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Capital IconMinnesota Legislature

SF 12

as introduced - 91st Legislature, 2019 1st Special Session (2019 - 2020) Posted on 08/29/2019 11:59am

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

Current Version - as introduced

Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 2.45 2.46 2.47 2.48 2.49 2.50 2.51 2.52 2.53 2.54 2.55 2.56 2.57 2.58 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34
3.35 3.36
3.37 3.38 3.39 3.40 3.41
3.42
3.43 3.44 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15
4.16
4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27
4.28
4.29 4.30 4.31 5.1 5.2
5.3
5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8
6.9
6.10 6.11 6.12 6.13 6.14 6.15 6.16
6.17
6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11
7.12
7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 8.1 8.2 8.3 8.4 8.5
8.6
8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30
8.31
9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11
9.12
9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26
9.27
9.28 9.29 9.30 9.31 9.32 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29
10.30
11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9
11.10
11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21
11.22
11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31
11.32
12.1 12.2 12.3 12.4 12.5
12.6
12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17
13.18
13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10
14.11
14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32
17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8
17.9
17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14
18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24
18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16
19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29
19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 22.33 22.34 23.1 23.2 23.3 23.4
23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 24.34 25.1 25.2 25.3 25.4 25.5 25.6 25.7
25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 26.34 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 27.33 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 28.33 28.34 29.1 29.2
29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32
31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19
31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 33.1 33.2 33.3 33.4 33.5 33.6
33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26
35.27 35.28 35.29 35.30 35.31 35.32 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29
37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11
37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24
37.25
37.26 37.27 37.28 37.29 37.30 37.31 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25
39.26
39.27 39.28 39.29 39.30 39.31 39.32 40.1 40.2 40.3 40.4
40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8
41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19
41.20 41.21 41.22 41.23 41.24 41.25 41.26
41.27 41.28 41.29 41.30 41.31 42.1 42.2 42.3
42.4
42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14
42.15
42.16 42.17 42.18 42.19 42.20 42.21
42.22
42.23 42.24 42.25 42.26
43.1 43.2
43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8
48.9
48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 49.1 49.2 49.3 49.4 49.5 49.6
49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31
52.32
53.1 53.2 53.3 53.4 53.5 53.6
53.7
53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21
54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 55.1 55.2
55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28
55.29
56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18
56.19
56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17
57.18
57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32
59.1
59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18
60.19
60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29
60.30
61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27
61.28
61.29 61.30 61.31 61.32 62.1 62.2
62.3
62.4 62.5 62.6 62.7 62.8 62.9
62.10
62.11 62.12 62.13 62.14
62.15
62.16 62.17 62.18 62.19 62.20 62.21
62.22
62.23 62.24 62.25 62.26 62.27 62.28
62.29
63.1 63.2 63.3 63.4 63.5 63.6
63.7
63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29
63.30
64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21
64.22
64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 65.1
65.2
65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23
65.24
65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18
69.19
69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31
69.32
70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 70.33 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16
71.17 71.18
71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6 72.7
72.8
72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21
74.22
74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12
75.13
75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 76.1 76.2
76.3
76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19
76.20
76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31
77.1
77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15
79.16
79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22
80.23
80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9
81.10
81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 81.33 82.1 82.2 82.3 82.4 82.5 82.6
82.7
82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33
83.1
83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 83.33 83.34 83.35 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17
84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 86.33 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12
87.13
87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17
89.18
89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 90.1 90.2 90.3 90.4 90.5 90.6
90.7
90.8 90.9 90.10 90.11 90.12 90.13
90.14
90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28
90.29
91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14
91.15
91.16 91.17 91.18 91.19 91.20 91.21
91.22
91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 92.1 92.2 92.3 92.4
92.5
92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17
92.18
92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18
94.19
94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25
95.26
95.27 95.28 95.29 95.30 95.31
96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18
106.19
106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 109.1 109.2 109.3
109.4
109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22
109.23
109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16
110.17
110.18 110.19 110.20 110.21
110.22
110.23 110.24 110.25 110.26 110.27 110.28
110.29
111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 111.34 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16
112.17
112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20
113.21
113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15
115.16
115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 116.1 116.2 116.3 116.4 116.5
116.6
116.7 116.8 116.9 116.10 116.11
116.12
116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22
117.23 117.24 117.25 117.26 117.27
117.28 117.29
118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8
118.9
118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9
119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30
120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32
120.33 120.34
121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24
121.25 121.26 121.27 121.28 121.29 121.30 121.31 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18
123.19 123.20
123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19
124.20 124.21
124.22 124.23 124.24 124.25 124.26 124.27
124.28 124.29
125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9
126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18
127.19
127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30
128.31
129.1 129.2 129.3 129.4 129.5 129.6
129.7
129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 130.1 130.2 130.3 130.4 130.5
130.6
130.7 130.8 130.9 130.10 130.11 130.12
130.13 130.14
130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30
130.31
131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15
131.16
131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24
131.25
131.26 131.27 131.28 131.29 131.30 131.31
132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19
132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 133.1 133.2
133.3
133.4 133.5 133.6 133.7 133.8
133.9
133.10 133.11 133.12 133.13
133.14
133.15 133.16 133.17 133.18 133.19
133.20
133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 134.1 134.2
134.3
134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10
135.11 135.12
135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31
136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9
136.10
136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 137.1 137.2
137.3
137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13
137.14
137.15 137.16 137.17 137.18
137.19
137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 138.1
138.2
138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11
138.12
138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28
138.29
139.1 139.2 139.3 139.4 139.5 139.6
139.7
139.8 139.9 139.10 139.11 139.12 139.13
139.14
139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26
139.27
139.28 139.29 139.30 139.31 140.1 140.2 140.3
140.4
140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12
140.13
140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 141.1 141.2 141.3 141.4 141.5
141.6
141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32
142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17
142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 143.1 143.2
143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12
144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4
145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 146.34 146.35 147.1 147.2
147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31
147.32
148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33
149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 150.34 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26
151.27 151.28 151.29 151.30 151.31 151.32 151.33 151.34 152.1 152.2 152.3 152.4
152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26
154.27 154.28 154.29 154.30 154.31 154.32 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20
155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32
156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19
156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4
157.5
157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30
157.31
158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24
158.25
158.26 158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14
159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31
160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27
160.28 160.29 160.30 160.31 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12
161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28
162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24
162.25
162.26 162.27 162.28 162.29 162.30 162.31 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22
163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32
163.33
164.1 164.2 164.3 164.4 164.5 164.6 164.7
164.8
164.9 164.10 164.11 164.12 164.13 164.14 164.15
164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25
164.26 164.27 164.28 164.29 164.30 164.31 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10
167.11
167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19
167.20 167.21 167.22 167.23 167.24 167.25
167.26 167.27
168.1 168.2
168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33
169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28
169.29
170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8
170.9 170.10 170.11 170.12
170.13 170.14
170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19
172.20
172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13
174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 175.34 175.35 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18
176.19
176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 182.35 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26
184.27
184.28 184.29 184.30 184.31 184.32 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16
187.17 187.18
187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28
189.29
189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30
190.31 190.32
191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19
191.20 191.21 191.22
191.23 191.24 191.25 191.26 191.27 191.28
191.29
191.30 191.31 191.32 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9
192.10
192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33
192.34
193.1 193.2 193.3 193.4
193.5 193.6
193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19
193.20
193.21 193.22 193.23 193.24 193.25
193.26 193.27
193.28 193.29 193.30 193.31
194.1 194.2
194.3 194.4 194.5 194.6 194.7
194.8 194.9
194.10 194.11 194.12 194.13 194.14
194.15 194.16
194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25
195.26 195.27 195.28
196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 197.34 198.1 198.2
198.3 198.4 198.5 198.6
198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27
200.28 200.29
200.30 200.31 200.32 200.33 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 201.33 201.34 202.1 202.2 202.3 202.4 202.5 202.6 202.7
202.8 202.9
202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11
203.12 203.13
203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27
205.28 205.29
206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17
206.18
206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 207.1 207.2
207.3 207.4
207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28
207.29
208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 208.33 209.1 209.2 209.3
209.4
209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22
209.23 209.24 209.25 209.26 209.27
209.28 209.29 209.30 210.1 210.2 210.3 210.4 210.5 210.6
210.7 210.8
210.9 210.10 210.11 210.12
210.13 210.14
210.15 210.16 210.17 210.18 210.19 210.20
210.21 210.22
210.23 210.24 210.25 210.26
210.27 210.28
211.1 211.2 211.3 211.4 211.5 211.6 211.7
211.8 211.9
211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20
211.21 211.22
211.23 211.24 211.25 211.26 211.27 211.28 211.29
211.30 211.31
212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10
212.11 212.12
212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8
213.9 213.10
213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30
213.31 213.32
214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23
215.24 215.25
215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 219.1 219.2 219.3
219.4 219.5 219.6
219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14
219.15
219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28
220.29 220.30 220.31 220.32 220.33 220.34 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8
221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19
221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 223.1 223.2
223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13
224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8
225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27
225.28 225.29 225.30
226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 226.34 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 227.33 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28
228.29 228.30 228.31 228.32 229.1 229.2 229.3 229.4 229.5 229.6 229.7
229.8
229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30
229.31
230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27
230.28 230.29 230.30
230.31 230.32 230.33
231.1
231.2 231.3 231.4 231.5 231.6 231.7 231.8
231.9
231.10 231.11 231.12 231.13 231.14
231.15
231.16 231.17 231.18 231.19
231.20
231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 232.1 232.2 232.3
232.4
232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28
232.29
233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16
233.17
233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 234.1 234.2 234.3 234.4 234.5 234.6 234.7
234.8
234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28
234.29
235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32
236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11
236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 236.33 236.34 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9
237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32
238.33
239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11
240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23
240.24
240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9
242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29
244.30
244.31 244.32 244.33 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 246.1 246.2 246.3
246.4
246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12
247.13
247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18
249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 250.34 250.35 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18
253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 253.33 253.34 254.1 254.2 254.3 254.4 254.5
254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16
254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 255.1 255.2
255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18
256.19 256.20 256.21
256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 256.33 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16
257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27
259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9
259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22
260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16
261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4
263.5
263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 263.33 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 265.1 265.2 265.3
265.4
265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19
267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 269.1 269.2 269.3 269.4 269.5
269.6 269.7 269.8
269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24
270.25
270.26 270.27 270.28 270.29 270.30 270.31 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26
277.27 277.28 277.29 277.30 277.31 277.32 277.33 277.34 278.1 278.2
278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 278.32 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9
281.10 281.11 281.12 281.13
281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19
283.20 283.21 283.22 283.23
283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10
285.11 285.12 285.13
285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20
287.21 287.22 287.23 287.24
287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18
290.19 290.20
290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28
292.29 292.30 292.31
293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 294.33 295.1 295.2 295.3
295.4
295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15
295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 295.32
296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17
296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 297.1 297.2 297.3 297.4 297.5
297.6
297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17
297.18
297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28
298.29
299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32
300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 302.1 302.2 302.3 302.4
302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25
303.26
303.27 303.28 303.29 303.30 304.1 304.2
304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31
305.1 305.2 305.3 305.4 305.5 305.6 305.7
305.8 305.9 305.10 305.11
305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14
306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30
309.1 309.2 309.3 309.4
309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26
311.27 311.28 311.29 311.30
311.31
312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21
312.22 312.23 312.24 312.25
312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18
313.19
313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 313.33 313.34
314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28
314.29 314.30 314.31 314.32 314.33 315.1 315.2 315.3
315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32
316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14
316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12
317.13
317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24
317.25
317.26 317.27 317.28 318.1 318.2 318.3
318.4 318.5
318.6 318.7
318.8 318.9 318.10 318.11 318.12
318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26
319.27
319.28 319.29 319.30 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 321.1 321.2 321.3 321.4 321.5
321.6
321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 321.32 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 323.33 323.34 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 325.1 325.2
325.3 325.4 325.5
325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24
325.25 325.26 325.27 325.28 325.29
326.1 326.2 326.3 326.4
326.5 326.6 326.7 326.8 326.9
326.10 326.11 326.12 326.13 326.14 326.15
326.16 326.17 326.18 326.19 326.20 326.21
326.22 326.23 326.24 326.25 326.26
326.27 326.28 326.29 326.30 327.1 327.2
327.3 327.4 327.5 327.6
327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21
327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15
331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 332.1 332.2 332.3
332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15
332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10
333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 336.1 336.2 336.3 336.4 336.5
336.6 336.7 336.8 336.9 336.10 336.11 336.12
336.13 336.14 336.15 336.16 336.17 336.18
336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 337.1 337.2 337.3 337.4 337.5 337.6
337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20
337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17
338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24
339.25 339.26 339.27 339.28 339.29
340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13
340.14 340.15 340.16 340.17 340.18 340.19
340.20 340.21 340.22 340.23 340.24 340.25 340.26
340.27 340.28 340.29 340.30 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9
341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10
342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23
342.24 342.25 342.26 342.27 342.28 342.29
343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30
344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20
344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18
345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32
347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33
348.1 348.2 348.3 348.4 348.5 348.6 348.7
348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33
349.1 349.2 349.3
349.4 349.5 349.6 349.7
349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16
349.17
349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28
350.29
350.30 350.31 350.32 350.33 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9
351.10
351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27
351.28
351.29 351.30 351.31 351.32 352.1 352.2 352.3 352.4 352.5
352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32
353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 354.1 354.2 354.3
354.4
354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 356.33 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13
357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25
357.26
357.27 357.28 357.29 357.30 357.31 358.1 358.2 358.3
358.4 358.5
358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14
359.15 359.16 359.17
359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29
359.30
360.1 360.2 360.3 360.4 360.5
360.6
360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 360.33 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9
361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31
361.32
362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13
362.14 362.15 362.16
362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28
362.29 362.30
363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14
363.15 363.16
363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31
364.1 364.2
364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18
364.19 364.20
364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19
365.20 365.21
365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6
366.7 366.8
366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 367.1 367.2 367.3 367.4
367.5 367.6
367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13
369.14 369.15
369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 370.1 370.2
370.3 370.4
370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18
371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16
372.17
372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29
372.30
373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16
373.17
373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28
373.29 373.30 373.31 373.32 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29
375.30 375.31 375.32 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21
376.22 376.23
376.24 376.25
376.26
376.27 376.28
376.29 376.30
377.1
377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12
377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29
379.30
380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19
380.20
380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26
381.27 381.28 381.29 381.30 381.31 381.32 381.33 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 383.1 383.2
383.3 383.4
383.5 383.6
383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 384.1 384.2 384.3 384.4 384.5 384.6
384.7
384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22
384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14
385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 386.33 386.34 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30
388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8
389.9
389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9
390.10
390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 391.33 391.34 391.35 392.1 392.2 392.3
392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12
392.13
392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 393.32 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 394.33 394.34 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33
396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 396.33 396.34 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 397.33 397.34 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19
398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 399.32 399.33 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21
400.22 400.23
400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 400.34 401.1 401.2 401.3 401.4 401.5
401.6 401.7 401.8 401.9 401.10 401.11 401.12
401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10
402.11
402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 403.32 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 404.33 404.34 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28
405.29
405.30 405.31 405.32 405.33 405.34 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32
407.1
407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17
407.18 407.19 407.20 407.21 407.22 407.23
407.24 407.25 407.26
407.27 407.28 407.29 407.30 408.1 408.2 408.3 408.4 408.5 408.6 408.7
408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31
409.32
410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8
410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26
410.27 410.28 410.29 410.30 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23 412.24
412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32 412.33 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 413.33 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13
414.14 414.15 414.16
414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 414.34 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 415.35 415.36 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33 416.34 416.35 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 417.33 417.34 417.35 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15
418.16 418.17 418.18 418.19
418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 418.33 418.34 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 419.33 420.1 420.2 420.3
420.4 420.5
420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 422.33 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20
424.21
424.22 424.23 424.24 424.25 424.26 424.27
424.28
425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12
425.13
425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 426.33 426.34 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 427.33 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 430.34 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11
431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23
431.24
431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10
432.11
432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 434.32 434.33 434.34 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9
435.10
435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 437.1 437.2 437.3 437.4 437.5 437.6 437.7
437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26
437.27 437.28 437.29 437.30
438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 438.32 438.33 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21
440.22 440.23 440.24
440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32
441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13
441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19
442.20 442.21 442.22 442.23 442.24 442.25
442.26 442.27 442.28 442.29 442.30 442.31 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8
443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20
443.21 443.22 443.23 443.24 443.25 443.26 443.27
443.28 443.29 443.30 443.31 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13
444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 445.32 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18
446.19 446.20 446.21 446.22 446.23
446.24 446.25
446.26 446.27 446.28 446.29 446.30 446.31 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18
447.19 447.20
447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 447.32 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20
448.21 448.22
448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33
449.1
449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 450.1 450.2 450.3 450.4 450.5 450.6 450.7
450.8 450.9
450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19
450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 450.33 451.1 451.2 451.3 451.4
451.5
451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27
452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13
453.14 453.15
453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 454.1 454.2
454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 454.32 454.33 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9
455.10 455.11
455.12 455.13 455.14 455.15 455.16 455.17 455.18
455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16
456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 457.1 457.2 457.3 457.4 457.5 457.6
457.7 457.8
457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 457.32 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 459.1 459.2 459.3 459.4 459.5 459.6 459.7
459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28
459.29 459.30
460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 460.31 460.32 461.1 461.2
461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 461.32 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22
462.23
462.24 462.25 462.26 462.27 462.28 462.29 462.30 462.31 462.32
463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19
463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10
464.11
464.12 464.13 464.14 464.15 464.16 464.17 464.18
464.19 464.20 464.21 464.22
464.23 464.24
464.25 464.26 464.27 464.28 464.29 464.30 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32
466.1 466.2 466.3 466.4 466.5
466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16
466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13
467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21
467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26
468.27 468.28 468.29 468.30 468.31 468.32 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 470.33 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 474.32 474.33 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 475.33 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16
477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27
477.28 477.29
477.30 477.31 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8
479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14
481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20
482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 483.1 483.2 483.3 483.4 483.5
483.6
483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26
483.27
484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16
484.17
484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 485.1 485.2 485.3 485.4 485.5 485.6 485.7
485.8 485.9 485.10 485.11 485.12
485.13 485.14 485.15 485.16
485.17 485.18
485.19 485.20
485.21 485.22
485.23 485.24
486.1 486.2 486.3
486.4 486.5 486.6 486.7 486.8 486.9 486.10
486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 487.1 487.2
487.3
487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22
487.23
487.24 487.25 487.26 487.27 487.28 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26
489.27 489.28 489.29 489.30 489.31 490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12
490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25
490.26
490.27 490.28 490.29 490.30 490.31 490.32 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28
491.29
492.1 492.2 492.3 492.4 492.5
492.6
492.7 492.8 492.9 492.10 492.11 492.12
492.13
492.14 492.15 492.16 492.17 492.18 492.19
492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 493.1 493.2 493.3 493.4 493.5
493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27
494.1 494.2
494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22
494.23 494.24 494.25 494.26 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13
495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 495.33 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 496.32 496.33 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 497.33 497.34 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 498.33 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24
499.25 499.26 499.27 499.28 499.29 499.30 499.31
500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20
500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 501.1 501.2 501.3 501.4 501.5 501.6
501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29 501.30 501.31 501.32 501.33 502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 502.33 503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13
503.14 503.15 503.16 503.17 503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 503.31 503.32 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15
504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31 504.32 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16
505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16
506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25
506.26 506.27 506.28 506.29 506.30 506.31 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15
507.16 507.17 507.18 507.19
507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24
508.25 508.26 508.27 508.28 508.29 508.30 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13
509.14 509.15 509.16 509.17 509.18
509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29 509.30 509.31 509.32 510.1 510.2 510.3 510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32 510.33 511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 511.31 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26 513.27 513.28 513.29 513.30 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18
516.19 516.20 516.21 516.22 516.23 516.24 516.25
516.26 516.27 516.28 516.29 516.30 516.31 516.32 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 517.32 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28
518.29 518.30 518.31 518.32 519.1 519.2 519.3 519.4 519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 519.32 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30
522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 522.31 522.32 522.33 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 523.31 523.32 523.33 524.1 524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17
524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 524.31 524.32 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 525.31 525.32 525.33 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 526.33 526.34 527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16 527.17 527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 527.32 527.33 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25
528.26 528.27 528.28 528.29 528.30 528.31 528.32 528.33 529.1 529.2 529.3
529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12
529.13 529.14 529.15 529.16 529.17 529.18
529.19 529.20 529.21 529.22
529.23
529.24 529.25
529.26 529.27 529.28 529.29 529.30 530.1 530.2 530.3
530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16
530.17
530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8
531.9
531.10 531.11 531.12 531.13
531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 532.1 532.2 532.3
532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16
532.17 532.18 532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 532.31 533.1 533.2 533.3 533.4 533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21
533.22 533.23 533.24 533.25 533.26 533.27 533.28 533.29 533.30 533.31 534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28
535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8
535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27
535.28 535.29 535.30 535.31
536.1 536.2 536.3 536.4 536.5 536.6 536.7
536.8 536.9 536.10 536.11 536.12 536.13
536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26
536.27 536.28 536.29 536.30 536.31 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20
537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32
537.33
538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19
538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18
539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31
540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9
541.10 541.11 541.12 541.13 541.14 541.15
541.16
541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 542.1 542.2 542.3 542.4
542.5 542.6 542.7 542.8 542.9 542.10
542.11 542.12 542.13
542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21
542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 543.1 543.2 543.3
543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17
543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 543.32 544.1 544.2 544.3 544.4 544.5 544.6
544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18
544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30
545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8
545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19
547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 547.33 547.34 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 548.33 548.34 549.1 549.2 549.3 549.4 549.5 549.6
549.7 549.8
549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30
549.31
550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16
550.17
550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 550.31 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21
552.22
552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 552.32
553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9
553.10 553.11 553.12 553.13 553.14 553.15
553.16 553.17 553.18 553.19 553.20
553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16
554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 555.32 555.33 555.34 555.35 555.36 555.37 555.38 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26
556.27
556.28 556.29 556.30 556.31 556.32 556.33 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 558.31 558.32 558.33 559.1 559.2
559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23
560.24 560.25 560.26 560.27 560.28 560.29 560.30 560.31 560.32 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21
561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12
562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 562.30 562.31 563.1 563.2 563.3 563.4 563.5
563.6 563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 563.32 563.33 563.34 564.1 564.2 564.3 564.4
564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24 564.25
564.26 564.27 564.28 564.29
565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26
565.27 565.28 565.29 565.30 565.31 565.32 565.33 566.1 566.2
566.3 566.4 566.5 566.6 566.7 566.8 566.9
566.10 566.11 566.12 566.13 566.14 566.15 566.16 566.17 566.18 566.19 566.20
566.21 566.22 566.23 566.24 566.25 566.26 566.27 566.28 566.29 566.30 566.31 566.32 567.1 567.2
567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27 567.28 567.29 567.30 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9
568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27 568.28 568.29 568.30 568.31
569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17
569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27 569.28 569.29 569.30 569.31 570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9 570.10 570.11
570.12 570.13 570.14 570.15 570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 570.31 571.1 571.2 571.3 571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12 571.13 571.14 571.15 571.16 571.17 571.18 571.19 571.20 571.21 571.22 571.23 571.24 571.25 571.26 571.27
571.28 571.29 571.30 571.31 571.32 572.1 572.2
572.3 572.4 572.5 572.6 572.7 572.8 572.9 572.10 572.11 572.12 572.13 572.14 572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24 572.25 572.26 572.27 572.28 572.29 572.30 572.31
573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10 573.11 573.12 573.13 573.14
573.15 573.16 573.17 573.18 573.19 573.20 573.21 573.22 573.23 573.24 573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 574.1 574.2 574.3 574.4 574.5 574.6 574.7 574.8
574.9 574.10 574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21
574.22 574.23 574.24 574.25 574.26 574.27 574.28 574.29 574.30 575.1 575.2 575.3 575.4 575.5 575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15 575.16 575.17 575.18
575.19 575.20 575.21 575.22 575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 575.32 575.33 576.1 576.2 576.3 576.4
576.5 576.6 576.7 576.8 576.9 576.10 576.11 576.12 576.13 576.14
576.15 576.16 576.17 576.18 576.19 576.20 576.21 576.22 576.23 576.24
576.25 576.26 576.27 576.28 576.29 576.30 576.31 576.32 577.1 577.2 577.3 577.4 577.5 577.6 577.7 577.8 577.9 577.10 577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20
577.21 577.22 577.23 577.24 577.25 577.26 577.27 577.28 577.29 577.30 577.31
578.1 578.2 578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17 578.18 578.19 578.20 578.21 578.22 578.23 578.24 578.25 578.26 578.27 578.28 578.29 578.30 579.1 579.2 579.3 579.4 579.5 579.6 579.7 579.8 579.9 579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29
579.30 579.31 579.32 579.33 579.34 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12 580.13 580.14 580.15 580.16 580.17 580.18 580.19 580.20 580.21 580.22 580.23 580.24 580.25
580.26 580.27 580.28 580.29 580.30 580.31 580.32 580.33 581.1 581.2 581.3 581.4 581.5 581.6 581.7
581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16
581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24 581.25 581.26 581.27 581.28 581.29 581.30 581.31 582.1 582.2 582.3 582.4 582.5 582.6 582.7 582.8 582.9 582.10 582.11 582.12 582.13 582.14 582.15 582.16 582.17 582.18 582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 582.30 582.31 582.32 583.1 583.2 583.3 583.4 583.5 583.6 583.7 583.8 583.9 583.10 583.11 583.12 583.13 583.14 583.15 583.16 583.17 583.18
583.19 583.20
583.21 583.22 583.23 583.24 583.25 583.26 583.27 583.28 583.29 583.30
584.1 584.2 584.3 584.4
584.5 584.6 584.7 584.8
584.9 584.10 584.11 584.12 584.13 584.14 584.15 584.16 584.17 584.18 584.19 584.20 584.21 584.22 584.23
584.24 584.25 584.26 584.27 584.28 584.29 584.30 585.1 585.2 585.3 585.4
585.5 585.6 585.7 585.8 585.9
585.10 585.11 585.12 585.13 585.14 585.15 585.16 585.17 585.18 585.19 585.20 585.21 585.22 585.23 585.24 585.25 585.26 585.27 585.28 585.29 585.30 585.31 586.1 586.2 586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18
586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29
586.30 586.31 586.32 587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8
587.9 587.10 587.11 587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19
587.20 587.21 587.22 587.23 587.24 587.25 587.26 587.27 587.28 587.29 587.30 587.31 587.32 588.1 588.2 588.3 588.4 588.5 588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26 588.27 588.28 588.29 588.30 588.31 588.32 588.33
589.1 589.2 589.3 589.4 589.5 589.6 589.7 589.8 589.9 589.10 589.11 589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27 589.28 589.29 589.30 589.31 589.32 589.33
590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10 590.11 590.12 590.13 590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22
590.23 590.24 590.25 590.26 590.27 590.28 590.29
590.30 590.31 590.32 591.1 591.2 591.3 591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19 591.20 591.21 591.22 591.23 591.24 591.25 591.26 591.27 591.28 591.29 591.30 591.31 591.32
592.1 592.2 592.3 592.4 592.5 592.6 592.7 592.8 592.9 592.10 592.11 592.12 592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21 592.22 592.23 592.24 592.25 592.26 592.27 592.28 592.29 592.30 592.31 593.1 593.2 593.3 593.4 593.5
593.6 593.7 593.8 593.9 593.10 593.11 593.12 593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22 593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 593.31 593.32 593.33 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28 594.29 594.30 594.31 594.32 594.33 595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12
595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23
595.24 595.25 595.26 595.27 595.28 595.29 595.30 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11 596.12 596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24 596.25 596.26 596.27 596.28 596.29 596.30 596.31 597.1 597.2 597.3 597.4
597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14 597.15
597.16 597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 597.30 597.31
598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21 598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 598.31 598.32 598.33 599.1 599.2 599.3 599.4 599.5 599.6 599.7 599.8 599.9 599.10 599.11 599.12 599.13 599.14 599.15
599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24
599.25 599.26 599.27 599.28 599.29 599.30 599.31 599.32 599.33
600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8 600.9 600.10 600.11 600.12 600.13 600.14 600.15 600.16 600.17 600.18 600.19 600.20
600.21 600.22 600.23 600.24 600.25 600.26 600.27 600.28 600.29 600.30 600.31 601.1
601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13 601.14 601.15 601.16 601.17 601.18 601.19 601.20 601.21 601.22 601.23 601.24 601.25 601.26 601.27 601.28 601.29 601.30 601.31 602.1 602.2 602.3 602.4 602.5 602.6 602.7 602.8 602.9 602.10 602.11 602.12 602.13 602.14 602.15 602.16 602.17 602.18 602.19 602.20 602.21 602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 602.30 602.31 602.32 602.33 603.1 603.2 603.3 603.4 603.5 603.6 603.7 603.8 603.9
603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23
603.24 603.25
603.26 603.27 603.28 603.29 603.30 604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 604.31 604.32 604.33 605.1 605.2 605.3 605.4 605.5 605.6 605.7 605.8 605.9
605.10 605.11
605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24 605.25 605.26
605.27 605.28 605.29 605.30 605.31 606.1 606.2 606.3 606.4 606.5 606.6 606.7 606.8 606.9 606.10 606.11 606.12 606.13 606.14 606.15 606.16 606.17 606.18 606.19 606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 606.31 606.32 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15 607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25 607.26 607.27 607.28 607.29 607.30 607.31 608.1 608.2 608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10 608.11 608.12 608.13 608.14 608.15 608.16 608.17 608.18 608.19 608.20 608.21 608.22 608.23 608.24 608.25 608.26 608.27 608.28 608.29 608.30 608.31
609.1 609.2 609.3 609.4 609.5 609.6 609.7 609.8 609.9 609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28 609.29 609.30 609.31 610.1 610.2 610.3 610.4 610.5 610.6 610.7 610.8 610.9 610.10 610.11 610.12 610.13 610.14 610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 611.1 611.2
611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14 611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30 611.31 612.1 612.2 612.3
612.4 612.5 612.6 612.7 612.8 612.9 612.10 612.11 612.12 612.13 612.14 612.15 612.16 612.17 612.18 612.19 612.20 612.21 612.22 612.23 612.24 612.25 612.26 612.27
612.28 612.29 612.30 613.1 613.2
613.3 613.4 613.5 613.6 613.7 613.8
613.9 613.10
613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21
613.22 613.23
613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32 614.1 614.2
614.3 614.4 614.5 614.6 614.7 614.8 614.9 614.10 614.11 614.12 614.13 614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26 614.27 614.28 614.29 614.30 614.31 614.32 614.33 615.1 615.2 615.3
615.4 615.5
615.6 615.7
615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15 615.16 615.17 615.18 615.19
615.20 615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15 616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25 616.26 616.27 616.28 616.29 616.30 616.31 616.32 616.33 616.34 617.1 617.2 617.3 617.4 617.5 617.6 617.7 617.8 617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 617.31 617.32 617.33 617.34 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11 618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 618.30 618.31 618.32 618.33 619.1 619.2 619.3 619.4 619.5 619.6 619.7 619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 619.31 619.32 619.33 619.34 619.35 620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8 620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21 620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 620.31 620.32 620.33 620.34 621.1 621.2 621.3 621.4 621.5 621.6 621.7 621.8 621.9 621.10 621.11 621.12 621.13 621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28 621.29 621.30 621.31 621.32 621.33 621.34 621.35 622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8 622.9 622.10 622.11 622.12 622.13 622.14 622.15 622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27 622.28 622.29 622.30 622.31 622.32 622.33 623.1 623.2 623.3 623.4 623.5 623.6 623.7 623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17 623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 623.33 623.34 623.35 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11 624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 624.30 624.31 624.32 624.33 624.34 625.1 625.2 625.3 625.4 625.5 625.6 625.7 625.8 625.9 625.10 625.11 625.12 625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 625.31 625.32 625.33 625.34 625.35 626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16 626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 626.32 626.33 626.34 626.35 627.1 627.2 627.3 627.4 627.5 627.6 627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21 627.22 627.23 627.24 627.25 627.26 627.27 627.28 627.29 627.30 627.31 627.32 627.33 627.34 627.35 627.36 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 628.32 628.33 628.34 628.35 629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 629.32 629.33 629.34 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 630.31 630.32 630.33 630.34 630.35 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 631.31 632.1 632.2 632.3 632.4 632.5 632.6 632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16 632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 632.32 632.33 632.34 632.35 633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22 633.23 633.24 633.25 633.26 633.27 633.28 633.29 633.30 633.31 633.32 633.33 633.34 633.35 634.1 634.2 634.3 634.4 634.5 634.6 634.7 634.8 634.9 634.10 634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19 634.20 634.21 634.22 634.23 634.24 634.25 634.26 634.27 634.28 634.29 634.30 634.31 634.32 634.33 634.34 635.1 635.2 635.3 635.4 635.5 635.6 635.7 635.8 635.9 635.10 635.11 635.12 635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20 635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28 635.29 635.30 635.31 635.32 635.33 635.34 636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26 636.27 636.28 636.29 636.30 636.31 636.32 636.33 636.34 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16
637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 637.32 637.33 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 638.31 638.32 638.33 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 639.32 639.33 639.34 640.1 640.2 640.3 640.4 640.5 640.6 640.7 640.8 640.9 640.10 640.11 640.12 640.13 640.14 640.15 640.16 640.17 640.18 640.19 640.20 640.21 640.22 640.23 640.24 640.25 640.26 640.27 640.28 640.29 640.30 640.31 640.32 640.33 641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16 641.17 641.18 641.19 641.20 641.21 641.22 641.23 641.24 641.25 641.26 641.27 641.28 641.29 641.30 641.31 641.32 641.33 641.34 642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17 642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26
642.27 642.28 642.29 642.30 642.31 642.32 642.33 643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 643.31 643.32 643.33 644.1 644.2 644.3 644.4 644.5 644.6 644.7 644.8 644.9 644.10 644.11 644.12 644.13 644.14 644.15 644.16 644.17 644.18 644.19 644.20 644.21 644.22 644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 644.32 644.33 644.34 644.35 645.1 645.2 645.3 645.4 645.5 645.6 645.7 645.8 645.9 645.10 645.11 645.12 645.13 645.14 645.15 645.16 645.17 645.18 645.19 645.20 645.21 645.22 645.23 645.24 645.25 645.26 645.27
645.28 645.29 645.30 645.31 645.32 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18 646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28 646.29 646.30
646.31
646.32 646.33 646.34 647.1 647.2 647.3 647.4 647.5
647.6
647.7
647.8 647.9 647.10 647.11
647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 647.31 647.32 647.33 647.34 648.1 648.2 648.3 648.4 648.5 648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14 648.15 648.16 648.17 648.18 648.19 648.20 648.21 648.22 648.23 648.24 648.25 648.26 648.27
648.28 648.29 648.30 648.31 648.32 648.33 648.34 649.1 649.2 649.3 649.4 649.5 649.6 649.7 649.8 649.9 649.10 649.11 649.12
649.13 649.14 649.15
649.16 649.17 649.18
649.19 649.20

