize. The maximum rate set by any county27.18shall not be lower than 110 percent or higher than 125 percent27.19of the median rate in that county for like care arrangements for27.20all types of care, including special needs and handicapped care,27.21as determined by the commissioner. If the county sets a maximum27.22rate, it must pay the provider's rate for each child receiving a27.23subsidy, up to the maximum rate set by the county. If a county27.24does not set a maximum provider rate, it shall pay the27.25provider's rate for every child in care. The maximum state27.26payment is 125 percent of the median provider rate. If the27.27county has not set a maximum provider rate and the provider rate27.28is greater than 125 percent of the median provider rate in the27.29county, the county shall pay the amount in excess of 125 percent27.30of the median provider rate from county funding sources. The27.31county shall pay the provider's full charges for every child in27.32care up to the maximum established. The commissioner shall27.33determine the maximum rate for each type of care, including27.34special needs and handicapped care.27.35(b)Effective July 1, 1991, the maximum rate paid for child 27.36 care assistance under the child care fund is the maximum rate 28.1 eligible for federal reimbursementexcept that a provider28.2receiving reimbursement under paragraph (a) as of January 1,28.31991, shall be paid at a rate no less than the rate of28.4reimbursement received under that paragraph. A rate which 28.5 includes a provider bonus paid under subdivision 2 or a special 28.6 needs rate paid under subdivision 3 may be in excess of the 28.7 maximum rate allowed under this subdivision. The department of 28.8 human services shall monitor the effect of this paragraph on 28.9 provider rates. The county shall pay the provider's full 28.10 charges for every child in care up to the maximum established. 28.11 The commissioner shall determine the maximum rate for each type 28.12 of care, including special needs and handicapped care. 28.13(c)When the provider charge is greater than the maximum 28.14 provider rate allowed, the parent is responsible for payment of 28.15 the difference in the rates in addition to any family copayment 28.16 fee. 28.17 Sec. 16. Minnesota Statutes 1994, section 256H.18, is 28.18 amended to read: 28.19 256H.18 [ADMINISTRATIVE EXPENSES.] 28.20 The commissioner shall use up toseven percentone-eleventh 28.21 of the state and federal fundsappropriatedavailable for the 28.22 basic sliding fee program for payments to counties for 28.23 administrative expenses.The commissioner shall use up to ten28.24percent of federal funds for payments to counties for28.25administrative expenses.28.26 Sec. 17. [REPEALER.] 28.27 Minnesota Statutes 1994, section 256H.03, subdivisions 2 28.28 and 5, are repealed. 28.29 ARTICLE 4 28.30 ECONOMIC SELF-SUFFICIENCY POLICY 28.31 Section 1. Minnesota Statutes 1994, section 256.034, 28.32 subdivision 1, is amended to read: 28.33 Subdivision 1. [CONSOLIDATION OF TYPES OF ASSISTANCE.] 28.34 Under the Minnesota family investment plan, assistance 28.35 previously provided to families through the AFDC, food stamp, 28.36 and general assistance programs must be combined into a single 29.1 cash assistance program. As authorized by Congress, families 29.2 receiving assistance through the Minnesota family investment 29.3 plan are automatically eligible for and entitled to medical 29.4 assistance under chapter 256B. Federal, state, and local funds 29.5 that would otherwise be allocated for assistance to families 29.6 under the AFDC, food stamp, and general assistance programs must 29.7 be transferred to the Minnesota family investment plan. The 29.8 provisions of the Minnesota family investment plan prevail over 29.9 any provisions of sections 245.771, 256.72 to 256.87, 256D.01 to 29.10 256D.21, or 393.07, subdivisions 10 and 10a, and any rules 29.11 implementing those sections with which they are irreconcilable. 29.12 The food stamp, general assistance, and work readiness programs 29.13 for single persons and couples who are not responsible for the 29.14 care of children are not replaced by the Minnesota family 29.15 investment plan. Unless stated otherwise in statutes or rules 29.16 governing the Minnesota family investment plan, participants in 29.17 the Minnesota family investment plan shall be considered to be 29.18 recipients of aid under aid to families with dependent children, 29.19 family general assistance, and food stamps for the purposes of 29.20 statutes and rules affecting such recipients or allocations of 29.21 funding based on the assistance status of the recipients, and to 29.22 specifically be subject to the provisions of section 256.98. 29.23 Sec. 2. Minnesota Statutes 1994, section 256.045, 29.24 subdivision 3, is amended to read: 29.25 Subd. 3. [STATE AGENCY HEARINGS.] (a) Any person applying 29.26 for, receiving or having received public assistance or a program 29.27 of social services granted by the state agency or a county 29.28 agency under sections 252.32, 256.031 to 256.036, and 256.72 to 29.29 256.879, chapters 256B, 256D, 256E, 261, or the federal Food 29.30 Stamp Act whose application for assistance is denied, not acted 29.31 upon with reasonable promptness, or whose assistance is 29.32 suspended, reduced, terminated, or claimed to have been 29.33 incorrectly paid, or any patient or relative aggrieved by an 29.34 order of the commissioner under section 252.27, or a party 29.35 aggrieved by a ruling of a prepaid health plan, may contest that 29.36 action or decision before the state agency by submitting a 30.1 written request for a hearing to the state agency within 30 days 30.2 after receiving written notice of the action or decision, or 30.3 within 90 days of such written notice if the applicant, 30.4 recipient, patient, or relative shows good cause why the request 30.5 was not submitted within the 30-day time limit. 30.6 (b) Except for a prepaid health plan, a vendor of medical 30.7 care as defined in section 256B.02, subdivision 7, or a vendor 30.8 under contract with a county agency to provide social services 30.9 under section 256E.08, subdivision 4, is not a party and may not 30.10 request a hearing under this section, except if assisting a 30.11 recipient as provided in subdivision 4. 30.12 (c) An applicant or recipient is not entitled to receive 30.13 social services beyond the services included in the amended 30.14 community social services plan developed under section 256E.081, 30.15 subdivision 3, if the county agency has met the requirements in 30.16 section 256E.081. 30.17 Sec. 3. Minnesota Statutes 1994, section 256.73, 30.18 subdivision 2, is amended to read: 30.19 Subd. 2. [ALLOWANCE BARRED BY OWNERSHIP OF PROPERTY.] 30.20 Ownership by an assistance unit of property as follows is a bar 30.21 to any allowance under sections 256.72 to 256.87: 30.22 (1) The value of real property other than the homestead, 30.23 which when combined with other assets exceeds the limits of 30.24 paragraph (2), unless the assistance unit is making a good faith 30.25 effort to sell the nonexcludable real property. The time period 30.26 for disposal must not exceed nine consecutive months. The 30.27 assistance unit must sign an agreement to dispose of the 30.28 property and torepay assistance received during the nine months30.29that would not have been paid had the property been sold at the30.30beginning of such period, but not to exceed the amount of the30.31net sale proceeds. The family has five working days from the30.32date it realizes cash from the sale of the property to repay the30.33overpayment. If the property is not sold within the required30.34time or the assistance unit becomes ineligible for any reason30.35during the nine-month period, the amount payable under the30.36agreement will not be determined and recovery will not begin31.1until the property is in fact sold.execute a lien covering that 31.2 property with the amount of assistance expended over the 31.3 nine-month period covered by the agreement. The amount payable 31.4 should be calculated and entered onto the lien form which shall 31.5 be filed for record with the recorder in the county where the 31.6 real property is situated. The lien takes priority from the 31.7 time of its attaching over all other liens subsequently acquired 31.8 and subsequent conveyances. The lien shall be enforced in the 31.9 manner provided by law for the enforcement of mechanics liens 31.10 upon real property and at such time as the property is in fact 31.11 sold. If the property is intentionally sold at less than fair 31.12 market value or if a good faith effort to sell the property is 31.13 not being made, the overpayment amount shall be computed using 31.14 the fair market value determined at the beginning of the 31.15 nine-month period. For the purposes of this section, 31.16 "homestead" means the home that is owned by, and is the usual 31.17 residence of, the child, relative, or other member of the 31.18 assistance unit together with the surrounding property which is 31.19 not separated from the home by intervening property owned by 31.20 others. "Usual residence" includes the home from which the 31.21 child, relative, or other members of the assistance unit is 31.22 temporarily absent due to an employability development plan 31.23 approved by the local human service agency, which includes 31.24 education, training, or job search within the state but outside 31.25 of the immediate geographic area. Public rights-of-way, such as 31.26 roads which run through the surrounding property and separate it 31.27 from the home, will not affect the exemption of the property; or 31.28 (2) Personal property of an equity value in excess of 31.29 $1,000 for the entire assistance unit, exclusive of personal 31.30 property used as the home, one motor vehicle of an equity value 31.31 not exceeding $1,500 or the entire equity value of a motor 31.32 vehicle determined to be necessary for the operation of a 31.33 self-employment business, one burial plot for each member of the 31.34 assistance unit, one prepaid burial contract with an equity 31.35 value of no more than $1,000 for each member of the assistance 31.36 unit, clothing and necessary household furniture and equipment 32.1 and other basic maintenance items essential for daily living, in 32.2 accordance with rules promulgated by and standards established 32.3 by the commissioner of human services. 32.4 Sec. 4. Minnesota Statutes 1994, section 256.98, 32.5 subdivision 1, is amended to read: 32.6 Subdivision 1. [WRONGFULLY OBTAINING ASSISTANCE.] A person 32.7 who obtains, or attempts to obtain, or aids or abets any person 32.8 to obtain by means of a willfully false statement or 32.9 representation, by intentional concealment of a material fact, 32.10 or by impersonation or other fraudulent device, assistance to 32.11 which the person is not entitled or assistance greater than that 32.12 to which the person is entitled, or who knowingly aids or abets 32.13 in buying or in any way disposing of the property of a recipient 32.14 or applicant of assistance without the consent of the county 32.15 agency with intent to defeat the purposes of sections 32.16 256.12, 256.031 to 256.0361, 256.72 to 256.871, and chapter 32.17 256B, or all of these sections is guilty of theft and shall be 32.18 sentenced pursuant to section 609.52, subdivision 3, clauses 32.19 (2), (3)(a) and (c), (4), and (5). 32.20 Sec. 5. Minnesota Statutes 1994, section 256.98, 32.21 subdivision 8, is amended to read: 32.22 Subd. 8. [DISQUALIFICATION FROM PROGRAM.] Any person found 32.23 to be guilty of wrongfully obtaining assistance by a federal or 32.24 state court or by an administrative hearing determination, or 32.25 waiver thereof, through a disqualification consent agreement, or 32.26 as part of any approved diversion plan under section 401.065 in 32.27eitherthe aid to families with dependent children programor, 32.28 the food stamp program, the Minnesota family investment plan, 32.29 the general assistance or family general assistance program, the 32.30 Minnesota supplemental aid program, or the work readiness 32.31 program shall be disqualified from that program. The needs of 32.32 that individual shall not be taken into consideration in 32.33 determining the grant level for that assistance unit: 32.34 (1) for six months after the first offense; 32.35 (2) for 12 months after the second offense; and 32.36 (3) permanently after the third or subsequent offense. 33.1AnyThe periodfor which sanctions are imposed is33.2effective,of program disqualification shall begin on the date 33.3 stipulated on the advance notice of disqualification without 33.4 possibility of postponement for administrative stay,or hearing 33.5 and shall continue through completion unless and until the 33.6 findings upon which the sanctions were imposed are reversed by a 33.7 court of competent jurisdiction. The period for which sanctions 33.8 are imposed is not subject to review. The sanctions provided 33.9 under this subdivision are in addition to, and not in 33.10 substitution for, any other sanctions that may be provided for 33.11 by law for the offense involved. Notwithstanding clauses (1) to 33.12 (3), the disqualification period shall not begin until the 33.13 disqualified individual establishes that they are otherwise 33.14 eligible for the program which is the subject of the 33.15 disqualification. 33.16 Sec. 6. Minnesota Statutes 1994, section 256D.05, 33.17 subdivision 7, is amended to read: 33.18 Subd. 7. [INELIGIBILITY FOR GENERAL ASSISTANCE.] No person 33.19disqualified from any federally aided assistance programshall 33.20 be eligible for general assistance duringthea periodcovered33.21by the disqualification sanctionof disqualification from any 33.22 federally aided assistance program; or if the person could be 33.23 considered an essential person under section 256.74, subdivision 33.24 1. 33.25 Sec. 7. Minnesota Statutes 1994, section 256D.46, 33.26 subdivision 1, is amended to read: 33.27 Subdivision 1. [ELIGIBILITY.] Emergency Minnesota 33.28 supplemental aid must be granted if the recipient is without 33.29 adequate resources to resolve an emergency that, if unresolved, 33.30 will threaten the health or safety of the recipient. For the 33.31 purposes of this section, the term "recipient" includes persons 33.32 for whom a group residential housing benefit is being paid under 33.33 sections 256I.01 to 256I.06. 33.34 Sec. 8. Minnesota Statutes 1994, section 256D.46, 33.35 subdivision 2, is amended to read: 33.36 Subd. 2. [INCOME AND RESOURCE TEST.] All income and 34.1 resources available to the recipientduring the month in which34.2the need for emergency Minnesota supplemental aid arisesmust be 34.3 considered in determining the recipient's ability to meet the 34.4 emergency need. Property that can be liquidated in time to 34.5 resolve the emergency and income (excluding Minnesota 34.6 supplemental aid issued for current month's need) that is 34.7 normally disregarded or excluded under the Minnesota 34.8 supplemental aid program must be considered available to meet 34.9 the emergency need. 34.10 Sec. 9. Minnesota Statutes 1994, section 256I.03, 34.11 subdivision 5, is amended to read: 34.12 Subd. 5. [MSA EQUIVALENT RATE.] "MSA equivalent rate" 34.13 means an amount equal to the total of: 34.14 (1) the combined maximum shelter and basic needs standards 34.15 for MSA recipients living alone specified in section 256D.44, 34.16 subdivisions 2, paragraph (a); and 3, paragraph (a); plus 34.17 (2)for persons who are not eligible to receive food stamps34.18due to living arrangement,the maximum allotment authorized by 34.19 the federal Food Stamp Program for a single individual which is 34.20 in effect on the first day of July each year; less 34.21 (3) the personal needs allowance authorized for medical 34.22 assistance recipients under section 256B.35. 34.23 The MSA equivalent rate is to be adjusted on the first day 34.24 of July each year to reflect changes in any of the component 34.25 rates under clauses (1) to (3). 34.26 Sec. 10. Minnesota Statutes 1994, section 256I.03, is 34.27 amended by adding a subdivision to read: 34.28 Subd. 7. [COUNTABLE INCOME.] "Countable income" means all 34.29 income received by an applicant or recipient less any applicable 34.30 exclusions or disregards. For a recipient of any cash benefit 34.31 from the SSI program, countable income means the SSI benefit 34.32 limit in effect at the time the person is in a GRH setting less 34.33 $20, less the medical assistance personal needs allowance. If 34.34 the SSI limit has been reduced for a person due to events 34.35 occurring prior to the persons entering the GRH setting, 34.36 countable income means actual income less any applicable 35.1 exclusions and disregards. 35.2 Sec. 11. Minnesota Statutes 1994, section 256I.04, 35.3 subdivision 2b, is amended to read: 35.4 Subd. 2b. [GROUP RESIDENTIAL HOUSING AGREEMENTS.] 35.5 Agreements between county agencies and providers of group 35.6 residential housing must be in writing and must specify the name 35.7 and address under which the establishment subject to the 35.8 agreement does business and under which the establishment, or 35.9 service provider, if different from the group residential 35.10 housing establishment, is licensed by the department of health 35.11 or the department of human services; the specific license or 35.12 registration from the department of health or the department of 35.13 human services held by the provider and the number of beds 35.14 subject to that license; the address of the location or 35.15 locations at which group residential housing is provided under 35.16 this agreement; the per diem and monthly rates that are to be 35.17 paid from group residential housing funds for each eligible 35.18 resident at each location; the number of beds at each location 35.19 which are subject to the group residential housing agreement; 35.20 whether the license holder is a not-for-profit corporation under 35.21 section 501(c)(3) of the Internal Revenue Code; and a statement 35.22 that the agreement is subject to the provisions of sections 35.23 256I.01 to 256I.06 and subject to any changes to those sections. 35.24 Sec. 12. Minnesota Statutes 1994, section 256I.05, 35.25 subdivision 1, is amended to read: 35.26 Subdivision 1. [MAXIMUM RATES.](a)Monthly room and board 35.27 rates negotiated by a county agency for a recipient living in 35.28 group residential housing must not exceed the MSA equivalent 35.29 rate specified under section 256I.03, subdivision 5, with the 35.30 exception that a county agency may negotiate a room and board 35.31 rate that exceeds the MSA equivalent rate by up to $426.37 for 35.32 recipients of waiver services under title XIX of the Social 35.33 Security Act. This exception is subject to the following 35.34 conditions: 35.35 (1) that the Secretary of Health and Human Services has not 35.36 approved a state request to include room and board costs which 36.1 exceed the MSA equivalent rate in an individual's set of waiver 36.2 services under title XIX of the Social Security Act; or 36.3 (2) that the Secretary of Health and Human Services has 36.4 approved the inclusion of room and board costs which exceed the 36.5 MSA equivalent rate, but in an amount that is insufficient to 36.6 cover costs which are included in a group residential housing 36.7 agreement in effect on June 30, 1994,; and 36.8 (3) the amount of the rate that is above the MSA equivalent 36.9 rate has been approved by the commissioner. The county agency 36.10 may at any time negotiate a lower room and board rate than the 36.11 rate that would otherwise be paid under this subdivision. 