A bill for an act
relating to health and human services; modifying provisions relating to children
and families, operations, direct care and treatment, continuing care for older adults,
disability services, chemical and mental health, health care, health coverage,
prescription drugs, health-related licensing boards, Health Department, and
additional miscellaneous provisions; modifying provisions governing child care
providers, child care assistance program, and medical assistance; establishing
Child Welfare Training Academy; modifying sections relating to data; establishing
Family Child Care Task Force; modifying provisions governing nursing facility
property payment rates, disability waiver rate-setting, and home and
community-based services; modifying requirements for substance use disorder
treatment; establishing Community Competency Restoration Task Force; modifying
step therapy exceptions; requiring certain coverage for PANDAS and PANS;
establishing cost-sharing limits for prescription insulin drugs; establishing
prescription drug repository program; requiring licensure of wholesale distributors
and third-party logistics providers; modifying sections relating to borings;
modifying provisions relating to hemp, cannabinoid products, and medical cannabis;
designating Maternal Mental Health Awareness Month; establishing grant programs;
modifying fees; making technical changes; requiring studies and reports; adjusting
the forecast; appropriating money; amending Minnesota Statutes 2018, sections
13.46, subdivisions 2, 3, 4; 13.461, subdivision 28; 13.69, subdivision 1; 13.851,
by adding a subdivision; 15C.02; 16A.055, subdivision 1a; 16A.724, subdivision
2; 18K.03; 62A.30, by adding a subdivision; 62D.12, by adding a subdivision;
62D.124, subdivision 3, by adding a subdivision; 62E.23, subdivision 3; 62E.24,
subdivision 2; 62J.23, subdivision 2; 62J.495, subdivisions 1, 3; 62K.07; 62K.075;
62K.10, subdivision 5; 62Q.01, by adding a subdivision; 62Q.184, subdivisions
1, 3; 62Q.47; 62U.04, subdivision 4; 103I.005, subdivisions 2, 8a, 17a; 103I.205,
subdivisions 1, 4, 9; 103I.208, subdivision 1; 103I.235, subdivision 3; 103I.301,
subdivision 6, by adding a subdivision; 103I.601, subdivision 4; 119B.011,
subdivisions 19, 20, by adding a subdivision; 119B.02, subdivisions 6, 7; 119B.025,
subdivision 1, by adding a subdivision; 119B.03, subdivision 9; 119B.09,
subdivisions 1, 7; 119B.095, subdivision 2, by adding a subdivision; 119B.125,
subdivision 6; 119B.13, subdivisions 6, 7; 119B.16, subdivisions 1, 1a, 1b, by
adding subdivisions; 144.057, subdivision 3; 144.121, subdivision 1a, by adding
a subdivision; 144.1506, subdivision 2; 144.225, subdivisions 2, 2a, 7; 144.3831,
subdivision 1; 144.412; 144.413, subdivisions 1, 4; 144.414, subdivisions 2, 3;
144.416; 144.4165; 144.4167, subdivision 4; 144.417, subdivision 4; 144.552;
144.562, subdivision 2; 144.586, by adding a subdivision; 144.966, subdivision
2; 144.99, subdivision 1; 144A.071, subdivisions 1a, 2, 3, 4a, 4c, 4d, 5a; 144A.073,
subdivision 3c, by adding a subdivision; 144A.43, subdivisions 11, 30, by adding
a subdivision; 144A.472, subdivisions 5, 7; 144A.473; 144A.474, subdivision 2;
144A.475, subdivisions 1, 2, 5; 144A.476, subdivision 1; 144A.479, subdivision
7, by adding a subdivision; 144A.4791, subdivisions 1, 3, 6, 7, 8, 9; 144A.4792,
subdivisions 1, 2, 5, 10; 144A.4793, subdivision 6; 144A.4796, subdivision 2;
144A.4797, subdivision 3; 144A.4798; 144A.4799, subdivisions 1, 3; 144A.484,
subdivision 1; 145.908, subdivision 1; 145.928, subdivisions 1, 7; 145.986,
subdivisions 1, 1a, 4, 5, 6; 147.037, subdivision 1; 147.0375, subdivision 1;
147D.27, by adding a subdivision; 147E.40, subdivision 1, as amended; 147F.17,
subdivision 1, as amended; 148.59; 148.6445, subdivisions 1, 2, 2a, 3, 4, 5, 6, 10;
148.7815, subdivision 1, as amended; 148E.180; 150A.06, subdivision 3, by adding
subdivisions; 150A.091, by adding subdivisions; 151.01, subdivisions 23, 31, 35;
151.06, by adding a subdivision; 151.065, subdivisions 1, 2, 3, 6; 151.071,
subdivision 2; 151.15, subdivision 1, by adding subdivisions; 151.19, subdivisions
1, 3; 151.211, subdivision 2, by adding a subdivision; 151.252, subdivisions 1, 1a,
3; 151.253, by adding a subdivision; 151.32; 151.40, subdivisions 1, 2; 151.43;
151.46; 151.47, subdivision 1, by adding a subdivision; 152.01, subdivision 9;
152.126, subdivisions 6, 7, by adding a subdivision; 152.22, subdivisions 6, 11,
13, by adding subdivisions; 152.25, subdivisions 1, 1a, 1c, 4; 152.27, subdivisions
2, 3, 4, 5, 6; 152.28, subdivision 1; 152.29, subdivisions 1, 2, 3, 3a; 152.31; 152.32,
subdivision 2; 152.33, subdivisions 1, 2; 152.34; 152.36, subdivision 2; 157.22;
214.25, subdivision 2; 237.50, subdivisions 4a, 6a, 10a, 11, by adding subdivisions;
237.51, subdivisions 1, 5a; 237.52, subdivision 5; 237.53; 245.095; 245.4889,
subdivision 1; 245.735, subdivision 3; 245A.02, subdivisions 3, 5a, 8, 9, 12, 14,
18, by adding subdivisions; 245A.03, subdivisions 1, 3; 245A.04, subdivisions 1,
2, 4, 6, 7, 10, by adding subdivisions; 245A.05; 245A.07, subdivisions 1, 2, 2a, 3;
245A.14, subdivisions 4, 8, by adding subdivisions; 245A.145, subdivisions 1, 2;
245A.151; 245A.16, subdivision 1; 245A.18, subdivision 2; 245A.40; 245A.41;
245A.50, subdivision 1; 245A.51, subdivision 3, by adding subdivisions; 245A.66,
subdivisions 2, 3; 245C.02, subdivision 6a, by adding subdivisions; 245C.03,
subdivision 1; 245C.05, subdivisions 4, 5, 5a; 245C.08, subdivisions 1, 3; 245C.10,
by adding a subdivision; 245C.13, subdivision 2, by adding a subdivision; 245C.22,
subdivisions 4, 5; 245C.24, subdivisions 1, 2, by adding a subdivision; 245C.30,
subdivisions 1, 2, 3; 245D.03, subdivision 1; 245D.071, subdivisions 1, 5;
245D.081, subdivision 3; 245D.09, subdivisions 5, 5a; 245D.091, subdivisions 2,
3, 4; 245E.02, by adding a subdivision; 245E.06, subdivision 3; 245F.05,
subdivision 2; 245G.01, subdivisions 8, 21, by adding subdivisions; 245G.04;
245G.05; 245G.06, subdivisions 1, 2, 4; 245G.07; 245G.08, subdivision 3; 245G.10,
subdivision 4; 245G.11, subdivisions 7, 8; 245G.12; 245G.13, subdivision 1;
245G.15, subdivisions 1, 2; 245G.18, subdivisions 3, 5; 245G.19, subdivision 4;
245G.22, subdivisions 1, 2, 3, 4, 6, 7, 15, 16, 17, 19; 245H.01, by adding
subdivisions; 245H.03, by adding a subdivision; 245H.07; 245H.10, subdivision
1; 245H.11; 245H.13, subdivision 5, by adding subdivisions; 245H.14, subdivisions
1, 2, 3, 4, 5, 6; 245H.15, subdivision 1; 246.54, by adding a subdivision; 246B.10;
252.27, subdivision 2a; 252.275, subdivision 3; 252.32, subdivision 1a; 252.41,
subdivisions 3, 4, 5, 6, 7, 9; 252.42; 252.43; 252.44; 252.45; 254A.03, subdivision
3; 254A.19, by adding a subdivision; 254B.02, subdivision 1; 254B.03, subdivisions
2, 4; 254B.04, subdivision 1, by adding a subdivision; 254B.05, subdivisions 1,
1a, 1b, 5; 254B.06, subdivisions 1, 2; 256.01, subdivision 14b; 256.043, as added;
256.046, subdivision 1, by adding a subdivision; 256.9365; 256.962, subdivision
5; 256.969, subdivisions 2b, 3a, 9, 17, 19; 256.98, subdivisions 1, 8; 256.983, by
adding a subdivision; 256B.02, subdivision 7; 256B.04, subdivisions 14, 21, 22,
by adding a subdivision; 256B.055, subdivision 2; 256B.056, subdivisions 1, 3,
5c, 7a; 256B.0625, subdivisions 3b, 13, 13e, 13f, 17, 24, 30, 43, 45a, 57, by adding
subdivisions; 256B.064, subdivisions 1a, 1b, 2, by adding subdivisions; 256B.0651,
subdivision 17; 256B.0658; 256B.0659, subdivisions 3a, 11, 12, 13, 19, 21, 24,
28, by adding a subdivision; 256B.0757, subdivisions 1, 2, 4, by adding
subdivisions; 256B.0911, subdivisions 1a, 3a, 3f, 5, by adding a subdivision;
256B.0915, subdivisions 3a, 6; 256B.092, subdivision 1b; 256B.0921; 256B.27,
subdivision 3; 256B.434, subdivisions 1, 3; 256B.49, subdivisions 13, 14;
256B.4912, by adding subdivisions; 256B.4913, subdivision 4a; 256B.4914,
subdivisions 2, 3, as amended, 4, 5, 6, 7, 8, 9, 10, 10a, 14, 15, by adding a
subdivision; 256B.5014; 256B.69, subdivision 4, by adding a subdivision;
256B.766; 256B.79, subdivisions 2, 3, 4, 5, 6; 256B.85, subdivisions 3, 10, 11,
12, 16, by adding a subdivision; 256I.03, subdivision 8; 256I.04, subdivisions 1,
2b, 2f, by adding subdivisions; 256I.06, subdivision 8; 256J.24, subdivision 5;
256K.45, subdivision 2; 256L.11, subdivision 2; 256M.41, subdivision 3, by adding
a subdivision; 256R.02, subdivisions 8, 19, 33, by adding subdivisions; 256R.21,
by adding a subdivision; 256R.25; 256R.26; 256R.44; 256R.50, subdivision 6;
260C.007, subdivision 18, by adding a subdivision; 260C.178, subdivision 1;
260C.201, subdivisions 1, 2, 6; 260C.212, subdivision 2; 260C.452, subdivision
4; 260C.503, subdivision 1; 518A.32, subdivision 3; 518A.51; 641.15, subdivision
3a; Laws 2017, chapter 13, article 1, section 15, as amended; Laws 2017, First
Special Session chapter 6, article 1, sections 44; 45; article 3, section 49; article
5, section 11; article 8, sections 71, as amended; 72, as amended; Laws 2019,
chapter 60, article 3, section 1, subdivision 5; proposing coding for new law in
Minnesota Statutes, chapters 10; 62A; 62K; 62Q; 119B; 144; 144A; 148; 151;
214; 245; 245A; 245D; 256B; 256K; 256R; 260C; repealing Minnesota Statutes
2018, sections 119B.125, subdivision 8; 119B.16, subdivision 2; 144.414,
subdivision 5; 144A.45, subdivision 6; 144A.481; 151.42; 151.44; 151.49; 151.50;
151.51; 151.55; 214.17; 214.18; 214.19; 214.20; 214.21; 214.22; 214.23; 214.24;
245E.06, subdivisions 2, 4, 5; 245H.10, subdivision 2; 246.18, subdivisions 8, 9;
252.41, subdivision 8; 252.431; 252.451; 254B.03, subdivision 4a; 256B.0625,
subdivisions 31c, 63; 256B.0659, subdivision 22; 256B.0705; 256B.431,
subdivisions 3i, 15, 16; 256B.434, subdivisions 6, 10; 256B.4913, subdivisions
4a, 5, 6, 7; 256B.79, subdivision 7; 256I.05, subdivision 3; 256L.11, subdivision
2a; 256R.53, subdivision 2; Laws 2010, First Special Session chapter 1, article
25, section 3, subdivision 10; Minnesota Rules, parts 2960.3030, subpart 3;
3400.0185, subpart 5; 6400.6970; 7200.6100; 7200.6105; 9502.0425, subparts 4,
16, 17; 9503.0155, subpart 8; 9549.0057; 9549.0060, subpart 14.

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

ARTICLE 1

CHILDREN AND FAMILIES

Section 1.

Minnesota Statutes 2018, section 119B.011, is amended by adding a subdivision
to read:


new text begin Subd. 13b. new text end

new text begin Homeless. new text end

new text begin "Homeless" means a self-declared housing status as defined in
the McKinney-Vento Homeless Assistance Act and United States Code, title 42, section
11302, paragraph (a).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
new text end

Sec. 2.

Minnesota Statutes 2018, section 119B.011, subdivision 19, is amended to read:


Subd. 19.

Provider.

"Provider" means:

(1) an individual or child care center or facilitydeleted text begin, either licensed or unlicensed, providing
legal child care services as defined
deleted text endnew text begin licensed to provide child carenew text end under deleted text beginsection 245A.03deleted text endnew text begin
chapter 245A when operating within the terms of the license
new text end; deleted text beginor
deleted text end

(2)new text begin a license exempt center required to be certified under chapter 245H;
new text end

new text begin (3)new text end an individual or child care center or facility deleted text beginholdingdeleted text end new text beginthat: (i) holds new text enda valid child care
license issued by another state or a tribe deleted text beginand providingdeleted text endnew text begin; (ii) providesnew text end child care services in
the licensing state or in the area under the licensing tribe's jurisdictionnew text begin; and (iii) is in
compliance with federal health and safety requirements as certified by the licensing state
or tribe, or as determined by receipt of child care development block grant funds in the
licensing state; or
new text end

new text begin (4) a legal nonlicensed child care provider as defined under section 119B.011, subdivision
16, providing legal child care services
new text end. A deleted text beginlegally unlicensed familydeleted text end new text beginlegal nonlicensed new text endchild
care provider must be at least 18 years of age, and not a member of the MFIP assistance
unit or a member of the family receiving child care assistance to be authorized under this
chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 3.

Minnesota Statutes 2018, section 119B.011, subdivision 20, is amended to read:


Subd. 20.

Transition year families.

"Transition year families" means families who have
received MFIP assistance, or who were eligible to receive MFIP assistance after choosing
to discontinue receipt of the cash portion of MFIP assistance under section 256J.31,
subdivision 12
, or families who have received DWP assistance under section 256J.95 for
at least deleted text beginthreedeleted text endnew text begin onenew text end of the last six months before losing eligibility for MFIP or DWP.
Notwithstanding Minnesota Rules, parts 3400.0040, subpart 10, and 3400.0090, subpart 2,
transition year child care may be used to support employment, approved education or training
programs, or job search that meets the requirements of section 119B.10. Transition year
child care is not available to families who have been disqualified from MFIP or DWP due
to fraud.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 23, 2020.
new text end

Sec. 4.

Minnesota Statutes 2018, section 119B.02, subdivision 7, is amended to read:


Subd. 7.

Child care market rate survey.

deleted text beginBiennially,deleted text end The commissioner shall new text beginconduct
the next
new text endsurvey new text beginof new text endprices charged by child care providers in Minnesota new text beginin state fiscal year
2021 and every three years thereafter
new text endto determine the 75th percentile for like-care
arrangements in county price clusters.

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2018, section 119B.025, subdivision 1, is amended to read:


Subdivision 1.

Applications.

(a) new text beginExcept as provided in paragraph (c), clause (4), new text endthe
county shall verify the following at all initial child care applications using the universal
application:

(1) identity of adults;

(2) presence of the minor child in the home, if questionable;

(3) relationship of minor child to the parent, stepparent, legal guardian, eligible relative
caretaker, or the spouses of any of the foregoing;

(4) age;

(5) immigration status, if related to eligibility;

(6) Social Security number, if given;

(7) counted income;

(8) spousal support and child support payments made to persons outside the household;

(9) residence; and

(10) inconsistent information, if related to eligibility.

(b) The county must mail a notice of approval or denial of assistance to the applicant
within 30 calendar days after receiving the application. The county may extend the response
time by 15 calendar days if the applicant is informed of the extension.

new text begin (c) For an applicant who declares that the applicant is homeless and who meets the
definition of homeless in section 119B.011, subdivision 13b, the county must:
new text end

new text begin (1) if information is needed to determine eligibility, send a request for information to
the applicant within five working days after receiving the application;
new text end

new text begin (2) if the applicant is eligible, send a notice of approval of assistance within five working
days after receiving the application;
new text end

new text begin (3) if the applicant is ineligible, send a notice of denial of assistance within 30 days after
receiving the application. The county may extend the response time by 15 calendar days if
the applicant is informed of the extension;
new text end

new text begin (4) not require verifications required by paragraph (a) before issuing the notice of approval
or denial; and
new text end

new text begin (5) follow limits set by the commissioner for how frequently expedited application
processing may be used for an applicant under this paragraph.
new text end

new text begin (d) An applicant who declares that the applicant is homeless must submit proof of
eligibility within three months of the date the application was received. If proof of eligibility
is not submitted within three months, eligibility ends. A 15-day adverse action notice is
required to end eligibility.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
new text end

Sec. 6.

Minnesota Statutes 2018, section 119B.025, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Information to applicants; child care fraud. new text end

new text begin At the time of initial application
and at redetermination, the county must provide written notice to the applicant or participant
listing the activities that constitute child care fraud and the consequences of committing
child care fraud. An applicant or participant shall acknowledge receipt of the child care
fraud notice in writing.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
new text end

Sec. 7.

Minnesota Statutes 2018, section 119B.03, subdivision 9, is amended to read:


Subd. 9.

Portability pool.

(a) The commissioner shall establish a pool of up to five
percent of the annual appropriation for the basic sliding fee program to provide continuous
child care assistance for eligible families who move between Minnesota counties. At the
end of each allocation period, any unspent funds in the portability pool must be used for
assistance under the basic sliding fee program. If expenditures from the portability pool
exceed the amount of money available, the reallocation pool must be reduced to cover these
shortages.

(b) deleted text beginTo be eligible for portable basic sliding fee assistance,deleted text end A family that has moved from
a county in which it was receiving basic sliding fee assistance to a county with a waiting
list for the basic sliding fee program must:

(1) meet the income and eligibility guidelines for the basic sliding fee program; and

(2) notify deleted text beginthe new county of residence within 60 days of moving and submit information
to the new county of residence to verify eligibility for the basic sliding fee program
deleted text endnew text begin the
family's previous county of residence of the family's move to a new county of residence
new text end.

(c) The receiving county must:

(1) accept administrative responsibility for applicants for portable basic sliding fee
assistance at the end of the two months of assistance under the Unitary Residency Act;

(2) continue new text beginportability pool new text endbasic sliding fee assistance deleted text beginfor the lesser of six months ordeleted text end
until the family is able to receive assistance under the county's regular basic sliding program;
and

(3) notify the commissioner through the quarterly reporting process of any family that
meets the criteria of the portable basic sliding fee assistance pool.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective December 2, 2019.
new text end

Sec. 8.

Minnesota Statutes 2018, section 119B.09, subdivision 1, is amended to read:


Subdivision 1.

General eligibility requirements.

(a) Child care services must be
available to families who need child care to find or keep employment or to obtain the training
or education necessary to find employment and who:

(1) have household income less than or equal to 67 percent of the state median income,
adjusted for family size, at application and redetermination, and meet the requirements of
section 119B.05; receive MFIP assistance; and are participating in employment and training
services under chapter 256J; or

(2) have household income less than or equal to 47 percent of the state median income,
adjusted for family size, at application and less than or equal to 67 percent of the state
median income, adjusted for family size, at redetermination.

(b) Child care services must be made available as in-kind services.

(c) All applicants for child care assistance and families currently receiving child care
assistance must be assisted and required to cooperate in establishment of paternity and
enforcement of child support obligations for all children in the family at application and
redetermination as a condition of program eligibility. For purposes of this section, a family
is considered to meet the requirement for cooperation when the family complies with the
requirements of section 256.741.

(d) All applicants for child care assistance and families currently receiving child care
assistance must pay the co-payment fee under section 119B.12, subdivision 2, as a condition
of eligibility. The co-payment fee may include additional recoupment fees due to a child
care assistance program overpayment.

new text begin (e) If a family has one child with a child care authorization and the child reaches 13
years of age or the child has a disability and reaches 15 years of age, the family remains
eligible until the redetermination.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 29, 2020.
new text end

Sec. 9.

Minnesota Statutes 2018, section 119B.095, subdivision 2, is amended to read:


Subd. 2.

Maintain steady child care authorizations.

(a) Notwithstanding Minnesota
Rules, chapter 3400, the amount of child care authorized under section 119B.10 for
employment, education, or an MFIP or DWP employment plan shall continue at the same
number of hours or more hours until redetermination, including:

(1) when the other parent moves in and is employed or has an education plan under
section 119B.10, subdivision 3, or has an MFIP or DWP employment plan; or

(2) when the participant's work hours are reduced or a participant temporarily stops
working or attending an approved education program. Temporary changes include, but are
not limited to, a medical leave, seasonal employment fluctuations, or a school break between
semesters.

(b) The county may increase the amount of child care authorized at any time if the
participant verifies the need for increased hours for authorized activities.

(c) The county may reduce the amount of child care authorized if a parent requests a
reduction or because of a change in:

(1) the child's school schedule;

(2) the custody schedule; or

(3) the provider's availability.

(d) The amount of child care authorized for a family subject to subdivision 1, paragraph
(b), must change when the participant's activity schedule changes. Paragraph (a) does not
apply to a family subject to subdivision 1, paragraph (b).

new text begin (e) When a child reaches 13 years of age or a child with a disability reaches 15 years of
age, the amount of child care authorized shall continue at the same number of hours or more
hours until redetermination.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 29, 2020.
new text end

Sec. 10.