36.12(b) The maximum monthly rate for an establishment that36.13enters into an initial group residential housing agreement with36.14a county agency on or after June 1, 1989, may not exceed 9036.15percent of the maximum rate established under this subdivision.36.16This is effective until June 30, 1994.36.17 Sec. 13. Minnesota Statutes 1994, section 256I.05, 36.18 subdivision 5, is amended to read: 36.19 Subd. 5. [ADULT FOSTER CARE RATES.] The commissioner shall 36.20 annually establish statewide maintenance and difficulty of 36.21 carerateslimits for adults in foster care.The commissioner36.22shall adopt rules to implement statewide rates. In adopting36.23rules, the commissioner shall consider existing maintenance and36.24difficulty of care rates so that, to the extent possible, an36.25adult for whom a maintenance or difficulty of care rate is36.26established will not be adversely affected.36.27 Sec. 14. Minnesota Statutes 1994, section 256I.06, 36.28 subdivision 2, is amended to read: 36.29 Subd. 2. [TIME OF PAYMENT.] A county agency may make 36.30 payments to a group residence in advance for an individual whose 36.31 stay in the group residence is expected to last beyond the 36.32 calendar month for which the payment is made and who does not 36.33 expect to receive countable earned income during the month for 36.34 which the payment is made. Group residential housing payments 36.35 made by a county agency on behalf of an individual who is not 36.36 expected to remain in the group residence beyond the month for 37.1 which payment is made must be made subsequent to the 37.2 individual's departure from the group residence. Group 37.3 residential housing payments made by a county agency on behalf 37.4 of an individual with countable earned income must be made 37.5 subsequent to receipt of a monthly household report form. 37.6 Sec. 15. Minnesota Statutes 1994, section 256I.06, 37.7 subdivision 6, is amended to read: 37.8 Subd. 6. [REPORTS.] Recipients must report changes in 37.9 circumstances that affect eligibility or group residential 37.10 housing payment amounts within ten days of the change. 37.11 Recipients with countable earned income must complete a monthly 37.12 household report form. If the report form is not received 37.13 before the end of the month in which it is due, the county 37.14 agency must terminate eligibility for group residential housing 37.15 payments. The termination shall be effective on the first day 37.16 of the month following the month in which the report was due. 37.17 If a complete report is received within the month eligibility 37.18 was terminated, the individual is considered to have continued 37.19 an application for group residential housing payment effective 37.20 the first day of the month the eligibility was terminated. 37.21 Sec. 16. Minnesota Statutes 1994, section 524.6-207, is 37.22 amended to read: 37.23 524.6-207 [RIGHTS OF CREDITORS.] 37.24 No multiple-party account will be effective against an 37.25 estate of a deceased party to transfer to a survivor sums needed 37.26 to pay debts, taxes, and expenses of administration, including 37.27 statutory allowances to the surviving spouse, minor children and 37.28 dependent children, if other assets of the estate are 37.29 insufficient, to the extent the deceased party is the source of 37.30 the funds or beneficial owner. A surviving party or P.O.D. 37.31 payee who receives payment from a multiple-party account after 37.32 the death of a deceased party shall be liable to account to the 37.33 deceased party's personal representative or a county agency with 37.34 a claim authorized by section 256B.15 for amounts the decedent 37.35 owned beneficially immediately before death to the extent 37.36 necessary to discharge any such claims and charges remaining 38.1 unpaid after the application of the assets of the decedent's 38.2 estate. No proceeding to assert this liability shall be 38.3 commenced unless the personal representative or a county agency 38.4 with a claim authorized by section 256B.15 has received a 38.5 written demand by a surviving spouse, a creditor or one acting 38.6 for a minor dependent child of the decedent, and no proceeding 38.7 shall be commenced later than two years following the death of 38.8 the decedent. Sums recovered by the personal representative or 38.9 a county agency with a claim authorized by section 256B.15 shall 38.10 be administered as part of the decedent's estate. This section 38.11 shall not affect the right of a financial institution to make 38.12 payment on multiple-party accounts according to the terms 38.13 thereof, or make it liable to the estate of a deceased party 38.14 unless, before payment, the institution has been served with 38.15 process in a proceeding by the personal representative or a 38.16 county agency with a claim authorized by section 256B.15. 38.17 Sec. 17. Minnesota Statutes 1994, section 550.37, 38.18 subdivision 14, is amended to read: 38.19 Subd. 14. [PUBLIC ASSISTANCE.] All relief based on need, 38.20 and the earnings or salary of a person who is a recipient of 38.21 relief based on need, shall be exempt from all claims of 38.22 creditors including any contractual setoff or security interest 38.23 asserted by a financial institution. For the purposes of this 38.24 chapter, relief based on need includes AFDC, general assistance 38.25 medical care, supplemental security income, medical assistance, 38.26 Minnesota supplemental assistance, and general assistance. The 38.27 salary or earnings of any debtor who is or has beenaan 38.28 eligible recipient of relief based on need, or an inmate of a 38.29 correctional institution shall, upon the debtor's return to 38.30 private employment or farming after having beenaan eligible 38.31 recipient of relief based on need, or an inmate of a 38.32 correctional institution, be exempt from attachment, 38.33 garnishment, or levy of execution for a period of six months 38.34 after the debtor's return to employment or farming and after all 38.35 public assistance for which eligibility existed has been 38.36 terminated. The exemption provisions contained in this 39.1 subdivision also apply for 60 days after deposit in any 39.2 financial institution, whether in a single or joint account. In 39.3 tracing the funds, the first-in first-out method of accounting 39.4 shall be used. The burden of establishing that funds are exempt 39.5 rests upon the debtor. Agencies distributing relief and the 39.6 correctional institutions shall, at the request of creditors, 39.7 inform them whether or not any debtor has beenaan eligible 39.8 recipient of relief based on need, or an inmate of a 39.9 correctional institution, within the preceding six months. 39.10 Sec. 18. Laws 1993, First Special Session chapter 1, 39.11 article 8, section 30, subdivision 2, is amended to read: 39.12 Subd. 2.Sections 1 to 3, 8, 9, 13 to 17, 22, 23, and 2639.13to 29 are effective July 1, 1994, contingent upon federal39.14recognition that group residential housing payments qualify as39.15optional state supplement payments to the supplemental security39.16income program under title XVI of the Social Security Act and39.17confer categorical eligibility for medical assistance under the39.18state plan for medical assistance.The amendments and repeals 39.19 by Laws 1993, First Special Session chapter 1, article 8, 39.20 sections 1 to 3, 8, 9, 13 to 17, 22, 23, 26, and 29, are 39.21 effective July 1, 1994. 39.22 Sec. 19. [EFFECTIVE DATE.] 39.23 Sections 9 to 15, and 18 (256I.03, subdivisions 5 and 7; 39.24 256I.04, subdivision 2b, 256I.05, subdivisions 1 and 5; 256I.06, 39.25 subdivisions 2 and 6; and Laws 1993 effective date) are 39.26 effective the day following final enactment. 39.27 Sections 3 (256.73, subdivision 2), 16 (524.6-207), and 17 39.28 (550.37, subdivision 14) are effective August 1, 1995. 39.29 ARTICLE 5 39.30 HEALTH CARE POLICY 39.31 Section 1. Minnesota Statutes 1994, section 144A.071, 39.32 subdivision 2, is amended to read: 39.33 Subd. 2. [MORATORIUM.] The commissioner of health, in 39.34 coordination with the commissioner of human services, shall deny 39.35 each request for new licensed or certified nursing home or 39.36 certified boarding care beds except as provided in subdivision 3 40.1 or 4a, or section 144A.073. "Certified bed" means a nursing 40.2 home bed or a boarding care bed certified by the commissioner of 40.3 health for the purposes of the medical assistance program, under 40.4 United States Code, title 42, sections 1396 et seq. 40.5 The commissioner of human services, in coordination with 40.6 the commissioner of health, shall deny any request to issue a 40.7 license under section 252.28 and chapter 245A to a nursing home 40.8 or boarding care home, if that license would result in an 40.9 increase in the medical assistance reimbursement amount. 40.10 In addition, the commissioner of health must not approve 40.11 any construction project whose cost exceeds $500,000, or 25 40.12 percent of the facility's appraised value, whichever is less, 40.13 unless: 40.14 (a) any construction costs exceeding the lesser of $500,000 40.15 or 25 percent of the facility's appraised value are not added to 40.16 the facility's appraised value and are not included in the 40.17 facility's payment rate for reimbursement under the medical 40.18 assistance program; or 40.19 (b) the project: 40.20 (1) has been approved through the process described in 40.21 section 144A.073; 40.22 (2) meets an exception in subdivision 3 or 4a; 40.23 (3) is necessary to correct violations of state or federal 40.24 law issued by the commissioner of health; 40.25 (4) is necessary to repair or replace a portion of the 40.26 facility that wasdestroyeddamaged by fire, lightning, or other 40.27 hazards provided that the provisions of subdivision 4a, clause 40.28 (a), are met; 40.29 (5) as of May 1, 1992, the facility has submitted to the 40.30 commissioner of health written documentation evidencing that the 40.31 facility meets the "commenced construction" definition as 40.32 specified in subdivision 1a, clause (d), or that substantial 40.33 steps have been taken prior to April 1, 1992, relating to the 40.34 construction project. "Substantial steps" require that the 40.35 facility has made arrangements with outside parties relating to 40.36 the construction project and include the hiring of an architect 41.1 or construction firm, submission of preliminary plans to the 41.2 department of health or documentation from a financial 41.3 institution that financing arrangements for the construction 41.4 project have been made; or 41.5 (6) is being proposed by a licensed nursing facility that 41.6 is not certified to participate in the medical assistance 41.7 program and will not result in new licensed or certified beds. 41.8 Prior to the final plan approval of any construction 41.9 project, the commissioner of health shall be provided with an 41.10 itemized cost estimate for the project construction costs. If a 41.11 construction project is anticipated to be completed in phases, 41.12 the total estimated cost of all phases of the project shall be 41.13 submitted to the commissioner and shall be considered as one 41.14 construction project. Once the construction project is 41.15 completed and prior to the final clearance by the commissioner, 41.16 the total project construction costs for the construction 41.17 project shall be submitted to the commissioner. If the final 41.18 project construction cost exceeds the dollar threshold in this 41.19 subdivision, the commissioner of human services shall not 41.20 recognize any of the project construction costs or the related 41.21 financing costs in excess of this threshold in establishing the 41.22 facility's property-related payment rate. 41.23 The dollar thresholds for construction projects are as 41.24 follows: for construction projects other than those authorized 41.25 in clauses (1) to (6), the dollar threshold is $500,000 or 25 41.26 percent of appraised value, whichever is less. For projects 41.27 authorized after July 1, 1993, under clause (1), the dollar 41.28 threshold is the cost estimate submitted with a proposal for an 41.29 exception under section 144A.073, plus inflation as calculated 41.30 according to section 256B.431, subdivision 3f, paragraph (a). 41.31 For projects authorized under clauses (2) to (4), the dollar 41.32 threshold is the itemized estimate project construction costs 41.33 submitted to the commissioner of health at the time of final 41.34 plan approval, plus inflation as calculated according to section 41.35 256B.431, subdivision 3f, paragraph (a). 41.36 The commissioner of health shall adopt emergency or 42.1 permanent rules to implement this section or to amend the 42.2 emergency rules for granting exceptions to the moratorium on 42.3 nursing homes under section 144A.073. The authority to adopt 42.4 emergency rules continues to December 30, 1992. 42.5 Sec. 2. Minnesota Statutes 1994, section 144A.071, 42.6 subdivision 4a, is amended to read: 42.7 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 42.8 best interest of the state to ensure that nursing homes and 42.9 boarding care homes continue to meet the physical plant 42.10 licensing and certification requirements by permitting certain 42.11 construction projects. Facilities should be maintained in 42.12 condition to satisfy the physical and emotional needs of 42.13 residents while allowing the state to maintain control over 42.14 nursing home expenditure growth. 42.15 The commissioner of health in coordination with the 42.16 commissioner of human services, may approve the renovation, 42.17 replacement, upgrading, or relocation of a nursing home or 42.18 boarding care home, under the following conditions: 42.19 (a) to license or certify beds in a new facility 42.20 constructed to replace a facility or to make repairs in an 42.21 existing facility that was destroyed or damaged after June 30, 42.22 1987, by fire, lightning, or other hazard provided: 42.23 (i) destruction was not caused by the intentional act of or 42.24 at the direction of a controlling person of the facility; 42.25 (ii) at the time the facility was destroyed or damaged the 42.26 controlling persons of the facility maintained insurance 42.27 coverage for the type of hazard that occurred in an amount that 42.28 a reasonable person would conclude was adequate; 42.29 (iii) the net proceeds from an insurance settlement for the 42.30 damages caused by the hazard are applied to the cost of the new 42.31 facility or repairs; 42.32 (iv) the new facility is constructed on the same site as 42.33 the destroyed facility or on another site subject to the 42.34 restrictions in section 144A.073, subdivision 5; 42.35 (v) the number of licensed and certified beds in the new 42.36 facility does not exceed the number of licensed and certified 43.1 beds in the destroyed facility; and 43.2 (vi) the commissioner determines that the replacement beds 43.3 are needed to prevent an inadequate supply of beds as defined in 43.4 subdivision 3, paragraph (a). 43.5 Project construction costs incurred for repairs authorized under 43.6 this clause shall not be considered in the dollar threshold 43.7 amount defined in subdivision 2; 43.8 (b) to license or certify beds that are moved from one 43.9 location to another within a nursing home facility, provided the 43.10 total costs of remodeling performed in conjunction with the 43.11 relocation of beds does not exceed 25 percent of the appraised 43.12 value of the facility or $500,000, whichever is less; 43.13 (c) to license or certify beds in a project recommended for 43.14 approval under section 144A.073; 43.15 (d) to license or certify beds that are moved from an 43.16 existing state nursing home to a different state facility, 43.17 provided there is no net increase in the number of state nursing 43.18 home beds; 43.19 (e) to certify and license as nursing home beds boarding 43.20 care beds in a certified boarding care facility if the beds meet 43.21 the standards for nursing home licensure, or in a facility that 43.22 was granted an exception to the moratorium under section 43.23 144A.073, and if the cost of any remodeling of the facility does 43.24 not exceed 25 percent of the appraised value of the facility or 43.25 $500,000, whichever is less. If boarding care beds are licensed 43.26 as nursing home beds, the number of boarding care beds in the 43.27 facility must not increase beyond the number remaining at the 43.28 time of the upgrade in licensure. The provisions contained in 43.29 section 144A.073 regarding the upgrading of the facilities do 43.30 not apply to facilities that satisfy these requirements; 43.31 (f) to license and certify up to 40 beds transferred from 43.32 an existing facility owned and operated by the Amherst H. Wilder 43.33 Foundation in the city of St. Paul to a new unit at the same 43.34 location as the existing facility that will serve persons with 43.35 Alzheimer's disease and other related disorders. The transfer 43.36 of beds may occur gradually or in stages, provided the total 44.1 number of beds transferred does not exceed 40. At the time of 44.2 licensure and certification of a bed or beds in the new unit, 44.3 the commissioner of health shall delicense and decertify the 44.4 same number of beds in the existing facility. As a condition of 44.5 receiving a license or certification under this clause, the 44.6 facility must make a written commitment to the commissioner of 44.7 human services that it will not seek to receive an increase in 44.8 its property-related payment rate as a result of the transfers 44.9 allowed under this paragraph; 44.10 (g) to license and certify nursing home beds to replace 44.11 currently licensed and certified boarding care beds which may be 44.12 located either in a remodeled or renovated boarding care or 44.13 nursing home facility or in a remodeled, renovated, newly 44.14 constructed, or replacement nursing home facility within the 44.15 identifiable complex of health care facilities in which the 44.16 currently licensed boarding care beds are presently located, 44.17 provided that the number of boarding care beds in the facility 44.18 or complex are decreased by the number to be licensed as nursing 44.19 home beds and further provided that, if the total costs of new 44.20 construction, replacement, remodeling, or renovation exceed ten 44.21 percent of the appraised value of the facility or $200,000, 44.22 whichever is less, the facility makes a written commitment to 44.23 the commissioner of human services that it will not seek to 44.24 receive an increase in its property-related payment rate by 44.25 reason of the new construction, replacement, remodeling, or 44.26 renovation. The provisions contained in section 144A.073 44.27 regarding the upgrading of facilities do not apply to facilities 44.28 that satisfy these requirements; 44.29 (h) to license as a nursing home and certify as a nursing 44.30 facility a facility that is licensed as a boarding care facility 44.31 but not certified under the medical assistance program, but only 44.32 if the commissioner of human services certifies to the 44.33 commissioner of health that licensing the facility as a nursing 44.34 home and certifying the facility as a nursing facility will 44.35 result in a net annual savings to the state general fund of 44.36 $200,000 or more; 45.1 (i) to certify, after September 30, 1992, and prior to July 45.2 1, 1993, existing nursing home beds in a facility that was 45.3 licensed and in operation prior to January 1, 1992; 45.4 (j) to license and certify new nursing home beds to replace 45.5 beds in a facility condemned as part of an economic 45.6 redevelopment plan in a city of the first class, provided the 45.7 new facility is located within one mile of the site of the old 45.8 facility. Operating and property costs for the new facility 45.9 must be determined and allowed under existing reimbursement 45.10 rules; 45.11 (k) to license and certify up to 20 new nursing home beds 45.12 in a community-operated hospital and attached convalescent and 45.13 nursing care facility with 40 beds on April 21, 1991, that 45.14 suspended operation of the hospital in April 1986. The 45.15 commissioner of human services shall provide the facility with 45.16 the same per diem property-related payment rate for each 45.17 additional licensed and certified bed as it will receive for its 45.18 existing 40 beds; 45.19 (l) to license or certify beds in renovation, replacement, 45.20 or upgrading projects as defined in section 144A.073, 45.21 subdivision 1, so long as the cumulative total costs of the 45.22 facility's remodeling projects do not exceed 25 percent of the 45.23 appraised value of the facility or $500,000, whichever is less; 45.24 (m) to license and certify beds that are moved from one 45.25 location to another for the purposes of converting up to five 45.26 four-bed wards to single or double occupancy rooms in a nursing 45.27 home that, as of January 1, 1993, was county-owned and had a 45.28 licensed capacity of 115 beds; 45.29 (n) to allow a facility that on April 16, 1993, was a 45.30 106-bed licensed and certified nursing facility located in 45.31 Minneapolis to layaway all of its licensed and certified nursing 45.32 home beds. These beds may be relicensed and recertified in a 45.33 newly-constructed teaching nursing home facility affiliated with 45.34 a teaching hospital upon approval by the legislature. The 45.35 proposal must be developed in consultation with the interagency 45.36 committee on long-term care planning. The beds on layaway 46.1 status shall have the same status as voluntarily delicensed and 46.2 decertified beds, except that beds on layaway status remain 46.3 subject to the surcharge in section 256.9657. This layaway 46.4 provision expires July 1, 1995; 46.5 (o) to allow a project which will be completed in 46.6 conjunction with an approved moratorium exception project for a 46.7 nursing home in southern Cass county and which is directly 46.8 related to that portion of the facility that must be repaired, 46.9 renovated, or replaced, to correct an emergency plumbing problem 46.10 for which a state correction order has been issued and which 46.11 must be corrected by August 31, 1993; 46.12 (p) to allow a facility that on April 16, 1993, was a 46.13 368-bed licensed and certified nursing facility located in 46.14 Minneapolis to layaway, upon 30 days prior written notice to the 46.15 commissioner, up to 30 of the facility's licensed and certified 46.16 beds by converting three-bed wards to single or double 46.17 occupancy. Beds on layaway status shall have the same status as 46.18 voluntarily delicensed and decertified beds except that beds on 46.19 layaway status remain subject to the surcharge in section 46.20 256.9657, remain subject to the license application and renewal 46.21 fees under section 144A.07 and shall be subject to a $100 per 46.22 bed reactivation fee. In addition, at any time within three 46.23 years of the effective date of the layaway, the beds on layaway 46.24 status may be: 46.25 (1) relicensed and recertified upon relocation and 46.26 reactivation of some or all of the beds to an existing licensed 46.27 and certified facility or facilities located in Pine River, 46.28 Brainerd, or International Falls; provided that the total 46.29 project construction costs related to the relocation of beds 46.30 from layaway status for any facility receiving relocated beds 46.31 may not exceed the dollar threshold provided in subdivision 2 46.32 unless the construction project has been approved through the 46.33 moratorium exception process under section 144A.073; 46.34 (2) relicensed and recertified, upon reactivation of some 46.35 or all of the beds within the facility which placed the beds in 46.36 layaway status, if the commissioner has determined a need for 47.1 the reactivation of the beds on layaway status. 47.2 The property-related payment rate of a facility placing 47.3 beds on layaway status must be adjusted by the incremental 47.4 change in its rental per diem after recalculating the rental per 47.5 diem as provided in section 256B.431, subdivision 3a, paragraph 47.6 (d). The property-related payment rate for a facility 47.7 relicensing and recertifying beds from layaway status must be 47.8 adjusted by the incremental change in its rental per diem after 47.9 recalculating its rental per diem using the number of beds after 47.10 the relicensing to establish the facility's capacity day 47.11 divisor, which shall be effective the first day of the month 47.12 following the month in which the relicensing and recertification 47.13 became effective. Any beds remaining on layaway status more 47.14 than three years after the date the layaway status became 47.15 effective must be removed from layaway status and immediately 47.16 delicensed and decertified; 47.17 (q) to license and certify beds in a renovation and 47.18 remodeling project to convert 13 three-bed wards into 13 two-bed 47.19 rooms and 13 single-bed rooms, expand space, and add 47.20 improvements in a nursing home that, as of January 1, 1994, met 47.21 the following conditions: the nursing home was located in 47.22 Ramsey county; was not owned by a hospital corporation; had a 47.23 licensed capacity of 64 beds; and had been ranked among the top 47.24 15 applicants by the 1993 moratorium exceptions advisory review 47.25 panel. The total project construction cost estimate for this 47.26 project must not exceed the cost estimate submitted in 47.27 connection with the 1993 moratorium exception process; or 47.28 (r) to license and certify beds in a renovation and 47.29 remodeling project to convert 12 four-bed wards into 24 two-bed 47.30 rooms, expand space, and add improvements in a nursing home 47.31 that, as of January 1, 1994, met the following conditions: the 47.32 nursing home was located in Ramsey county; had a licensed 47.33 capacity of 154 beds; and had been ranked among the top 15 47.34 applicants by the 1993 moratorium exceptions advisory review 47.35 panel. The total project construction cost estimate for this 47.36 project must not exceed the cost estimate submitted in 48.1 connection with the 1993 moratorium exception process. 48.2 Sec. 3. Minnesota Statutes 1994, section 144A.071, is 48.3 amended by adding a subdivision to read: 48.4 Subd. 5a. [COST ESTIMATE OF A MORATORIUM EXCEPTION 48.5 PROJECT.] For the purposes of this section and section 144A.073, 48.6 the cost estimate of a moratorium exception project shall 48.7 include the effects of the proposed project on the costs of the 48.8 state subsidy for community-based services, nursing services, 48.9 and housing in institutional and noninstitutional settings. The 48.10 commissioner of health, in cooperation with the commissioner of 48.11 human services, shall define the method for estimating these 48.12 costs in the permanent rule implementing section 144A.073. The 48.13 commissioner of human services shall prepare an estimate of the 48.14 total state annual long-term costs of each moratorium exception 48.15 proposal. 48.16 Sec. 4. Minnesota Statutes 1994, section 144A.073, 48.17 subdivision 1, is amended to read: 48.18 Subdivision 1. [DEFINITIONS.] For purposes of this 48.19 section, the following terms have the meanings given them: 48.20 (a) "Conversion" means the relocation of a nursing home bed 48.21 from a nursing home to an attached hospital. 48.22 (b) "Relocation" means the movement of licensed nursing 48.23 home beds or certified boarding care beds as permitted under 48.24 subdivision 4, clause (3), and subdivision 5. 48.25 (c) "Renovation" means extensive remodeling of, or 48.26 construction of an addition to, a facility on an existing site 48.27 with a total cost exceeding ten percent of the appraised value 48.28 of the facility or $200,000, whichever is less. 48.29(c)(d) "Replacement" means the demolitionor, delicensure, 48.30 reconstruction, or construction of an addition to all or part of 48.31 an existing facility. 48.32(d)(e) "Upgrading" means a change in the level of 48.33 licensure of a bed from a boarding care bed to a nursing home 48.34 bed in a certified boarding care facility. 48.35 Sec. 5. Minnesota Statutes 1994, section 144A.073, 48.36 subdivision 2, is amended to read: 49.1 Subd. 2. [REQUEST FOR PROPOSALS.] At theintervals49.2specified in rulesauthorization by the legislature of 49.3 additional medical assistance expenditures for exceptions to the 49.4 moratorium on nursing homes, the interagency committee shall 49.5 publish in the State Register a request for proposals for 49.6 nursing home projects to be licensed or certified under section 49.7 144A.071, subdivision 4a, clause (c). The public notice of this 49.8 funding and the request for proposals must specify how the 49.9 approval criteria will be prioritized by the advisory review 49.10 panel, the interagency long-term care planning committee, and 49.11 the commissioner. The notice must describe the information that 49.12 must accompany a request and state that proposals must be 49.13 submitted to the interagency committee within 90 days of the 49.14 date of publication. The notice must include the amount of the 49.15 legislative appropriation available for the additional costs to 49.16 the medical assistance program of projects approved under this 49.17 section. If no money is appropriated for a year,the notice for49.18that year must state that proposals will not be requested49.19because no appropriations were madethe interagency committee 49.20 shall publish a notice to that effect, and no proposals shall be 49.21 requested. If money is appropriated, the interagency committee 49.22 shall initiate the application and review process described in 49.23 this section at least twice each biennium and up to four times 49.24 each biennium, according to dates established by rule. 49.25 Authorized funds shall be allocated proportionally to the number 49.26 of processes. Funds not encumbered by an earlier process within 49.27 a biennium shall carry forward to subsequent iterations of the 49.28 process. Authorization for expenditures does not carry forward 49.29 into the following biennium. To be considered for approval, a 49.30 proposal must include the following information: 49.31 (1) whether the request is for renovation, replacement, 49.32 upgrading,orconversion, or relocation; 49.33 (2) a description of the problem the project is designed to 49.34 address; 49.35 (3) a description of the proposed project; 49.36 (4) an analysis of projected costs of the nursing facility 50.1 proposal, including initial construction and remodeling costs,; 50.2 site preparation costs,; financing costs, including the current 50.3 estimated long-term financing costs of the proposal, which 50.4 consists of the amount and sources of money, reserves if 50.5 required under the proposed funding mechanism, annual payments 50.6 scheduled, interest rates, length of term, closing costs and 50.7 fees, insurance costs, and any completed marketing study or 50.8 underwriting review; and estimated operating costs during the 50.9 first two years after completion of the project; 50.10 (5) for proposals involving replacement of all or part of a 50.11 facility, the proposed location of the replacement facility and 50.12 an estimate of the cost of addressing the problem through 50.13 renovation; 50.14 (6) for proposals involving renovation, an estimate of the 50.15 cost of addressing the problem through replacement; 50.16 (7) the proposed timetable for commencing construction and 50.17 completing the project;and50.18 (8) a statement of any licensure or certification issues, 50.19 such as certification survey deficiencies; 50.20 (9) the proposed alternative disposition of current 50.21 residents if beds are to be closed so that the department of 50.22 human services can estimate the total costs of a proposal; and 50.23 (10) other information required by permanent rule of the 50.24 commissioner of health in accordance with subdivisions 4 and 8. 50.25 Sec. 6. Minnesota Statutes 1994, section 144A.073, 50.26 subdivision 3, is amended to read: 50.27 Subd. 3. [REVIEW AND APPROVAL OF PROPOSALS.] Within the 50.28 limits of money specifically appropriated to the medical 50.29 assistance program for this purpose, the interagency long-term 50.30 care planning committee may recommend that the commissioner of 50.31 health grant exceptions to the nursing home licensure or 50.32 certification moratorium for proposals that satisfy the 50.33 requirements of this section. The interagency committee shall 50.34 appoint an advisory review panel composed of representatives of 50.35 consumers and providers to review proposals and provide comments 50.36 and recommendations to the committee. The commissioners of 51.1 human services and health shall provide staff and technical 51.2 assistance to the committee for the review and analysis of 51.3 proposals. The interagency committee shall hold a public 51.4 hearing before submitting recommendations to the commissioner of 51.5 health on project requests. The committee shall submit 51.6 recommendations within 150 days of the date of the publication 51.7 of the notice, based on a comparison and ranking of proposals51.8using the criteria in subdivision 4. The commissioner of health 51.9 shall approve or disapprove a project within 30 days after 51.10 receiving the committee's recommendations. The advisory review 51.11 panel, the committee, and the commissioner of health shall base 51.12 their recommendations, approvals, or disapprovals on a 51.13 comparison and ranking of proposals using only the criteria in 51.14 subdivision 4 and in emergency and permanent rules adopted by 51.15 the commissioner. The cost to the medical assistance program of 51.16 the proposals approved must be within the limits of the 51.17 appropriations specifically made for this purpose. Approval of 51.18 a proposal expires 18 months after approval by the commissioner 51.19 of health unless the facility has commenced construction as 51.20 defined in section 144A.071, subdivision 1a, paragraph (d). The 51.21 committee's report to the legislature, as required under section 51.22 144A.31, must include the projects approved, the criteria used 51.23 to recommend proposals for approval, and the estimated costs of 51.24 the projects, including the costs of initial construction and 51.25 remodeling, and the estimated operating costs during the first 51.26 two years after the project is completed. 51.27 Sec. 7. Minnesota Statutes 1994, section 144A.073, is 51.28 amended by adding a subdivision to read: 51.29 Subd. 3c. [COST NEUTRAL RELOCATION 51.30 PROJECTS.] Notwithstanding subdivision 3, the interagency 51.31 committee may at any time accept proposals or amendments to 51.32 proposals previously approved under this section for relocations 51.33 that are cost neutral with respect to state costs as defined in 51.34 section 144A.071, subdivision 5a. The committee shall review 51.35 these applications and make recommendations to the commissioner 51.36 within 90 days. The committee must evaluate proposals according 52.1 to subdivision 4, clauses (1), (2), and (3), and other criteria 52.2 established in rule. The commissioner shall approve or 52.3 disapprove a project within 30 days of receiving the committee's 52.4 recommendation. Proposals and amendments approved under this 52.5 subdivision are not subject to the six-mile limit in subdivision 52.6 5, paragraph (e), and an amendment under this section to a 52.7 proposal originally approved before April 1, 1995, involving the 52.8 replacement of 102 licensed and certified beds may include the 52.9 relocation of 50 percent of the beds to each of two other 52.10 locations. A project previously approved under this section 52.11 that applies for and is granted an amendment under this 52.12 subdivision prior to July 1, 1995, shall have an additional six 52.13 months to commence construction beyond the limit established in 52.14 subdivision 3b. 52.15 Sec. 8. Minnesota Statutes 1994, section 144A.073, 52.16 subdivision 4, is amended to read: 52.17 Subd. 4. [CRITERIA FOR REVIEW.](a)The following criteria 52.18mustshall be used in a consistent manner to compareand, 52.19 evaluate, and rank all proposals submitted. Except for the 52.20 criteria specified in clause (3), the application of criteria 52.21 listed under this subdivision shall not reflect any distinction 52.22 based on the geographic location of the proposed project: 52.23 (1)the extent to which the average occupancy rate of the52.24facility supports the need for the proposed project;52.25(2) the extent to which the average occupancy rate of all52.26facilities in the county in which the applicant is located,52.27together with all contiguous Minnesota counties, supports the52.28need for the proposed project;52.29(3)the extent to which the proposal furthers state 52.30 long-term care goals, including the goals stated in section 52.31 144A.31, and including the goal of enhancing the availability 52.32 and use of alternative care services and the goal of reducing 52.33 the number of long-term care resident rooms with more than two 52.34 beds; 52.35(4) the cost-effectiveness of the proposal, including(2) 52.36 the proposal's long-term effects onthestate costsof the53.1medical assistance program, as determined by the commissioner of53.2human services; andincluding the cost estimate of the project 53.3 according to section 144A.071, subdivision 5a; 53.4(5) other factors developed in rule by the commissioner of53.5health that evaluate and assess how the proposed project will53.6further promote or protect the health, safety, comfort,53.7treatment, or well-being of the facility's residents.53.8(b) In addition to the criteria in paragraph (a), the53.9following criteria must be used to evaluate, compare, and rank53.10proposals involving renovation or replacement:53.11 (3) the extent to which the proposal promotes equitable 53.12 access to long-term care services in nursing homes through 53.13 redistribution of the nursing home bed supply, as measured by 53.14 the number of beds relative to the population 85 or older, 53.15 projected to the year 2000 by the state demographer, and 53.16 according to items (i) through (iv): 53.17 (i) reduce beds in counties where the supply is relatively 53.18 high, and increase beds in counties where the supply is 53.19 relatively low; 53.20 (ii) adjust the bed supply so as to create the greatest 53.21 benefits in improving the distribution of beds; 53.22 (iii) adjust the existing bed supply (A) in counties in the 53.23 seven-county metropolitan area so that the bed supply in the 53.24 counties, together with all contiguous Minnesota counties, moves 53.25 toward the statewide mean and (B) in other counties so that the 53.26 supply in the 50-mile radius surrounding the project under 53.27 review moves toward the statewide mean; and 53.28 (iv) adjust the existing bed supply so that the 53.29 distribution of beds as projected for the year 2020 would be 53.30 consistent with projected need; 53.31(1)(4) the extent to which the project improves conditions 53.32 that affect the health or safety of residents, such as narrow 53.33 corridors, narrow door frames, unenclosed fire exits, and wood 53.34 frame construction, and similar provisions contained in fire and 53.35 life safety codes and licensure and certification rules; 53.36(2)(5) the extent to which the project improves conditions 54.1 that affect the comfort or quality of life of residents in a 54.2 facility or the ability of the facility to provide efficient 54.3 care, such as a relatively high number of residents in a room; 54.4 inadequate lighting or ventilation; poor access to bathing or 54.5 toilet facilities; a lack of available ancillary space for 54.6 dining rooms, day rooms, or rooms used for other activities; 54.7 problems relating to heating, cooling, or energy efficiency; 54.8 inefficient location of nursing stations; narrow corridors; or 54.9 other provisions contained in the licensure and certification 54.10 rules; 54.11 (6) the extent to which the applicant demonstrates the 54.12 delivery of quality care to residents as evidenced by the two 54.13 most recent state agency certification surveys and the 54.14 applicants' response to those surveys; 54.15 (7) the extent to which the project removes the need for 54.16 waivers or variances previously granted by either the licensing 54.17 agency, certifying agency, fire marshal, or local government 54.18 entity; and 54.19 (8) other factors that may be developed in permanent rule 54.20 by the commissioner of health that evaluate and assess how the 54.21 proposed project will further promote or protect the health, 54.22 safety, comfort, treatment, or well-being of the facility's 54.23 residents. 