Minnesota Statutes 2018, section 119B.095, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Assistance for persons who are homeless. new text end

new text begin An applicant who is homeless and
eligible for child care assistance is exempt from the activity participation requirements under
this chapter for three months. The applicant under this subdivision is eligible for 60 hours
of child care assistance per service period for three months from the date the county receives
the application. Additional hours may be authorized as needed based on the applicant's
participation in employment, education, or MFIP or DWP employment plan. To continue
receiving child care assistance after the initial three months, the applicant must verify that
the applicant meets eligibility and activity requirements for child care assistance under this
chapter.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 21, 2020.
new text end

Sec. 11.

Minnesota Statutes 2018, section 119B.16, subdivision 1, is amended to read:


Subdivision 1.

Fair hearing allowednew text begin for applicants and recipientsnew text end.

new text begin(a) new text endAn applicant
or recipient adversely affected by new text beginan action of new text enda county agency deleted text beginactiondeleted text endnew text begin or the commissioner,
for an action taken directly against the applicant or recipient,
new text end may request new text beginand receive new text enda fair
hearing in accordance with new text beginthis subdivision and new text endsection 256.045.new text begin An applicant or recipient
does not have a right to a fair hearing if a county agency or the commissioner takes action
against a provider.
new text end

new text begin (b) A county agency must offer an informal conference to an applicant or recipient who
is entitled to a fair hearing under this section. A county agency must advise an applicant or
recipient that a request for a conference is optional and does not delay or replace the right
to a fair hearing.
new text end

new text begin (c) If a provider's authorization is suspended, denied, or revoked, a county agency or
the commissioner must mail notice to each child care assistance program recipient receiving
care from the provider.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 12.

Minnesota Statutes 2018, section 119B.16, subdivision 1a, is amended to read:


Subd. 1a.

Fair hearing allowed for providers.

(a) This subdivision applies to providers
caring for children receiving child care assistance.

deleted text begin (b) A provider to whom a county agency has assigned responsibility for an overpayment
may request a fair hearing in accordance with section 256.045 for the limited purpose of
challenging the assignment of responsibility for the overpayment and the amount of the
overpayment. The scope of the fair hearing does not include the issues of whether the
provider wrongfully obtained public assistance in violation of section 256.98 or was properly
disqualified under section 256.98, subdivision 8, paragraph (c), unless the fair hearing has
been combined with an administrative disqualification hearing brought against the provider
under section 256.046.
deleted text end

new text begin (b) A provider may request a fair hearing according to sections 256.045 and 256.046
only if a county agency or the commissioner:
new text end

new text begin (1) denies or revokes a provider's authorization, unless the action entitles the provider
to an administrative review under section 119B.161;
new text end

new text begin (2) assigns responsibility for an overpayment to a provider under section 119B.11,
subdivision 2a;
new text end

new text begin (3) establishes an overpayment for failure to comply with section 119B.125, subdivision
6;
new text end

new text begin (4) seeks monetary recovery or recoupment under section 245E.02, subdivision 4,
paragraph (c), clause (2);
new text end

new text begin (5) initiates an administrative fraud disqualification hearing; or
new text end

new text begin (6) issues a payment and the provider disagrees with the amount of the payment.
new text end

new text begin (c) A provider may request a fair hearing by submitting a written request to the
Department of Human Services, Appeals Division. A provider's request must be received
by the Appeals Division no later than 30 days after the date a county or the commissioner
mails the notice.
new text end

new text begin (d) The provider's appeal request must contain the following:
new text end

new text begin (1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
new text end

new text begin (2) the computation the provider believes to be correct, if applicable;
new text end

new text begin (3) the statute or rule relied on for each disputed item; and
new text end

new text begin (4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 13.

Minnesota Statutes 2018, section 119B.16, subdivision 1b, is amended to read:


Subd. 1b.

Joint fair hearings.

deleted text beginWhen a provider requests a fair hearing under subdivision
1a, the family in whose case the overpayment was created must be made a party to the fair
hearing. All other issues raised by the family must be resolved in the same proceeding.
When a family requests a fair hearing and claims that the county should have assigned
responsibility for an overpayment to a provider, the provider must be made a party to the
fair hearing.
deleted text end The human services judge assigned to a fair hearing may join a family or a
provider as a party to the fair hearing whenever joinder of that party is necessary to fully
and fairly resolve deleted text beginoverpaymentdeleted text end issues raised in the appeal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 14.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 1c. new text end

new text begin Notice to providers. new text end

new text begin (a) Before taking an action appealable under subdivision
1a, paragraph (b), a county agency or the commissioner must mail written notice to the
provider against whom the action is being taken. Unless otherwise specified under chapter
119B or 245E or Minnesota Rules, chapter 3400, a county agency or the commissioner must
mail the written notice at least 15 calendar days before the adverse action's effective date.
new text end

new text begin (b) The notice shall state (1) the factual basis for the department's determination, (2) the
action the department intends to take, (3) the dollar amount of the monetary recovery or
recoupment, if known, and (4) the provider's right to appeal the department's proposed
action.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 15.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Fair hearing stayed. new text end

new text begin (a) If a county agency or the commissioner denies or
revokes a provider's authorization based on a licensing action under section 245A.07, and
the provider appeals, the provider's fair hearing must be stayed until the commissioner issues
an order as required under section 245A.08, subdivision 5.
new text end

new text begin (b) If the commissioner denies or revokes a provider's authorization based on
decertification under section 245H.07, and the provider appeals, the provider's fair hearing
must be stayed until the commissioner issues a final order as required under section 245H.07.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 16.

Minnesota Statutes 2018, section 119B.16, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Final department action. new text end

new text begin Unless the commissioner receives a timely and
proper request for an appeal, a county agency's or the commissioner's action shall be
considered a final department action.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 17.

new text begin [119B.161] ADMINISTRATIVE REVIEW.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin A provider has the right to an administrative review under
this section if (1) a payment was suspended under chapter 245E, or (2) the provider's
authorization was denied or revoked under section 119B.13, subdivision 6, paragraph (d),
clause (1) or (2).
new text end

new text begin Subd. 2. new text end

new text begin Notice. new text end

new text begin (a) A county agency or the commissioner must mail written notice to
a provider within five days of suspending payment or denying or revoking the provider's
authorization under subdivision 1.
new text end

new text begin (b) The notice must:
new text end

new text begin (1) state the provision under which a county agency or the commissioner is denying,
revoking, or suspending the provider's authorization or suspending payment to the provider;
new text end

new text begin (2) set forth the general allegations leading to the denial, revocation, or suspension of
the provider's authorization. The notice need not disclose any specific information concerning
an ongoing investigation;
new text end

new text begin (3) state that the denial, revocation, or suspension of the provider's authorization is for
a temporary period and explain the circumstances under which the action expires; and
new text end

new text begin (4) inform the provider of the right to submit written evidence and argument for
consideration by the commissioner.
new text end

new text begin (c) Notwithstanding Minnesota Rules, part 3400.0185, if a county agency or the
commissioner suspends payment to a provider under chapter 245E or denies or revokes a
provider's authorization under section 119B.13, subdivision 6, paragraph (d), clause (1) or
(2), a county agency or the commissioner must send notice of service authorization closure
to each affected family. The notice sent to an affected family is effective on the date the
notice is created.
new text end

new text begin Subd. 3. new text end

new text begin Duration. new text end

new text begin If a provider's payment is suspended under chapter 245E or a
provider's authorization is denied or revoked under section 119B.13, subdivision 6, paragraph
(d), clause (1) or (2), the provider's denial, revocation, temporary suspension, or payment
suspension remains in effect until:
new text end

new text begin (1) the commissioner or a law enforcement authority determines that there is insufficient
evidence warranting the action and a county agency or the commissioner does not pursue
an additional administrative remedy under chapter 245E or section 256.98; or
new text end

new text begin (2) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted.
new text end

new text begin Subd. 4. new text end

new text begin Good cause exception. new text end

new text begin The commissioner may find that good cause exists not
to deny, revoke, or suspend a provider's authorization, or not to continue a denial, revocation,
or suspension of a provider's authorization if any of the following are applicable:
new text end

new text begin (1) a law enforcement authority specifically requested that a provider's authorization
not be denied, revoked, or suspended because that action may compromise an ongoing
investigation;
new text end

new text begin (2) the commissioner determines that the denial, revocation, or suspension should be
removed based on the provider's written submission; or
new text end

new text begin (3) the commissioner determines that the denial, revocation, or suspension is not in the
best interests of the program.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 18.

Minnesota Statutes 2018, section 245E.06, subdivision 3, is amended to read:


Subd. 3.

Appeal of department deleted text beginsanctiondeleted text endnew text begin actionnew text end.

deleted text begin (a) If the department does not pursue
a criminal action against a provider, license holder, controlling individual, or recipient for
financial misconduct, but the department imposes an administrative sanction under section
245E.02, subdivision 4, paragraph (c), any individual or entity against whom the sanction
was imposed may appeal the department's administrative sanction under this section pursuant
to section 119B.16 or 256.045 with the additional requirements in clauses (1) to (4). An
appeal must specify:
deleted text end

deleted text begin (1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item, if appropriate;
deleted text end

deleted text begin (2) the computation that is believed to be correct, if appropriate;
deleted text end

deleted text begin (3) the authority in the statute or rule relied upon for each disputed item; and
deleted text end

deleted text begin (4) the name, address, and phone number of the person at the provider's place of business
with whom contact may be made regarding the appeal.
deleted text end

deleted text begin (b) Notwithstanding section 245E.03, subdivision 4, an appeal is considered timely only
if postmarked or received by the department's Appeals Division within 30 days after receiving
a notice of department sanction.
deleted text end

deleted text begin (c) Before the appeal hearing, the department may deny or terminate authorizations or
payment to the entity or individual if the department determines that the action is necessary
to protect the public welfare or the interests of the child care assistance program.
deleted text end new text begin A provider's
rights related to the department's action taken under this chapter against a provider are
established in sections 119B.16 and 119B.161.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 19.

Minnesota Statutes 2018, section 256.01, subdivision 14b, is amended to read:


Subd. 14b.

American Indian child welfare projects.

(a) The commissioner of human
services may authorize projects to deleted text begintestdeleted text endnew text begin initiatenew text end tribal delivery of child welfare services to
American Indian children and their parents and custodians living on the reservation. The
commissioner has authority to solicit and determine which tribes may participate in a project.
Grants may be issued to Minnesota Indian tribes to support the projects. The commissioner
may waive existing state rules as needed to accomplish the projects. The commissioner may
authorize projects to use alternative methods of (1) new text beginscreening, new text endinvestigatingnew text begin,new text end and assessing
reports of child maltreatment, and (2) administrative reconsideration, administrative appeal,
and judicial appeal of maltreatment determinations, provided the alternative methods used
by the projects comply with the provisions of sections 256.045 and 626.556 deleted text begindealingdeleted text endnew text begin that
deal
new text end with the rights of individuals who are the subjects of reports or investigations, including
notice and appeal rights and data practices requirements.new text begin The commissioner shall only
authorize alternative methods that comply with the public policy under section 626.556,
subdivision 1.
new text end The commissioner may seek any federal approvals necessary to carry out the
projects as well as seek and use any funds available to the commissioner, including use of
federal funds, foundation funds, existing grant funds, and other funds. The commissioner
is authorized to advance state funds as necessary to operate the projects. Federal
reimbursement applicable to the projects is appropriated to the commissioner for the purposes
of the projects. The projects must be required to address responsibility for safety, permanency,
and well-being of children.

(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.

(c) In order to qualify for an American Indian child welfare project, a tribe must:

(1) be one of the existing tribes with reservation land in Minnesota;

(2) have a tribal court with jurisdiction over child custody proceedings;

(3) have a substantial number of children for whom determinations of maltreatment have
occurred;

(4)new text begin(i)new text end have capacity to respond to reports of abuse and neglect under section 626.556;new text begin
or (ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
new text end

(5) provide a wide range of services to families in need of child welfare services; and

(6) have a tribal-state title IV-E agreement in effect.

(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:

(1) assessment and prevention of child abuse and neglect;

(2) family preservation;

(3) facilitative, supportive, and reunification services;

(4) out-of-home placement for children removed from the home for child protective
purposes; and

(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.

(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under section 626.556 for those children during the time
within which the tribal project is in effect and funded. The commissioner shall work with
tribes and affected counties to develop procedures for data collection, evaluation, and
clarification of ongoing role and financial responsibilities of the county and tribe for child
welfare services prior to initiation of the project. Children who have not been identified by
the tribe as participating in the project shall remain the responsibility of the county. Nothing
in this section shall alter responsibilities of the county for law enforcement or court services.

(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:

(1) the child must be receiving child protective services;

(2) the child must be in foster care; or

(3) the child's parents must have had parental rights suspended or terminated.

Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.

(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.

(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.

(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.

Sec. 20.

Minnesota Statutes 2018, section 256J.24, subdivision 5, is amended to read:


Subd. 5.

MFIP transitional standard.

new text begin(a) new text endThe MFIP transitional standard is based on
the number of persons in the assistance unit eligible for both food and cash assistance. The
amount of the transitional standard is published annually by the Department of Human
Services.

new text begin (b) The amount of the MFIP cash assistance portion of the transitional standard is
increased $100 per month per household. This increase shall be reflected in the MFIP cash
assistance portion of the transitional standard published annually by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 1, 2020.
new text end

Sec. 21.

Minnesota Statutes 2018, section 256M.41, subdivision 3, is amended to read:


Subd. 3.

Payments deleted text beginbased on performancedeleted text end.

deleted text begin(a)deleted text end The commissioner shall make payments
under this section to each county deleted text beginboard on a calendar year basis in an amount determined
under paragraph (b)
deleted text endnew text begin on or before July 10 of each yearnew text end.

deleted text begin (b) Calendar year allocations under subdivision 1 shall be paid to counties in the following
manner:
deleted text end

deleted text begin (1) 80 percent of the allocation as determined in subdivision 1 must be paid to counties
on or before July 10 of each year;
deleted text end

deleted text begin (2) ten percent of the allocation shall be withheld until the commissioner determines if
the county has met the performance outcome threshold of 90 percent based on face-to-face
contact with alleged child victims. In order to receive the performance allocation, the county
child protection workers must have a timely face-to-face contact with at least 90 percent of
all alleged child victims of screened-in maltreatment reports. The standard requires that
each initial face-to-face contact occur consistent with timelines defined in section 626.556,
subdivision 10
, paragraph (i). The commissioner shall make threshold determinations in
January of each year and payments to counties meeting the performance outcome threshold
shall occur in February of each year. Any withheld funds from this appropriation for counties
that do not meet this requirement shall be reallocated by the commissioner to those counties
meeting the requirement; and
deleted text end

deleted text begin (3) ten percent of the allocation shall be withheld until the commissioner determines
that the county has met the performance outcome threshold of 90 percent based on
face-to-face visits by the case manager. In order to receive the performance allocation, the
total number of visits made by caseworkers on a monthly basis to children in foster care
and children receiving child protection services while residing in their home must be at least
90 percent of the total number of such visits that would occur if every child were visited
once per month. The commissioner shall make such determinations in January of each year
and payments to counties meeting the performance outcome threshold shall occur in February
of each year. Any withheld funds from this appropriation for counties that do not meet this
requirement shall be reallocated by the commissioner to those counties meeting the
requirement. For 2015, the commissioner shall only apply the standard for monthly foster
care visits.
deleted text end

deleted text begin (c) The commissioner shall work with stakeholders and the Human Services Performance
Council under section 402A.16 to develop recommendations for specific outcome measures
that counties should meet in order to receive funds withheld under paragraph (b), and include
in those recommendations a determination as to whether the performance measures under
paragraph (b) should be modified or phased out. The commissioner shall report the
recommendations to the legislative committees having jurisdiction over child protection
issues by January 1, 2018.
deleted text end

Sec. 22.

Minnesota Statutes 2018, section 256M.41, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin County performance on child protection measures. new text end

new text begin The commissioner shall
set child protection measures and standards. The commissioner shall require an
underperforming county to demonstrate that the county designated sufficient funds and
implemented a reasonable strategy to improve child protection performance, including the
provision of a performance improvement plan and additional remedies identified by the
commissioner. The commissioner may redirect up to 20 percent of a county's funds under
this section toward the performance improvement plan. Sanctions under section 256M.20,
subdivision 3, related to noncompliance with federal performance standards also apply.
new text end

Sec. 23.

Minnesota Statutes 2018, section 260C.007, subdivision 18, is amended to read:


Subd. 18.

Foster care.

new text begin(a) new text end"Foster care" means deleted text begin24 hourdeleted text endnew text begin 24-hournew text end substitute care for
deleted text begin children placed away from their parents or guardian anddeleted text endnew text begin a childnew text end for whom a responsible
social services agency has placement and care responsibilitydeleted text begin. "Foster care" includes, but is
not limited to, placement
deleted text endnew text begin and:
new text end

new text begin (1) who is placed away from the child's parent or guardiannew text end in foster family homes, foster
homes of relatives, group homes, emergency shelters, residential facilities not excluded in
this subdivision, child care institutions, and preadoptive homesdeleted text begin.deleted text endnew text begin; or
new text end

new text begin (2) who is colocated with the child's parent or guardian in a licensed residential
family-based substance use disorder treatment program as defined in subdivision 22a; or
new text end

new text begin (3) who is returned to the care of the child's parent or guardian from whom the child
was removed under a trial home visit pursuant to section 260C.201, subdivision 1, paragraph
(a), clause (3).
new text end

new text begin (b)new text end A child is in foster care under this definition regardless of whether the facility is
licensed and payments are made for the cost of care. Nothing in this definition creates any
authority to place a child in a home or facility that is required to be licensed which is not
licensed. "Foster care" does not include placement in any of the following facilities: hospitals,
inpatient chemical dependency treatment facilitiesnew text begin where the child is the recipient of the
treatment
new text end, facilities that are primarily for delinquent children, any corrections facility or
program within a particular correction's facility not meeting requirements for title IV-E
facilities as determined by the commissioner, facilities to which a child is committed under
the provision of chapter 253B, forestry camps, or jails. Foster care is intended to provide
for a child's safety or to access treatment. Foster care must not be used as a punishment or
consequence for a child's behavior.

Sec. 24.

Minnesota Statutes 2018, section 260C.007, is amended by adding a subdivision
to read:


new text begin Subd. 22a. new text end

new text begin Licensed residential family-based substance use disorder treatment
program.
new text end

new text begin "Licensed residential family-based substance use disorder treatment program"
means a residential treatment facility that provides the parent or guardian with parenting
skills training, parent education, or individual and family counseling, under an organizational
structure and treatment framework that involves understanding, recognizing, and responding
to the effects of all types of trauma according to recognized principles of a trauma-informed
approach and trauma-specific interventions to address the consequences of trauma and
facilitate healing. The residential program must be licensed by the Department of Human
Services under chapter 245A and sections 245G.01 to 245G.16, 245G.19, and 245G.21 as
a residential substance use disorder treatment program specializing in the treatment of clients
with children.
new text end

Sec. 25.

Minnesota Statutes 2018, section 260C.178, subdivision 1, is amended to read:


Subdivision 1.

Hearing and release requirements.

(a) If a child was taken into custody
under section 260C.175, subdivision 1, clause (1) or (2), item (ii), the court shall hold a
hearing within 72 hours of the time the child was taken into custody, excluding Saturdays,
Sundays, and holidays, to determine whether the child should continue in custody.

(b) Unless there is reason to believe that the child would endanger self or others or not
return for a court hearing, or that the child's health or welfare would be immediately
endangered, the child shall be released to the custody of a parent, guardian, custodian, or
other suitable person, subject to reasonable conditions of release including, but not limited
to, a requirement that the child undergo a chemical use assessment as provided in section
260C.157, subdivision 1.

(c) If the court determines there is reason to believe that the child would endanger self
or others or not return for a court hearing, or that the child's health or welfare would be
immediately endangered if returned to the care of the parent or guardian who has custody
and from whom the child was removed, the court shall order the child into foster carenew text begin as
defined in section 260C.007, subdivision 18,
new text end under the legal responsibility of the responsible
social services agency or responsible probation or corrections agency for the purposes of
protective care as that term is used in the juvenile court rules or into the home of a
noncustodial parent and order the noncustodial parent to comply with any conditions the
court determines to be appropriate to the safety and care of the child, including cooperating
with paternity establishment proceedings in the case of a man who has not been adjudicated
the child's father. The court shall not give the responsible social services legal custody and
order a trial home visit at any time prior to adjudication and disposition under section
260C.201, subdivision 1, paragraph (a), clause (3), but may order the child returned to the
care of the parent or guardian who has custody and from whom the child was removed and
order the parent or guardian to comply with any conditions the court determines to be
appropriate to meet the safety, health, and welfare of the child.

(d) In determining whether the child's health or welfare would be immediately
endangered, the court shall consider whether the child would reside with a perpetrator of
domestic child abuse.

(e) The court, before determining whether a child should be placed in or continue in
foster care under the protective care of the responsible agency, shall also make a
determination, consistent with section 260.012 as to whether reasonable efforts were made
to prevent placement or whether reasonable efforts to prevent placement are not required.
In the case of an Indian child, the court shall determine whether active efforts, according
to section 260.762 and the Indian Child Welfare Act of 1978, United States Code, title 25,
section 1912(d), were made to prevent placement. The court shall enter a finding that the
responsible social services agency has made reasonable efforts to prevent placement when
the agency establishes either:

(1) that it has actually provided services or made efforts in an attempt to prevent the
child's removal but that such services or efforts have not proven sufficient to permit the
child to safely remain in the home; or

(2) that there are no services or other efforts that could be made at the time of the hearing
that could safely permit the child to remain home or to return home. When reasonable efforts
to prevent placement are required and there are services or other efforts that could be ordered
which would permit the child to safely return home, the court shall order the child returned
to the care of the parent or guardian and the services or efforts put in place to ensure the
child's safety. When the court makes a prima facie determination that one of the
circumstances under paragraph (g) exists, the court shall determine that reasonable efforts
to prevent placement and to return the child to the care of the parent or guardian are not
required.

If the court finds the social services agency's preventive or reunification efforts have
not been reasonable but further preventive or reunification efforts could not permit the child
to safely remain at home, the court may nevertheless authorize or continue the removal of
the child.

(f) The court may not order or continue the foster care placement of the child unless the
court makes explicit, individualized findings that continued custody of the child by the
parent or guardian would be contrary to the welfare of the child and that placement is in the
best interest of the child.

(g) At the emergency removal hearing, or at any time during the course of the proceeding,
and upon notice and request of the county attorney, the court shall determine whether a
petition has been filed stating a prima facie case that:

(1) the parent has subjected a child to egregious harm as defined in section 260C.007,
subdivision 14
;

(2) the parental rights of the parent to another child have been involuntarily terminated;

(3) the child is an abandoned infant under section 260C.301, subdivision 2, paragraph
(a), clause (2);

(4) the parents' custodial rights to another child have been involuntarily transferred to a
relative under Minnesota Statutes 2010, section 260C.201, subdivision 11, paragraph (e),
clause (1); section 260C.515, subdivision 4; or a similar law of another jurisdiction;

(5) the parent has committed sexual abuse as defined in section 626.556, subdivision 2,
against the child or another child of the parent;

(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or

(7) the provision of services or further services for the purpose of reunification is futile
and therefore unreasonable.

(h) When a petition to terminate parental rights is required under section 260C.301,
subdivision 4, or 260C.503, subdivision 2, but the county attorney has determined not to
proceed with a termination of parental rights petition, and has instead filed a petition to
transfer permanent legal and physical custody to a relative under section 260C.507, the
court shall schedule a permanency hearing within 30 days of the filing of the petition.

(i) If the county attorney has filed a petition under section 260C.307, the court shall
schedule a trial under section 260C.163 within 90 days of the filing of the petition except
when the county attorney determines that the criminal case shall proceed to trial first under
section 260C.503, subdivision 2, paragraph (c).

(j) If the court determines the child should be ordered into foster care and the child's
parent refuses to give information to the responsible social services agency regarding the
child's father or relatives of the child, the court may order the parent to disclose the names,
addresses, telephone numbers, and other identifying information to the responsible social
services agency for the purpose of complying with sections 260C.151, 260C.212, 260C.215,
and 260C.221.

(k) If a child ordered into foster care has siblings, whether full, half, or step, who are
also ordered into foster care, the court shall inquire of the responsible social services agency
of the efforts to place the children together as required by section 260C.212, subdivision 2,
paragraph (d), if placement together is in each child's best interests, unless a child is in
placement for treatment or a child is placed with a previously noncustodial parent who is
not a parent to all siblings. If the children are not placed together at the time of the hearing,
the court shall inquire at each subsequent hearing of the agency's reasonable efforts to place
the siblings together, as required under section 260.012. If any sibling is not placed with
another sibling or siblings, the agency must develop a plan to facilitate visitation or ongoing
contact among the siblings as required under section 260C.212, subdivision 1, unless it is
contrary to the safety or well-being of any of the siblings to do so.

(l) When the court has ordered the child into foster care or into the home of a noncustodial
parent, the court may order a chemical dependency evaluation, mental health evaluation,
medical examination, and parenting assessment for the parent as necessary to support the
development of a plan for reunification required under subdivision 7 and section 260C.212,
subdivision 1
, or the child protective services plan under section 626.556, subdivision 10,
and Minnesota Rules, part 9560.0228.

Sec. 26.

new text begin [260C.190] FAMILY-FOCUSED RESIDENTIAL PLACEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Placement. new text end

new text begin (a) An agency with legal responsibility for a child under
section 260C.178, subdivision 1, paragraph (c), or legal custody of a child under section
260C.201, subdivision 1, paragraph (a), clause (3), may colocate a child with a parent who
is receiving services in a licensed residential family-based substance use disorder treatment
program for up to 12 months.
new text end

new text begin (b) During the child's placement under paragraph (a), the agency: (1) may visit the child
as the agency deems necessary and appropriate; (2) shall continue to have access to
information under section 260C.208; and (3) shall continue to provide appropriate services
to both the parent and the child.
new text end

new text begin (c) The agency may terminate the child's placement under paragraph (a) to protect the
child's health, safety, or welfare and may remove the child to foster care without a prior
court order or authorization.
new text end

new text begin Subd. 2. new text end

new text begin Case plans. new text end

new text begin (a) Before a child may be colocated with a parent in a licensed
residential family-based substance use disorder treatment program, a recommendation that
the child's placement with a parent is in the child's best interests must be documented in the
child's case plan. Each child must have a written case plan developed with the parent and
the treatment program staff that describes the safety plan for the child and the treatment
program's responsibilities if the parent leaves or is discharged without completing the
program. The treatment program must be provided with a copy of the case plan that includes
the recommendations and safety plan at the time the child is colocated with the parent.
new text end

new text begin (b) An out-of-home placement plan under section 260C.212, subdivision 1, must be
completed no later than 30 days from when a child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program. The written plan
developed with parent and treatment program staff in paragraph (a) may be updated and
must be incorporated into the out-of-home placement plan. The treatment program must be
provided with a copy of the child's out-of-home placement plan.
new text end

new text begin Subd. 3. new text end

new text begin Required reviews and permanency proceedings. new text end

new text begin (a) For a child colocated
with a parent under subdivision 1, court reviews must occur according to section 260C.202.
new text end

new text begin (b) If a child has been in foster care for six months, a court review under section 260C.202
may be conducted in lieu of a permanency progress review hearing under section 260C.204
when the child is colocated with a parent consistent with section 260C.503, subdivision 3,
paragraph (c), in a licensed residential family-based substance use disorder treatment
program.
new text end

new text begin (c) If the child is colocated with a parent in a licensed residential family-based substance
use disorder treatment program 12 months after the child was placed in foster care, the
agency must file a report with the court regarding the parent's progress in the treatment
program and the agency's reasonable efforts to finalize the child's safe and permanent return
to the care and custody of the parent consistent with section 260C.503, subdivision 3,
paragraph (c), in lieu of filing a petition required under section 260C.505.
new text end

new text begin (d) The court shall make findings regarding the reasonable efforts of the agency to
finalize the child's return home as the permanency disposition order in the child's best
interests. The court may continue the child's foster care placement colocated with a parent
in a licensed residential family-based substance use disorder treatment program for up to
12 months. When a child has been in foster care placement for 12 months, but the duration
of the colocation with a parent in a licensed residential family-based substance use disorder
treatment program is less than 12 months, the court may continue the colocation with the
total time spent in foster care not exceeding 15 out of the most recent 22 months. If the
court finds that the agency fails to make reasonable efforts to finalize the child's return home
as the permanency disposition order in the child's best interests, the court may order additional
efforts to support the child remaining in the care of the parent.
new text end

new text begin (e) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program, the child's placement under
this section is terminated and the agency may remove the child to foster care without a prior
court order or authorization. Within three days of any termination of a child's placement,
the agency shall notify the court and each party.
new text end

new text begin (f) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child has been in
foster care for less than six months, the court must hold a review hearing within ten days
of receiving notice of a termination of a child's placement and must order an alternative
disposition under section 260C.201.
new text end

new text begin (g) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than six months but less than
12 months, the court must conduct a permanency progress review hearing under section
260C.204 no later than 30 days after the day the parent leaves or is discharged.
new text end

new text begin (h) If a parent leaves or is discharged from a licensed residential family-based substance
use disorder treatment program without completing the program and the child is colocated
with a parent and the child has been in foster care for more than 12 months, the court shall
begin permanency proceedings under sections 260C.503 to 260C.521.
new text end

Sec. 27.