54.24 Sec. 9. Minnesota Statutes 1994, section 144A.073, 54.25 subdivision 8, is amended to read: 54.26 Subd. 8. [RULEMAKING.] The commissioner of health shall 54.27 adoptemergency orpermanent rules to implement this 54.28 section. The permanent rules must be in accordance with and 54.29 implement only the criteria listed in this section. The 54.30 authority to adoptemergencypermanent rules continues until 54.31December 30, 1988July 1, 1996. 54.32 Sec. 10. Minnesota Statutes 1994, section 256.015, 54.33 subdivision 1, is amended to read: 54.34 Subdivision 1. [STATE AGENCY HAS LIEN.] When the state 54.35 agency provides, pays for, or becomes liable for medical care or 54.36 furnishes subsistence or other payments to a person, the agency 55.1 has a lien for the cost of the care and payments on all causes 55.2 of action that accrue to the person to whom the care or payments 55.3 were furnished, or to the person's legal representatives, as a 55.4 result of the occurrence that necessitated the medical care, 55.5 subsistence, or other payments. For purposes of this section, 55.6 "state agency" includes authorized agents of the state agency. 55.7 Sec. 11. Minnesota Statutes 1994, section 256.015, 55.8 subdivision 2, is amended to read: 55.9 Subd. 2. [PERFECTION; ENFORCEMENT.] The state agency may 55.10 perfect and enforce its lien under sections 514.69, 514.70, and 55.11 514.71, and must file the verified lien statement with the 55.12 appropriate court administrator in the county of financial 55.13 responsibility. The verified lien statement must contain the 55.14 following: the name and address of the person to whom medical 55.15 care, subsistence, or other payment was furnished; the date of 55.16 injury; the name and address of vendors furnishing medical care; 55.17 the dates of the service or payment; the amount claimed to be 55.18 due for the care or payment; and to the best of the state 55.19 agency's knowledge, the names and addresses of all persons, 55.20 firms, or corporations claimed to be liable for damages arising 55.21 from the injuries. 55.22 This section does not affect the priority of any attorney's 55.23 lien. The state agency is not subject to any limitations period 55.24 referred to in section 514.69 or 514.71 and has one year from 55.25 the date notice is first received by it under subdivision 4, 55.26 paragraph (c), even if the notice is untimely, or one year from 55.27 the date medical bills are first paid by the state agency, 55.28 whichever is later, to file its verified lien statement. The 55.29 state agency may commence an action to enforce the lien within 55.30 one year of (1) the date the notice required by subdivision 4, 55.31 paragraph (c), is received, or (2) the date the person's cause 55.32 of action is concluded by judgment, award, settlement, or 55.33 otherwise, whichever is later. 55.34 Sec. 12. Minnesota Statutes 1994, section 256.9353, 55.35 subdivision 8, is amended to read: 55.36 Subd. 8. [LIEN.] When the state agency provides, pays for, 56.1 or becomes liable for covered health services, the agency shall 56.2 have a lien for the cost of the covered health services upon any 56.3 and all causes of action accruing to the enrollee, or to the 56.4 enrollee's legal representatives, as a result of the occurrence 56.5 that necessitated the payment for the covered health services. 56.6 All liens under this section shall be subject to the provisions 56.7 of section 256.015. For purposes of this subdivision, "state 56.8 agency" includes authorized agents of the state agency. 56.9 Sec. 13. Minnesota Statutes 1994, section 256.969, 56.10 subdivision 10, is amended to read: 56.11 Subd. 10. [SEPARATE BILLING BY CERTIFIED REGISTERED NURSE 56.12 ANESTHETISTS.] Hospitals may exclude certified registered nurse 56.13 anesthetist costs from the operating payment rate as allowed by 56.14 section 256B.0625, subdivision 11. To be eligible, a hospital 56.15 must notify the commissioner in writing by October 1 of the year 56.16 preceding the rate year of the request to exclude certified 56.17 registered nurse anesthetist costs. The hospital must agree 56.18 that all hospital claims for the cost and charges of certified 56.19 registered nurse anesthetist services will not be included as 56.20 part of the rates for inpatient services provided during the 56.21 rate year. In this case, the operating payment rate shall be 56.22 adjusted to exclude the cost of certified registered nurse 56.23 anesthetist services.Payments made through separate claims for56.24certified registered nurse anesthetist services shall not be56.25paid directly through the hospital provider number or indirectly56.26by the certified registered nurse anesthetist to the hospital or56.27related organizations.56.28 For admissions occurring on or after July 1, 1991, and 56.29 until the expiration date of section 256.9695, subdivision 3, 56.30 services of certified registered nurse anesthetists provided on 56.31 an inpatient basis may be paid as allowed by section 256B.0625, 56.32 subdivision 11, when the hospital's base year did not include 56.33 the cost of these services. To be eligible, a hospital must 56.34 notify the commissioner in writing by July 1, 1991, of the 56.35 request and must comply with all other requirements of this 56.36 subdivision. 57.1 Sec. 14. Minnesota Statutes 1994, section 256.969, 57.2 subdivision 16, is amended to read: 57.3 Subd. 16. [INDIAN HEALTH SERVICE FACILITIES.] Indian 57.4 health service facilities are exempt from the rate establishment 57.5 methods required by this section and shall be reimbursed at 57.6 charges as limited to the amount allowed under federal law. 57.7This exemption is not effective for payments under general57.8assistance medical care.57.9 Sec. 15. Minnesota Statutes 1994, section 256B.042, 57.10 subdivision 2, is amended to read: 57.11 Subd. 2. [LIEN ENFORCEMENT.] The state agency may perfect 57.12 and enforce its lien by following the procedures set forth in 57.13 sections 514.69, 514.70 and 514.71, and its verified lien 57.14 statement shall be filed with the appropriate court 57.15 administrator in the county of financial responsibility. The 57.16 verified lien statement shall contain the following: the name 57.17 and address of the person to whom medical care was furnished, 57.18 the date of injury, the name and address of the vendor or 57.19 vendors furnishing medical care, the dates of the service, the 57.20 amount claimed to be due for the care, and, to the best of the 57.21 state agency's knowledge, the names and addresses of all 57.22 persons, firms, or corporations claimed to be liable for damages 57.23 arising from the injuries. This section shall not affect the 57.24 priority of any attorney's lien. The state agency is not 57.25 subject to any limitations period referred to in section 514.69 57.26 or 514.71 and has one year from the date notice is first 57.27 received by it under subdivision 4, paragraph (c), even if the 57.28 notice is untimely, or one year from the date medical bills are 57.29 first paid by the state agency, whichever is later, to file its 57.30 verified lien statement. The state agency may commence an 57.31 action to enforce the lien within one year of (1) the date the 57.32 notice required by subdivision 4, paragraph (c), is received or 57.33 (2) the date the recipient's cause of action is concluded by 57.34 judgment, award, settlement, or otherwise, whichever is 57.35 later. For purposes of this section, "state agency" includes 57.36 authorized agents of the state agency. 58.1 Sec. 16. Minnesota Statutes 1994, section 256B.056, 58.2 subdivision 4, is amended to read: 58.3 Subd. 4. [INCOME.] To be eligible for medical assistance, 58.4 a person must not have, or anticipate receiving, semiannual 58.5 income in excess of 120 percent of the income standards by 58.6 family size used in the aid to families with dependent children 58.7 program, except that families and children may have an income up 58.8 to 133-1/3 percent of the AFDC income standard. In computing 58.9 income to determine eligibility of persons who are not residents 58.10 of long-term care facilities, the commissioner shall disregard 58.11 increases in income as required by Public Law Numbers 94-566, 58.12 section 503; 99-272; and 99-509. Veterans aid and attendance 58.13 benefits are considered income to the recipient. 58.14 Sec. 17. Minnesota Statutes 1994, section 256B.0575, is 58.15 amended to read: 58.16 256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 58.17 PERSONS.] 58.18 When an institutionalized person is determined eligible for 58.19 medical assistance, the income that exceeds the deductions in 58.20 paragraphs (a) and (b) must be applied to the cost of 58.21 institutional care. 58.22 (a) The following amounts must be deducted from the 58.23 institutionalized person's income in the following order: 58.24 (1) the personal needs allowance under section 256B.35 or, 58.25 for a veteran who does not have a spouse or child, or a 58.26 surviving spouse of a veteran having no child, the amount of an 58.27 improved pension received from the veteran's administration not 58.28 exceeding $90 per month; 58.29 (2) the personal allowance for disabled individuals under 58.30 section 256B.36; 58.31 (3) if the institutionalized person has a legally appointed 58.32 guardian or conservator, five percent of the recipient's gross 58.33 monthly income up to $100 as reimbursement for guardianship or 58.34 conservatorship services; 58.35 (4) a monthly income allowance determined under section 58.36 256B.058, subdivision 2, but only to the extent income of the 59.1 institutionalized spouse is made available to the community 59.2 spouse; 59.3 (5) a monthly allowance for children under age 18 which, 59.4 together with the net income of the children, would provide 59.5 income equal to the medical assistance standard for families and 59.6 children according to section 256B.056, subdivision 4, for a 59.7 family size that includes only the minor children. This 59.8 deduction applies only if the children do not live with the 59.9 community spouse and only if the children resided with the 59.10 institutionalized person immediately prior to admission; 59.11 (6) a monthly family allowance for other family members, 59.12 equal to one-third of the difference between 122 percent of the 59.13 federal poverty guidelines and the monthly income for that 59.14 family member; 59.15 (7) reparations payments made by the Federal Republic of 59.16 Germany and reparations payments made by the Netherlands for 59.17 victims of Nazi persecution between 1940 and 1945; and 59.18 (8) amounts for reasonable expenses incurred for necessary 59.19 medical or remedial care for the institutionalized spouse that 59.20 are not medical assistance covered expenses and that are not 59.21 subject to payment by a third party. 59.22 For purposes of clause (6), "other family member" means a 59.23 person who resides with the community spouse and who is a minor 59.24 or dependent child, dependent parent, or dependent sibling of 59.25 either spouse. "Dependent" means a person who could be claimed 59.26 as a dependent for federal income tax purposes under the 59.27 Internal Revenue Code. 59.28 (b) Income shall be allocated to an institutionalized 59.29 person for a period of up to three calendar months, in an amount 59.30 equal to the medical assistance standard for a family size of 59.31 one if: 59.32 (1) a physician certifies that the person is expected to 59.33 reside in the long-term care facility for three calendar months 59.34 or less; 59.35 (2) if the person has expenses of maintaining a residence 59.36 in the community; and 60.1 (3) if one of the following circumstances apply: 60.2 (i) the person was not living together with a spouse or a 60.3 family member as defined in paragraph (a) when the person 60.4 entered a long-term care facility; or 60.5 (ii) the person and the person's spouse become 60.6 institutionalized on the same date, in which case the allocation 60.7 shall be applied to the income of one of the spouses. 60.8 For purposes of this paragraph, a person is determined to be 60.9 residing in a licensed nursing home, regional treatment center, 60.10 or medical institution if the person is expected to remain for a 60.11 period of one full calendar month or more. 60.12 Sec. 18. Minnesota Statutes 1994, section 256B.059, 60.13 subdivision 1, is amended to read: 60.14 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 60.15 section, the terms defined in this subdivision have the meanings 60.16 given them. 60.17 (b) "Community spouse" means the spouse of an 60.18 institutionalizedpersonspouse. 60.19 (c) "Spousal share" means one-half of the total value of 60.20 all assets, to the extent that either the institutionalized 60.21 spouse or the community spouse had an ownership interest at the 60.22 time of institutionalization. 60.23 (d) "Assets otherwise available to the community spouse" 60.24 means assets individually or jointly owned by the community 60.25 spouse, other than assets excluded by subdivision 5, paragraph 60.26 (c). 60.27 (e) "Community spouse asset allowance" is the value of 60.28 assets that can be transferred under subdivision 3. 60.29 (f) "Institutionalized spouse" means a person who is: 60.30 (1) in a hospital, nursing facility, or intermediate care 60.31 facility for persons with mental retardation, or receiving home 60.32 and community-based services under section 256B.0915 or 256B.49, 60.33 and is expected to remain in the facility or institution or 60.34 receive the home and community-based services for at least 30 60.35 consecutive days; and 60.36 (2) married to a person who is not in a hospital, nursing 61.1 facility, or intermediate care facility for persons with mental 61.2 retardation, and is not receiving home and community-based 61.3 services under section 256B.0915 or 256B.49. 61.4 Sec. 19. Minnesota Statutes 1994, section 256B.059, 61.5 subdivision 3, is amended to read: 61.6 Subd. 3. [COMMUNITY SPOUSE ASSET ALLOWANCE.] An 61.7 institutionalized spouse may transfer assets to the community 61.8 spouse solely for the benefit of the community spouse. Except 61.9 for increased amounts allowable under subdivision 4, the maximum 61.10 amount of assets allowed to be transferred is the amount which, 61.11 when added to the assets otherwise available to the community 61.12 spouse, is as follows: 61.13 (1) prior to July 1, 1994, the greater of: 61.14 (i) $14,148; 61.15 (ii) the lesser of the spousal share or $70,740; or 61.16 (iii) the amount required by court order to be paid to the 61.17 community spouse; and 61.18 (2) for personswho beginwhose date of initial 61.19 determination of eligibility for medical assistance following 61.20 their first continuous period of institutionalization occurs on 61.21 or after July 1, 1994, the greater of: 61.22 (i) $20,000; 61.23 (ii) the lesser of the spousal share or $70,740; or 61.24 (iii) the amount required by court order to be paid to the 61.25 community spouse. 61.26 If the assets available to the community spouse are already 61.27 at the limit permissible under this section, or the higher limit 61.28 attributable to increases under subdivision 4, no assets may be 61.29 transferred from the institutionalized spouse to the community 61.30 spouse. The transfer must be made as soon as practicable after 61.31 the date the institutionalized spouse is determined eligible for 61.32 medical assistance, or within the amount of time needed for any 61.33 court order required for the transfer. On January 1, 1994, and 61.34 every January 1 thereafter, the limits in this subdivision shall 61.35 be adjusted by the same percentage change in the consumer price 61.36 index for all urban consumers (all items; United States city 62.1 average) between the two previous Septembers. These adjustments 62.2 shall also be applied to the limits in subdivision 5. 62.3 Sec. 20. Minnesota Statutes 1994, section 256B.059, 62.4 subdivision 5, is amended to read: 62.5 Subd. 5. [ASSET AVAILABILITY.] (a) At the time of 62.6applicationinitial determination of eligibility for medical 62.7 assistance benefits following the first continuous period of 62.8 institutionalization, assets considered available to the 62.9 institutionalized spouse shall be the total value of all assets 62.10 in which either spouse has an ownership interest, reduced by the 62.11 following: 62.12 (1) prior to July 1, 1994, the greater of: 62.13 (i) $14,148; 62.14 (ii) the lesser of the spousal share or $70,740; or 62.15 (iii) the amount required by court order to be paid to the 62.16 community spouse; 62.17 (2) for personswho beginwhose date of initial 62.18 determination of eligibility for medical assistance following 62.19 their first continuous period of institutionalization occurs on 62.20 or after July 1, 1994, the greater of: 62.21 (i) $20,000; 62.22 (ii) the lesser of the spousal share or $70,740; or 62.23 (iii) the amount required by court order to be paid to the 62.24 community spouse. If the community spouse asset allowance has 62.25 been increased under subdivision 4, then the assets considered 62.26 available to the institutionalized spouse under this subdivision 62.27 shall be further reduced by the value of additional amounts 62.28 allowed under subdivision 4. 62.29 (b) An institutionalized spouse may be found eligible for 62.30 medical assistance even though assets in excess of the allowable 62.31 amount are found to be available under paragraph (a) if the 62.32 assets are owned jointly or individually by the community 62.33 spouse, and the institutionalized spouse cannot use those assets 62.34 to pay for the cost of care without the consent of the community 62.35 spouse, and if: (i) the institutionalized spouse assigns to the 62.36 commissioner the right to support from the community spouse 63.1 under section 256B.14, subdivision 3; (ii) the institutionalized 63.2 spouse lacks the ability to execute an assignment due to a 63.3 physical or mental impairment; or (iii) the denial of 63.4 eligibility would cause an imminent threat to the 63.5 institutionalized spouse's health and well-being. 63.6 (c) After the month in which the institutionalized spouse 63.7 is determined eligible for medical assistance, during the 63.8 continuous period of institutionalization, no assets of the 63.9 community spouse are considered available to the 63.10 institutionalized spouse, unless the institutionalized spouse 63.11 has been found eligible underclauseparagraph (b). 63.12 (d) Assets determined to be available to the 63.13 institutionalized spouse under this section must be used for the 63.14 health care or personal needs of the institutionalized spouse. 63.15 (e) For purposes of this section, assets do not include 63.16 assets excluded undersection 256B.056, without regard to the63.17limitations on total value in that sectionthe supplemental 63.18 security income program. 63.19 Sec. 21. Minnesota Statutes 1994, section 256B.0595, 63.20 subdivision 1, is amended to read: 63.21 Subdivision 1. [PROHIBITED TRANSFERS.] (a) For transfers 63.22 of assets made on or before August 10, 1993, if a person or the 63.23 person's spouse has given away, sold, or disposed of, for less 63.24 than fair market value, any asset or interest therein, except 63.25 assets other than the homestead that are excluded undersection63.26256B.056, subdivision 3the supplemental security program, 63.27 within 30 months before or any time after the date of 63.28 institutionalization if the person has been determined eligible 63.29 for medical assistance, or within 30 months before or any time 63.30 after the date of the first approved application for medical 63.31 assistance if the person has not yet been determined eligible 63.32 for medical assistance, the person is ineligible for long-term 63.33 care services for the period of time determined under 63.34 subdivision 2. 63.35 (b) Effective for transfers madeon orafterJuly 1, 1993,63.36or upon federal approval, whichever is laterAugust 10, 1993, a 64.1 person, a person's spouse, ora person's authorized64.2representativeany person, court, or administrative body with 64.3 legal authority to act in place of, on behalf of, at the 64.4 direction of, or upon the request of the person or person's 64.5 spouse, may not give away, sell, or dispose of, for less than 64.6 fair market value, any asset or interest therein, except assets 64.7 other than the homestead that are excluded under the 64.8 supplemental security income program, for the purpose of 64.9 establishing or maintaining medical assistance eligibility. For 64.10 purposes of determining eligibility formedical assistance64.11 long-term care services, any transfer ofan assetsuch assets 64.12 within6036 monthspreceding applicationbefore or any time 64.13 after an institutionalized person applies for medical assistance 64.14or during the period of medical assistance eligibility,64.15including assets excluded under section 256B.056, subdivision 3, 64.16 or 36 months before or any time after a medical assistance 64.17 recipient becomes institutionalized, for less than fair market 64.18 value may be considered. Any such transferfor less than fair64.19market value made within 60 months preceding application for64.20medical assistance or during the period of medical assistance64.21eligibilityis presumed to have been made for the purpose of 64.22 establishing or maintaining medical assistance eligibility and 64.23 the person is ineligible formedical assistancelong-term care 64.24 services for the period of time determined under subdivision 2, 64.25 unless the person furnishes convincing evidence to establish 64.26 that the transaction was exclusively for another purpose, or 64.27 unless the transfer is permitted undersubdivisionssubdivision 64.28 3 or 4. Notwithstanding the provisions of this paragraph, in 64.29 the case of payments from a trust or portions of a trust that 64.30 are considered transfers of assets under federal law, any 64.31 transfers made within 60 months before or any time after an 64.32 institutionalized person applies for medical assistance and 64.33 within 60 months before or any time after a medical assistance 64.34 recipient becomes institutionalized, may be considered. 64.35 (c) This section applies to transfers, for less than fair 64.36 market value, of income or assets, including assets that are 65.1 considered income in the month received, such as inheritances, 65.2 court settlements, and retroactive benefit payments or income to 65.3 which the person or the person's spouse is entitled but does not 65.4 receive due to action by the person, the person's spouse, or any 65.5 person, court, or administrative body with legal authority to 65.6 act in place of, on behalf of, at the direction of, or upon the 65.7 request of the person or the person's spouse. 65.8 (d) This section applies to payments for care or personal 65.9 services provided by a relative, unless the compensation was 65.10 stipulated in a notarized, written agreement which was in 65.11 existence when the service was performed, the care or services 65.12 directly benefited the person, and the payments made represented 65.13 reasonable compensation for the care or services provided. A 65.14 notarized written agreement is not required if payment for the 65.15 services was made within 60 days after the service was provided. 65.16 (e) This section applies to the portion of any asset or 65.17 interest that a personor, a person's spousetransfers, or any 65.18 person, court, or administrative body with legal authority to 65.19 act in place of, on behalf of, at the direction of, or upon the 65.20 request of the person or the person's spouse, toan65.21irrevocableany trust, annuity, or other instrument, that 65.22 exceeds the value of the benefit likely to be returned to the 65.23 person or spouse while alive, based on estimated life expectancy 65.24 using the life expectancy tables employed by the supplemental 65.25 security income program to determine the value of an agreement 65.26 for services for life. The commissioner may adopt rules 65.27 reducing life expectancies based on the need for long-term care. 65.28 (f) For purposes of this section, long-term care services 65.29 include services in a nursing facility, services that are 65.30 eligible for payment according to section 256B.0625, subdivision 65.31 2, because they are provided in a swing bed, intermediate care 65.32 facility for persons with mental retardation, and home and 65.33 community-based services provided pursuant tosection 256B.49165.34 sections 256B.0915, 256B.092, and 256B.49. For purposes of this 65.35 subdivision and subdivisions 2, 3, and 4, "institutionalized 65.36 person" includes a person who is an inpatient in a nursing 66.1 facility,or in a swing bed, or intermediate care facility for 66.2 persons with mental retardation or who is receiving home and 66.3 community-based services undersection 256B.491sections 66.4 256B.0915, 256B.092, and 256B.49. 66.5 Sec. 22. Minnesota Statutes 1994, section 256B.0595, 66.6 subdivision 2, is amended to read: 66.7 Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any 66.8 uncompensated transfer occurring on or before August 10, 1993, 66.9 the number of months of ineligibility for long-term care 66.10 services shall be the lesser of 30 months, or the uncompensated 66.11 transfer amount divided by the average medical assistance rate 66.12 for nursing facility services in the state in effect on the date 66.13 of application. The amount used to calculate the average 66.14 medical assistance payment rate shall be adjusted each July 1 to 66.15 reflect payment rates for the previous calendar year. The 66.16 period of ineligibility begins with the month in which the 66.17 assets were transferred. If the transfer was not reported to 66.18 the local agency at the time of application, and the applicant 66.19 received long-term care services during what would have been the 66.20 period of ineligibility if the transfer had been reported, a 66.21 cause of action exists against the transferee for the cost of 66.22 long-term care services provided during the period of 66.23 ineligibility, or for the uncompensated amount of the transfer, 66.24 whichever is less. The action may be brought by the state or 66.25 the local agency responsible for providing medical assistance 66.26 under chapter 256G. The uncompensated transfer amount is the 66.27 fair market value of the asset at the time it was given away, 66.28 sold, or disposed of, less the amount of compensation received. 66.29 (b) For uncompensated transfers madeon orafterJuly 1,66.30 August 10, 1993,or upon federal approval, whichever is later,66.31 the number of months of ineligibility, including partial months,66.32 formedical assistancelong-term care services shall be the 66.33 total uncompensated value of the resources transferred divided 66.34 by the average medical assistance rate for nursing facility 66.35 services in the state in effect on the date of application.If66.36a calculation of a penalty period results in a partial month,67.1payments for medical assistance services will be reduced in an67.2amount equal to the fraction, except that in calculating the67.3value of uncompensated transfers, uncompensated transfers not to67.4exceed $1,000 in total value per month shall be disregarded for67.5each month prior to the month of application for medical67.6assistance.The amount used to calculate the average medical 67.7 assistance payment rate shall be adjusted each July 1 to reflect 67.8 payment rates for the previous calendar year. The period of 67.9 ineligibility begins with the month in which the assets were 67.10 transferred except that if one or more uncompensated transfers 67.11 are made during a period of ineligibility, the total assets 67.12 transferred during the ineligibility period shall be combined 67.13 and a penalty period calculated to begin in the month the first 67.14 uncompensated transfer was made.The penalty in this paragraph67.15shall not apply to uncompensated transfers of assets not to67.16exceed a total of $1,000 per month during a medical assistance67.17eligibility certification period.If the transfer was not 67.18 reported to the local agency at the time of application, and the 67.19 applicant received medical assistance services during what would 67.20 have been the period of ineligibility if the transfer had been 67.21 reported, a cause of action exists against the transferee for 67.22 the cost of medical assistance services provided during the 67.23 period of ineligibility, or for the uncompensated amount of the 67.24 transfer, whichever is less. The action may be brought by the 67.25 state or the local agency responsible for providing medical 67.26 assistance under chapter 256G. The uncompensated transfer 67.27 amount is the fair market value of the asset at the time it was 67.28 given away, sold, or disposed of, less the amount of 67.29 compensation received. 67.30 (c)If the total value of all uncompensated transfers made67.31in a month exceeds $1,000, the disregards allowed under67.32paragraph (b) do not apply.If a calculation of a penalty 67.33 period results in a partial month, payments for long-term care 67.34 services shall be reduced in an amount equal to the fraction, 67.35 except that in calculating the value of uncompensated transfers, 67.36 if the total value of all uncompensated transfers made in a 68.1 month does not exceed $1,000, then such transfers shall be 68.2 disregarded for each month prior to the month of application for 68.3 or during receipt of medical assistance. 68.4 Sec. 23. Minnesota Statutes 1994, section 256B.0595, 68.5 subdivision 3, is amended to read: 68.6 Subd. 3. [HOMESTEAD EXCEPTION TO TRANSFER PROHIBITION.] 68.7 (a) An institutionalized person is not ineligible for long-term 68.8 care services due to a transfer of assets for less than fair 68.9 market value if the asset transferred was a homestead and: 68.10 (1) title to the homestead was transferred to the 68.11 individual's 68.12 (i) spouse; 68.13 (ii) child who is under age 21; 68.14 (iii) blind or permanently and totally disabled child as 68.15 defined in the supplemental security income program; 68.16 (iv) sibling who has equity interest in the home and who 68.17 was residing in the home for a period of at least one year 68.18 immediately before the date of the individual's admission to the 68.19 facility; or 68.20 (v) son or daughter who was residing in the individual's 68.21 home for a period of at least two years immediately before the 68.22 date of the individual's admission to the facility, and who 68.23 provided care to the individual that permitted the individual to 68.24 reside at home rather than in an institution or facility; 68.25 (2) a satisfactory showing is made that the individual 68.26 intended to dispose of the homestead at fair market value or for 68.27 other valuable consideration; or 68.28 (3) the local agency grants a waiver of the excess 68.29 resources created by the uncompensated transfer because denial 68.30 of eligibility would cause undue hardship for the individual, 68.31 based on imminent threat to the individual's health and 68.32 well-being. 68.33 (b) When a waiver is granted under paragraph (a), clause 68.34 (3), a cause of action exists against the person to whom the 68.35 homestead was transferred for that portion of long-term care 68.36 services granted within: 69.1 (1) 30 months ofthea transfer made on or before August 69.2 10, 1993; 69.3 (2) 60 months if the homestead was transferred after August 69.4 10, 1993, to a trust or portion of a trust that is considered a 69.5 transfer of assets under federal law; or 69.6 (3) 36 months if transferred in any other manner after 69.7 August 10, 1993, 69.8 or the amount of the uncompensated transfer, whichever is less, 69.9 together with the costs incurred due to the action. The action 69.10 may be brought by the state or the local agency responsible for 69.11 providing medical assistance under chapter 256G. 69.12(c) Effective for transfers made on or after July 1, 1993,69.13or upon federal approval, whichever is later, an69.14institutionalized person is not ineligible for medical69.15assistance services due to a transfer of assets for less than69.16fair market value if the asset transferred was a homestead and:69.17(1) title to the homestead was transferred to the69.18individual's69.19(i) spouse;69.20(ii) child who is under age 21;69.21(iii) blind or permanently and totally disabled child as69.22defined in the supplemental security income program;69.23(iv) sibling who has equity interest in the home and who69.24was residing in the home for a period of at least one year69.25immediately before the date of the individual's admission to the69.26facility; or69.27(v) son or daughter who was residing in the individual's69.28home for a period of at least two years immediately before the69.29date of the individual's admission to the facility, and who69.30provided care to the individual that permitted the individual to69.31reside at home rather than in an institution or facility;69.32(2) a satisfactory showing is made that the individual69.33intended to dispose of the homestead at fair market value or for69.34other valuable consideration; or69.35(3) the local agency grants a waiver of the excess69.36resources created by the uncompensated transfer because denial70.1of eligibility would cause undue hardship for the individual,70.2based on imminent threat to the individual's health and70.3well-being.70.4(d) When a waiver is granted under paragraph (c), clause70.5(3), a cause of action exists against the person to whom the70.6homestead was transferred for that portion of medical assistance70.7services granted during the period of ineligibility under70.8subdivision 2, or the amount of the uncompensated transfer,70.9whichever is less, together with the costs incurred due to the70.10action. The action may be brought by the state or the local70.11agency responsible for providing medical assistance under70.12chapter 256G.70.13 Sec. 24. Minnesota Statutes 1994, section 256B.0595, 70.14 subdivision 4, is amended to read: 70.15 Subd. 4. [OTHER EXCEPTIONS TO TRANSFER PROHIBITION.](a)70.16 An institutionalized person who has made, or whose spouse has 70.17 made a transfer prohibited by subdivision 1, is not ineligible 70.18 for long-term care services if one of the following conditions 70.19 applies: 70.20 (1) the assets were transferred to thecommunity70.21 individual's spouse, as defined in section 256B.059or to 70.22 another for the sole benefit of the spouse; or 70.23 (2) the institutionalized spouse, prior to being 70.24 institutionalized, transferred assets to a spouse, provided that 70.25 the spouse to whom the assets were transferred does not then 70.26 transfer those assets to another person for less than fair 70.27 market value. (At the time when one spouse is 70.28 institutionalized, assets must be allocated between the spouses 70.29 as provided under section 256B.059); or 70.30 (3) the assets were transferred to the individual's child 70.31 who is blind or permanently and totally disabled as determined 70.32 in the supplemental security income program; or 70.33 (4) a satisfactory showing is made that the individual 70.34 intended to dispose of the assets either at fair market value or 70.35 for other valuable consideration; or 70.36 (5) the local agency determines that denial of eligibility 71.1 for long-term care services would work an undue hardship and 71.2 grants a waiver of excess assets. When a waiver is granted, a 71.3 cause of action exists against the person to whom the assets 71.4 were transferred for that portion of long-term care services 71.5 granted within 30 months of the transfer, or the amount of the 71.6 uncompensated transfer, whichever is less, together with the 71.7 costs incurred due to the action. The action may be brought by 71.8 the state or the local agency responsible for providing medical 71.9 assistance under this chapter.; or 71.10 (6) for transfers occurring after August 10, 1993, the 71.11 assets were transferred by the person or person's spouse: (i) 71.12 into a trust established solely for the benefit of a son or 71.13 daughter of any age who is blind or disabled as defined by the 71.14 Supplemental Security Income program; or (ii) into a trust 71.15 established solely for the benefit of an individual who is under 71.16 65 years of age who is disabled as defined by the Supplemental 71.17 Security Income program. 71.18(b) Effective for transfers made on or after July 1, 1993,71.19or upon federal approval, whichever is later, an71.20institutionalized person who has made, or whose spouse has made71.21a transfer prohibited by subdivision 1, is not ineligible for71.22medical assistance services if one of the following conditions71.23applies:71.24(1) the assets were transferred to the community spouse, as71.25defined in section 256B.059; or71.26(2) the institutionalized spouse, prior to being71.27institutionalized, transferred assets to a spouse, provided that71.28the spouse to whom the assets were transferred does not then71.29transfer those assets to another person for less than fair71.30market value. (At the time when one spouse is71.31institutionalized, assets must be allocated between the spouses71.32as provided under section 256B.059); or71.33(3) the assets were transferred to the individual's child71.34who is blind or permanently and totally disabled as determined71.35in the supplemental security income program; or71.36(4) a satisfactory showing is made that the individual72.1intended to dispose of the assets either at fair market value or72.2for other valuable consideration; or72.3(5) the local agency determines that denial of eligibility72.4for medical assistance services would work an undue hardship and72.5grants a waiver of excess assets. When a waiver is granted, a72.6cause of action exists against the person to whom the assets72.7were transferred for that portion of medical assistance services72.8granted during the period of ineligibility determined under72.9subdivision 2 or the amount of the uncompensated transfer,72.10whichever is less, together with the costs incurred due to the72.11action. The action may be brought by the state or the local72.12agency responsible for providing medical assistance under this72.13chapter.72.14 Sec. 25. Minnesota Statutes 1994, section 256B.06, 72.15 subdivision 4, is amended to read: 72.16 Subd. 4. [CITIZENSHIP REQUIREMENTS.] Eligibility for 72.17 medical assistance is limited to citizens of the United States 72.18 and aliens lawfully admitted for permanent residence or 72.19 otherwise permanently residing in the United States under the 72.20 color of law. Aliens who are seeking legalization under the 72.21 Immigration Reform and Control Act of 1986, Public Law Number 72.22 99-603, who are under age 18, over age 65, blind, disabled, or 72.23 Cuban or Haitian, and who meet the eligibility requirements of 72.24 medical assistance under subdivision 1 and sections 256B.055 to 72.25 256B.062 are eligible to receive medical assistance. Pregnant 72.26 women who are aliens seeking legalization under the Immigration 72.27 Reform and Control Act of 1986, Public Law Number 99-603, and 72.28 who meet the eligibility requirements of medical assistance 72.29 under subdivision 1 are eligible for payment of care and 72.30 services through the period of pregnancy and six weeks 72.31 postpartum. Payment shall also be made for care and services 72.32 that are furnished to an alien, regardless of immigration 72.33 status, who otherwise meets the eligibility requirements of this 72.34 section if such care and services are necessary for the 72.35 treatment of an emergency medical condition, except for organ 72.36 transplants and related care and services. For purposes of this 73.1 subdivision, the term "emergency medical condition" means a 73.2 medical condition, including labor and delivery, that if not 73.3 immediately treated could cause a person physical or mental 73.4 disability, continuation of severe pain, or death. 