Minnesota Statutes 2018, section 260C.201, subdivision 1, is amended to read:


Subdivision 1.

Dispositions.

(a) If the court finds that the child is in need of protection
or services or neglected and in foster care, it shall enter an order making any of the following
dispositions of the case:

(1) place the child under the protective supervision of the responsible social services
agency or child-placing agency in the home of a parent of the child under conditions
prescribed by the court directed to the correction of the child's need for protection or services:

(i) the court may order the child into the home of a parent who does not otherwise have
legal custody of the child, however, an order under this section does not confer legal custody
on that parent;

(ii) if the court orders the child into the home of a father who is not adjudicated, the
father must cooperate with paternity establishment proceedings regarding the child in the
appropriate jurisdiction as one of the conditions prescribed by the court for the child to
continue in the father's home; and

(iii) the court may order the child into the home of a noncustodial parent with conditions
and may also order both the noncustodial and the custodial parent to comply with the
requirements of a case plan under subdivision 2; or

(2) transfer legal custody to one of the following:

(i) a child-placing agency; or

(ii) the responsible social services agency. In making a foster care placement for a child
whose custody has been transferred under this subdivision, the agency shall make an
individualized determination of how the placement is in the child's best interests using the
consideration for relatives deleted text beginanddeleted text endnew text begin,new text end the best interest factors in section 260C.212, subdivision 2,
paragraph (b)
new text begin, and may include a child colocated with a parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190
new text end; or

(3) order a trial home visit without modifying the transfer of legal custody to the
responsible social services agency under clause (2). Trial home visit means the child is
returned to the care of the parent or guardian from whom the child was removed for a period
not to exceed six months. During the period of the trial home visit, the responsible social
services agency:

(i) shall continue to have legal custody of the child, which means the agency may see
the child in the parent's home, at school, in a child care facility, or other setting as the agency
deems necessary and appropriate;

(ii) shall continue to have the ability to access information under section 260C.208;

(iii) shall continue to provide appropriate services to both the parent and the child during
the period of the trial home visit;

(iv) without previous court order or authorization, may terminate the trial home visit in
order to protect the child's health, safety, or welfare and may remove the child to foster care;

(v) shall advise the court and parties within three days of the termination of the trial
home visit when a visit is terminated by the responsible social services agency without a
court order; and

(vi) shall prepare a report for the court when the trial home visit is terminated whether
by the agency or court order which describes the child's circumstances during the trial home
visit and recommends appropriate orders, if any, for the court to enter to provide for the
child's safety and stability. In the event a trial home visit is terminated by the agency by
removing the child to foster care without prior court order or authorization, the court shall
conduct a hearing within ten days of receiving notice of the termination of the trial home
visit by the agency and shall order disposition under this subdivision or deleted text beginconduct a permanency
hearing under subdivision 11 or 11a
deleted text endnew text begin commence permanency proceedings under sections
260C.503 to 260C.515
new text end. The time period for the hearing may be extended by the court for
good cause shown and if it is in the best interests of the child as long as the total time the
child spends in foster care without a permanency hearing does not exceed 12 months;

(4) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a physical or mental
disability or emotional disturbance as defined in section 245.4871, subdivision 15, the court
may order the child's parent, guardian, or custodian to provide it. The court may order the
child's health plan company to provide mental health services to the child. Section 62Q.535
applies to an order for mental health services directed to the child's health plan company.
If the health plan, parent, guardian, or custodian fails or is unable to provide this treatment
or care, the court may order it provided. Absent specific written findings by the court that
the child's disability is the result of abuse or neglect by the child's parent or guardian, the
court shall not transfer legal custody of the child for the purpose of obtaining special
treatment or care solely because the parent is unable to provide the treatment or care. If the
court's order for mental health treatment is based on a diagnosis made by a treatment
professional, the court may order that the diagnosing professional not provide the treatment
to the child if it finds that such an order is in the child's best interests; or

(5) if the court believes that the child has sufficient maturity and judgment and that it is
in the best interests of the child, the court may order a child 16 years old or older to be
allowed to live independently, either alone or with others as approved by the court under
supervision the court considers appropriate, if the county board, after consultation with the
court, has specifically authorized this dispositional alternative for a child.

(b) If the child was adjudicated in need of protection or services because the child is a
runaway or habitual truant, the court may order any of the following dispositions in addition
to or as alternatives to the dispositions authorized under paragraph (a):

(1) counsel the child or the child's parents, guardian, or custodian;

(2) place the child under the supervision of a probation officer or other suitable person
in the child's own home under conditions prescribed by the court, including reasonable rules
for the child's conduct and the conduct of the parents, guardian, or custodian, designed for
the physical, mental, and moral well-being and behavior of the child;

(3) subject to the court's supervision, transfer legal custody of the child to one of the
following:

(i) a reputable person of good moral character. No person may receive custody of two
or more unrelated children unless licensed to operate a residential program under sections
245A.01 to 245A.16; or

(ii) a county probation officer for placement in a group foster home established under
the direction of the juvenile court and licensed pursuant to section 241.021;

(4) require the child to pay a fine of up to $100. The court shall order payment of the
fine in a manner that will not impose undue financial hardship upon the child;

(5) require the child to participate in a community service project;

(6) order the child to undergo a chemical dependency evaluation and, if warranted by
the evaluation, order participation by the child in a drug awareness program or an inpatient
or outpatient chemical dependency treatment program;

(7) if the court believes that it is in the best interests of the child or of public safety that
the child's driver's license or instruction permit be canceled, the court may order the
commissioner of public safety to cancel the child's license or permit for any period up to
the child's 18th birthday. If the child does not have a driver's license or permit, the court
may order a denial of driving privileges for any period up to the child's 18th birthday. The
court shall forward an order issued under this clause to the commissioner, who shall cancel
the license or permit or deny driving privileges without a hearing for the period specified
by the court. At any time before the expiration of the period of cancellation or denial, the
court may, for good cause, order the commissioner of public safety to allow the child to
apply for a license or permit, and the commissioner shall so authorize;

(8) order that the child's parent or legal guardian deliver the child to school at the
beginning of each school day for a period of time specified by the court; or

(9) require the child to perform any other activities or participate in any other treatment
programs deemed appropriate by the court.

To the extent practicable, the court shall enter a disposition order the same day it makes
a finding that a child is in need of protection or services or neglected and in foster care, but
in no event more than 15 days after the finding unless the court finds that the best interests
of the child will be served by granting a delay. If the child was under eight years of age at
the time the petition was filed, the disposition order must be entered within ten days of the
finding and the court may not grant a delay unless good cause is shown and the court finds
the best interests of the child will be served by the delay.

(c) If a child who is 14 years of age or older is adjudicated in need of protection or
services because the child is a habitual truant and truancy procedures involving the child
were previously dealt with by a school attendance review board or county attorney mediation
program under section 260A.06 or 260A.07, the court shall order a cancellation or denial
of driving privileges under paragraph (b), clause (7), for any period up to the child's 18th
birthday.

(d) In the case of a child adjudicated in need of protection or services because the child
has committed domestic abuse and been ordered excluded from the child's parent's home,
the court shall dismiss jurisdiction if the court, at any time, finds the parent is able or willing
to provide an alternative safe living arrangement for the child, as defined in Laws 1997,
chapter 239, article 10, section 2.

(e) When a parent has complied with a case plan ordered under subdivision 6 and the
child is in the care of the parent, the court may order the responsible social services agency
to monitor the parent's continued ability to maintain the child safely in the home under such
terms and conditions as the court determines appropriate under the circumstances.

Sec. 28.

Minnesota Statutes 2018, section 260C.201, subdivision 2, is amended to read:


Subd. 2.

Written findings.

(a) Any order for a disposition authorized under this section
shall contain written findings of fact to support the disposition and case plan ordered and
shall also set forth in writing the following information:

(1) why the best interests and safety of the child are served by the disposition and case
plan ordered;

(2) what alternative dispositions or services under the case plan were considered by the
court and why such dispositions or services were not appropriate in the instant case;

(3) when legal custody of the child is transferred, the appropriateness of the particular
placement made or to be made by the placing agency using the factors in section 260C.212,
subdivision 2, paragraph (b)
new text begin, or the appropriateness of a child colocated with a parent in a
licensed residential family-based substance use disorder treatment program under section
260C.190
new text end;

(4) whether reasonable efforts to finalize the permanent plan for the child consistent
with section 260.012 were made including reasonable efforts:

(i) to prevent the child's placement and to reunify the child with the parent or guardian
from whom the child was removed at the earliest time consistent with the child's safety.
The court's findings must include a brief description of what preventive and reunification
efforts were made and why further efforts could not have prevented or eliminated the
necessity of removal or that reasonable efforts were not required under section 260.012 or
260C.178, subdivision 1;

(ii) to identify and locate any noncustodial or nonresident parent of the child and to
assess such parent's ability to provide day-to-day care of the child, and, where appropriate,
provide services necessary to enable the noncustodial or nonresident parent to safely provide
day-to-day care of the child as required under section 260C.219, unless such services are
not required under section 260.012 or 260C.178, subdivision 1;

(iii) to make the diligent search for relatives and provide the notices required under
section 260C.221; a finding made pursuant to a hearing under section 260C.202 that the
agency has made diligent efforts to conduct a relative search and has appropriately engaged
relatives who responded to the notice under section 260C.221 and other relatives, who came
to the attention of the agency after notice under section 260C.221 was sent, in placement
and case planning decisions fulfills the requirement of this item;

(iv) to identify and make a foster care placement in the home of an unlicensed relative,
according to the requirements of section 245A.035, a licensed relative, or other licensed
foster care provider who will commit to being the permanent legal parent or custodian for
the child in the event reunification cannot occur, but who will actively support the
reunification plan for the child; and

(v) to place siblings together in the same home or to ensure visitation is occurring when
siblings are separated in foster care placement and visitation is in the siblings' best interests
under section 260C.212, subdivision 2, paragraph (d); and

(5) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a mental disability or
emotional disturbance as defined in section 245.4871, subdivision 15, the written findings
shall also set forth:

(i) whether the child has mental health needs that must be addressed by the case plan;

(ii) what consideration was given to the diagnostic and functional assessments performed
by the child's mental health professional and to health and mental health care professionals'
treatment recommendations;

(iii) what consideration was given to the requests or preferences of the child's parent or
guardian with regard to the child's interventions, services, or treatment; and

(iv) what consideration was given to the cultural appropriateness of the child's treatment
or services.

(b) If the court finds that the social services agency's preventive or reunification efforts
have not been reasonable but that further preventive or reunification efforts could not permit
the child to safely remain at home, the court may nevertheless authorize or continue the
removal of the child.

(c) If the child has been identified by the responsible social services agency as the subject
of concurrent permanency planning, the court shall review the reasonable efforts of the
agency to develop a permanency plan for the child that includes a primary plan which is
for reunification with the child's parent or guardian and a secondary plan which is for an
alternative, legally permanent home for the child in the event reunification cannot be achieved
in a timely manner.

Sec. 29.

Minnesota Statutes 2018, section 260C.201, subdivision 6, is amended to read:


Subd. 6.

Case plan.

(a) For each disposition ordered where the child is placed away
from a parent or guardian, the court shall order the responsible social services agency to
prepare a written out-of-home placement plan according to the requirements of section
260C.212, subdivision 1.new text begin When a foster child is colocated with a parent in a licensed
residential family-based substance use disorder treatment program under section 260C.190,
the case plan must specify the recommendation for the colocation before the child is colocated
with the parent.
new text end

(b) In cases where the child is not placed out of the home or is ordered into the home of
a noncustodial parent, the responsible social services agency shall prepare a plan for delivery
of social services to the child and custodial parent under section 626.556, subdivision 10,
or any other case plan required to meet the needs of the child. The plan shall be designed
to safely maintain the child in the home or to reunite the child with the custodial parent.

(c) The court may approve the case plan as presented or modify it after hearing from
the parties. Once the plan is approved, the court shall order all parties to comply with it. A
copy of the approved case plan shall be attached to the court's order and incorporated into
it by reference.

(d) A party has a right to request a court review of the reasonableness of the case plan
upon a showing of a substantial change of circumstances.

Sec. 30.

Minnesota Statutes 2018, section 260C.212, subdivision 2, is amended to read:


Subd. 2.

Placement decisions based on best interests of the child.

(a) The policy of
the state of Minnesota is to ensure that the child's best interests are met by requiring an
individualized determination of the needs of the child and of how the selected placement
will serve the needs of the child being placed. The authorized child-placing agency shall
place a child, released by court order or by voluntary release by the parent or parents, in a
family foster home selected by considering placement with relatives and important friends
in the following order:

(1) with an individual who is related to the child by blood, marriage, or adoption; or

(2) with an individual who is an important friend with whom the child has resided or
had significant contact.

For an Indian child, the agency shall follow the order of placement preferences in the Indian
Child Welfare Act of 1978, United States Code, title 25, section 1915.

(b) Among the factors the agency shall consider in determining the needs of the child
are the following:

(1) the child's current functioning and behaviors;

(2) the medical needs of the child;

(3) the educational needs of the child;

(4) the developmental needs of the child;

(5) the child's history and past experience;

(6) the child's religious and cultural needs;

(7) the child's connection with a community, school, and faith community;

(8) the child's interests and talents;

(9) the child's relationship to current caretakers, parents, siblings, and relatives;

(10) the reasonable preference of the child, if the court, or the child-placing agency in
the case of a voluntary placement, deems the child to be of sufficient age to express
preferences; and

(11) for an Indian child, the best interests of an Indian child as defined in section 260.755,
subdivision 2a
.

(c) Placement of a child cannot be delayed or denied based on race, color, or national
origin of the foster parent or the child.

(d) Siblings should be placed together for foster care and adoption at the earliest possible
time unless it is documented that a joint placement would be contrary to the safety or
well-being of any of the siblings or unless it is not possible after reasonable efforts by the
responsible social services agency. In cases where siblings cannot be placed together, the
agency is required to provide frequent visitation or other ongoing interaction between
siblings unless the agency documents that the interaction would be contrary to the safety
or well-being of any of the siblings.

(e) Except for emergency placement as provided for in section 245A.035, the following
requirements must be satisfied before the approval of a foster or adoptive placement in a
related or unrelated home: (1) a completed background study under section 245C.08; and
(2) a completed review of the written home study required under section 260C.215,
subdivision 4
, clause (5), or 260C.611, to assess the capacity of the prospective foster or
adoptive parent to ensure the placement will meet the needs of the individual child.

new text begin (f) The agency must determine whether colocation with a parent who is receiving services
in a licensed residential family-based substance use disorder treatment program is in the
child's best interests according to paragraph (b) and include that determination in the child's
case plan. The agency may consider additional factors not identified in paragraph (b). The
agency's determination must be documented in the child's case plan before the child is
colocated with a parent.
new text end

Sec. 31.

new text begin [260C.228] VOLUNTARY FOSTER CARE; CHILD IS COLOCATED
WITH PARENT IN TREATMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin When a parent requests assistance from an agency and both
the parent and agency agree that a child's placement in foster care and colocation with a
parent in a licensed residential family-based substance use treatment facility as defined by
section 260C.007, subdivision 22a, is in the child's best interests, the agency must specify
the recommendation for the placement in the child's case plan. After the child's case plan
includes the recommendation, the agency and the parent may enter into a written voluntary
placement agreement on a form approved by the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Judicial review. new text end

new text begin (a) A judicial review of a child's voluntary placement is
required within 165 days of the date the voluntary agreement was signed. The agency
responsible for the child's placement in foster care shall request the judicial review.
new text end

new text begin (b) The agency must forward a written report to the court at least five business days
prior to the judicial review in paragraph (a). The report must contain:
new text end

new text begin (i) a statement regarding whether the colocation of the child with a parent in a licensed
residential family-based substance use disorder treatment program meets the child's needs
and continues to be in the child's best interests;
new text end

new text begin (ii) the child's name, dates of birth, race, gender, and current address;
new text end

new text begin (iii) the names, race, dates of birth, residences, and post office addresses of the child's
parents or custodian;
new text end

new text begin (iv) a statement regarding the child's eligibility for membership or enrollment in an
Indian tribe and the agency's compliance with applicable provisions of sections 260.751 to
260.835;
new text end

new text begin (v) the name and address of the licensed residential family-based substance use disorder
treatment program where the child and parent or custodian are colocated;
new text end

new text begin (vi) a copy of the out-of-home placement plan under section 260C.212, subdivisions 1
and 3;
new text end

new text begin (vii) a written summary of the proceedings of any administrative review required under
section 260C.203; and
new text end

new text begin (viii) any other information the agency, parent or custodian, child, or licensed residential
family-based substance use disorder treatment program wants the court to consider.
new text end

new text begin (c) The agency must inform a child, if the child is 12 years of age or older; the child's
parent; and the licensed residential family-based substance use disorder treatment program
of the reporting and court review requirements of this section and of their rights to submit
information to the court as follows:
new text end

new text begin (1) if the child, the child's parent, or the licensed residential family-based substance use
disorder treatment program wants to send information to the court, the agency shall advise
those persons of the reporting date and the date by which the agency must receive the
information to submit to the court with the agency's report; and
new text end

new text begin (2) the agency must inform the child, the child's parent, and the licensed residential
family-based substance use disorder treatment program that they have the right to be heard
in person by the court. An in-person hearing must be held if requested by the child, parent
or legal guardian, or licensed residential family-based substance use disorder treatment
program.
new text end

new text begin (d) If, at the time required for the agency's report under this section, a child 12 years of
age or older disagrees about the placement colocating the child with the parent in a licensed
residential family-based substance use disorder treatment program or services provided
under the out-of-home placement plan under section 260C.212, subdivision 1, the agency
shall include information regarding the child's disagreement and to the extent possible the
basis for the child's disagreement in the report.
new text end

new text begin (e) Regardless of whether an in-person hearing is requested within ten days of receiving
the agency's report, the court has jurisdiction to and must determine:
new text end

new text begin (i) whether the voluntary foster care arrangement is in the child's best interests;
new text end

new text begin (ii) whether the parent and agency are appropriately planning for the child; and
new text end

new text begin (iii) if a child 12 years of age or older disagrees with the foster care placement colocating
the child with the parent in a licensed residential family-based substance use disorder
treatment program or services provided under the out-of-home placement plan, whether to
appoint counsel and a guardian ad litem for the child according to section 260C.163.
new text end

new text begin (f) Unless requested by the parent, representative of the licensed residential family-based
substance use disorder treatment program, or child, an in-person hearing is not required for
the court to make findings and issue an order.
new text end

new text begin (g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit individualized findings to support the court's determination.
The individual findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported to the court under paragraph (d).
new text end

new text begin (h) The court shall send a copy of the order to the county attorney, the agency, the parent,
a child 12 years of age or older, and the licensed residential family-based substance use
disorder treatment program.
new text end

new text begin (i) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent is not appropriately planning for the child, the
court shall notify the agency, the parent, the licensed residential family-based substance
use disorder treatment program, a child 12 years of age or older, and the county attorney of
the court's determination and the basis for the court's determination. The court shall set the
matter for hearing and appoint a guardian ad litem for the child under section 260C.163,
subdivision 5.
new text end

new text begin Subd. 3. new text end

new text begin Termination. new text end

new text begin The voluntary placement agreement terminates at the parent's
discharge from the licensed residential family-based substance use disorder treatment
program, or upon receipt of a written and dated request from the parent, unless the request
specifies a later date. If the child's voluntary foster care placement meets the calculated time
to require a permanency proceeding under section 260C.503, subdivision 3, paragraph (a),
and the child is not returned home, the agency must file a petition according to section
260C.141 or 260C.505.
new text end

Sec. 32.

Minnesota Statutes 2018, section 260C.452, subdivision 4, is amended to read:


Subd. 4.

Administrative or court review of placements.

(a) When the child is 14 years
of age or older, the court, in consultation with the child, shall review the independent living
plan according to section 260C.203, paragraph (d).

(b) The responsible social services agency shall file a copy of the notification required
in subdivision 3 with the court. If the responsible social services agency does not file the
notice by the time the child is 17-1/2 years of age, the court shall require the responsible
social services agency to file the notice.

(c) The court shall ensure that the responsible social services agency assists the child in
obtaining the following documents before the child leaves foster care: a Social Security
card; an official or certified copy of the child's birth certificate; a state identification card
or driver's license, tribal enrollment identification card, green card, or school visa; health
insurance information; the child's school, medical, and dental records; a contact list of the
child's medical, dental, and mental health providers; and contact information for the child's
siblings, if the siblings are in foster care.

(d) For a child who will be discharged from foster care at 18 years of age or older, the
responsible social services agency must develop a personalized transition plan as directed
by the child during the 90-day period immediately prior to the expected date of discharge.
The transition plan must be as detailed as the child elects and include specific options,
including but not limited to:

(1) affordable housing with necessary supports that does not include a homeless shelter;

(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;

(3) education, including application to the Education and Training Voucher Program;

(4) local opportunities for mentors and continuing support services, including the Healthy
Transitions and Homeless Prevention program, if available;

(5) workforce supports and employment services;

(6) a copy of the child's consumer credit report as defined in section 13C.001 and
assistance in interpreting and resolving any inaccuracies in the report, at no cost to the child;

(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
child if the child becomes unable to participate in decisions; deleted text beginand
deleted text end

(8) appropriate contact information through 21 years of age if the child needs information
or help dealing with a crisis situationdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (9) official documentation that the youth was previously in foster care.
new text end

Sec. 33.

Minnesota Statutes 2018, section 260C.503, subdivision 1, is amended to read:


Subdivision 1.

Required permanency proceedings.

new text begin(a) new text endExcept for children in foster
care pursuant to chapter 260D, where the child is in foster care or in the care of a noncustodial
or nonresident parent, the court shall commence proceedings to determine the permanent
status of a child by holding the admit-deny hearing required under section 260C.507 not
later than 12 months after the child is placed in foster care or in the care of a noncustodial
or nonresident parent. Permanency proceedings for children in foster care pursuant to chapter
260D shall be according to section 260D.07.

new text begin (b) Permanency proceedings for a foster child who is colocated with a parent in a licensed
residential family-based substance use disorder treatment program shall be conducted
according to section 260C.190.
new text end

Sec. 34.

Minnesota Statutes 2018, section 518A.32, subdivision 3, is amended to read:


Subd. 3.

Parent not considered voluntarily unemployed, underemployed, or employed
on a less than full-time basis.

A parent is not considered voluntarily unemployed,
underemployed, or employed on a less than full-time basis upon a showing by the parent
that:

(1) the unemployment, underemployment, or employment on a less than full-time basis
is temporary and will ultimately lead to an increase in income;

(2) the unemployment, underemployment, or employment on a less than full-time basis
represents a bona fide career change that outweighs the adverse effect of that parent's
diminished income on the child; or

(3) the unemployment, underemployment, or employment on a less than full-time basis
is because a parent is physically or mentally incapacitated or due to incarcerationdeleted text begin, except
where the reason for incarceration is the parent's nonpayment of support
deleted text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 35.

Minnesota Statutes 2018, section 518A.51, is amended to read:


518A.51 FEES FOR IV-D SERVICES.

(a) When a recipient of IV-D services is no longer receiving assistance under the state's
title IV-A, IV-E foster care, or medical assistance programs, the public authority responsible
for child support enforcement must notify the recipient, within five working days of the
notification of ineligibility, that IV-D services will be continued unless the public authority
is notified to the contrary by the recipient. The notice must include the implications of
continuing to receive IV-D services, including the available services and fees, cost recovery
fees, and distribution policies relating to fees.

(b) In the case of an individual who has never received assistance under a state program
funded under title IV-A of the Social Security Act and for whom the public authority has
collected at least deleted text begin$500deleted text endnew text begin $550new text end of support, the public authority must impose an annual federal
collections fee of deleted text begin$25deleted text endnew text begin $35new text end for each case in which services are furnished. This fee must be
retained by the public authority from support collected on behalf of the individual, but not
from the first deleted text begin$500deleted text endnew text begin $550new text end collected.

(c) When the public authority provides full IV-D services to an obligee who has applied
for those services, upon written notice to the obligee, the public authority must charge a
cost recovery fee of two percent of the amount collected. This fee must be deducted from
the amount of the child support and maintenance collected and not assigned under section
256.741 before disbursement to the obligee. This fee does not apply to an obligee who:

(1) is currently receiving assistance under the state's title IV-A, IV-E foster care, or
medical assistance programs; or

(2) has received assistance under the state's title IV-A or IV-E foster care programs,
until the person has not received this assistance for 24 consecutive months.

(d) When the public authority provides full IV-D services to an obligor who has applied
for such services, upon written notice to the obligor, the public authority must charge a cost
recovery fee of two percent of the monthly court-ordered child support and maintenance
obligation. The fee may be collected through income withholding, as well as by any other
enforcement remedy available to the public authority responsible for child support
enforcement.

(e) Fees assessed by state and federal tax agencies for collection of overdue support
owed to or on behalf of a person not receiving public assistance must be imposed on the
person for whom these services are provided. The public authority upon written notice to
the obligee shall assess a fee of $25 to the person not receiving public assistance for each
successful federal tax interception. The fee must be withheld prior to the release of the funds
received from each interception and deposited in the general fund.

(f) Federal collections fees collected under paragraph (b) and cost recovery fees collected
under paragraphs (c) and (d) retained by the commissioner of human services shall be
considered child support program income according to Code of Federal Regulations, title
45, section 304.50, and shall be deposited in the special revenue fund account established
under paragraph (h). The commissioner of human services must elect to recover costs based
on either actual or standardized costs.

(g) The limitations of this section on the assessment of fees shall not apply to the extent
inconsistent with the requirements of federal law for receiving funds for the programs under
title IV-A and title IV-D of the Social Security Act, United States Code, title 42, sections
601 to 613 and United States Code, title 42, sections 651 to 662.

(h) The commissioner of human services is authorized to establish a special revenue
fund account to receive the federal collections fees collected under paragraph (b) and cost
recovery fees collected under paragraphs (c) and (d).

(i) The nonfederal share of the cost recovery fee revenue must be retained by the
commissioner and distributed as follows:

(1) one-half of the revenue must be transferred to the child support system special revenue
account to support the state's administration of the child support enforcement program and
its federally mandated automated system;

(2) an additional portion of the revenue must be transferred to the child support system
special revenue account for expenditures necessary to administer the fees; and

(3) the remaining portion of the revenue must be distributed to the counties to aid the
counties in funding their child support enforcement programs.

(j) The nonfederal share of the federal collections fees must be distributed to the counties
to aid them in funding their child support enforcement programs.