73.5 Sec. 26. Minnesota Statutes 1994, section 256B.0625, 73.6 subdivision 5, is amended to read: 73.7 Subd. 5. [COMMUNITY MENTAL HEALTH CENTER SERVICES.] 73.8 Medical assistance covers community mental health center 73.9 services, as defined in rules adopted by the commissioner73.10pursuant to section 256B.04, subdivision 2, andprovided by a 73.11 community mental health centeras defined in section 245.62,73.12subdivision 2that meets the requirements in paragraphs (a) to 73.13 (j). 73.14 (a) The provider is licensed under Minnesota Rules, parts 73.15 9520.0750 to 9520.0870. 73.16 (b) The provider provides mental health services under the 73.17 clinical supervision of a mental health professional who is 73.18 licensed for independent practice at the doctoral level or by a 73.19 board-certified psychiatrist or a psychiatrist who is eligible 73.20 for board certification. Clinical supervision has the meaning 73.21 given in Minnesota Rules, part 9505.0323, subpart 1, item F. 73.22 (c) The provider must be a private nonprofit corporation or 73.23 a governmental agency and have a community board of directors as 73.24 specified by section 245.66. 73.25 (d) The provider must have a sliding fee scale that meets 73.26 the requirements in Minnesota Rules, part 9550.0060, and agree 73.27 to serve within the limits of its capacity, all individuals 73.28 residing in its service delivery area. 73.29 (e) At a minimum, the provider must provide the following 73.30 outpatient mental health services: diagnostic assessment; 73.31 explanation of findings; family, group, and individual 73.32 psychotherapy, including crisis intervention psychotherapy 73.33 services, multiple family group psychotherapy, psychological 73.34 testing, and medication management. In addition, the provider 73.35 must provide or be capable of providing upon request of the 73.36 local mental health authority day treatment services and 74.1 professional home-based mental health services. The provider 74.2 must have the capacity to provide such services to specialized 74.3 populations such as the elderly, families with children, persons 74.4 who are seriously and persistently mentally ill, and children 74.5 who are seriously emotionally disturbed. 74.6 (f) The provider must be capable of providing the services 74.7 specified in paragraph (e) to individuals who are diagnosed with 74.8 both mental illness or emotional disturbance, and chemical 74.9 dependency, and to individuals dually diagnosed with a mental 74.10 illness or emotional disturbance and mental retardation or a 74.11 related condition. 74.12 (g) The provider must provide 24-hour emergency care 74.13 services or demonstrate the capacity to assist recipients in 74.14 need of such services to access such services on a 24-hour basis. 74.15 (h) The provider must have a contract with the local mental 74.16 health authority to provide one or more of the services 74.17 specified in paragraph (e). 74.18 (i) The provider must agree, upon request of the local 74.19 mental health authority, to enter into a contract with the 74.20 county to provide mental health services not reimbursable under 74.21 the medical assistance program. 74.22 (j) The provider may not be enrolled with the medical 74.23 assistance program as both a hospital and a community mental 74.24 health center. The community mental health center's 74.25 administrative, organizational, and financial structure must be 74.26 separate and distinct from that of the hospital. 74.27 Sec. 27. Minnesota Statutes 1994, section 256B.0625, 74.28 subdivision 13a, is amended to read: 74.29 Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A 74.3012-membernine-member drug utilization review board is 74.31 established. The board is comprised ofsixat least three but 74.32 no more than four licensed physicians actively engaged in the 74.33 practice of medicine in Minnesota;fiveat least three licensed 74.34 pharmacists actively engaged in the practice of pharmacy in 74.35 Minnesota; and one consumer representative; the remainder to be 74.36 made up of health care professionals who are licensed in their 75.1 field and have recognized knowledge in the clinically 75.2 appropriate prescribing, dispensing, and monitoring of covered 75.3 outpatient drugs. The board shall be staffed by an employee of 75.4 the department who shall serve as an ex officio nonvoting member 75.5 of the board. The members of the board shall be appointed by 75.6 the commissioner and shall serve three-year terms. 75.7 Thephysicianmembers shall be selected from lists submitted by 75.8 professionalmedicalassociations.The pharmacist members shall75.9be selected from lists submitted by professional pharmacist75.10associations.The commissioner shall appoint the initial 75.11 members of the board for terms expiring as follows:fourthree 75.12 members for terms expiring June 30,19951996;fourthree 75.13 members for terms expiring June 30,19941997; andfourthree 75.14 members for terms expiring June 30,19931998. Members may be 75.15 reappointed once. The board shall annually elect a chair from 75.16 among the members. 75.17 The commissioner shall, with the advice of the board: 75.18 (1) implement a medical assistance retrospective and 75.19 prospective drug utilization review program as required by 75.20 United States Code, title 42, section 1396r-8(g)(3); 75.21 (2) develop and implement the predetermined criteria and 75.22 practice parameters for appropriate prescribing to be used in 75.23 retrospective and prospective drug utilization review; 75.24 (3) develop, select, implement, and assess interventions 75.25 for physicians, pharmacists, and patients that are educational 75.26 and not punitive in nature; 75.27 (4) establish a grievance and appeals process for 75.28 physicians and pharmacists under this section; 75.29 (5) publish and disseminate educational information to 75.30 physicians and pharmacists regarding the board and the review 75.31 program; 75.32 (6) adopt and implement procedures designed to ensure the 75.33 confidentiality of any information collected, stored, retrieved, 75.34 assessed, or analyzed by the board, staff to the board, or 75.35 contractors to the review program that identifies individual 75.36 physicians, pharmacists, or recipients; 76.1 (7) establish and implement an ongoing process to (i) 76.2 receive public comment regarding drug utilization review 76.3 criteria and standards, and (ii) consider the comments along 76.4 with other scientific and clinical information in order to 76.5 revise criteria and standards on a timely basis; and 76.6 (8) adopt any rules necessary to carry out this section. 76.7 The board may establish advisory committees. The 76.8 commissioner may contract with appropriate organizations to 76.9 assist the board in carrying out the board's duties. The 76.10 commissioner may enter into contracts for services to develop 76.11 and implement a retrospective and prospective review program. 76.12 The board shall report to the commissioner annually on 76.13December 1the date the Drug Utilization Review Annual Report is 76.14 due to the Health Care Financing Administration. This report is 76.15 to cover the preceding federal fiscal year. The commissioner 76.16 shall make the report available to the public upon request. The 76.17 report must include information on the activities of the board 76.18 and the program; the effectiveness of implemented interventions; 76.19 administrative costs; and any fiscal impact resulting from the 76.20 program. An honorarium of $50 per meeting shall be paid to each 76.21 board member in attendance. 76.22 Sec. 28. Minnesota Statutes 1994, section 256B.0625, 76.23 subdivision 18, is amended to read: 76.24 Subd. 18. [BUS OR TAXICAB TRANSPORTATION.] To the extent 76.25 authorized by rule of the state agency, medical assistance 76.26 covers costs ofbus or taxicabthe most appropriate and 76.27 cost-effective form of transportation incurred by any ambulatory 76.28 eligible person for obtaining nonemergency medical care. 76.29 Sec. 29. Minnesota Statutes 1994, section 256B.0628, 76.30 subdivision 2, is amended to read: 76.31 Subd. 2. [DUTIES.] (a) The commissioner may contract with 76.32 or employ qualified registered nurses and necessary support 76.33 staff, or contract with qualified agencies, to provide home care 76.34 prior authorization and review services for medical assistance 76.35 recipients who are receiving home care services. 76.36 (b) Reimbursement for the prior authorization function 77.1 shall be made through the medical assistance administrative 77.2 authority. The state shall pay the nonfederal share. The 77.3 functions will be to: 77.4 (1) assess the recipient's individual need for services 77.5 required to be cared for safely in the community; 77.6 (2) ensure that a care plan that meets the recipient's 77.7 needs is developed by the appropriate agency or individual; 77.8 (3) ensure cost-effectiveness of medical assistance home 77.9 care services; 77.10 (4) recommend the approval or denial of the use of medical 77.11 assistance funds to pay for home care serviceswhen home care77.12services exceed thresholds established by the commissioner under77.13Minnesota Rules, parts 9505.0170 to 9505.0475; 77.14 (5) reassess the recipient's need for and level of home 77.15 care services at a frequency determined by the commissioner; and 77.16 (6) conduct on-site assessments when determined necessary 77.17 by the commissioner and recommend changes to care plans that 77.18 will provide more efficient and appropriate home care. 77.19 (c) In addition, the commissioner or the commissioner's 77.20 designee may: 77.21 (1) review care plans and reimbursement data for 77.22 utilization of services that exceed community-based standards 77.23 for home care, inappropriate home care services, medical 77.24 necessity, home care services that do not meet quality of care 77.25 standards, or unauthorized services and make appropriate 77.26 referrals within the department or to other appropriate entities 77.27 based on the findings; 77.28 (2) assist the recipient in obtaining services necessary to 77.29 allow the recipient to remain safely in or return to the 77.30 community; 77.31 (3) coordinate home care services with other medical 77.32 assistance services under section 256B.0625; 77.33 (4) assist the recipient with problems related to the 77.34 provision of home care services; and 77.35 (5) assure the quality of home care services. 77.36 (d) For the purposes of this section, "home care services" 78.1 means medical assistance services defined under section 78.2 256B.0625, subdivisions 6a, 7, and 19a. 78.3 Sec. 30. Minnesota Statutes 1994, section 256B.0911, 78.4 subdivision 2, is amended to read: 78.5 Subd. 2. [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 78.6 All applicants to Medicaid certified nursing facilities must be 78.7 screened prior to admission, regardless of income, assets, or 78.8 funding sources, except the following: 78.9 (1) patients who, having entered acute care facilities from 78.10 certified nursing facilities, are returning to a certified 78.11 nursing facility; 78.12 (2) residents transferred from other certified nursing 78.13 facilities located within the state of Minnesota; 78.14 (3) individuals who have a contractual right to have their 78.15 nursing facility care paid for indefinitely by the veteran's 78.16 administration;or78.17 (4) individuals who are enrolled in the Ebenezer/Group 78.18 Health social health maintenance organization project, or 78.19 enrolled in a demonstration project under section 256B.69, 78.20 subdivision 18, at the time of application to a nursing home; or 78.21 (5) individuals previously screened and currently being 78.22 served under the alternative care program or under a home- and 78.23 community-based services waiver authorized under section 1915(c) 78.24 of the Social Security Act. 78.25 Regardless of the exemptions in clauses (2) to (4), persons 78.26 who have a diagnosis or possible diagnosis of mental illness, 78.27 mental retardation, or a related condition must be screened 78.28 before admission unless the admission prior to screening is 78.29 authorized by the local mental health authority or the local 78.30 developmental disabilities case manager, or unless authorized by 78.31 the county agency according to Public Law Number 101-508. 78.32 Before admission to a Medicaid certified nursing home or 78.33 boarding care home, all persons must be screened and approved 78.34 for admission through an assessment process. The nursing 78.35 facility is authorized to conduct case mix assessments which are 78.36 not conducted by the county public health nurse under Minnesota 79.1 Rules, part 9549.0059. The designated county agency is 79.2 responsible for distributing the quality assurance and review 79.3 form for all new applicants to nursing homes. 79.4 Other persons who are not applicants to nursing facilities 79.5 must be screened if a request is made for a screening. 79.6 Sec. 31. Minnesota Statutes 1994, section 256B.0911, 79.7 subdivision 2a, is amended to read: 79.8 Subd. 2a. [SCREENING REQUIREMENTS.] Persons may be 79.9 screened by telephone or in a face-to-face consultation. The 79.10 screener will identify each individual's needs according to the 79.11 following categories: (1) needs no face-to-face screening; (2) 79.12 needs an immediate face-to-face screening interview; or (3) 79.13 needs a face-to-face screening interview after admission to a 79.14 certified nursing facility or after a return home. The screener 79.15 shall confer with the screening team to assure that the health 79.16 and social needs of the individual are assessed. Persons who 79.17 are not admitted to a Medicaid certified nursing facility must 79.18 be screened within ten working days after the date of referral. 79.19 Persons admitted on a nonemergency basis to a Medicaid certified 79.20 nursing facility must be screened prior to the certified nursing 79.21 facility admission. Persons admitted to the Medicaid certified 79.22 nursing facility from the community on an emergency basis or 79.23 from an acute care facility on a nonworking day must be screened 79.24 the first working day after admission and the reason for the 79.25 emergency admission must be certified by the attending physician 79.26 in the person's medical record. 79.27 Sec. 32. Minnesota Statutes 1994, section 256B.0911, 79.28 subdivision 3, is amended to read: 79.29 Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE 79.30 PREADMISSION SCREENING.] (a) A local screening team shall be 79.31 established by the county board of commissioners. Each local 79.32 screening team shall consist of screeners who are a social 79.33 worker and a public health nurse from their respective county 79.34 agencies. If a county does not have a public health nurse 79.35 available, it may request approval from the commissioner to 79.36 assign a county registered nurse with at least one year 80.1 experience in home care to participate on the team. The 80.2 screening team members must confer regarding the most 80.3 appropriate care for each individual screened. Two or more 80.4 counties may collaborate to establish a joint local screening 80.5 team or teams. 80.6 (b) In assessing a person's needs, screeners shall have a 80.7 physician available for consultation and shall consider the 80.8 assessment of the individual's attending physician, if any. The 80.9 individual's physician shall be included if the physician 80.10 chooses to participate. Other personnel may be included on the 80.11 team as deemed appropriate by the county agencies. 80.12 Sec. 33. [256B.0912] [ALTERNATIVE CARE AND WAIVERED 80.13 SERVICE PROGRAMS.] 80.14 Subdivision 1. [RESTRUCTURING PLAN.] By January 1, 1996, 80.15 the commissioner shall present a plan to the legislature to 80.16 restructure administration of the alternative care, elderly 80.17 waiver, and disabled waiver programs. The plan must demonstrate 80.18 cost neutrality and provide counties with the flexibility, 80.19 authority, and accountability to administer home- and 80.20 community-based service programs within predetermined fixed 80.21 budgets. To support this local program administration, the 80.22 commissioner shall explore options with the health care 80.23 financing administration to assure flexibility to expand core 80.24 services within the elderly and disabled waivers as long as cost 80.25 neutrality is maintained. 80.26 Subd. 2. [WAIVER PROGRAM MODIFICATIONS.] The commissioner 80.27 of human services shall make the following modifications in 80.28 medical assistance waiver programs, effective for services 80.29 rendered after June 30, 1995, or, if necessary, after federal 80.30 approval is granted: 80.31 (a) The community alternatives for disabled individuals 80.32 waiver shall: 80.33 (1) if medical supplies and equipment or adaptations are or 80.34 will be purchased for a waiver services recipient, allow the 80.35 prorating of costs on a monthly basis throughout the year in 80.36 which they are purchased. If the monthly cost of a recipient's 81.1 other waivered services exceeds the monthly limit established in 81.2 this paragraph, the annual cost of the waivered services shall 81.3 be determined. In this event, the annual cost of waivered 81.4 services shall not exceed 12 times the monthly limit calculated 81.5 in this paragraph; 81.6 (2) require client reassessments once every 12 months; 81.7 (3) permit the purchase of supplies and equipment costing 81.8 $150 or less without prior approval of the commissioner of human 81.9 services. A county is not required to contract with a provider 81.10 of supplies and equipment if the monthly cost of supplies and 81.11 equipment is less than $250; and 81.12 (4) allow the implementation of care plans without the 81.13 approval of the county of financial responsibility when the 81.14 client receives services from another county. 81.15 (b) The traumatic brain injury waiver shall: 81.16 (1) require client reassessments once every 12 months; 81.17 (2) permit the purchase of supplies and equipment costing 81.18 $250 or less without having a contract with the supplier; and 81.19 (3) allow the implementation of care plans without the 81.20 approval of the county of financial responsibility when the 81.21 client receives services from another county. 81.22 Sec. 34. Minnesota Statutes 1994, section 256B.0913, 81.23 subdivision 4, is amended to read: 81.24 Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 81.25 NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 81.26 under the alternative care program is available to persons who 81.27 meet the following criteria: 81.28 (1) the person has been screened by the county screening 81.29 team or, if previously screened and served under the alternative 81.30 care program, assessed by the local county social worker or 81.31 public health nurse; 81.32 (2) the person is age 65 or older; 81.33 (3) the person would be financially eligible for medical 81.34 assistance within 180 days of admission to a nursing facility; 81.35 (4) the person meets the asset transfer requirements of the 81.36 medical assistance program; 82.1 (5) the screening team would recommend nursing facility 82.2 admission or continued stay for the person if alternative care 82.3 services were not available; 82.4 (6) the person needs services that are not available at 82.5 that time in the county through other county, state, or federal 82.6 funding sources; and 82.7 (7) the monthly cost of the alternative care services 82.8 funded by the program for this person does not exceed 75 percent 82.9 of the statewide average monthly medical assistance payment for 82.10 nursing facility care at the individual's case mix 82.11 classification to which the individual would be assigned under 82.12 Minnesota Rules, parts 9549.0050 to 9549.0059. If medical 82.13 supplies and equipment or adaptations are or will be purchased 82.14 for an alternative care services recipient, the costs may be 82.15 prorated on a monthly basis throughout the year in which they 82.16 are purchased. If the monthly cost of a recipient's other 82.17 alternative care services exceeds the monthly limit established 82.18 in this paragraph, the annual cost of the alternative care 82.19 services shall be determined. In this event, the annual cost of 82.20 alternative care services shall not exceed 12 times the monthly 82.21 limit calculated in this paragraph. 82.22 (b) Individuals who meet the criteria in paragraph (a) and 82.23 who have been approved for alternative care funding are called 82.24 180-day eligible clients. 82.25 (c) The statewide average payment for nursing facility care 82.26 is the statewide average monthly nursing facility rate in effect 82.27 on July 1 of the fiscal year in which the cost is incurred, less 82.28 the statewide average monthly income of nursing facility 82.29 residents who are age 65 or older and who are medical assistance 82.30 recipients in the month of March of the previous fiscal year. 82.31 This monthly limit does not prohibit the 180-day eligible client 82.32 from paying for additional services needed or desired. 82.33 (d) In determining the total costs of alternative care 82.34 services for one month, the costs of all services funded by the 82.35 alternative care program, including supplies and equipment, must 82.36 be included. 83.1 (e) Alternative care funding under this subdivision is not 83.2 available for a person who is a medical assistance recipient or 83.3 who would be eligible for medical assistance without a spenddown 83.4 if the person applied, unless authorized by the commissioner. A 83.5 person whose application for medical assistance is being 83.6 processed may be served under the alternative care program for a 83.7 period up to 60 days. If the individual is found to be eligible 83.8 for medical assistance, the county must bill medical assistance 83.9 from the date the individual was found eligible for the medical 83.10 assistance services provided that are reimbursable under the 83.11 elderly waiver program. 83.12 (f) Alternative care funding is not available for a person 83.13 who resides in a licensed nursing home or boarding care home, 83.14 except for case management services which are being provided in 83.15 support of the discharge planning process. 83.16 Sec. 35. Minnesota Statutes 1994, section 256B.0913, 83.17 subdivision 5, is amended to read: 83.18 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 83.19 Alternative care funding may be used for payment of costs of:83.20 (1) adult foster care; 83.21 (2) adult day care; 83.22 (3) home health aide; 83.23 (4) homemaker services; 83.24 (5) personal care; 83.25 (6) case management; 83.26 (7) respite care; 83.27 (8) assisted living; 83.28 (9) residential care services; 83.29 (10) care-related supplies and equipment; 83.30 (11) meals delivered to the home; 83.31 (12) transportation; 83.32 (13) skilled nursing; 83.33 (14) chore services; 83.34 (15) companion services; 83.35 (16) nutrition services; and 83.36 (17) training for direct informal caregivers. 84.1 (b) The county agency must ensure that the funds are used 84.2 only to supplement and not supplant services available through 84.3 other public assistance or services programs. 84.4 (c) Unless specified in statute, the service standards for 84.5 alternative care services shall be the same as the service 84.6 standards defined in the elderly waiver. Persons or agencies 84.7 must be employed by or under a contract with the county agency 84.8 or the public health nursing agency of the local board of health 84.9 in order to receive funding under the alternative care program. 84.10 (d) The adult foster care rate shall be considered a 84.11 difficulty of care payment and shall not include room and 84.12 board. The adult foster care daily rate shall be negotiated 84.13 between the county agency and the foster care provider. The 84.14 rate established under this section shall not exceed 75 percent 84.15 of the state average monthly nursing home payment for the case 84.16 mix classification to which the individual receiving foster care 84.17 is assigned, and it must allow for other alternative care 84.18 services to be authorized by the case manager. 84.19 (e) Personal care services may be provided by a personal 84.20 care provider organization. A county agency may contract with a 84.21 relative of the client to provide personal care services, but 84.22 must ensure nursing supervision. Covered personal care services 84.23 defined in section 256B.0627, subdivision 4, must meet 84.24 applicable standards in Minnesota Rules, part 9505.0335. 84.25 (f) Costs for supplies and equipment that exceed $150 per 84.26 item per month must have prior approval from the commissioner. 84.27 A county may use alternative care funds to purchase supplies and 84.28 equipment from a non-Medicaid certified vendor if the cost for 84.29 the items is less than that of a Medicaid vendor. A county is 84.30 not required to contract with a provider of supplies and 84.31 equipment if the monthly cost of the supplies and equipment is 84.32 less than $250. 84.33 (g) For purposes of this section, residential care services 84.34 are services which are provided to individuals living in 84.35 residential care homes. Residential care homes are currently 84.36 licensed as board and lodging establishments and are registered 85.1 with the department of health as providing special services. 85.2 Residential care services are defined as "supportive services" 85.3 and "health-related services." "Supportive services" means the 85.4 provision of up to 24-hour supervision and oversight. 85.5 Supportive services includes: (1) transportation, when provided 85.6 by the residential care center only; (2) socialization, when 85.7 socialization is part of the plan of care, has specific goals 85.8 and outcomes established, and is not diversional or recreational 85.9 in nature; (3) assisting clients in setting up meetings and 85.10 appointments; (4) assisting clients in setting up medical and 85.11 social services; (5) providing assistance with personal laundry, 85.12 such as carrying the client's laundry to the laundry room. 85.13 Assistance with personal laundry does not include any laundry, 85.14 such as bed linen, that is included in the room and board rate. 85.15 Health-related services are limited to minimal assistance with 85.16 dressing, grooming, and bathing and providing reminders to 85.17 residents to take medications that are self-administered or 85.18 providing storage for medications, if requested. Individuals 85.19 receiving residential care services cannot receive both personal 85.20 care services and residential care services. 85.21 (h) For the purposes of this section, "assisted living" 85.22 refers to supportive services provided by a single vendor to 85.23 clients who reside in the same apartment building of three or 85.24 more units. Assisted living services are defined as up to 85.25 24-hour supervision, and oversight, supportive services as 85.26 defined in clause (1), individualized home care aide tasks as 85.27 defined in clause (2), and individualized home management tasks 85.28 as defined in clause (3) provided to residents of a residential 85.29 center living in their units or apartments with a full kitchen 85.30 and bathroom. A full kitchen includes a stove, oven, 85.31 refrigerator, food preparation counter space, and a kitchen 85.32 utensil storage compartment. Assisted living services must be 85.33 provided by the management of the residential center or by 85.34 providers under contract with the management or with the county. 85.35 (1) Supportive services include: 85.36 (i) socialization, when socialization is part of the plan 86.1 of care, has specific goals and outcomes established, and is not 86.2 diversional or recreational in nature; 86.3 (ii) assisting clients in setting up meetings and 86.4 appointments; and 86.5 (iii) providing transportation, when provided by the 86.6 residential center only. 86.7 Individuals receiving assisted living services will not 86.8 receive both assisted living services and homemaking or personal 86.9 care services. Individualized means services are chosen and 86.10 designed specifically for each resident's needs, rather than 86.11 provided or offered to all residents regardless of their 86.12 illnesses, disabilities, or physical conditions. 86.13 (2) Home care aide tasks means: 86.14 (i) preparing modified diets, such as diabetic or low 86.15 sodium diets; 86.16 (ii) reminding residents to take regularly scheduled 86.17 medications or to perform exercises; 86.18 (iii) household chores in the presence of technically 86.19 sophisticated medical equipment or episodes of acute illness or 86.20 infectious disease; 86.21 (iv) household chores when the resident's care requires the 86.22 prevention of exposure to infectious disease or containment of 86.23 infectious disease; and 86.24 (v) assisting with dressing, oral hygiene, hair care, 86.25 grooming, and bathing, if the resident is ambulatory, and if the 86.26 resident has no serious acute illness or infectious disease. 86.27 Oral hygiene means care of teeth, gums, and oral prosthetic 86.28 devices. 86.29 (3) Home management tasks means: 86.30 (i) housekeeping; 86.31 (ii) laundry; 86.32 (iii) preparation of regular snacks and meals; and 86.33 (iv) shopping. 86.34A person's eligibility to reside in the building must not86.35be contingent on the person's acceptance or use of the assisted86.36living services.Assisted living services as defined in this 87.1 section shall not be authorized in boarding and lodging 87.2 establishments licensed according to sections 157.01 to 157.031. 87.3 Reimbursement for assisted living services and residential 87.4 care services shall be made by the lead agency to the vendor as 87.5 a monthly rate negotiated with the county agency. The rate 87.6 shall not exceed the nonfederal share of the greater of either 87.7 the statewide or any of the geographic groups' weighted average 87.8 monthly medical assistance nursing facility payment rate of the 87.9 case mix resident class to which the 180-day eligible client 87.10 would be assigned under Minnesota Rules, parts 9549.0050 to 87.11 9549.0059, except for alternative care assisted living projects 87.12 established under Laws 1988, chapter 689, article 2, section 87.13 256, whose rates may not exceed 65 percent of either the 87.14 statewide or any of the geographic groups' weighted average 87.15 monthly medical assistance nursing facility payment rate of the 87.16 case mix resident class to which the 180-day eligible client 87.17 would be assigned under Minnesota Rules, parts 9549.0050 to 87.18 9549.0059. The rate may not cover rent and direct food costs. 87.19 (i) For purposes of this section, companion services are 87.20 defined as nonmedical care, supervision and oversight, provided 87.21 to a functionally impaired adult. Companions may assist the 87.22 individual with such tasks as meal preparation, laundry and 87.23 shopping, but do not perform these activities as discrete 87.24 services. The provision of companion services does not entail 87.25 hands-on medical care. Providers may also perform light 87.26 housekeeping tasks which are incidental to the care and 87.27 supervision of the recipient. This service must be approved by 87.28 the case manager as part of the care plan. Companion services 87.29 must be provided by individuals or nonprofit organizations who 87.30 are under contract with the local agency to provide the 87.31 service. Any person related to the waiver recipient by blood, 87.32 marriage or adoption cannot be reimbursed under this service. 87.33 Persons providing companion services will be monitored by the 87.34 case manager. 87.35 (j) For purposes of this section, training for direct 87.36 informal caregivers is defined as a classroom or home course of 88.1 instruction which may include: transfer and lifting skills, 88.2 nutrition, personal and physical cares, home safety in a home 88.3 environment, stress reduction and management, behavioral 88.4 management, long-term care decision making, care coordination 88.5 and family dynamics. The training is provided to an informal 88.6 unpaid caregiver of a 180-day eligible client which enables the 88.7 caregiver to deliver care in a home setting with high levels of 88.8 quality. The training must be approved by the case manager as 88.9 part of the individual care plan. Individuals, agencies, and 88.10 educational facilities which provide caregiver training and 88.11 education will be monitored by the case manager. 88.12 Sec. 36. Minnesota Statutes 1994, section 256B.0913, 88.13 subdivision 8, is amended to read: 88.14 Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 88.15 case manager shall implement the plan of care for each 180-day 88.16 eligible client and ensure that a client's service needs and 88.17 eligibility are reassessed at least everysix12 months. The 88.18 plan shall include any services prescribed by the individual's 88.19 attending physician as necessary to allow the individual to 88.20 remain in a community setting. In developing the individual's 88.21 care plan, the case manager should include the use of volunteers 88.22 from families and neighbors, religious organizations, social 88.23 clubs, and civic and service organizations to support the formal 88.24 home care services. The county shall be held harmless for 88.25 damages or injuries sustained through the use of volunteers 88.26 under this subdivision including workers' compensation 88.27 liability. The lead agency shall provide documentation to the 88.28 commissioner verifying that the individual's alternative care is 88.29 not available at that time through any other public assistance 88.30 or service program. The lead agency shall provide documentation 88.31 in each individual's plan of care and to the commissioner that 88.32 the most cost-effective alternatives available have been offered 88.33 to the individual and that the individual was free to choose 88.34 among available qualified providers, both public and private. 88.35 The case manager must give the individual a ten-day written 88.36 notice of any decrease in or termination of alternative care 89.1 services. 89.2 (b) If the county administering alternative care services 89.3 is different than the county of financial responsibility, the 89.4 care plan may be implemented without the approval of the county 89.5 of financial responsibility. 89.6 Sec. 37. Minnesota Statutes 1994, section 256B.0913, 89.7 subdivision 12, is amended to read: 89.8 Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for 89.9 all 180-day eligible clients to help pay for the cost of 89.10 participating in the program. The amount of the premium for the 89.11 alternative care client shall be determined as follows: 89.12 (1) when the alternative care client's income less 89.13 recurring and predictable medical expenses is greater than the 89.14 medical assistance income standard but less than 150 percent of 89.15 the federal poverty guideline, and total assets are less than 89.16 $6,000, the fee is zero; 89.17 (2) when the alternative care client's income less 89.18 recurring and predictable medical expenses is greater than 150 89.19 percent of the federal poverty guideline and total assets are 89.20 less than $6,000, the fee is 25 percent of the cost of 89.21 alternative care services or the difference between 150 percent 89.22 of the federal poverty guideline and the client's income less 89.23 recurring and predictable medical expenses, whichever is less; 89.24 and 89.25 (3) when the alternative care client's total assets are 89.26 greater than $6,000, the fee is 25 percent of the cost of 89.27 alternative care services. 89.28 For married persons, total assets are defined as the total 89.29 marital assets less the estimated community spouse asset 89.30 allowance, under section 256B.059, if applicable. For married 89.31 persons, total income is defined as the client's income less the 89.32 monthly spousal allotment, under section 256B.058. 89.33 All alternative care services except case management shall 89.34 be included in the estimated costs for the purpose of 89.35 determining 25 percent of the costs. 89.36 The monthly premium shall be calculatedand be payable in90.1thebased on the cost of the first full monthin which theof 90.2 alternative care servicesbeginand shall continue unalteredfor90.3six months until the semiannual reassessment unless the actual90.4cost of services falls below the feeuntil the next reassessment 90.5 is completed or at the end of 12 months, whichever comes first. 90.6 Premiums are due and payable each month alternative care 90.7 services are received unless the actual cost of the services is 90.8 less than the premium. 90.9 (b) The fee shall be waived by the commissioner when: 90.10 (1) a person who is residing in a nursing facility is 90.11 receiving case management only; 90.12 (2) a person is applying for medical assistance; 90.13 (3) a married couple is requesting an asset assessment 90.14 under the spousal impoverishment provisions; 90.15 (4) a person is a medical assistance recipient, but has 90.16 been approved for alternative care-funded assisted living 90.17 services; 90.18 (5) a person is found eligible for alternative care, but is 90.19 not yet receiving alternative care services; 90.20 (6) a person is an adult foster care resident for whom 90.21 alternative care funds are being used to meet a portion of the 90.22 person's medical assistance spenddown, as authorized in 90.23 subdivision 4; and 90.24 (7) a person's fee under paragraph (a) is less than $25. 90.25 (c) The county agency must collect the premium from the 90.26 client and forward the amounts collected to the commissioner in 90.27 the manner and at the times prescribed by the commissioner. 