(k) The commissioner of human services shall distribute quarterly any of the funds
dedicated to the counties under paragraphs (i) and (j) using the methodology specified in
section 256.979, subdivision 11. The funds received by the counties must be reinvested in
the child support enforcement program and the counties must not reduce the funding of
their child support programs by the amount of the funding distributed.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2019.
new text end

Sec. 36. new text beginINSTRUCTION TO COMMISSIONER.
new text end

new text begin All individuals in connection with a licensed children's residential facility required to
complete a background study under Minnesota Statutes, chapter 245C, must complete a
new background study consistent with the obligations and requirements of this article. The
commissioner of human services shall establish a schedule for (1) individuals in connection
with a licensed children's residential facility that serves children eligible to receive federal
Title IV-E funding to complete the new background study by March 1, 2020, and (2)
individuals in connection with a licensed children's residential facility that serves children
not eligible to receive federal Title IV-E funding to complete the new background study by
March 1, 2021.
new text end

Sec. 37. new text beginCHILD WELFARE TRAINING ACADEMY.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin The commissioner of human services shall
modify the Child Welfare Training System developed pursuant to Minnesota Statutes,
section 626.5591, subdivision 2, according to this section. The new training framework
shall be known as the Child Welfare Training Academy.
new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin (a) The Child Welfare Training Academy must be administered
through five regional hubs in northwest, northeast, southwest, southeast, and central
Minnesota. Each hub must deliver training targeted to the needs of the hub's particular
region, taking into account varying demographics, resources, and practice outcomes.
new text end

new text begin (b) The Child Welfare Training Academy must use training methods best suited to the
training content. National best practices in adult learning must be used to the greatest extent
possible, including online learning methodologies, coaching, mentoring, and simulated skill
application.
new text end

new text begin (c) Content of training delivered by the Child Welfare Training Academy must be
informed using multidisciplinary approaches and must include input from stakeholders,
including but not limited to child welfare professionals, resource parents, biological parents
and caregivers, and other community members with expertise in child welfare racial
disparities and implicit bias. Content must be structured to reflect the variety of communities
served by the child welfare system in Minnesota and must be informed with attention to
both child safety and the evidence-based understanding that maintaining family relationships
and preventing out-of-home placement are essential to child well-being. Training delivered
by the Child Welfare Training Academy must emphasize racial disparities and
disproportionate child welfare outcomes that exist in Minnesota and must include specific
content on recognizing and addressing implicit bias.
new text end

new text begin (d) Each child welfare worker and supervisor must complete a certification, including
a competency-based knowledge test and a skills demonstration, at the completion of the
worker's or supervisor's initial training and biennially thereafter. The commissioner shall
develop ongoing training requirements and a method for tracking certifications.
new text end

new text begin (e) The Child Welfare Training Academy must serve the primary training audiences of
(1) county and tribal child welfare workers, (2) county and tribal child welfare supervisors,
and (3) staff at private agencies providing out-of-home placement services for children
involved in Minnesota's county and tribal child welfare system.
new text end

new text begin Subd. 3. new text end

new text begin Partnerships. new text end

new text begin The commissioner of human services shall enter into a partnership
with the University of Minnesota to collaborate in the administration of workforce training.
new text end

new text begin Subd. 4. new text end

new text begin Rulemaking. new text end

new text begin The commissioner of human services may adopt rules as necessary
to establish the Child Welfare Training Academy.
new text end

Sec. 38. new text beginCHILD WELFARE CASELOAD STUDY.
new text end

new text begin (a) The commissioner of human services shall conduct a child welfare caseload study
to collect data on (1) the number of child welfare workers in Minnesota, and (2) the amount
of time that child welfare workers spend on different components of child welfare work.
The study must be completed by October 1, 2020.
new text end

new text begin (b) The commissioner shall report the results of the child welfare caseload study to the
governor and to the chairs and ranking minority members of the committees in the house
of representatives and senate with jurisdiction over human services by December 1, 2020.
new text end

new text begin (c) After the child welfare caseload study is complete, the commissioner shall work with
counties and other stakeholders to develop a process for ongoing monitoring of child welfare
workers' caseloads.
new text end

Sec. 39. new text beginDIRECTION TO COMMISSIONER; HOMELESS YOUTH ACCESS TO
BIRTH RECORDS AND MINNESOTA IDENTIFICATION CARDS.
new text end

new text begin No later than January 15, 2020, the commissioner of human services, in consultation
with the commissioners of health and public safety, shall report to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over the
Homeless Youth Act with recommendations on providing homeless youth with access to
birth records and Minnesota identification cards at no cost.
new text end

Sec. 40. new text beginDIRECTION TO COMMISSIONER; FAMILY FIRST PREVENTION
KINSHIP SERVICES.
new text end

new text begin The commissioner of human services shall review opportunities to implement kinship
navigator models that support placement of children with relative foster parents in anticipation
of reimbursement for eligible services under the Family First Prevention Services Act.
Kinship navigator models would assist relative foster parents with home studies and licensing
requirements and provide ongoing support to the relative caregivers and children in
out-of-home placement with relatives.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 41. new text beginDIRECTION TO COMMISSIONER; RELATIVE SEARCH.
new text end

new text begin The commissioner of human services shall develop and provide guidance to assist local
social services agencies in conducting relative searches under Minnesota Statutes, section
260C.221. The commissioner shall issue a bulletin containing relative search guidance by
January 1, 2020. Guidance from the commissioner shall relate to:
new text end

new text begin (1) easily understandable methods of relative notification;
new text end

new text begin (2) resources for local social services agency child welfare staff to improve engagement
and communication with relatives and kin; and
new text end

new text begin (3) providing information to relatives and kin about all permanency options, sustaining
relationships, visitation options, and supporting permanency.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 42. new text beginREVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes, in consultation with the Department of Human Services, House
Research Department, and Senate Counsel, Research and Fiscal Analysis shall change the
terms "food support" and "food stamps" to "Supplemental Nutrition Assistance Program"
or "SNAP" in Minnesota Statutes when appropriate. The revisor may make technical and
other necessary changes to sentence structure to preserve the meaning of the text.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 43. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 119B.16, subdivision 2; and 245E.06, subdivisions
2, 4, and 5,
new text end new text begin and new text end new text begin Minnesota Rules, part 3400.0185, subpart 5, new text end new text begin are repealed effective February
26, 2021.
new text end

ARTICLE 2

OPERATIONS

Section 1.

Minnesota Statutes 2018, section 13.46, subdivision 2, is amended to read:


Subd. 2.

General.

(a) Data on individuals collected, maintained, used, or disseminated
by the welfare system are private data on individuals, and shall not be disclosed except:

(1) according to section 13.05;

(2) according to court order;

(3) according to a statute specifically authorizing access to the private data;

(4) to an agent of the welfare system and an investigator acting on behalf of a county,
the state, or the federal government, including a law enforcement person or attorney in the
investigation or prosecution of a criminal, civil, or administrative proceeding relating to the
administration of a program;

(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to an
individual or family across programs; coordinate services for an individual or family;
evaluate the effectiveness of programs; assess parental contribution amounts; and investigate
suspected fraud;

(6) to administer federal funds or programs;

(7) between personnel of the welfare system working in the same program;

(8) to the Department of Revenue to assess parental contribution amounts for purposes
of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit programs
and to identify individuals who may benefit from these programs. The following information
may be disclosed under this paragraph: an individual's and their dependent's names, dates
of birth, Social Security numbers, income, addresses, and other data as required, upon
request by the Department of Revenue. Disclosures by the commissioner of revenue to the
commissioner of human services for the purposes described in this clause are governed by
section 270B.14, subdivision 1. Tax refund or tax credit programs include, but are not limited
to, the dependent care credit under section 290.067, the Minnesota working family credit
under section 290.0671, the property tax refund and rental credit under section 290A.04,
and the Minnesota education credit under section 290.0674;

(9) between the Department of Human Services, the Department of Employment and
Economic Development, and when applicable, the Department of Education, for the following
purposes:

(i) to monitor the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency;

(ii) to administer any rehabilitation program or child care assistance program, whether
alone or in conjunction with the welfare system;

(iii) to monitor and evaluate the Minnesota family investment program or the child care
assistance program by exchanging data on recipients and former recipients of food support,
cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance under chapter
119B, medical programs under chapter 256B or 256L, or a medical program formerly
codified under chapter 256D; and

(iv) to analyze public assistance employment services and program utilization, cost,
effectiveness, and outcomes as implemented under the authority established in Title II,
Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of 1999.
Health records governed by sections 144.291 to 144.298 and "protected health information"
as defined in Code of Federal Regulations, title 45, section 160.103, and governed by Code
of Federal Regulations, title 45, parts 160-164, including health care claims utilization
information, must not be exchanged under this clause;

(10) to appropriate parties in connection with an emergency if knowledge of the
information is necessary to protect the health or safety of the individual or other individuals
or persons;

(11) data maintained by residential programs as defined in section 245A.02 may be
disclosed to the protection and advocacy system established in this state according to Part
C of Public Law 98-527 to protect the legal and human rights of persons with developmental
disabilities or other related conditions who live in residential facilities for these persons if
the protection and advocacy system receives a complaint by or on behalf of that person and
the person does not have a legal guardian or the state or a designee of the state is the legal
guardian of the person;

(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;

(13) data on a child support obligor who makes payments to the public agency may be
disclosed to the Minnesota Office of Higher Education to the extent necessary to determine
eligibility under section 136A.121, subdivision 2, clause (5);

(14) participant Social Security numbers and names collected by the telephone assistance
program may be disclosed to the Department of Revenue to conduct an electronic data
match with the property tax refund database to determine eligibility under section 237.70,
subdivision 4a
;

(15) the current address of a Minnesota family investment program participant may be
disclosed to law enforcement officers who provide the name of the participant and notify
the agency that:

(i) the participant:

(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or

(B) is violating a condition of probation or parole imposed under state or federal law;

(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and

(iii) the request is made in writing and in the proper exercise of those duties;

(16) the current address of a recipient of general assistance may be disclosed to probation
officers and corrections agents who are supervising the recipient and to law enforcement
officers who are investigating the recipient in connection with a felony level offense;

(17) information obtained from food support applicant or recipient households may be
disclosed to local, state, or federal law enforcement officials, upon their written request, for
the purpose of investigating an alleged violation of the Food Stamp Act, according to Code
of Federal Regulations, title 7, section 272.1(c);

(18) the address, Social Security number, and, if available, photograph of any member
of a household receiving food support shall be made available, on request, to a local, state,
or federal law enforcement officer if the officer furnishes the agency with the name of the
member and notifies the agency that:

(i) the member:

(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;

(B) is violating a condition of probation or parole imposed under state or federal law;
or

(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);

(ii) locating or apprehending the member is within the officer's official duties; and

(iii) the request is made in writing and in the proper exercise of the officer's official duty;

(19) the current address of a recipient of Minnesota family investment program, general
assistance, or food support may be disclosed to law enforcement officers who, in writing,
provide the name of the recipient and notify the agency that the recipient is a person required
to register under section 243.166, but is not residing at the address at which the recipient is
registered under section 243.166;

(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;

(21) data on child support payments made by a child support obligor and data on the
distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the income
of the obligor or obligee may be disclosed to the other party;

(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7
;

(23) to the Department of Education for the purpose of matching Department of Education
student data with public assistance data to determine students eligible for free and
reduced-price meals, meal supplements, and free milk according to United States Code,
title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and state
funds that are distributed based on income of the student's family; and to verify receipt of
energy assistance for the telephone assistance plan;

(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a community health board as
defined in section 145A.02, subdivision 5, when the commissioner or community health
board has reason to believe that a program recipient is a disease case, carrier, suspect case,
or at risk of illness, and the data are necessary to locate the person;

(25) to other state agencies, statewide systems, and political subdivisions of this state,
including the attorney general, and agencies of other states, interstate information networks,
federal agencies, and other entities as required by federal regulation or law for the
administration of the child support enforcement program;

(26) to personnel of public assistance programs as defined in section 256.741, for access
to the child support system database for the purpose of administration, including monitoring
and evaluation of those public assistance programs;

(27) to monitor and evaluate the Minnesota family investment program by exchanging
data between the Departments of Human Services and Education, on recipients and former
recipients of food support, cash assistance under chapter 256, 256D, 256J, or 256K, child
care assistance under chapter 119B, medical programs under chapter 256B or 256L, or a
medical program formerly codified under chapter 256D;

(28) to evaluate child support program performance and to identify and prevent fraud
in the child support program by exchanging data between the Department of Human Services,
Department of Revenue under section 270B.14, subdivision 1, paragraphs (a) and (b),
without regard to the limitation of use in paragraph (c), Department of Health, Department
of Employment and Economic Development, and other state agencies as is reasonably
necessary to perform these functions;

(29) counties new text beginand the Department of Human Services new text endoperating child care assistance
programs under chapter 119B may disseminate data on program participants, applicants,
and providers to the commissioner of education;

(30) child support data on the child, the parents, and relatives of the child may be
disclosed to agencies administering programs under titles IV-B and IV-E of the Social
Security Act, as authorized by federal law;

(31) to a health care provider governed by sections 144.291 to 144.298, to the extent
necessary to coordinate services;

(32) to the chief administrative officer of a school to coordinate services for a student
and family; data that may be disclosed under this clause are limited to name, date of birth,
gender, and address; or

(33) to county correctional agencies to the extent necessary to coordinate services and
diversion programs; data that may be disclosed under this clause are limited to name, client
demographics, program, case status, and county worker information.

(b) Information on persons who have been treated for drug or alcohol abuse may only
be disclosed according to the requirements of Code of Federal Regulations, title 42, sections
2.1 to 2.67.

(c) Data provided to law enforcement agencies under paragraph (a), clause (15), (16),
(17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).

(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but are
not subject to the access provisions of subdivision 10, paragraph (b).

For the purposes of this subdivision, a request will be deemed to be made in writing if
made through a computer interface system.

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2018, section 13.46, subdivision 3, is amended to read:


Subd. 3.

Investigative data.

(a) Data on persons, including data on vendors of services,
licensees, and applicants that is collected, maintained, used, or disseminated by the welfare
system in an investigation, authorized by statute, and relating to the enforcement of rules
or law are confidential data on individuals pursuant to section 13.02, subdivision 3, or
protected nonpublic data not on individuals pursuant to section 13.02, subdivision 13, and
shall not be disclosed except:

(1) pursuant to section 13.05;

(2) pursuant to statute or valid court order;

(3) to a party named in a civil or criminal proceeding, administrative or judicial, for
preparation of defense; deleted text beginor
deleted text end

new text begin (4) to an agent of the welfare system or an investigator acting on behalf of a county,
state, or federal government, including a law enforcement officer or attorney in the
investigation or prosecution of a criminal, civil, or administrative proceeding, unless the
commissioner of human services determines that disclosure may compromise a Department
of Human Services ongoing investigation; or
new text end

deleted text begin (4)deleted text endnew text begin (5)new text end to provide notices required or permitted by statute.

The data referred to in this subdivision shall be classified as public data upon submission
to an administrative law judge or court in an administrative or judicial proceeding. Inactive
welfare investigative data shall be treated as provided in section 13.39, subdivision 3.

(b) Notwithstanding any other provision in law, the commissioner of human services
shall provide all active and inactive investigative data, including the name of the reporter
of alleged maltreatment under section 626.556 or 626.557, to the ombudsman for mental
health and developmental disabilities upon the request of the ombudsman.

(c) Notwithstanding paragraph (a) and section 13.39, the existence of an investigation
by the commissionernew text begin of human servicesnew text end of possible overpayments of public funds to a service
provider or recipient may be disclosed if the commissioner determines that it will not
compromise the investigation.

Sec. 3.

Minnesota Statutes 2018, section 13.46, subdivision 4, is amended to read:


Subd. 4.

Licensing data.

(a) As used in this subdivision:

(1) "licensing data" are all data collected, maintained, used, or disseminated by the
welfare system pertaining to persons licensed or registered or who apply for licensure or
registration or who formerly were licensed or registered under the authority of the
commissioner of human services;

(2) "client" means a person who is receiving services from a licensee or from an applicant
for licensure; and

(3) "personal and personal financial data" are Social Security numbers, identity of and
letters of reference, insurance information, reports from the Bureau of Criminal
Apprehension, health examination reports, and social/home studies.

(b)(1)(i) Except as provided in paragraph (c), the following data on applicants, license
holders, and former licensees are public: name, address, telephone number of licensees,
date of receipt of a completed application, dates of licensure, licensed capacity, type of
client preferred, variances granted, record of training and education in child care and child
development, type of dwelling, name and relationship of other family members, previous
license history, class of license, the existence and status of complaints, and the number of
serious injuries to or deaths of individuals in the licensed program as reported to the
commissioner of human services, the local social services agency, or any other county
welfare agency. For purposes of this clause, a serious injury is one that is treated by a
physician.

(ii) new text beginExcept as provided in item (v), new text endwhen a correction order, an order to forfeit a fine,
an order of license suspension, an order of temporary immediate suspension, an order of
license revocation, an order of license denial, or an order of conditional license has been
issued, or a complaint is resolved, the following data on current and former licensees and
applicants are public: the general nature of the complaint or allegations leading to the
temporary immediate suspension; the substance and investigative findings of the licensing
or maltreatment complaint, licensing violation, or substantiated maltreatment; the existence
of settlement negotiations; the record of informal resolution of a licensing violation; orders
of hearing; findings of fact; conclusions of law; specifications of the final correction order,
fine, suspension, temporary immediate suspension, revocation, denial, or conditional license
contained in the record of licensing action; whether a fine has been paid; and the status of
any appeal of these actions.

(iii) When a license denial under section 245A.05 or a sanction under section 245A.07
is based on a determination that a license holder, applicant, or controlling individual is
responsible for maltreatment under section 626.556 or 626.557, the identity of the applicant,
license holder, or controlling individual as the individual responsible for maltreatment is
public data at the time of the issuance of the license denial or sanction.

(iv) When a license denial under section 245A.05 or a sanction under section 245A.07
is based on a determination that a license holder, applicant, or controlling individual is
disqualified under chapter 245C, the identity of the license holder, applicant, or controlling
individual as the disqualified individual and the reason for the disqualification are public
data at the time of the issuance of the licensing sanction or denial. If the applicant, license
holder, or controlling individual requests reconsideration of the disqualification and the
disqualification is affirmed, the reason for the disqualification and the reason to not set aside
the disqualification are public data.

new text begin (v) A correction order or fine issued to a child care provider for a licensing violation is
private data on individuals under section 13.02, subdivision 12, or nonpublic data under
section 13.02, subdivision 9, if the correction order or fine is seven years old or older.
new text end

(2) For applicants who withdraw their application prior to licensure or denial of a license,
the following data are public: the name of the applicant, the city and county in which the
applicant was seeking licensure, the dates of the commissioner's receipt of the initial
application and completed application, the type of license sought, and the date of withdrawal
of the application.

(3) For applicants who are denied a license, the following data are public: the name and
address of the applicant, the city and county in which the applicant was seeking licensure,
the dates of the commissioner's receipt of the initial application and completed application,
the type of license sought, the date of denial of the application, the nature of the basis for
the denial, the existence of settlement negotiations, the record of informal resolution of a
denial, orders of hearings, findings of fact, conclusions of law, specifications of the final
order of denial, and the status of any appeal of the denial.

(4) When maltreatment is substantiated under section 626.556 or 626.557 and the victim
and the substantiated perpetrator are affiliated with a program licensed under chapter 245A,
the commissioner of human services, local social services agency, or county welfare agency
may inform the license holder where the maltreatment occurred of the identity of the
substantiated perpetrator and the victim.

(5) Notwithstanding clause (1), for child foster care, only the name of the license holder
and the status of the license are public if the county attorney has requested that data otherwise
classified as public data under clause (1) be considered private data based on the best interests
of a child in placement in a licensed program.

(c) The following are private data on individuals under section 13.02, subdivision 12,
or nonpublic data under section 13.02, subdivision 9: personal and personal financial data
on family day care program and family foster care program applicants and licensees and
their family members who provide services under the license.

(d) The following are private data on individuals: the identity of persons who have made
reports concerning licensees or applicants that appear in inactive investigative data, and the
records of clients or employees of the licensee or applicant for licensure whose records are
received by the licensing agency for purposes of review or in anticipation of a contested
matter. The names of reporters of complaints or alleged violations of licensing standards
under chapters 245A, 245B, 245C, and 245D, and applicable rules and alleged maltreatment
under sections 626.556 and 626.557, are confidential data and may be disclosed only as
provided in section 626.556, subdivision 11, or 626.557, subdivision 12b.

(e) Data classified as private, confidential, nonpublic, or protected nonpublic under this
subdivision become public data if submitted to a court or administrative law judge as part
of a disciplinary proceeding in which there is a public hearing concerning a license which
has been suspended, immediately suspended, revoked, or denied.

(f) Data generated in the course of licensing investigations that relate to an alleged
violation of law are investigative data under subdivision 3.

(g) Data that are not public data collected, maintained, used, or disseminated under this
subdivision that relate to or are derived from a report as defined in section 626.556,
subdivision 2
, or 626.5572, subdivision 18, are subject to the destruction provisions of
sections 626.556, subdivision 11c, and 626.557, subdivision 12b.

(h) Upon request, not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report of substantiated maltreatment as
defined in section 626.556 or 626.557 may be exchanged with the Department of Health
for purposes of completing background studies pursuant to section 144.057 and with the
Department of Corrections for purposes of completing background studies pursuant to
section 241.021.

(i) Data on individuals collected according to licensing activities under chapters 245A
and 245C, data on individuals collected by the commissioner of human services according
to investigations under chapters 245A, 245B, 245C, and 245D, and sections 626.556 and
626.557 may be shared with the Department of Human Rights, the Department of Health,
the Department of Corrections, the ombudsman for mental health and developmental
disabilities, and the individual's professional regulatory board when there is reason to believe
that laws or standards under the jurisdiction of those agencies may have been violated or
the information may otherwise be relevant to the board's regulatory jurisdiction. Background
study data on an individual who is the subject of a background study under chapter 245C
for a licensed service for which the commissioner of human services is the license holder
may be shared with the commissioner and the commissioner's delegate by the licensing
division. Unless otherwise specified in this chapter, the identity of a reporter of alleged
maltreatment or licensing violations may not be disclosed.

(j) In addition to the notice of determinations required under section 626.556, subdivision
10f
, if the commissioner or the local social services agency has determined that an individual
is a substantiated perpetrator of maltreatment of a child based on sexual abuse, as defined
in section 626.556, subdivision 2, and the commissioner or local social services agency
knows that the individual is a person responsible for a child's care in another facility, the
commissioner or local social services agency shall notify the head of that facility of this
determination. The notification must include an explanation of the individual's available
appeal rights and the status of any appeal. If a notice is given under this paragraph, the
government entity making the notification shall provide a copy of the notice to the individual
who is the subject of the notice.

(k) All not public data collected, maintained, used, or disseminated under this subdivision
and subdivision 3 may be exchanged between the Department of Human Services, Licensing
Division, and the Department of Corrections for purposes of regulating services for which
the Department of Human Services and the Department of Corrections have regulatory
authority.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 4.

Minnesota Statutes 2018, section 13.461, subdivision 28, is amended to read:


Subd. 28.

Child care assistance program.

Data collected, maintained, used, or
disseminated by the welfare system pertaining to persons selected as legal nonlicensed child
care providers by families receiving child care assistance are classified under section 119B.02,
subdivision 6
new text begin, paragraph (a)new text end.new text begin Child care assistance program payment data is classified under
section 119B.02, subdivision 6, paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2018, section 15C.02, is amended to read:


15C.02 LIABILITY FOR CERTAIN ACTS.

(a) A person who commits any act described in clauses (1) to (7) is liable to the state or
the political subdivision for a civil penalty deleted text beginof not less than $5,500 and not more than $11,000
per false or fraudulent claim
deleted text endnew text begin in the amounts set forth in the federal False Claims Act, United
States Code, title 31, section 3729, and as modified by the federal Civil Penalties Inflation
Adjustment Act Improvements Act of 2015
new text end, plus three times the amount of damages that
the state or the political subdivision sustains because of the act of that person, except as
otherwise provided in paragraph (b):

(1) knowingly presents, or causes to be presented, a false or fraudulent claim for payment
or approval;

(2) knowingly makes or uses, or causes to be made or used, a false record or statement
material to a false or fraudulent claim;

(3) knowingly conspires to commit a violation of clause (1), (2), (4), (5), (6), or (7);

(4) has possession, custody, or control of property or money used, or to be used, by the
state or a political subdivision and knowingly delivers or causes to be delivered less than
all of that money or property;

(5) is authorized to make or deliver a document certifying receipt for money or property
used, or to be used, by the state or a political subdivision and, intending to defraud the state
or a political subdivision, makes or delivers the receipt without completely knowing that
the information on the receipt is true;

(6) knowingly buys, or receives as a pledge of an obligation or debt, public property
from an officer or employee of the state or a political subdivision who lawfully may not
sell or pledge the property; or

(7) knowingly makes or uses, or causes to be made or used, a false record or statement
material to an obligation to pay or transmit money or property to the state or a political
subdivision, or knowingly conceals or knowingly and improperly avoids or decreases an
obligation to pay or transmit money or property to the state or a political subdivision.

(b) Notwithstanding paragraph (a), the court may assess not less than two times the
amount of damages that the state or the political subdivision sustains because of the act of
the person if:

(1) the person committing a violation under paragraph (a) furnished an officer or
employee of the state or the political subdivision responsible for investigating the false or
fraudulent claim violation with all information known to the person about the violation
within 30 days after the date on which the person first obtained the information;

(2) the person fully cooperated with any investigation by the state or the political
subdivision of the violation; and

(3) at the time the person furnished the state or the political subdivision with information
about the violation, no criminal prosecution, civil action, or administrative action had been
commenced under this chapter with respect to the violation and the person did not have
actual knowledge of the existence of an investigation into the violation.

(c) A person violating this section is also liable to the state or the political subdivision
for the costs of a civil action brought to recover any penalty or damages.

(d) A person is not liable under this section for mere negligence, inadvertence, or mistake
with respect to activities involving a false or fraudulent claim.

Sec. 6.

Minnesota Statutes 2018, section 16A.055, subdivision 1a, is amended to read:


Subd. 1a.

Additional duties.

The commissioner may assist state agencies by providing
analytical, statisticalnew text begin, program evaluation using experimental or quasi-experimental designnew text end,
and organizational development services to state agencies in order to assist the agency to
achieve the agency's mission and to operate efficiently and effectively. new text beginFor purposes of this
section, "experimental design" means a method of evaluating the impact of a service that
uses random assignment to assign participants into groups that respectively receive the
studied service and those that receive service as usual, so that any difference in outcomes
found at the end of the evaluation can be attributed to the studied service; and
"quasi-experimental design" means a method of evaluating the impact of a service that uses
strategies other than random assignment to establish statistically similar groups that
respectively receive the service and those that receive service as usual, so that any difference
in outcomes found at the end of the evaluation can be attributed to the studied service.
new text end

Sec. 7.

Minnesota Statutes 2018, section 119B.02, subdivision 6, is amended to read:


Subd. 6.

Data.

new text begin(a) new text endData collected, maintained, used, or disseminated by the welfare
system pertaining to persons selected as legal nonlicensed child care providers by families
receiving child care assistance shall be treated as licensing data as provided in section 13.46,
subdivision 4
.

new text begin (b) For purposes of this paragraph, "child care assistance program payment data" means
data for a specified time period showing (1) that a child care assistance program payment
under this chapter was made, and (2) the amount of child care assistance payments made
to a child care center. Child care assistance program payment data may include the number
of families and children on whose behalf payments were made for the specified time period.
Any child care assistance program payment data that may identify a specific child care
assistance recipient or benefit paid on behalf of a specific child care assistance recipient,
as determined by the commissioner, is private data on individuals as defined in section
13.02, subdivision 12. Data related to a child care assistance payment is public if the data
relates to a child care assistance payment made to a licensed child care center or a child
care center exempt from licensure and:
new text end

new text begin (1) the child care center receives payment of more than $100,000 from the child care
assistance program under this chapter in a period of one year or less; or
new text end

new text begin (2) when the commissioner or county agency either:
new text end

new text begin (i) disqualified the center from receipt of a payment from the child care assistance
program under this chapter for wrongfully obtaining child care assistance under section
256.98, subdivision 8, paragraph (c);
new text end

new text begin (ii) refused a child care authorization, revoked a child care authorization, stopped
payment, or denied payment for a bill for the center under section 119B.13, subdivision 6,
paragraph (d); or
new text end

new text begin (iii) made a finding of financial misconduct under section 245E.02.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 8.

Minnesota Statutes 2018, section 119B.09, subdivision 7, is amended to read:


Subd. 7.

Date of eligibility for assistance.

(a) The date of eligibility for child care
assistance under this chapter is the later of the date the application was received by the
county; the beginning date of employment, education, or training; the date the infant is born
for applicants to the at-home infant care program; or the date a determination has been made
that the applicant is a participant in employment and training services under Minnesota
Rules, part 3400.0080, or chapter 256J.

(b) Payment ceases for a family under the at-home infant child care program when a
family has used a total of 12 months of assistance as specified under section 119B.035.
Payment of child care assistance for employed persons on MFIP is effective the date of
employment or the date of MFIP eligibility, whichever is later. Payment of child care
assistance for MFIP or DWP participants in employment and training services is effective
the date of commencement of the services or the date of MFIP or DWP eligibility, whichever
is later. Payment of child care assistance for transition year child care must be made
retroactive to the date of eligibility for transition year child care.

(c) Notwithstanding paragraph (b), payment of child care assistance for participants
eligible under section 119B.05 may only be made retroactive for a maximum of deleted text beginsixdeleted text endnew text begin threenew text end
months from the date of application for child care assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 9.

Minnesota Statutes 2018, section 119B.125, subdivision 6, is amended to read:


Subd. 6.

Record-keeping requirement.

new text begin(a) As a condition of payment, new text endall providers
receiving child care assistance payments mustnew text begin:
new text end

new text begin (1)new text end keep new text beginaccurate and legible new text enddaily attendance records at the site where services are
delivered for children receiving child care assistancenew text begin;new text end and

deleted text begin mustdeleted text end new text begin(2) new text endmake those records available immediately to the county or the commissioner
upon request. new text beginAny records not provided to a county or the commissioner at the date and
time of the request are deemed inadmissible if offered as evidence by the provider in any
proceeding to contest an overpayment or disqualification of the provider.
new text end

deleted text begin Thedeleted text endnew text begin (b) As a condition of payment,new text end attendance records must be completed daily and
include the date, the first and last name of each child in attendance, and the times when
each child is dropped off and picked up. To the extent possible, the times that the child was
dropped off to and picked up from the child care provider must be entered by the person
dropping off or picking up the child. The daily attendance records must be retained at the
site where services are delivered for six years after the date of service.

new text begin (c)new text end A county or the commissioner may deny new text beginor revoke a provider's new text endauthorization deleted text beginas a
child care provider to any applicant, rescind authorization of any provider,
deleted text endnew text begin to receive child
care assistance payments under section 119B.13, subdivision 6, paragraph (d), pursue a
fraud disqualification under section 256.98, take an action against the provider under chapter
245E,
new text end or establish an new text beginattendance record new text endoverpayment deleted text beginclaim in the systemdeleted text endnew text begin under paragraph
(d)
new text end against a current or former provider, when the county or the commissioner knows or
has reason to believe that the provider has not complied with the record-keeping requirement
in this subdivision. deleted text beginA provider's failure to produce attendance records as requested on more
than one occasion constitutes grounds for disqualification as a provider.
deleted text end

new text begin (d) To calculate an attendance record overpayment under this subdivision, the
commissioner or county agency shall subtract the maximum daily rate from the total amount
paid to a provider for each day that a child's attendance record is missing, unavailable,
incomplete, inaccurate, or otherwise inadequate.
new text end

new text begin (e) The commissioner shall develop criteria for a county to determine an attendance
record overpayment under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 10.

Minnesota Statutes 2018, section 119B.13, subdivision 6, is amended to read:


Subd. 6.

Provider payments.

(a) new text beginA provider shall bill only for services documented
according to section 119B.125, subdivision 6.
new text endThe provider shall bill for services provided
within ten days of the end of the service period. Payments under the child care fund shall
be made within 21 days of receiving a complete bill from the provider. Counties or the state
may establish policies that make payments on a more frequent basis.

(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.

(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of six months from the date the provider is issued an
authorization of care and billing form.

(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:

(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;

(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;

(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;

(4) the provider is operating after:

(i) an order of suspension of the provider's license issued by the commissioner;

(ii) an order of revocation of the provider's license; or

(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;

(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request; deleted text beginor
deleted text end

(6) the provider gives false child care price informationdeleted text begin.deleted text endnew text begin; or
new text end

new text begin (7) the provider fails to report decreases in a child's attendance as required under section
119B.125, subdivision 9.
new text end

(e) For purposes of paragraph (d), clauses (3), (5), deleted text beginanddeleted text end (6), new text beginand (7), new text endthe county or the
commissioner may withhold the provider's authorization or payment for a period of time
not to exceed three months beyond the time the condition has been corrected.

(f) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 11.

Minnesota Statutes 2018, section 119B.13, subdivision 7, is amended to read:


Subd. 7.

Absent days.

(a) Licensed child care providers and license-exempt centers
must not be reimbursed for more than 25 full-day absent days per child, excluding holidays,
in a deleted text beginfiscaldeleted text endnew text begin calendarnew text end year, or for more than ten consecutive full-day absent days. new text begin"Absent
day" means any day that the child is authorized and scheduled to be in care with a licensed
provider or license-exempt center, and the child is absent from the care for the entire day.
new text end Legal nonlicensed family child care providers must not be reimbursed for absent days. If a
child attends for part of the time authorized to be in care in a day, but is absent for part of
the time authorized to be in care in that same day, the absent time must be reimbursed but
the time must not count toward the absent days limit. Child care providers must only be
reimbursed for absent days if the provider has a written policy for child absences and charges
all other families in care for similar absences.

(b) Notwithstanding paragraph (a), children with documented medical conditions that
cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
full-day absent days limit. Absences due to a documented medical condition of a parent or
sibling who lives in the same residence as the child receiving child care assistance do not
count against the absent days limit in a deleted text beginfiscaldeleted text endnew text begin calendarnew text end year. Documentation of medical
conditions must be on the forms and submitted according to the timelines established by
the commissioner. A public health nurse or school nurse may verify the illness in lieu of a
medical practitioner. If a provider sends a child home early due to a medical reason,
including, but not limited to, fever or contagious illness, the child care center director or
lead teacher may verify the illness in lieu of a medical practitioner.

(c) Notwithstanding paragraph (a), children in families may exceed the absent days limit
if at least one parent: (1) is under the age of 21; (2) does not have a high school diploma or
commissioner of education-selected high school equivalency certification; and (3) is a
student in a school district or another similar program that provides or arranges for child
care, parenting support, social services, career and employment supports, and academic
support to achieve high school graduation, upon request of the program and approval of the
county. If a child attends part of an authorized day, payment to the provider must be for the
full amount of care authorized for that day.

(d) Child care providers must be reimbursed for up to ten federal or state holidays or
designated holidays per year when the provider charges all families for these days and the
holiday or designated holiday falls on a day when the child is authorized to be in attendance.
Parents may substitute other cultural or religious holidays for the ten recognized state and
federal holidays. Holidays do not count toward the absent days limit.

(e) A family or child care provider must not be assessed an overpayment for an absent
day payment unless (1) there was an error in the amount of care authorized for the family,
(2) all of the allowed full-day absent payments for the child have been paid, or (3) the family
or provider did not timely report a change as required under law.

(f) The provider and family shall receive notification of the number of absent days used
upon initial provider authorization for a family and ongoing notification of the number of
absent days used as of the date of the notification.

(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent days
per child, excluding holidays, in a deleted text beginfiscaldeleted text endnew text begin calendarnew text end year; and ten consecutive full-day absent
days.

new text begin (h) For purposes of this subdivision, "holidays limit" means ten full-day holidays per
child, excluding absent days, in a calendar year.
new text end

new text begin (i) If a day meets the criteria of an absent day or a holiday under this subdivision, the
provider must bill that day as an absent day or holiday. A provider's failure to properly bill
an absent day or a holiday results in an overpayment, regardless of whether the child reached,
or is exempt from, the absent days limit or holidays limit for the calendar year.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 12.

Minnesota Statutes 2018, section 144.057, subdivision 3, is amended to read:


Subd. 3.

Reconsiderations.

The commissioner of health shall review and decide
reconsideration requests, including the granting of variances, in accordance with the
procedures and criteria contained in chapter 245C. new text beginThe commissioner must set aside a
disqualification for an individual who requests reconsideration and who meets the criteria
described in section 245C.22, subdivision 4, paragraph (d).
new text endThe commissioner's decision
shall be provided to the individual and to the Department of Human Services. The
commissioner's decision to grant or deny a reconsideration of disqualification is the final
administrative agency action, except for the provisions under sections 245C.25, 245C.27,
and 245C.28, subdivision 3.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 13.

Minnesota Statutes 2018, section 245.095, is amended to read:


245.095 LIMITS ON RECEIVING PUBLIC FUNDS.

Subdivision 1.

Prohibition.

new text begin(a) new text endIf a provider, vendor, or individual enrolled, licensed,
deleted text begin ordeleted text end receiving funds under a grant contractnew text begin, or registerednew text end in any program administered by the
commissionernew text begin, including under the commissioner's powers and authorities in section 256.01,new text end
is excluded from deleted text beginanydeleted text endnew text begin thatnew text end program deleted text beginadministered by the commissioner, including under the
commissioner's powers and authorities in section 256.01
deleted text end, the commissioner shallnew text begin:
new text end

new text begin (1) new text endprohibit the excluded provider, vendor, or individual from enrolling deleted text beginordeleted text endnew text begin,new text end becoming
licensednew text begin, receiving grant funds, or registeringnew text end in any other program administered by the
commissionerdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (2) disenroll, revoke or suspend a license, disqualify, or debar the excluded provider,
vendor, or individual in any other program administered by the commissioner.
new text end

new text begin (b)new text end The duration of this prohibitionnew text begin, disenrollment, revocation, suspension,
disqualification, or debarment
new text end must last for the longest applicable sanction or disqualifying
period in effect for the provider, vendor, or individual permitted by state or federal law.

Subd. 2.

Definitions.

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

(b) "Excluded" means disenrolled, deleted text beginsubject to license revocation or suspension,
disqualified, or subject to vendor debarment
deleted text endnew text begin disqualified, having a license that has been
revoked or suspended under chapter 245A, or debarred or suspended
new text end under Minnesota Rules,
part 1230.1150new text begin, or excluded pursuant to section 256B.064, subdivision 3new text end.

(c) "Individual" means a natural person providing products or services as a provider or
vendor.

(d) "Provider" deleted text beginmeansdeleted text endnew text begin includes any entity or individual receiving payment from a program
administered by the Department of Human Services, and
new text end an owner, controlling individual,
license holder, director, or managerial officialnew text begin of an entity receiving payment from a program
administered by the Department of Human Services
new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

Minnesota Statutes 2018, section 245A.02, subdivision 3, is amended to read:


Subd. 3.

Applicant.

"Applicant" means an individual, deleted text begincorporation, partnership, voluntary
association, controlling individual, or other
deleted text end organizationnew text begin, or government entity, as defined
in section 13.02, subdivision 7a,
new text end that deleted text beginhas applied for licensure under this chapter and the
rules of the commissioner
deleted text endnew text begin is subject to licensure under this chapter and that has applied for
but not yet been granted a license under this chapter
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 15.

Minnesota Statutes 2018, section 245A.02, is amended by adding a subdivision
to read:


new text begin Subd. 3b. new text end

new text begin Authorized agent. new text end

new text begin "Authorized agent" means the controlling individual
designated by the license holder responsible for communicating with the commissioner of
human services on all matters related to this chapter and on whom service of all notices and
orders must be made pursuant to section 245A.04, subdivision 1.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 16.

Minnesota Statutes 2018, section 245A.02, subdivision 8, is amended to read:


Subd. 8.

License.

"License" means a certificate issued by the commissioner new text beginunder section
245A.04
new text endauthorizing the license holder to provide a specified program for a specified period
of time and in accordance with the terms of the license and the rules of the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 17.

Minnesota Statutes 2018, section 245A.02, subdivision 9, is amended to read:


Subd. 9.

License holder.

"License holder" means an individual, deleted text begincorporation, partnership,
voluntary association, or other
deleted text end organizationnew text begin, or government entitynew text end that is legally responsible
for the operation of the programnew text begin or servicenew text end, new text beginand new text endhas been granted a license by the
commissioner under this chapter deleted text beginor chapter 245Ddeleted text end and the rules of the commissionerdeleted text begin, and
is a controlling individual
deleted text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 18.

Minnesota Statutes 2018, section 245A.02, is amended by adding a subdivision
to read:


new text begin Subd. 10c. new text end

new text begin Organization. new text end

new text begin "Organization" means a domestic or foreign corporation,
nonprofit corporation, limited liability company, partnership, limited partnership, limited
liability partnership, association, voluntary association, and any other legal or commercial
entity. For purposes of this chapter, organization does not include a government entity.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 19.

Minnesota Statutes 2018, section 245A.02, subdivision 12, is amended to read:


Subd. 12.

Private agency.

"Private agency" means an deleted text beginindividual, corporation, partnership,
voluntary association or other
deleted text end organization, other than a county agency, or a court with
jurisdiction, that places persons who cannot remain in their own homes in residential
programs, foster care, or adoptive homes.new text begin A private agency is designated to perform the
commissioner's licensing functions under section 245A.16.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 20.

Minnesota Statutes 2018, section 245A.02, subdivision 14, is amended to read:


Subd. 14.

Residential program.

new text begin(a) Except as provided in paragraph (b), new text end"residential
program" means a program that provides 24-hour-a-day care, supervision, food, lodging,
rehabilitation, training, education, habilitation, or treatment outside a person's own home,
including a program in an intermediate care facility for four or more persons with
developmental disabilities; and chemical dependency or chemical abuse programs that are
located in a hospital or nursing home and receive public funds for providing chemical abuse
or chemical dependency treatment services under chapter 254B. deleted text beginResidential programs
include home and community-based services for persons with disabilities or persons age
65 and older that are provided in or outside of a person's own home under chapter 245D.
deleted text end

new text begin (b) For a residential program under chapter 245D, "residential program" means a single
or multifamily dwelling that is under the control, either directly or indirectly, of the service
provider licensed under chapter 245D and in which at least one person receives services
under chapter 245D, including residential supports and services under section 245D.03,
subdivision 1, paragraph (c), clause (3); out-of-home crisis respite services under section
245D.03, subdivision 1, paragraph (c), clause (1), item (ii); and out-of-home respite services
under section 245D.03, subdivision 1, paragraph (b), clause (1). A residential program does
not include out-of-home respite services when a case manager has determined that an
unlicensed site meets the assessed needs of the person. A residential program also does not
include multifamily dwellings where persons receive integrated community supports, even
if authorization to provide these supports is granted under chapter 245D and approved in
the federal waiver.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 21.

Minnesota Statutes 2018, section 245A.02, subdivision 18, is amended to read:


Subd. 18.

Supervision.

new text begin (a) new text endFor purposes ofnew text begin licensednew text end child care centers, "supervision"
means when a program staff personnew text begin:
new text end

new text begin (1)new text end is deleted text beginwithin sight and hearing of a child at all times so that the program staffdeleted text endnew text begin accountable
for the child's care;
new text end

new text begin (2)new text end can intervene to protect the health and safety of the childdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (3) is within sight and hearing of the child at all times except as described in paragraphs
(b) to (d).
new text end

new text begin (b)new text end When an infant is placed in a crib room to sleep, supervision occurs when anew text begin programnew text end
staff person is within sight or hearing of the infant. When supervision of a crib room is
provided by sight or hearing, the center must have a plan to address the other supervision
deleted text begin componentdeleted text endnew text begin componentsnew text end.

new text begin (c) When a single school-age child uses the restroom within the licensed space,
supervision occurs when a program staff person has knowledge of the child's activity and
location and checks on the child at least every five minutes. When a school-age child uses
the restroom outside the licensed space, including but not limited to field trips, supervision
occurs when staff accompany children to the restroom.
new text end

new text begin (d) When a school-age child leaves the classroom but remains within the licensed space
to deliver or retrieve items from the child's personal storage space, supervision occurs when
a program staff person has knowledge of the child's activity and location and checks on the
child at least every five minutes.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 22.

Minnesota Statutes 2018, section 245A.03, subdivision 1, is amended to read:


Subdivision 1.

License required.

Unless licensed by the commissionernew text begin under this chapternew text end,
an individual, deleted text begincorporation, partnership, voluntary association, otherdeleted text end organization, or
deleted text begin controlling individualdeleted text endnew text begin government entitynew text end must not:

(1) operate a residential or a nonresidential program;

(2) receive a child or adult for care, supervision, or placement in foster care or adoption;

(3) help plan the placement of a child or adult in foster care or adoption or engage in
placement activities as defined in section 259.21, subdivision 9, in this state, whether or not
the adoption occurs in this state; or

(4) advertise a residential or nonresidential program.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 23.

Minnesota Statutes 2018, section 245A.03, subdivision 3, is amended to read:


Subd. 3.

Unlicensed programs.

(a) It is a misdemeanor for an individual, deleted text begincorporation,
partnership, voluntary association, other
deleted text end organization, or deleted text begina controlling individualdeleted text endnew text begin government
entity
new text end to provide a residential or nonresidential program without a license new text beginissued under this
chapter
new text endand in willful disregard of this chapter unless the program is excluded from licensure
under subdivision 2.

(b) The commissioner may ask the appropriate county attorney or the attorney general
to begin proceedings to secure a court order against the continued operation of the program,
if an individual, deleted text begincorporation, partnership, voluntary association, otherdeleted text end organization, or
deleted text begin controlling individualdeleted text endnew text begin government entitynew text end has:

(1) failed to apply for a license new text beginunder this chapter new text endafter receiving notice that a license is
required or continues to operate without a license after receiving notice that a license is
required;

(2) continued to operate without a license after deleted text beginthedeleted text endnew text begin anew text end license new text beginissued under this chapter
new text end has been revoked or suspended under deleted text beginsection 245A.07deleted text endnew text begin this chapternew text end, and the commissioner
has issued a final order affirming the revocation or suspension, or the license holder did not
timely appeal the sanction; or

(3) continued to operate without a license after deleted text beginthedeleted text endnew text begin a temporary immediate suspension
of a
new text end license has been deleted text begintemporarily suspended under section 245A.07deleted text endnew text begin issued under this chapternew text end.

new text begin (c) new text endThe county attorney and the attorney general have a duty to cooperate with the
commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 24.

Minnesota Statutes 2018, section 245A.04, subdivision 1, is amended to read:


Subdivision 1.

Application for licensure.

(a) An individual, deleted text begincorporation, partnership,
voluntary association, other
deleted text end organization deleted text beginor controlling individualdeleted text endnew text begin, or government entitynew text end
that is subject to licensure under section 245A.03 must apply for a license. The application
must be made on the forms and in the manner prescribed by the commissioner. The
commissioner shall provide the applicant with instruction in completing the application and
provide information about the rules and requirements of other state agencies that affect the
applicant. An applicant seeking licensure in Minnesota with headquarters outside of
Minnesota must have a program office located within new text begin30 miles of new text endthe deleted text beginstatedeleted text endnew text begin Minnesota bordernew text end.new text begin
An applicant who intends to buy or otherwise acquire a program or services licensed under
this chapter that is owned by another license holder must apply for a license under this
chapter and comply with the application procedures in this section and section 245A.03.
new text end

The commissioner shall act on the application within 90 working days after a complete
application and any required reports have been received from other state agencies or
departments, counties, municipalities, or other political subdivisions. The commissioner
shall not consider an application to be complete until the commissioner receives all of the
deleted text begin informationdeleted text end required deleted text beginunder section 245C.05deleted text endnew text begin informationnew text end.

When the commissioner receives an application for initial licensure that is incomplete
because the applicant failed to submit required documents or that is substantially deficient
because the documents submitted do not meet licensing requirements, the commissioner
shall provide the applicant written notice that the application is incomplete or substantially
deficient. In the written notice to the applicant the commissioner shall identify documents
that are missing or deficient and give the applicant 45 days to resubmit a second application
that is substantially complete. An applicant's failure to submit a substantially complete
application after receiving notice from the commissioner is a basis for license denial under
section 245A.05.

(b) An application for licensure must identify all controlling individuals new text beginas defined in
section 245A.02, subdivision 5a,
new text endand must deleted text beginspecify andeleted text endnew text begin designate one individual to be the
authorized
new text end agent deleted text beginwho is responsible for dealing with the commissioner of human services
on all matters provided for in this chapter and on whom service of all notices and orders
must be made
deleted text end. new text beginThe application must be signed by the authorized agent and must include
the authorized agent's first, middle, and last name; mailing address; and e-mail address. By
submitting an application for licensure, the authorized agent consents to electronic
communication with the commissioner throughout the application process.
new text endThe new text beginauthorized
new text end agent must be authorized to accept service on behalf of all of the controlling individuals deleted text beginof
the program
deleted text end.new text begin A government entity that holds multiple licenses under this chapter may
designate one authorized agent for all licenses issued under this chapter or may designate
a different authorized agent for each license.
new text end Service on the new text beginauthorized new text endagent is service on
all of the controlling individuals deleted text beginof the programdeleted text end. It is not a defense to any action arising
under this chapter that service was not made on each controlling individual deleted text beginof the programdeleted text end.
The designation of deleted text beginone or moredeleted text endnew text begin anew text end controlling deleted text beginindividualsdeleted text endnew text begin individualnew text end as deleted text beginagentsdeleted text endnew text begin the authorized
agent
new text end under this paragraph does not affect the legal responsibility of any other controlling
individual under this chapter.

(c) An applicant or license holder must have a policy that prohibits license holders,
employees, subcontractors, and volunteers, when directly responsible for persons served
by the program, from abusing prescription medication or being in any manner under the
influence of a chemical that impairs the individual's ability to provide services or care. The
license holder must train employees, subcontractors, and volunteers about the program's
drug and alcohol policy.

(d) An applicant and license holder must have a program grievance procedure that permits
persons served by the program and their authorized representatives to bring a grievance to
the highest level of authority in the program.

(e) deleted text beginThe applicant must be able to demonstrate competent knowledge of the applicable
requirements of this chapter and chapter 245C, and the requirements of other licensing
statutes and rules applicable to the program or services for which the applicant is seeking
to be licensed. Effective January 1, 2013,
deleted text endnew text begin The commissioner may limit communication
during the application process to the authorized agent or the controlling individuals identified
on the license application and for whom a background study was initiated under chapter
245C.
new text end The commissioner may require the applicant, except for child foster care, to
demonstrate competence in the applicable licensing requirements by successfully completing
a written examination. The commissioner may develop a prescribed written examination
format.

(f) When an applicant is an individual, the deleted text beginindividualdeleted text endnew text begin applicantnew text end must provide:

(1) the applicant's taxpayer identification numbers including the Social Security numbernew text begin
or Minnesota tax identification number
new text end, and federal employer identification number if the
applicant has employees;

(2) new text beginat the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes
new text endthe complete business name, if anydeleted text begin, anddeleted text endnew text begin;
new text end

new text begin (3) new text endif doing business under a different name, the doing business as (DBA) name, as
registered with the secretary of state; deleted text beginand
deleted text end

deleted text begin (3) a notarized signature of the applicant. deleted text end new text begin (4) if applicable, the applicant's National
Provider Identifier (NPI) number and Unique Minnesota Provider Identifier (UMPI) number;
and
new text end

new text begin (5) at the request of the commissioner, the notarized signature of the applicant or
authorized agent.
new text end

(g) When an applicant is deleted text begina nonindividualdeleted text endnew text begin an organizationnew text end, the applicant must provide
deleted text begin thedeleted text end:

(1) new text beginthe new text endapplicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;

(2) new text beginat the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the
new text endcomplete business name, and if doing business under a different
name, the doing business as (DBA) name, as registered with the secretary of state;

(3) new text beginthe new text endfirst, middle, and last name, and address for all individuals who will be controlling
individuals, including all officers, owners, and managerial officials as defined in section
245A.02, subdivision 5a, and the date that the background study was initiated by the applicant
for each controlling individual; deleted text beginand
deleted text end

deleted text begin (4) first, middle, and last name, mailing address, and notarized signature of the agent
authorized by the applicant to accept service on behalf of the controlling individuals.
deleted text end

new text begin (4) if applicable, the applicant's NPI number and UMPI number;
new text end

new text begin (5) the documents that created the organization and that determine the organization's
internal governance and the relations among the persons that own the organization, have
an interest in the organization, or are members of the organization, in each case as provided
or authorized by the organization's governing statute, which may include a partnership
agreement, bylaws, articles of organization, organizational chart, and operating agreement,
or comparable documents as provided in the organization's governing statute; and
new text end

new text begin (6) the notarized signature of the applicant or authorized agent.
new text end

new text begin (h) When the applicant is a government entity, the applicant must provide:
new text end

new text begin (1) the name of the government agency, political subdivision, or other unit of government
seeking the license and the name of the program or services that will be licensed;
new text end

new text begin (2) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
new text end

new text begin (3) a letter signed by the manager, administrator, or other executive of the government
entity authorizing the submission of the license application; and
new text end

new text begin (4) if applicable, the applicant's NPI number and UMPI number.
new text end

deleted text begin (h)deleted text endnew text begin (i)new text end At the time of application for licensure or renewal of a licensenew text begin under this chapternew text end,
the applicant or license holder must acknowledge on the form provided by the commissioner
if the applicant or license holder elects to receive any public funding reimbursement from
the commissioner for services provided under the license that:

(1) the applicant's or license holder's compliance with the provider enrollment agreement
or registration requirements for receipt of public funding may be monitored by the
commissioner as part of a licensing investigation or licensing inspection; and

(2) noncompliance with the provider enrollment agreement or registration requirements
for receipt of public funding that is identified through a licensing investigation or licensing
inspection, or noncompliance with a licensing requirement that is a basis of enrollment for
reimbursement for a service, may result in:

(i) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;

(ii) nonpayment of claims submitted by the license holder for public program
reimbursement;

(iii) recovery of payments made for the service;

(iv) disenrollment in the public payment program; or

(v) other administrative, civil, or criminal penalties as provided by law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 25.

Minnesota Statutes 2018, section 245A.04, subdivision 2, is amended to read:


Subd. 2.

Notification of affected municipality.

The commissioner must not issue a
license new text beginunder this chapter new text endwithout giving 30 calendar days' written notice to the affected
municipality or other political subdivision unless the program is considered a permitted
single-family residential use under sections 245A.11 and 245A.14. new text beginThe commissioner may
provide notice through electronic communication.
new text endThe notification must be given before
the first issuance of a license new text beginunder this chapter new text endand annually after that time if annual
notification is requested in writing by the affected municipality or other political subdivision.
State funds must not be made available to or be spent by an agency or department of state,
county, or municipal government for payment to a residential or nonresidential program
licensed under this chapter until the provisions of this subdivision have been complied with
in full. The provisions of this subdivision shall not apply to programs located in hospitals.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 26.

Minnesota Statutes 2018, section 245A.04, subdivision 4, is amended to read:


Subd. 4.

Inspections; waiver.

(a) Before issuing deleted text beginan initialdeleted text endnew text begin anew text end licensenew text begin under this chapternew text end,
the commissioner shall conduct an inspection of the program. The inspection must include
but is not limited to:

(1) an inspection of the physical plant;

(2) an inspection of records and documents;

deleted text begin (3) an evaluation of the program by consumers of the program;
deleted text end

deleted text begin (4)deleted text endnew text begin (3)new text end observation of the program in operation; and

deleted text begin (5)deleted text endnew text begin (4)new text end an inspection for the health, safety, and fire standards in licensing requirements
for a child care license holder.

deleted text begin For the purposes of this subdivision, "consumer" means a person who receives the
services of a licensed program, the person's legal guardian, or the parent or individual having
legal custody of a child who receives the services of a licensed program.
deleted text end

(b) The deleted text beginevaluation required in paragraph (a), clause (3), or thedeleted text end observation in paragraph
(a), clause deleted text begin(4)deleted text endnew text begin (3)new text end, is not required prior to issuing deleted text beginan initialdeleted text endnew text begin anew text end license under subdivision 7. If
the commissioner issues deleted text beginan initialdeleted text endnew text begin anew text end license under deleted text beginsubdivision 7deleted text endnew text begin this chapternew text end, these
requirements must be completed within one year after the issuance of deleted text beginan initialdeleted text endnew text begin thenew text end license.

(c) Before completing a licensing inspection in a family child care program or child care
center, the licensing agency must offer the license holder an exit interview to discuss
violations new text beginor potential violations new text endof law or rule observed during the inspection and offer
technical assistance on how to comply with applicable laws and rules. deleted text beginNothing in this
paragraph limits the ability of the commissioner to issue a correction order or negative
action for violations of law or rule not discussed in an exit interview or in the event that a
license holder chooses not to participate in an exit interview.
deleted text endnew text begin The commissioner shall not
issue a correction order or negative licensing action for violations of law or rule not discussed
in an exit interview, unless a license holder chooses not to participate in an exit interview
or not to complete the exit interview. If the license holder is unable to complete the exit
interview, the licensing agency must offer an alternate time for the license holder to complete
the exit interview.
new text end

new text begin (d) If a family child care license holder disputes a county licensor's interpretation of a
licensing requirement during a licensing inspection or exit interview, the license holder
may, within five business days after the exit interview or licensing inspection, request
clarification from the commissioner, in writing, in a manner prescribed by the commissioner.
The license holder's request must describe the county licensor's interpretation of the licensing
requirement at issue, and explain why the license holder believes the county licensor's
interpretation is inaccurate. The commissioner and the county must include the license
holder in all correspondence regarding the disputed interpretation, and must provide an
opportunity for the license holder to contribute relevant information that may impact the
commissioner's decision. The county licensor must not issue a correction order related to
the disputed licensing requirement until the commissioner has provided clarification to the
license holder about the licensing requirement.
new text end

deleted text begin (d)deleted text endnew text begin (e)new text end The commissioner or the county shall inspect at least annually a child care provider
licensed under this chapter and Minnesota Rules, chapter 9502 or 9503, for compliance
with applicable licensing standards.

deleted text begin (e)deleted text endnew text begin (f)new text end No later than November 19, 2017, the commissioner shall make publicly available
on the department's website the results of inspection reports of all child care providers
licensed under this chapter and under Minnesota Rules, chapter 9502 or 9503, and the
number of deaths, serious injuries, and instances of substantiated child maltreatment that
occurred in licensed child care settings each year.

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to paragraphs (a) and (b) are effective January
1, 2020. The amendments to paragraphs (c) to (f) are effective September 30, 2019.
new text end

Sec. 27.

Minnesota Statutes 2018, section 245A.04, subdivision 6, is amended to read:


Subd. 6.