90.28 Money collected must be deposited in the general fund and is 90.29 appropriated to the commissioner for the alternative care 90.30 program. The client must supply the county with the client's 90.31 social security number at the time of application. If a client 90.32 fails or refuses to pay the premium due, the county shall supply 90.33 the commissioner with the client's social security number and 90.34 other information the commissioner requires to collect the 90.35 premium from the client. The commissioner shall collect unpaid 90.36 premiums using the revenue recapture act in chapter 270A and 91.1 other methods available to the commissioner. The commissioner 91.2 may require counties to inform clients of the collection 91.3 procedures that may be used by the state if a premium is not 91.4 paid. 91.5 (d) The commissioner shall begin to adopt emergency or 91.6 permanent rules governing client premiums within 30 days after 91.7 July 1, 1991, including criteria for determining when services 91.8 to a client must be terminated due to failure to pay a premium. 91.9 Sec. 38. Minnesota Statutes 1994, section 256B.0913, 91.10 subdivision 14, is amended to read: 91.11 Subd. 14. [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 91.12 Reimbursement for expenditures for the alternative care services 91.13 as approved by the client's case manager shall be through the 91.14 invoice processing procedures of the department's Medicaid 91.15 Management Information System (MMIS), only with the approval of91.16the client's case manager. To receive reimbursement, the county 91.17 or vendor must submit invoices within120 days12 months 91.18 following themonthdate of service. The county agency and its 91.19 vendors under contract shall not be reimbursed for services 91.20 which exceed the county allocation. 91.21 (b) If a county collects less than 50 percent of the client 91.22 premiums due under subdivision 12, the commissioner may withhold 91.23 up to three percent of the county's final alternative care 91.24 program allocation determined under subdivisions 10 and 11. 91.25 (c) Beginning July 1, 1991, the state will reimburse 91.26 counties, up to the limits of state appropriations, according to 91.27 the payment schedule in section 256.025 for the county share of 91.28 costs incurred under this subdivision on or after January 1, 91.29 1991, for individuals who would be eligible for medical 91.30 assistance within 180 days of admission to a nursing home. 91.31 (d) For fiscal years beginning on or after July 1, 1993, 91.32 the commissioner of human services shall not provide automatic 91.33 annual inflation adjustments for alternative care services. The 91.34 commissioner of finance shall include as a budget change request 91.35 in each biennial detailed expenditure budget submitted to the 91.36 legislature under section 16A.11 annual adjustments in 92.1 reimbursement rates for alternative care services based on the 92.2 forecasted percentage change in the Home Health Agency Market 92.3 Basket of Operating Costs, for the fiscal year beginning July 1, 92.4 compared to the previous fiscal year, unless otherwise adjusted 92.5 by statute. The Home Health Agency Market Basket of Operating 92.6 Costs is published by Data Resources, Inc. The forecast to be 92.7 used is the one published for the calendar quarter beginning 92.8 January 1, six months prior to the beginning of the fiscal year 92.9 for which rates are set. 92.10 (e) The county shall negotiate individual rates with 92.11 vendors and may be reimbursed for actual costs up to the greater 92.12 of the county's current approved rate or 60 percent of the 92.13 maximum rate in fiscal year 1994 and 65 percent of the maximum 92.14 rate in fiscal year 1995 for each alternative care service. 92.15 Notwithstanding any other rule or statutory provision to the 92.16 contrary, the commissioner shall not be authorized to increase 92.17 rates by an annual inflation factor, unless so authorized by the 92.18 legislature. 92.19 (f) On July 1, 1993, the commissioner shall increase the 92.20 maximum rate for home delivered meals to $4.50 per meal. 92.21 Sec. 39. Minnesota Statutes 1994, section 256B.0915, 92.22 subdivision 3, is amended to read: 92.23 Subd. 3. [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 92.24 FORECASTING.] (a) The number of medical assistance waiver 92.25 recipients that a county may serve must be allocated according 92.26 to the number of medical assistance waiver cases open on July 1 92.27 of each fiscal year. Additional recipients may be served with 92.28 the approval of the commissioner. 92.29 (b) The monthly limit for the cost of waivered services to 92.30 an individual waiver client shall be the statewide average 92.31 payment rate of the case mix resident class to which the waiver 92.32 client would be assigned under the medical assistance case mix 92.33 reimbursement system. If medical supplies and equipment or 92.34 adaptations are or will be purchased for an elderly waiver 92.35 services recipient, the costs may be prorated on a monthly basis 92.36 throughout the year in which they are purchased. If the monthly 93.1 cost of a recipient's other waivered services exceeds the 93.2 monthly limit established in this paragraph, the annual cost of 93.3 the waivered services shall be determined. In this event, the 93.4 annual cost of waivered services shall not exceed 12 times the 93.5 monthly limit calculated in this paragraph. The statewide 93.6 average payment rate is calculated by determining the statewide 93.7 average monthly nursing home rate, effective July 1 of the 93.8 fiscal year in which the cost is incurred, less the statewide 93.9 average monthly income of nursing home residents who are age 65 93.10 or older, and who are medical assistance recipients in the month 93.11 of March of the previous state fiscal year. The annual cost 93.12 divided by 12 of elderly or disabled waivered services for a 93.13 person who is a nursing facility resident at the time of 93.14 requesting a determination of eligibility for elderly or 93.15 disabled waivered services shall not exceed the monthly payment 93.16 for the resident class assigned under Minnesota Rules, parts 93.17 9549.0050 to 9549.0059, for that resident in the nursing 93.18 facility where the resident currently resides. The following 93.19 costs must be included in determining the total monthly costs 93.20 for the waiver client: 93.21 (1) cost of all waivered services, including extended 93.22 medical supplies and equipment; and 93.23 (2) cost of skilled nursing, home health aide, and personal 93.24 care services reimbursable by medical assistance. 93.25 (c) Medical assistance funding for skilled nursing 93.26 services, home health aide, and personal care services for 93.27 waiver recipients must be approved by the case manager and 93.28 included in the individual care plan. 93.29 (d) Expenditures for extended medical supplies and 93.30 equipment that cost over $150 per month for both the elderly 93.31 waiver and the disabled waiver must have the commissioner's 93.32 prior approval. A county is not required to contract with a 93.33 provider of supplies and equipment if the monthly cost of the 93.34 supplies and equipment is less than $250. 93.35 (e) For the fiscal year beginning on July 1, 1993, and for 93.36 subsequent fiscal years, the commissioner of human services 94.1 shall not provide automatic annual inflation adjustments for 94.2 home and community-based waivered services. The commissioner of 94.3 finance shall include as a budget change request in each 94.4 biennial detailed expenditure budget submitted to the 94.5 legislature under section 16A.11, annual adjustments in 94.6 reimbursement rates for home and community-based waivered 94.7 services, based on the forecasted percentage change in the Home 94.8 Health Agency Market Basket of Operating Costs, for the fiscal 94.9 year beginning July 1, compared to the previous fiscal year, 94.10 unless otherwise adjusted by statute. The Home Health Agency 94.11 Market Basket of Operating Costs is published by Data Resources, 94.12 Inc. The forecast to be used is the one published for the 94.13 calendar quarter beginning January 1, six months prior to the 94.14 beginning of the fiscal year for which rates are set. The adult 94.15 foster care rate shall be considered a difficulty of care 94.16 payment and shall not include room and board. 94.17 (f) The adult foster care daily rate for the elderly and 94.18 disabled waivers shall be negotiated between the county agency 94.19 and the foster care provider. The rate established under this 94.20 section shall not exceed the state average monthly nursing home 94.21 payment for the case mix classification to which the individual 94.22 receiving foster care is assigned, and it; the rate must allow 94.23 for other waiver and medical assistance home care services to be 94.24 authorized by the case manager. 94.25 (g) The assisted living and residential care service rates 94.26 for elderly anddisabledcommunity alternatives for disabled 94.27 individuals (CADI) waivers shall be made to the vendor as a 94.28 monthly rate negotiated with the county agency. The rate shall 94.29 not exceed the nonfederal share of the greater of either the 94.30 statewide or any of the geographic groups' weighted average 94.31 monthly medical assistance nursing facility payment rate of the 94.32 case mix resident class to which the elderly or disabled client 94.33 would be assigned under Minnesota Rules, parts 9549.0050 to 94.34 9549.0059, except. For alternative care assisted living 94.35 projects established under Laws 1988, chapter 689, article 2, 94.36 section 256,whosemonthly rates may not exceed 65 percent of 95.1 the greater of either the statewide or any of the geographic 95.2 groups' weighted average monthly medical assistance nursing 95.3 facility payment rate for the case mix resident class to which 95.4 the elderly or disabled client would be assigned under Minnesota 95.5 Rules, parts 9549.0050 to 9549.0059. The rate may not cover 95.6 direct rent or food costs. 95.7 (h) The county shall negotiate individual rates with 95.8 vendors and may be reimbursed for actual costs up to the greater 95.9 of the county's current approved rate or 60 percent of the 95.10 maximum rate in fiscal year 1994 and 65 percent of the maximum 95.11 rate in fiscal year 1995 for each service within each program. 95.12 (i) On July 1, 1993, the commissioner shall increase the 95.13 maximum rate for home-delivered meals to $4.50 per meal. 95.14 (j) Reimbursement for the medical assistance recipients 95.15 under the approved waiver shall be made from the medical 95.16 assistance account through the invoice processing procedures of 95.17 the department's Medicaid Management Information System (MMIS), 95.18 only with the approval of the client's case manager. The budget 95.19 for the state share of the Medicaid expenditures shall be 95.20 forecasted with the medical assistance budget, and shall be 95.21 consistent with the approved waiver. 95.22 (k) Beginning July 1, 1991, the state shall reimburse 95.23 counties according to the payment schedule in section 256.025 95.24 for the county share of costs incurred under this subdivision on 95.25 or after January 1, 1991, for individuals who are receiving 95.26 medical assistance. 95.27 Sec. 40. Minnesota Statutes 1994, section 256B.0915, 95.28 subdivision 5, is amended to read: 95.29 Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A 95.30 reassessment of a client served under the elderly or disabled 95.31 waiver must be conducted at least everysix12 months and at 95.32 other times when the case manager determines that there has been 95.33 significant change in the client's functioning. This may 95.34 include instances where the client is discharged from the 95.35 hospital. 95.36 Sec. 41. Minnesota Statutes 1994, section 256B.0915, is 96.1 amended by adding a subdivision to read: 96.2 Subd. 6. [IMPLEMENTATION OF CARE PLAN.] If the county 96.3 administering waivered services is different than the county of 96.4 financial responsibility, the care plan may be implemented 96.5 without the approval of the county of financial responsibility. 96.6 Sec. 42. Minnesota Statutes 1994, section 256B.093, 96.7 subdivision 1, is amended to read: 96.8 Subdivision 1. [STATE TRAUMATIC BRAIN INJURY PROGRAM.] The 96.9 commissioner of human services shall: 96.10 (1)establish andmaintain a statewide traumatic brain 96.11 injury program; 96.12 (2) designate a full-time position to supervise and 96.13 coordinate services and policies for persons with traumatic 96.14 brain injuries; 96.15 (3) contract with qualified agencies or employ staff to 96.16 provide statewide administrative case management and 96.17 consultation; 96.18 (4)establishmaintain an advisory committee to provide 96.19 recommendations ina reportreports to the commissioner 96.20 regarding program and service needs of persons with traumatic 96.21 brain injuries. The advisory committee shall consist of no less 96.22 than ten members and no more than 30 members. The commissioner 96.23 shall appoint all advisory committee members to one- or two-year 96.24 terms and appoint one member as chair;and96.25 (5) investigate the need for the development of rules or 96.26 statutes for:96.27(i)the traumatic brain injury home and community-based 96.28 services waiver; and 96.29(ii) traumatic brain injury services not covered by any96.30other statute or rule(6) investigate present and potential 96.31 models of service coordination which can be delivered at the 96.32 local level. 96.33 Sec. 43. Minnesota Statutes 1994, section 256B.093, 96.34 subdivision 2, is amended to read: 96.35 Subd. 2. [ELIGIBILITY.] Persons eligible for traumatic 96.36 brain injury administrative case management and consultation 97.1 must be eligible medical assistance recipients who have 97.2 traumatic or certain acquired brain injury and:97.3(1)are at risk of institutionalization; or97.4(2) exceed limits established by the commissioner in97.5section 256B.0627, subdivision 5, paragraph (b). 97.6 Sec. 44. Minnesota Statutes 1994, section 256B.093, 97.7 subdivision 3, is amended to read: 97.8 Subd. 3. [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 97.9 department shall fund administrative case management under this 97.10 subdivision using medical assistance administrative funds. The 97.11 traumatic brain injury program duties include: 97.12(1) assessing the person's individual needs for services97.13required to prevent institutionalization;97.14(2) ensuring that a care plan that addresses the person's97.15needs is developed, implemented, and monitored on an ongoing97.16basis by the appropriate agency or individual;97.17(3) assisting the person in obtaining services necessary to97.18allow the person to remain in the community;97.19(4) coordinating home care services with other medical97.20assistance services under section 256B.0625;97.21(5) ensuring appropriate, accessible, and cost-effective97.22medical assistance services;97.23(6) recommending to the commissioner the approval or denial97.24of the use of medical assistance funds to pay for home care97.25services when home care services exceed thresholds established97.26by the commissioner under section 256B.0627;97.27(7) assisting the person with problems related to the97.28provision of home care services;97.29(8) ensuring the quality of home care services;97.30(9) reassessing the person's need for and level of home97.31care services at a frequency determined by the commissioner;97.32(10)(1) recommending to the commissioner the approval or 97.33 denial of medical assistance funds to pay for out-of-state 97.34 placements for traumatic brain injury services and in-state 97.35 traumatic brain injury services provided by designated Medicare 97.36 long-term care hospitals; 98.1(11)(2) coordinating the traumatic brain injury home and 98.2 community-based waiver;and98.3(12)(3) approving traumatic brain injury waiver 98.4 eligibility or care plans or both; 98.5 (4) providing ongoing technical assistance and consultation 98.6 to county and facility case managers to facilitate care plan 98.7 development for appropriate, accessible, and cost-effective 98.8 medical assistance services; 98.9 (5) providing technical assistance to promote statewide 98.10 development of appropriate, accessible, and cost-effective 98.11 medical assistance services and related policy; 98.12 (6) providing training and outreach to facilitate access to 98.13 appropriate home and community-based services to prevent 98.14 institutionalization; 98.15 (7) facilitating appropriate admissions, continued stay 98.16 review, discharges, and utilization review for neurobehavioral 98.17 hospitals and other specialized institutions; 98.18 (8) providing technical assistance on the use of prior 98.19 authorization of home care services and coordination of these 98.20 services with other medical assistance services; 98.21 (9) developing a system for identification of nursing 98.22 facility and hospital residents with traumatic brain injury to 98.23 assist in long-term planning for medical assistance services. 98.24 Factors will include, but are not limited to, number of 98.25 individuals served, length of stay, services received, and 98.26 barriers to community placement; and 98.27 (10) providing information, referral, and case consultation 98.28 to access medical assistance services for recipients without a 98.29 county or facility case manager. Direct access to this 98.30 assistance may be limited due to the regional structure of the 98.31 program. 98.32 Sec. 45. Minnesota Statutes 1994, section 256B.093, is 98.33 amended by adding a subdivision to read: 98.34 Subd. 3a. [TRAUMATIC BRAIN INJURY CASE MANAGEMENT 98.35 SERVICES.] The annual appropriation established under section 98.36 171.29, subdivision 2, paragraph (b), clause (5), shall be used 99.1 for traumatic brain injury program services that include, but 99.2 are not limited to: 99.3 (1) collaborating with counties, providers, and other 99.4 public and private organizations to expand and strengthen local 99.5 capacity for delivering needed services and supports, including 99.6 efforts to increase access to supportive residential housing 99.7 options; 99.8 (2) participating in planning and accessing services not 99.9 otherwise covered in subdivision 3 to allow individuals to 99.10 attain and maintain community-based services; 99.11 (3) providing information, referral, and case consultation 99.12 to access health and human services for persons with traumatic 99.13 brain injury not eligible for medical assistance, though direct 99.14 access to this assistance may be limited due to the regional 99.15 structure of the program; and 99.16 (4) collaborating on injury prevention efforts. 99.17 Sec. 46. Minnesota Statutes 1994, section 256B.431, is 99.18 amended by adding a subdivision to read: 99.19 Subd. 2s. [OPERATING COSTS AFTER JUNE 30, 1997.] (a) In 99.20 general, the commissioner shall establish maximum standard rates 99.21 for the prospective reimbursement of nursing facility costs. 99.22 The maximum standard rates must take into account the level of 99.23 reimbursement which is adequate to cover the base-level costs of 99.24 economically operated nursing facilities. In determining the 99.25 base-level costs, the commissioner shall consider geographic 99.26 location, types of nursing facilities (Rule 80, 99.27 short-length-of-stay, hospital attached, etc.), minimum nursing 99.28 standards, case mix assessment of residents, and other factors 99.29 as determined by the commissioner. 99.30 The commissioner shall also develop additional 99.31 incentive-based payments which if achieved for specified 99.32 outcomes will be added to the maximum standard rates. The 99.33 specified outcomes must be measurable, and shall be based on 99.34 criteria to be developed by the commissioner during fiscal year 99.35 1996. The commissioner may establish various levels of 99.36 achievement within an outcome. Once the outcomes are