Commissioner's evaluation.

new text begin(a) new text endBefore issuing, denying, suspending, revoking,
or making conditional a license, the commissioner shall evaluate information gathered under
this section. The commissioner's evaluation shall consider new text beginthe applicable requirements of
statutes and rules for the program or services for which the applicant seeks a license,
including the disqualification standards set forth in chapter 245C, and shall evaluate
new text endfacts,
conditions, or circumstances concerningnew text begin:
new text end

new text begin (1) new text endthe program's operationdeleted text begin,deleted text endnew text begin;
new text end

new text begin (2) new text endthe well-being of persons served by the programdeleted text begin,deleted text endnew text begin;
new text end

new text begin (3) new text endavailable deleted text beginconsumerdeleted text end evaluations of the programdeleted text begin, anddeleted text endnew text begin by persons receiving services;
new text end

new text begin (4) new text endinformation about the qualifications of the personnel employed by the applicant or
license holderdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (5) the applicant's or license holder's ability to demonstrate competent knowledge of the
applicable requirements of statutes and rules, including this chapter and chapter 245C, for
which the applicant seeks a license or the license holder is licensed.
new text end

new text begin (b) new text endThe commissioner shall new text beginalso new text endevaluate the results of the study required in subdivision
3 and determine whether a risk of harm to the persons served by the program exists. In
conducting this evaluation, the commissioner shall apply the disqualification standards set
forth in chapter 245C.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 28.

Minnesota Statutes 2018, section 245A.04, subdivision 7, is amended to read:


Subd. 7.

Grant of license; license extension.

(a) If the commissioner determines that
the program complies with all applicable rules and laws, the commissioner shall issue a
licensenew text begin consistent with this section or, if applicable, a temporary change of ownership license
under section 245A.043
new text end. At minimum, the license shall state:

(1) the name of the license holder;

(2) the address of the program;

(3) the effective date and expiration date of the license;

(4) the type of license;

(5) the maximum number and ages of persons that may receive services from the program;
and

(6) any special conditions of licensure.

(b) The commissioner may issue deleted text beginan initialdeleted text endnew text begin anew text end license for a period not to exceed two years
if:

(1) the commissioner is unable to conduct the evaluation or observation required by
subdivision 4, paragraph (a), deleted text beginclauses (3) anddeleted text endnew text begin clausenew text end (4), because the program is not yet
operational;

(2) certain records and documents are not available because persons are not yet receiving
services from the program; and

(3) the applicant complies with applicable laws and rules in all other respects.

(c) A decision by the commissioner to issue a license does not guarantee that any person
or persons will be placed or cared for in the licensed program. deleted text beginA license shall not be
transferable to another individual, corporation, partnership, voluntary association, other
organization, or controlling individual or to another location.
deleted text end

deleted text begin (d) A license holder must notify the commissioner and obtain the commissioner's approval
before making any changes that would alter the license information listed under paragraph
(a).
deleted text end

deleted text begin (e)deleted text endnew text begin (d)new text end Except as provided in paragraphs deleted text begin(g)deleted text endnew text begin (f)new text end and deleted text begin(h)deleted text endnew text begin (g)new text end, the commissioner shall not
issue or reissue a license if the applicant, license holder, or controlling individual has:

(1) been disqualified and the disqualification was not set aside and no variance has been
granted;

(2) been denied a license new text beginunder this chapter, new text endwithin the past two years;

(3) had a license new text beginissued under this chapter new text endrevoked within the past five years;

(4) an outstanding debt related to a license fee, licensing fine, or settlement agreement
for which payment is delinquent; or

(5) failed to submit the information required of an applicant under subdivision 1,
paragraph (f) or (g), after being requested by the commissioner.

When a license new text beginissued under this chapter new text endis revoked under clause (1) or (3), the license
holder and controlling individual may not hold any license under chapter 245A deleted text beginor 245Ddeleted text end for
five years following the revocation, and other licenses held by the applicant, license holder,
or controlling individual shall also be revoked.

deleted text begin (f)deleted text end new text begin(e) new text endThe commissioner shall not issue or reissue a license new text beginunder this chapter new text endif an
individual living in the household where the deleted text beginlicenseddeleted text end services will be provided as specified
under section 245C.03, subdivision 1, has been disqualified and the disqualification has not
been set aside and no variance has been granted.

deleted text begin (g)deleted text endnew text begin (f)new text end Pursuant to section 245A.07, subdivision 1, paragraph (b), when a license new text beginissued
under this chapter
new text endhas been suspended or revoked and the suspension or revocation is under
appeal, the program may continue to operate pending a final order from the commissioner.
If the license under suspension or revocation will expire before a final order is issued, a
temporary provisional license may be issued provided any applicable license fee is paid
before the temporary provisional license is issued.

deleted text begin (h)deleted text endnew text begin (g)new text end Notwithstanding paragraph deleted text begin(g)deleted text endnew text begin (f)new text end, when a revocation is based on the
disqualification of a controlling individual or license holder, and the controlling individual
or license holder is ordered under section 245C.17 to be immediately removed from direct
contact with persons receiving services or is ordered to be under continuous, direct
supervision when providing direct contact services, the program may continue to operate
only if the program complies with the order and submits documentation demonstrating
compliance with the order. If the disqualified individual fails to submit a timely request for
reconsideration, or if the disqualification is not set aside and no variance is granted, the
order to immediately remove the individual from direct contact or to be under continuous,
direct supervision remains in effect pending the outcome of a hearing and final order from
the commissioner.

deleted text begin (i)deleted text endnew text begin (h)new text end For purposes of reimbursement for meals only, under the Child and Adult Care
Food Program, Code of Federal Regulations, title 7, subtitle B, chapter II, subchapter A,
part 226, relocation within the same county by a licensed family day care provider, shall
be considered an extension of the license for a period of no more than 30 calendar days or
until the new license is issued, whichever occurs first, provided the county agency has
determined the family day care provider meets licensure requirements at the new location.

deleted text begin (j)deleted text endnew text begin (i)new text end Unless otherwise specified by statute, all licenses new text beginissued under this chapter new text endexpire
at 12:01 a.m. on the day after the expiration date stated on the license. A license holder must
apply for and be granted a new license to operate the program or the program must not be
operated after the expiration date.

deleted text begin (k)deleted text endnew text begin (j)new text end The commissioner shall not issue or reissue a license new text beginunder this chapter new text endif it has
been determined that a tribal licensing authority has established jurisdiction to license the
program or service.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 29.

Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:


new text begin Subd. 7a. new text end

new text begin Notification required. new text end

new text begin (a) A license holder must notify the commissioner, in
a manner prescribed by the commissioner, and obtain the commissioner's approval before
making any change that would alter the license information listed under subdivision 7,
paragraph (a).
new text end

new text begin (b) A license holder must also notify the commissioner, in a manner prescribed by the
commissioner, before making any change:
new text end

new text begin (1) to the license holder's authorized agent as defined in section 245A.02, subdivision
3b;
new text end

new text begin (2) to the license holder's controlling individual as defined in section 245A.02, subdivision
5a;
new text end

new text begin (3) to the license holder information on file with the secretary of state;
new text end

new text begin (4) in the location of the program or service licensed under this chapter; and
new text end

new text begin (5) to the federal or state tax identification number associated with the license holder.
new text end

new text begin (c) When, for reasons beyond the license holder's control, a license holder cannot provide
the commissioner with prior notice of the changes in paragraph (b), clauses (1) to (3), the
license holder must notify the commissioner by the tenth business day after the change and
must provide any additional information requested by the commissioner.
new text end

new text begin (d) When a license holder notifies the commissioner of a change to the license holder
information on file with the secretary of state, the license holder must provide amended
articles of incorporation and other documentation of the change.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 30.

Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:


new text begin Subd. 9a. new text end

new text begin Child foster home variances for capacity. new text end

new text begin (a) The commissioner, or the
commissioner of corrections under section 241.021, may grant a variance for a licensed
family foster parent to allow additional foster children if:
new text end

new text begin (1) the variance is needed to allow: (i) a parenting youth in foster care to remain with
the child of the parenting youth; (ii) siblings to remain together; (iii) a child with an
established meaningful relationship with the family to remain with the family; or (iv) a
family with special training or skills to provide care to a child who has a severe disability;
new text end

new text begin (2) there is no risk of harm to a child currently in the home;
new text end

new text begin (3) the structural characteristics of the home, including sleeping space, accommodates
additional foster children;
new text end

new text begin (4) the home remains in compliance with applicable zoning, health, fire, and building
codes; and
new text end

new text begin (5) the statement of intended use specifies conditions for an exception to capacity limits
and specifies how the license holder will maintain a ratio of adults to children that ensures
the safety and appropriate supervision of all the children in the home.
new text end

new text begin (b) A variance granted to a family foster home under Minnesota Rules, part 2960.3030,
subpart 3, prior to October 1, 2019, remains in effect until January 1, 2020.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2019.
new text end

Sec. 31.

Minnesota Statutes 2018, section 245A.04, subdivision 10, is amended to read:


Subd. 10.

Adoption agency; additional requirements.

In addition to the other
requirements of this section, an individualdeleted text begin, corporation, partnership, voluntary association,
other
deleted text endnew text begin ornew text end organizationdeleted text begin, or controlling individualdeleted text end applying for a license to place children for
adoption must:

(1) incorporate as a nonprofit corporation under chapter 317A;

(2) file with the application for licensure a copy of the disclosure form required under
section 259.37, subdivision 2;

(3) provide evidence that a bond has been obtained and will be continuously maintained
throughout the entire operating period of the agency, to cover the cost of transfer of records
to and storage of records by the agency which has agreed, according to rule established by
the commissioner, to receive the applicant agency's records if the applicant agency voluntarily
or involuntarily ceases operation and fails to provide for proper transfer of the records. The
bond must be made in favor of the agency which has agreed to receive the records; and

(4) submit a certified audit to the commissioner each year the license is renewed as
required under section 245A.03, subdivision 1.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 32.

Minnesota Statutes 2018, section 245A.04, is amended by adding a subdivision
to read:


new text begin Subd. 18. new text end

new text begin Plain-language handbook. new text end

new text begin By January 1, 2020, the commissioner of human
services shall, following consultation with family child care license holders, parents, and
county agencies, develop a plain-language handbook that describes the process and
requirements to become a licensed family child care provider. The handbook shall include
a list of the applicable statutory provisions and rules that apply to licensed family child care
providers. The commissioner shall electronically publish the handbook on the Department
of Human Services website, available at no charge to the public. Each county human services
office and the Department of Human Services shall maintain physical copies of the handbook
for public use.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 33.

new text begin [245A.043] LICENSE APPLICATION AFTER CHANGE OF OWNERSHIP.
new text end

new text begin Subdivision 1. new text end

new text begin Transfer prohibited. new text end

new text begin A license issued under this chapter is only valid
for a premises and individual, organization, or government entity identified by the
commissioner on the license. A license is not transferable or assignable.
new text end

new text begin Subd. 2. new text end

new text begin Change in ownership. new text end

new text begin (a) If the commissioner determines that there is a change
in ownership, the commissioner shall require submission of a new license application. This
subdivision does not apply to a licensed program or service located in a home where the
license holder resides. A change in ownership occurs when:
new text end

new text begin (1) the license holder sells or transfers 100 percent of the property, stock, or assets;
new text end

new text begin (2) the license holder merges with another organization;
new text end

new text begin (3) the license holder consolidates with two or more organizations, resulting in the
creation of a new organization;
new text end

new text begin (4) there is a change to the federal tax identification number associated with the license
holder; or
new text end

new text begin (5) all controlling individuals associated with the original application have changed.
new text end

new text begin (b) Notwithstanding paragraph (a), clauses (1) and (5), no change in ownership has
occurred if at least one controlling individual has been listed as a controlling individual for
the license for at least the previous 12 months.
new text end

new text begin Subd. 3. new text end

new text begin Change of ownership process. new text end

new text begin (a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
new text end

new text begin (b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
new text end

new text begin (c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
new text end

new text begin (d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
new text end

new text begin (e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
new text end

new text begin (f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
new text end

new text begin (g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
new text end

new text begin (h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
new text end

new text begin (i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
new text end

new text begin Subd. 4. new text end

new text begin Temporary change in ownership license. new text end

new text begin (a) After receiving the party's
application pursuant to subdivision 3, upon the written request of the existing license holder
and the party, the commissioner may issue a temporary change in ownership license to the
party while the commissioner evaluates the party's application. Until a decision is made to
grant or deny a license under this chapter, the existing license holder and the party shall
both be responsible for operating the program or service according to applicable laws and
rules, and the sale or transfer of the existing license holder's ownership interest in the licensed
program or service does not terminate the existing license.
new text end

new text begin (b) The commissioner may issue a temporary change in ownership license when a license
holder's death, divorce, or other event affects the ownership of the program and an applicant
seeks to assume operation of the program or service to ensure continuity of the program or
service while a license application is evaluated.
new text end

new text begin (c) This subdivision applies to any program or service licensed under this chapter.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 34.

Minnesota Statutes 2018, section 245A.05, is amended to read:


245A.05 DENIAL OF APPLICATION.

(a) The commissioner may deny a license if an applicant or controlling individual:

(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;

(2) fails to comply with applicable laws or rules;

(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;

(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;

(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;

(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted; deleted text beginor
deleted text end

(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g)deleted text begin.deleted text endnew text begin;
new text end

new text begin (8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
new text end

new text begin (9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C; or
new text end

new text begin (10) is prohibited from holding a license according to section 245.095.
new text end

(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail or personal service. The notice must state the reasons the
application was denied and must inform the applicant of the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The applicant may
appeal the denial by notifying the commissioner in writing by certified mail or personal
service. If mailed, the appeal must be postmarked and sent to the commissioner within 20
calendar days after the applicant received the notice of denial. If an appeal request is made
by personal service, it must be received by the commissioner within 20 calendar days after
the applicant received the notice of denial. Section 245A.08 applies to hearings held to
appeal the commissioner's denial of an application.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 35.

new text begin [245A.055] CLOSING A LICENSE.
new text end

new text begin Subdivision 1. new text end

new text begin Inactive programs. new text end

new text begin The commissioner may close a license if the
commissioner determines that a licensed program has not been serving any client for a
consecutive period of 12 months or longer. The license holder is not prohibited from
reapplying for a license if the license holder's license was closed under this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Reconsideration of closure. new text end

new text begin If a license is closed, the commissioner must
notify the license holder of closure by certified mail or personal service. If mailed, the notice
of closure must be mailed to the last known address of the license holder and must inform
the license holder why the license was closed and that the license holder has the right to
request reconsideration of the closure. If the license holder believes that the license was
closed in error, the license holder may ask the commissioner to reconsider the closure. The
license holder's request for reconsideration must be made in writing and must include
documentation that the licensed program has served a client in the previous 12 months. The
request for reconsideration must be postmarked and sent to the commissioner within 20
calendar days after the license holder receives the notice of closure. A timely request for
reconsideration stays imposition of the license closure until the commissioner issues a
decision on the request for reconsideration.
new text end

new text begin Subd. 3. new text end

new text begin Reconsideration final. new text end

new text begin The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 36.

Minnesota Statutes 2018, section 245A.07, subdivision 1, is amended to read:


Subdivision 1.

Sanctions; appeals; license.

(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rule. When applying sanctions authorized under
this section, the commissioner shall consider the nature, chronicity, or severity of the violation
of law or rule and the effect of the violation on the health, safety, or rights of persons served
by the program.

(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. If a license holder fails to comply with
applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.

(c) If a license holder is under investigation and the license new text beginissued under this chapter new text endis
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.

(d) Failure to reapply or closure of a license new text beginissued under this chapter new text endby the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this sectiondeleted text begin,deleted text endnew text begin ornew text end section 245A.06deleted text begin, or 245A.08deleted text end at the
conclusion of the investigation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 37.

Minnesota Statutes 2018, section 245A.07, subdivision 2, is amended to read:


Subd. 2.

Temporary immediate suspension.

(a) The commissioner shall act immediately
to temporarily suspend a license new text beginissued under this chapter new text endif:

(1) the license holder's actions or failure to comply with applicable law or rule, or the
actions of other individuals or conditions in the program, pose an imminent risk of harm to
the health, safety, or rights of persons served by the program; deleted text beginor
deleted text end

(2) while the program continues to operate pending an appeal of an order of revocation,
the commissioner identifies one or more subsequent violations of law or rule which may
adversely affect the health or safety of persons served by the programdeleted text begin.deleted text endnew text begin; or
new text end

new text begin (3) the license holder is criminally charged in state or federal court with an offense that
involves fraud or theft against a program administered by the commissioner.
new text end

(b) No state funds shall be made available or be expended by any agency or department
of state, county, or municipal government for use by a license holder regulated under this
chapter while a license new text beginissued under this chapter new text endis under immediate suspension. A notice
stating the reasons for the immediate suspension and informing the license holder of the
right to an expedited hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to
1400.8612, must be delivered by personal service to the address shown on the application
or the last known address of the license holder. The license holder may appeal an order
immediately suspending a license. The appeal of an order immediately suspending a license
must be made in writing by certified mail deleted text beginordeleted text endnew text begin,new text end personal servicenew text begin, or other means expressly set
forth in the commissioner's order
new text end. If mailed, the appeal must be postmarked and sent to the
commissioner within five calendar days after the license holder receives notice that the
license has been immediately suspended. If a request is made by personal service, it must
be received by the commissioner within five calendar days after the license holder received
the order. A license holder and any controlling individual shall discontinue operation of the
program upon receipt of the commissioner's order to immediately suspend the license.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 38.

Minnesota Statutes 2018, section 245A.07, subdivision 2a, is amended to read:


Subd. 2a.

Immediate suspension expedited hearing.

(a) Within five working days of
receipt of the license holder's timely appeal, the commissioner shall request assignment of
an administrative law judge. The request must include a proposed date, time, and place of
a hearing. A hearing must be conducted by an administrative law judge within 30 calendar
days of the request for assignment, unless an extension is requested by either party and
granted by the administrative law judge for good cause. The commissioner shall issue a
notice of hearing by certified mail or personal service at least ten working days before the
hearing. The scope of the hearing shall be limited solely to the issue of whether the temporary
immediate suspension should remain in effect pending the commissioner's final order under
section 245A.08, regarding a licensing sanction issued under subdivision 3 following the
immediate suspension. For suspensions under subdivision 2, paragraph (a), clause (1), the
burden of proof in expedited hearings under this subdivision shall be limited to the
commissioner's demonstration that reasonable cause exists to believe that the license holder's
actions or failure to comply with applicable law or rule poses, or the actions of other
individuals or conditions in the program poses an imminent risk of harm to the health, safety,
or rights of persons served by the program. "Reasonable cause" means there exist specific
articulable facts or circumstances which provide the commissioner with a reasonable
suspicion that there is an imminent risk of harm to the health, safety, or rights of persons
served by the program. When the commissioner has determined there is reasonable cause
to order the temporary immediate suspension of a license based on a violation of safe sleep
requirements, as defined in section 245A.1435, the commissioner is not required to
demonstrate that an infant died or was injured as a result of the safe sleep violations. For
suspensions under subdivision 2, paragraph (a), clause (2), the burden of proof in expedited
hearings under this subdivision shall be limited to the commissioner's demonstration by a
preponderance of new text beginthe new text endevidence that, since the license was revoked, the license holder
committed additional violations of law or rule which may adversely affect the health or
safety of persons served by the program.

(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The record
shall close at the end of the ten-day period for submission of exceptions. The commissioner's
final order shall be issued within ten working days from the close of the record. When an
appeal of a temporary immediate suspension is withdrawn or dismissed, the commissioner
shall issue a final order affirming the temporary immediate suspension within ten calendar
days of the commissioner's receipt of the withdrawal or dismissal. Within 90 calendar days
after a final order affirming an immediate suspension, the commissioner shall make a
determination regarding whether a final licensing sanction shall be issued under subdivision
3. The license holder shall continue to be prohibited from operation of the program during
this 90-day period.

(c) When the final order under paragraph (b) affirms an immediate suspension, and a
final licensing sanction is issued under subdivision 3 and the license holder appeals that
sanction, the license holder continues to be prohibited from operation of the program pending
a final commissioner's order under section 245A.08, subdivision 5, regarding the final
licensing sanction.

new text begin (d) For suspensions under subdivision 2, paragraph (a), clause (3), the burden of proof
in expedited hearings under this subdivision shall be limited to the commissioner's
demonstration by a preponderance of the evidence that a criminal complaint and warrant
or summons was issued for the license holder that was not dismissed, and that the criminal
charge is an offense that involves fraud or theft against a program administered by the
commissioner.
new text end

Sec. 39.

Minnesota Statutes 2018, section 245A.07, subdivision 3, is amended to read:


Subd. 3.

License suspension, revocation, or fine.

(a) The commissioner may suspend
or revoke a license, or impose a fine if:

(1) a license holder fails to comply fully with applicable laws or rulesnew text begin including but not
limited to the requirements of this chapter and chapter 245C
new text end;

(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
deleted text begin adeleted text endnew text begin been disqualified and thenew text end disqualification deleted text beginwhich hasdeleted text endnew text begin wasnew text end not deleted text beginbeendeleted text end set aside deleted text beginunder section
245C.22
deleted text endnew text begin and no variance has been grantednew text end;

(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules; deleted text beginor
deleted text end

(4) deleted text beginafter July 1, 2012, and upon request by the commissioner, a license holder fails to
submit the information required of an applicant under section 245A.04, subdivision 1,
paragraph (f) or (g).
deleted text endnew text begin a license holder is excluded from any program administered by the
commissioner under section 245.095; or
new text end

new text begin (5) revocation is required under section 245A.04, subdivision 7, paragraph (d).
new text end

A license holder who has had a license new text beginissued under this chapter new text endsuspended, revoked,
or has been ordered to pay a fine must be given notice of the action by certified mail or
personal service. If mailed, the notice must be mailed to the address shown on the application
or the last known address of the license holder. The notice must state in plain language the
reasons the license was suspended or revoked, or a fine was ordered.

(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs deleted text begin(g)deleted text endnew text begin (f)new text end
and deleted text begin(h)deleted text endnew text begin (g)new text end, until the commissioner issues a final order on the suspension or revocation.

(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.

(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.

(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.

(4) Fines shall be assessed as follows:

(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under section 626.556 or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
626.556, subdivision 10e, paragraph (i), or 626.557, subdivision 9c, paragraph (c);

(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;

(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to deleted text begin9502.0495deleted text endnew text begin 9502.0445new text end, the fine assessed against
the license holder shall not exceed $1,000 for each determination of maltreatment;

(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and

(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).

For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1
, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.

(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.

(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 40.

Minnesota Statutes 2018, section 245A.14, subdivision 4, is amended to read:


Subd. 4.

Special family day care homes.

Nonresidential child care programs serving
14 or fewer children that are conducted at a location other than the license holder's own
residence shall be licensed under this section and the rules governing family day care or
group family day care if:

(a) the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwelling that is located on a residential lot;

(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;

(c) the license holder is a church or religious organization;

(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;

(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:

(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;

(2) the program meets a one to seven staff-to-child ratio during the variance period;

(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;

(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;

(5) the program is in compliance with local zoning regulations;

(6) the program is in compliance with the applicable fire code as follows:

(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code deleted text begin2003deleted text endnew text begin
2015
new text end, Section 202; or

(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code deleted text begin2003deleted text endnew text begin
2015
new text end, Section 202new text begin, unless the rooms in which the children are cared for are located on a
level of exit discharge and each of these child care rooms has an exit door directly to the
exterior, then the applicable fire code is Group E occupancies, as provided in the Minnesota
State Fire Code 2015, Section 202
new text end; and

(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or

(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:

(1) the program is in compliance with local zoning regulations;

(2) the program is in compliance with the applicable fire code as follows:

(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code deleted text begin2003deleted text endnew text begin
2015
new text end, Section 202; or

(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code deleted text begin2003deleted text endnew text begin
2015
new text end, Section 202;

(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and

(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."

new text begin (g) The commissioner may approve two or more licenses under paragraphs (a) to (f) to
be issued at the same location or under one contiguous roof, if each license holder is able
to demonstrate compliance with all applicable rules and laws. Each license holder must
operate the license holder's respective licensed program as a distinct program and within
the capacity, age, and ratio distributions of each license.
new text end

new text begin (h) The commissioner may grant variances to this section to allow a primary provider
of care, a not-for-profit organization, a church or religious organization, an employer, or a
community collaborative to be licensed to provide child care under paragraphs (e) and (f)
if the license holder meets the other requirements of the statute.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 41.

Minnesota Statutes 2018, section 245A.14, subdivision 8, is amended to read:


Subd. 8.

Experienced aides; child care centers.

(a) An individual employed as an aide
at a child care center may work with children without being directly supervised for an
amount of time that does not exceed 25 percent of the child care center's daily hours if:

(1) a teacher is in the facility;

deleted text begin (2) the individual has received within the last three years first aid training that meets the
requirements under section 245A.40, subdivision 3, and CPR training that meets the
requirements under section 245A.40, subdivision 4;
deleted text end

deleted text begin (3)deleted text endnew text begin (2)new text end the individual is at least 20 years old; and

deleted text begin (4)deleted text endnew text begin (3)new text end the individual has at least 4,160 hours of child care experience as a staff member
in a licensed child care center or as the license holder of a family day care home, 120 days
of which must be in the employment of the current company.

(b) A child care center that uses experienced aides under this subdivision must notify
parents or guardians by posting the notification in each classroom that uses experienced
aides, identifying which staff member is the experienced aide. Records of experienced aide
usage must be kept on site and given to the commissioner upon request.

(c) A child care center may not use the experienced aide provision for one year following
two determined experienced aide violations within a one-year period.

(d) A child care center may use one experienced aide per every four full-time child care
classroom staff.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 42.

Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision
to read:


new text begin Subd. 16. new text end

new text begin Valid driver's license. new text end

new text begin Notwithstanding any law to the contrary, when a
licensed child care center provides transportation for children or contracts to provide
transportation for children, a person who has a current, valid driver's license appropriate to
the vehicle driven may transport the child.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 43.

Minnesota Statutes 2018, section 245A.14, is amended by adding a subdivision
to read:


new text begin Subd. 17. new text end

new text begin Reusable water bottles or cups. new text end

new text begin Notwithstanding any law to the contrary, a
licensed child care center may provide drinking water to a child in a reusable water bottle
or reusable cup if the center develops and ensures implementation of a written policy that
at a minimum includes the following procedures:
new text end

new text begin (1) each day the water bottle or cup is used, the child care center cleans and sanitizes
the water bottle or cup using procedures that comply with the Food Code under Minnesota
Rules, chapter 4626;
new text end

new text begin (2) a water bottle or cup is assigned to a specific child and labeled with the child's first
and last name;
new text end

new text begin (3) water bottles and cups are stored in a manner that reduces the risk of a child using
the wrong water bottle or cup; and
new text end

new text begin (4) a water bottle or cup is used only for water.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 44.

Minnesota Statutes 2018, section 245A.145, subdivision 1, is amended to read:


Subdivision 1.

Policies and procedures.

(a) deleted text beginAll licensed child care providersdeleted text endnew text begin The
Department of Human Services
new text end must develop policies and procedures for reporting suspected
child maltreatment that fulfill the requirements in section 626.556 and deleted text beginmust develop policies
and procedures for reporting complaints about the operation of a child care program. The
policies and procedures must include the telephone numbers of the local county child
protection agency for reporting suspected maltreatment; the county licensing agency for
family and group family child care providers; and the state licensing agency for child care
centers.
deleted text endnew text begin provide the policies and procedures to all licensed child care providers. The policies
and procedures must be written in plain language.
new text end

(b) The policies and procedures required in paragraph (a) must:

(1) be provided to the parents of all children at the time of enrollment in the child care
program; and

(2) be made available upon request.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 45.

Minnesota Statutes 2018, section 245A.145, subdivision 2, is amended to read:


Subd. 2.

Licensing agency phone number displayed.

deleted text beginBy July 1, 2002,deleted text end A new or
renewed child care license must includenew text begin the licensing agency's telephone number andnew text end a
statement that informs parents who have deleted text beginconcernsdeleted text endnew text begin questionsnew text end about their child's care that
they may call the licensing agency. deleted text beginThe commissioner shall print the telephone number for
the licensing agency in bold and large font on the license issued to child care providers.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 46.

new text begin [245A.149] SUPERVISION OF FAMILY CHILD CARE LICENSE
HOLDER'S OWN CHILD.
new text end

new text begin (a) Notwithstanding Minnesota Rules, part 9502.0365, subpart 5, an individual may be
present in the licensed space, may supervise the family child care license holder's own child
both inside and outside of the licensed space, and is exempt from the training and supervision
requirements of this chapter and Minnesota Rules, chapter 9502, if the individual:
new text end

new text begin (1) is related to the license holder, as defined in section 245A.02, subdivision 13;
new text end

new text begin (2) is not a designated caregiver, helper, or substitute for the licensed program;
new text end

new text begin (3) is involved only in the care of the license holder's own child; and
new text end

new text begin (4) does not have direct, unsupervised contact with any nonrelative children receiving
services.
new text end

new text begin (b) If the individual in paragraph (a) is not a household member, the individual is also
exempt from background study requirements under chapter 245C.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 47.

Minnesota Statutes 2018, section 245A.151, is amended to read:


245A.151 FIRE MARSHAL INSPECTION.

When licensure under this chapternew text begin or certification under chapter 245Hnew text end requires an
inspection by a fire marshal to determine compliance with the State Fire Code under section
299F.011, a local fire code inspector approved by the state fire marshal may conduct the
inspection. If a community does not have a local fire code inspector or if the local fire code
inspector does not perform the inspection, the state fire marshal must conduct the inspection.
A local fire code inspector or the state fire marshal may recover the cost of these inspections
through a fee of no more than $50 per inspection charged to the applicant or license holdernew text begin
or license-exempt child care center certification holder
new text end. The fees collected by the state fire
marshal under this section are appropriated to the commissioner of public safety for the
purpose of conducting the inspections.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 48.

Minnesota Statutes 2018, section 245A.16, subdivision 1, is amended to read:


Subdivision 1.

Delegation of authority to agencies.

(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:

(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;

(2) adult foster care maximum capacity;

(3) adult foster care minimum age requirement;

(4) child foster care maximum age requirement;

(5) variances regarding disqualified individuals except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;

(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours; deleted text beginand
deleted text end

(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holderdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in care.
new text end

Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.

(b) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2
, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.

(c) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.

(d) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.

(e) A license issued under this section may be issued for up to two years.

(f) During implementation of chapter 245D, the commissioner shall consider:

(1) the role of counties in quality assurance;

(2) the duties of county licensing staff; and

(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.

Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.

(g) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.

(h) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:

(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued; deleted text beginand
deleted text end

(2) any death, serious injury, or determination of substantiated maltreatmentdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the State Fire Marshal within two
business days of receiving notice from a licensed family child care provider.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 49.

Minnesota Statutes 2018, section 245A.18, subdivision 2, is amended to read:


Subd. 2.

Child passenger restraint systems; training requirement.

(a) Programs
licensed by the Department of Human Services under Minnesota Rules, chapter 2960, that
serve a child or children under deleted text beginninedeleted text end new text begineightnew text end years of age must document training that fulfills
the requirements in this subdivision.

(b) Before a license holder, staff person, or caregiver transports a child or children under
age deleted text beginninedeleted text end new text begineightnew text end in a motor vehicle, the person transporting the child must satisfactorily
complete training on the proper use and installation of child restraint systems in motor
vehicles. Training completed under this section may be used to meet initial or ongoing
training under Minnesota Rules, part 2960.3070, subparts 1 and 2.

deleted text begin For all providers licensed prior to July 1, 2006, the training required in this subdivision
must be obtained by December 31, 2007.
deleted text end

(c) Training required under this section must be deleted text beginat least one hour in length,deleted text end completed
at orientation or initial trainingdeleted text begin,deleted text end and repeated at least once every five years. At a minimum,
the training must address the proper use of child restraint systems based on the child's size,
weight, and age, and the proper installation of a car seat or booster seat in the motor vehicle
used by the license holder to transport the child or children.

(d) Training under paragraph (c) must be provided by individuals who are certified and
approved by the Department of Public Safety, Office of Traffic Safety. License holders may
obtain a list of certified and approved trainers through the Department of Public Safety
website or by contacting the agency.

deleted text begin (e) Child care providers that only transport school age children as defined in section
245A.02, subdivision 16, in school buses as defined in section 169.011, subdivision 71,
paragraphs (c) to (f), are exempt from this subdivision.
deleted text end

new text begin (e) Notwithstanding paragraph (a), for an emergency relative placement under section
245A.035, the commissioner may grant a variance to the training required by this subdivision
for a relative who completes a child seat safety check up. The child seat safety check up
trainer must be approved by the Department of Public Safety, Office of Traffic Safety, and
must provide one-on-one instruction on placing a child of a specific age in the exact child
passenger restraint in the motor vehicle in which the child will be transported. Once granted
a variance, and if all other licensing requirements are met, the relative applicant may receive
a license and may transport a relative foster child younger than eight years of age. A child
seat safety check up must be completed each time a child requires a different size car seat
according to car seat and vehicle manufacturer guidelines. A relative license holder must
complete training that meets the other requirements of this subdivision prior to placement
of another foster child younger than eight years of age in the home or prior to the renewal
of the child foster care license.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 50.

new text begin [245A.24] MANDATORY REPORTING.
new text end

new text begin Any individual engaging in licensing functions and activities under this chapter, including
authorities delegated under section 245A.16, must immediately report any suspected fraud
to county human services investigators or the Department of Human Services Office of
Inspector General.
new text end

Sec. 51.

Minnesota Statutes 2018, section 245A.40, is amended to read:


245A.40 CHILD CARE CENTER TRAINING REQUIREMENTS.

Subdivision 1.

Orientation.

new text begin(a) new text endThe child care center license holder must ensure that
deleted text begin everydeleted text endnew text begin the director,new text end staff deleted text beginperson and volunteer isdeleted text endnew text begin persons, substitutes, and unsupervised
volunteers are
new text end given orientation training and successfully deleted text begincompletesdeleted text endnew text begin completenew text end the training
before starting assigned duties. deleted text beginThe orientation training in this subdivision applies to
volunteers who will have direct contact with or access to children and who are not under
the direct supervision of a staff person. Completion of the orientation must be documented
in the individual's personnel record.
deleted text end The orientation training must include information about:

(1) the center's philosophy, child care program, and procedures for maintaining health
and safety according to section 245A.41 and Minnesota Rules, part 9503.0140, and handling
emergencies and accidents according to Minnesota Rules, part 9503.0110;

(2) specific job responsibilities;

(3) the behavior guidance standards in Minnesota Rules, part 9503.0055; deleted text beginand
deleted text end

(4) the reporting responsibilities in section 626.556, and Minnesota Rules, part
9503.0130deleted text begin.deleted text endnew text begin;
new text end

new text begin (5) the center's drug and alcohol policy under section 245A.04, subdivision 1, paragraph
(c);
new text end

new text begin (6) the center's risk reduction plan as required under section 245A.66, subdivision 2;
new text end

new text begin (7) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required in subdivision 5, if applicable;
new text end

new text begin (8) at least one-half hour of training on the risk of abusive head trauma as required for
the director and staff under subdivision 5a, if applicable; and
new text end

new text begin (9) training required by a child's individual child care program plan as required under
Minnesota Rules, part 9503.0065, subpart 3, if applicable.
new text end

new text begin (b) In addition to paragraph (a), before having unsupervised direct contact with a child,
the director and staff persons within the first 90 days of employment, and substitutes and
unsupervised volunteers within 90 days after the first date of direct contact with a child,
must complete:
new text end

new text begin (1) pediatric first aid, in accordance with subdivision 3; and
new text end

new text begin (2) pediatric cardiopulmonary resuscitation, in accordance with subdivision 4.
new text end

new text begin (c) In addition to paragraph (b), the director and staff persons within the first 90 days
of employment, and substitutes and unsupervised volunteers within 90 days from the first
date of direct contact with a child, must complete training in child development, in accordance
with subdivision 2.
new text end

new text begin (d) The license holder must ensure that documentation, as required in subdivision 10,
identifies the number of hours completed for each topic with a minimum training time
identified, if applicable, and that all required content is included.
new text end

new text begin (e) Training in this subdivision must not be used to meet in-service training requirements
in subdivision 7.
new text end

new text begin (f) Training completed within the previous 12 months under paragraphs (a), clauses (7)
and (8), and (c) are transferable to another child care center.
new text end

new text begin Subd. 1a. new text end

new text begin Definitions. new text end

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

new text begin (b) "Substitute" means an adult who is temporarily filling a position as a director, teacher,
assistant teacher, or aide in a licensed child care center for less than 240 hours total in a
calendar year due to the absence of a regularly employed staff person.
new text end

new text begin (c) "Staff person" means an employee of a child care center who provides direct contact
services to children.
new text end

new text begin (d) "Unsupervised volunteer" means an individual who:
new text end

new text begin (1) assists in the care of a child in care;
new text end

new text begin (2) is not under the continuous direct supervision of a staff person; and
new text end

new text begin (3) is not employed by the child care center.
new text end

Subd. 2.

Child development and learning training.

(a) deleted text beginFor purposes of child care
centers,
deleted text end The director and all staff deleted text beginhired after July 1, 2006,deleted text endnew text begin persons, substitutes, and
unsupervised volunteers
new text end shall complete deleted text beginand document at least two hours ofdeleted text end child development
and learning training within the first 90 days of employment.new text begin The director and staff persons,
not including substitutes, must complete at least two hours of training on child development
and learning. The training for substitutes and unsupervised volunteers is not required to be
of a minimum length.
new text end For purposes of this subdivision, "child development and learning
training" meansnew text begin anynew text end training innew text begin Knowledge and Competency Area I: Child Development
and Learning, which is training in
new text end understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community. deleted text beginTraining completed under this subdivision may be used to meet the in-service
training requirements under subdivision 7.
deleted text end

(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:

(1) have taken a three-credit college course on early childhood development within the
past five years;

(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;

(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or

(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.

new text begin (c) The director and staff persons, not including substitutes, must complete at least two
hours of child development and learning training every second calendar year.
new text end

new text begin (d) Substitutes and unsupervised volunteers must complete child development and
learning training every second calendar year. There is no minimum number of training hours
required.
new text end

new text begin (e) Except for training required under paragraph (a), training completed under this
subdivision may be used to meet the in-service training requirements under subdivision 7.
new text end

Subd. 3.

First aid.

(a) deleted text beginAll teachers and assistant teachers in a child care center governed
by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least one staff person during
field trips and when transporting children in care, must satisfactorily complete pediatric
first aid training within 90 days of the start of work, unless the training has been completed
within the previous two years.
deleted text endnew text begin Unless training has been completed within the previous two
years, the director, staff persons, substitutes, and unsupervised volunteers must satisfactorily
complete pediatric first aid training prior to having unsupervised direct contact with a child,
but not to exceed the first 90 days of employment.
new text end

(b) deleted text beginNotwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed pediatric first aid training must be present
at all times in the center, during field trips, and when transporting children in care.
deleted text endnew text begin Pediatric
first aid training must be repeated at least every second calendar year. First aid training
under this subdivision must be provided by an individual approved as a first aid instructor
and must not be used to meet in-service training requirements under subdivision 7.
new text end

deleted text begin (c) The pediatric first aid training must be repeated at least every two years, documented
in the person's personnel record and indicated on the center's staffing chart, and provided
by an individual approved as a first aid instructor. This training may be less than eight hours.
deleted text end

Subd. 4.

Cardiopulmonary resuscitation.

deleted text begin (a) All teachers and assistant teachers in a
child care center governed by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least
one staff person during field trips and when transporting children in care, must satisfactorily
complete training in cardiopulmonary resuscitation (CPR) that includes CPR techniques
for infants and children and in the treatment of obstructed airways. The CPR training must
be completed within 90 days of the start of work, unless the training has been completed
within the previous two years. The CPR training must have been provided by an individual
approved to provide CPR instruction, must be repeated at least once every two years, and
must be documented in the staff person's records.
deleted text end

deleted text begin (b) Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed cardiopulmonary resuscitation training
must be present at all times in the center, during field trips, and when transporting children
in care.
deleted text end

deleted text begin (c) CPR training may be provided for less than four hours.
deleted text end

deleted text begin (d) Persons providing CPR training must use CPR training that has been developed:
deleted text end

deleted text begin (1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
deleted text end

deleted text begin (2) using nationally recognized, evidence-based guidelines for CPR and incorporates
psychomotor skills to support the instruction.
deleted text end

new text begin (a) Unless training has been completed within the previous two years, the director, staff
persons, substitutes, and unsupervised volunteers must satisfactorily complete pediatric
cardiopulmonary resuscitation (CPR) training that meets the requirements of this subdivision.
Pediatric CPR training must be completed prior to having unsupervised direct contact with
a child, but not to exceed the first 90 days of employment.
new text end

new text begin (b) Pediatric CPR training must be provided by an individual approved to provide
pediatric CPR instruction.
new text end

new text begin (c) The Pediatric CPR training must:
new text end

new text begin (1) cover CPR techniques for infants and children and the treatment of obstructed airways;
new text end

new text begin (2) include instruction, hands-on practice, and an in-person, observed skills assessment
under the direct supervision of a CPR instructor; and
new text end

new text begin (3) be developed by the American Heart Association, the American Red Cross, or another
organization that uses nationally recognized, evidence-based guidelines for CPR.
new text end

new text begin (d) Pediatric CPR training must be repeated at least once every second calendar year.
new text end

new text begin (e) Pediatric CPR training in this subdivision must not be used to meet in-service training
requirements under subdivision 7.
new text end

Subd. 5.

Sudden unexpected infant death deleted text beginand abusive head traumadeleted text end training.

new text begin (a)
Before caring for infants, the director, staff persons, substitutes, unsupervised volunteers,
and any other volunteers must receive training on the standards under section 245A.1435
and on reducing the risk of sudden unexpected infant death during orientation and each
calendar year thereafter.
new text end

new text begin (b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length. At a minimum, the training must address the risk
factors related to sudden unexpected infant death, means of reducing the risk of sudden
unexpected infant death in child care, and license holder communication with parents
regarding reducing the risk of sudden unexpected infant death.
new text end

new text begin (c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
new text end

new text begin Subd. 5a. new text end

new text begin Abusive head trauma training. new text end

deleted text begin (a) License holders must document that
before staff persons and volunteers care for infants, they are instructed on the standards in
section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
death. In addition, license holders must document that before staff persons care for infants
or children under school age, they receive training on the risk of abusive head trauma from
shaking infants and young children. The training in this subdivision may be provided as
orientation training under subdivision 1 and in-service training under subdivision 7.
deleted text end new text begin (a)
Before caring for children under school age, the director, staff persons, substitutes, and
unsupervised volunteers must receive training on the risk of abusive head trauma during
orientation and each calendar year thereafter.
new text end

deleted text begin (b) Sudden unexpected infant death reduction training required under this subdivision
must be at least one-half hour in length and must be completed at least once every year. At
a minimum, the training must address the risk factors related to sudden unexpected infant
death, means of reducing the risk of sudden unexpected infant death in child care, and license
holder communication with parents regarding reducing the risk of sudden unexpected infant
death.
deleted text end

deleted text begin (c)deleted text endnew text begin (b)new text end Abusive head trauma training under this subdivision must be at least one-half
hour in length deleted text beginand must be completed at least once every yeardeleted text end. At a minimum, the training
must address the risk factors related to shaking infants and young children, means to reduce
the risk of abusive head trauma in child care, and license holder communication with parents
regarding reducing the risk of abusive head trauma.

new text begin (c) Except if completed during orientation, training taken under this subdivision may
be used to meet the in-service training requirements under subdivision 7.
new text end

(d) The commissioner shall make available for viewing a video presentation on the
dangers associated with shaking infants and young children, which may be used in
conjunction with the annual training required under paragraph deleted text begin(c)deleted text endnew text begin (a)new text end.

Subd. 6.

Child passenger restraint systemsdeleted text begin; training requirementdeleted text end.

deleted text begin (a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685. (b) Child care centers that serve a child or children under nine years
of age must document training that fulfills the requirements in this subdivision.
deleted text end

deleted text begin (1)deleted text endnew text begin (a)new text end Before a license holder transports a child or children under age deleted text beginninedeleted text endnew text begin eightnew text end in a
motor vehicle, the person placing the child or children in a passenger restraint must
satisfactorily complete training on the proper use and installation of child restraint systems
in motor vehicles. deleted text beginTraining completed under this subdivision may be used to meet orientation
training under subdivision 1 and in-service training under subdivision 7.
deleted text end

deleted text begin (2)deleted text endnew text begin (b)new text end Training required under this subdivision must be deleted text beginat least one hour in length,
completed at orientation, and
deleted text end repeated at least once every five years. At a minimum, the
training must address the proper use of child restraint systems based on the child's size,
weight, and age, and the proper installation of a car seat or booster seat in the motor vehicle
used by the license holder to transport the child or children.

deleted text begin (3)deleted text endnew text begin (c)new text end Training required under this subdivision must be provided by individuals who
are certified and approved by the Department of Public Safety, Office of Traffic Safety.
License holders may obtain a list of certified and approved trainers through the Department
of Public Safety website or by contacting the agency.

deleted text begin (4)deleted text endnew text begin (d)new text end Child care providers that only transport school-age children as defined in section
245A.02, subdivision 16, in child care buses as defined in section 169.448, subdivision 1,
paragraph (e), are exempt from this subdivision.

new text begin (e) Training completed under this subdivision may be used to meet in-service training
requirements under subdivision 7. Training completed within the previous five years is
transferable upon a staff person's change in employment to another child care center.
new text end

Subd. 7.

In-service.

(a) A license holder must ensure that the center director deleted text beginand all staff
who have direct contact with a child complete annual in-service training. In-service training
requirements must be met by a staff person's participation in the following training areas:
deleted text endnew text begin,
staff persons, substitutes, and unsupervised volunteers complete in-service training each
calendar year.
new text end

new text begin (b) The center director and staff persons who work more than 20 hours per week must
complete 24 hours of in-service training each calendar year. Staff persons who work 20
hours or less per week must complete 12 hours of in-service training each calendar year.
Substitutes and unsupervised volunteers must complete the requirements of paragraphs (e)
to (h) and do not otherwise have a minimum number of hours of training to complete.
new text end

new text begin (c) The number of in-service training hours may be prorated for individuals not employed
for an entire year.
new text end

new text begin (d) Each year, in-service training must include:
new text end

new text begin (1) the center's procedures for maintaining health and safety according to section 245A.41
and Minnesota Rules, part 9503.0140, and handling emergencies and accidents according
to Minnesota Rules, part 9503.0110;
new text end

new text begin (2) the reporting responsibilities under section 626.556 and Minnesota Rules, part
9503.0130;
new text end

new text begin (3) at least one-half hour of training on the standards under section 245A.1435 and on
reducing the risk of sudden unexpected infant death as required under subdivision 5, if
applicable; and
new text end

new text begin (4) at least one-half hour of training on the risk of abusive head trauma from shaking
infants and young children as required under subdivision 5a, if applicable.
new text end

new text begin (e) Each year, or when a change is made, whichever is more frequent, in-service training
must be provided on: (1) the center's risk reduction plan under section 245A.66, subdivision
2; and (2) a child's individual child care program plan as required under Minnesota Rules,
part 9503.0065, subpart 3.
new text end

new text begin (f) At least once every two calendar years, the in-service training must include:
new text end

new text begin (1) child development and learning training under subdivision 2;
new text end

new text begin (2) pediatric first aid that meets the requirements of subdivision 3;
new text end

new text begin (3) pediatric cardiopulmonary resuscitation training that meets the requirements of
subdivision 4;
new text end

new text begin (4) cultural dynamics training to increase awareness of cultural differences; and
new text end

new text begin (5) disabilities training to increase awareness of differing abilities of children.
new text end

new text begin (g) At least once every five years, in-service training must include child passenger
restraint training that meets the requirements of subdivision 6, if applicable.
new text end

new text begin (h) The remaining hours of the in-service training requirement must be met by completing
training in the following content areas of the Minnesota Knowledge and Competency
Framework:
new text end

(1)new text begin Content area I:new text end child development and learning;

(2)new text begin Content area II:new text end developmentally appropriate learning experiences;

(3)new text begin Content area III:new text end relationships with families;

(4)new text begin Content area IV:new text end assessment, evaluation, and individualization;

(5)new text begin Content area V:new text end historical and contemporary development of early childhood
education;

(6)new text begin Content area VI:new text end professionalism; deleted text beginand
deleted text end

(7)new text begin Content area VII:new text end health, safety, and nutritionnew text begin; and
new text end

new text begin (8) Content area VIII: application through clinical experiencesnew text end.

deleted text begin (b)deleted text endnew text begin (i)new text end For purposes of this subdivision, the following terms have the meanings given
them.

(1) "Child development and learning training" deleted text beginhas the meaning given it in subdivision
2, paragraph (a).
deleted text endnew text begin means training in understanding how children develop physically,
cognitively, emotionally, and socially and learn as part of the children's family, culture, and
community.
new text end

(2) "Developmentally appropriate learning experiences" means creating positive learning
experiences, promoting cognitive development, promoting social and emotional development,
promoting physical development, and promoting creative development.

(3) "Relationships with families" means training on building a positive, respectful
relationship with the child's family.

(4) "Assessment, evaluation, and individualization" means training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality.

(5) "Historical and contemporary development of early childhood education" means
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs.

(6) "Professionalism" means training in knowledge, skills, and abilities that promote
ongoing professional development.

(7) "Health, safety, and nutrition" means training in establishing health practices, ensuring
safety, and providing healthy nutrition.

new text begin (8) "Application through clinical experiences" means clinical experiences in which a
person applies effective teaching practices using a range of educational programming models.
new text end

deleted text begin (c) The director and all program staff persons must annually complete a number of hours
of in-service training equal to at least two percent of the hours for which the director or
program staff person is annually paid, unless one of the following is applicable.
deleted text end

deleted text begin (1) A teacher at a child care center must complete one percent of working hours of
in-service training annually if the teacher:
deleted text end

deleted text begin (i) possesses a baccalaureate or master's degree in early childhood education or school-age
care;
deleted text end

deleted text begin (ii) is licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
deleted text end

deleted text begin (iii) possesses a baccalaureate degree with a Montessori certificate.
deleted text end

deleted text begin (2) A teacher or assistant teacher at a child care center must complete one and one-half
percent of working hours of in-service training annually if the individual is:
deleted text end

deleted text begin (i) a registered nurse or licensed practical nurse with experience working with infants;
deleted text end

deleted text begin (ii) possesses a Montessori certificate, a technical college certificate in early childhood
development, or a child development associate certificate; or
deleted text end

deleted text begin (iii) possesses an associate of arts degree in early childhood education, a baccalaureate
degree in child development, or a technical college diploma in early childhood development.
deleted text end

deleted text begin (d) The number of required training hours may be prorated for individuals not employed
full time or for an entire year.
deleted text end

deleted text begin (e) The annual in-service training must be completed within the calendar year for which
it was required. In-service training completed by staff persons is transferable upon a staff
person's change in employment to another child care program.
deleted text end

deleted text begin (f)deleted text endnew text begin (j)new text end The license holder must ensure thatdeleted text begin, when a staff person completes in-service
training, the training is documented in the staff person's personnel record. The documentation
must include the date training was completed, the goal of the training and topics covered,
trainer's name and organizational affiliation, trainer's signed statement that training was
successfully completed,
deleted text endnew text begin documentation, as required in subdivision 10, includes the number
of total training hours required to be completed, name of the training, the Minnesota
Knowledge and Competency Framework content area, number of hours completed,
new text end and the
director's approval of the training.

new text begin (k) In-service training completed by a staff person that is not specific to that child care
center is transferable upon a staff person's change in employment to another child care
program.
new text end

deleted text begin Subd. 8. deleted text end

deleted text begin Cultural dynamics and disabilities training for child care providers. deleted text end

deleted text begin (a)
The training required of licensed child care center staff must include training in the cultural
dynamics of early childhood development and child care. The cultural dynamics and
disabilities training and skills development of child care providers must be designed to
achieve outcomes for providers of child care that include, but are not limited to:
deleted text end

deleted text begin (1) an understanding and support of the importance of culture and differences in ability
in children's identity development;
deleted text end

deleted text begin (2) understanding the importance of awareness of cultural differences and similarities
in working with children and their families;
deleted text end

deleted text begin (3) understanding and support of the needs of families and children with differences in
ability;
deleted text end

deleted text begin (4) developing skills to help children develop unbiased attitudes about cultural differences
and differences in ability;
deleted text end

deleted text begin (5) developing skills in culturally appropriate caregiving; and
deleted text end

deleted text begin (6) developing skills in appropriate caregiving for children of different abilities.
deleted text end

deleted text begin (b) Curriculum for cultural dynamics and disability training shall be approved by the
commissioner.
deleted text end

deleted text begin (c) The commissioner shall amend current rules relating to the training of the licensed
child care center staff to require cultural dynamics training. Timelines established in the
rule amendments for complying with the cultural dynamics training requirements must be
based on the commissioner's determination that curriculum materials and trainers are available
statewide.
deleted text end

deleted text begin (d) For programs caring for children with special needs, the license holder shall ensure
that any additional staff training required by the child's individual child care program plan
required under Minnesota Rules, part 9503.0065, subpart 3, is provided.
deleted text end

deleted text begin Subd. 9. deleted text end

deleted text begin Ongoing health and safety training. deleted text end

deleted text begin A staff person's orientation training on
maintaining health and safety and handling emergencies and accidents, as required in
subdivision 1, must be repeated at least once each calendar year by each staff person. The
completion of the annual training must be documented in the staff person's personnel record.
deleted text end

new text begin Subd. 10. new text end

new text begin Documentation. new text end

new text begin All training must be documented and maintained on site in
each personnel record. In addition to any requirements for each training provided in this
section, documentation for each staff person must include the staff person's first date of
direct contact and first date of unsupervised contact with a child in care.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 52.

Minnesota Statutes 2018, section 245A.41, is amended to read:


245A.41 CHILD CARE CENTER HEALTH AND SAFETY REQUIREMENTS.

Subdivision 1.

Allergy prevention and response.

(a) Before admitting a child for care,
the license holder must obtain documentation of any known allergy from the child's parent
or legal guardian or the child's source of medical care. If a child has a known allergy, the
license holder must maintain current information about the allergy in the child's record and
develop an individual child care program plan as specified in Minnesota Rules, part
9503.0065, subpart 3. The individual child care program plan must include but not be limited
to a description of the allergy, specific triggers, avoidance techniques, symptoms of an
allergic reaction, and procedures for responding to an allergic reaction, including medication,
dosages, and a doctor's contact information.

(b) The license holder must ensure that each staff person who is responsible for carrying
out the individual child care program plan review and follow the plan. Documentation of a
staff person's review must be kept on site.

(c) At least deleted text beginannuallydeleted text endnew text begin once each calendar yearnew text end or following any changes made to
allergy-related information in the child's record, the license holder must update the child's
individual child care program plan and inform each staff person who is responsible for
carrying out the individual child care program plan of the change. The license holder must
keep on site documentation that a staff person was informed of a change.

(d) A child's allergy information must be available at all times including on site, when
on field trips, or during transportation. A child's food allergy information must be readily
available to a staff person in the area where food is prepared and served to the child.

(e) The license holder must contact the child's parent or legal guardian as soon as possible
in any instance of exposure or allergic reaction that requires medication or medical
intervention. The license holder must call emergency medical services when epinephrine
is administered to a child in the license holder's care.

Subd. 2.

Handling and disposal of bodily fluids.

The licensed child care center must
comply with the following procedures for safely handling and disposing of bodily fluids:

(1) surfaces that come in contact with potentially infectious bodily fluids, including
blood and vomit, must be cleaned and disinfected according to Minnesota Rules, part
9503.0005, subpart 11;

(2) blood-contaminated material must be disposed of in a plastic bag with a secure tie;

(3) sharp items used for a child with special care needs must be disposed of in a "sharps
container." The sharps container must be stored out of reach of a child;

(4) the license holder must have the following bodily fluid disposal supplies in the center:
disposable gloves, disposal bags, and eye protection; and

(5) the license holder must ensure that each staff person deleted text beginis trained ondeleted text endnew text begin followsnew text end universal
precautions to reduce the risk of spreading infectious disease. deleted text beginA staff person's completion
of the training must be documented in the staff person's personnel record.
deleted text end

Subd. 3.

Emergency preparedness.

(a) deleted text beginNo later than September 30, 2017,deleted text end A licensed
child care center must have a written emergency plan for emergencies that require evacuation,
sheltering, or other protection of a child, such as fire, natural disaster, intruder, or other
threatening situation that may pose a health or safety hazard to a child. The plan must be
written on a form developed by the commissioner and must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the evacuation, relocation,
shelter-in-place, or lockdown, including procedures for reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text beginand
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin; and
new text end

new text begin (8) accommodations for infants and toddlersnew text end.

(b) The license holder must train staff persons on the emergency plan at orientation,
when changes are made to the plan, and at least once each calendar year. Training must be
documented in each staff person's personnel file.

(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9503.0110, subpart 3. The date and time of the drills must be documented.

(d) The license holder must review and update the emergency plan annually.
Documentation of the annual emergency plan review shall be maintained in the program's
administrative records.

(e) The license holder must include the emergency plan in the program's policies and
procedures as specified under section 245A.04, subdivision 14. The license holder must
provide a physical or electronic copy of the emergency plan to the child's parent or legal
guardian upon enrollment.

(f) The relocation site and evacuation route must be posted in a visible place as part of
the written procedures for emergencies and accidents in Minnesota Rules, part 9503.0140,
subpart 21.

new text begin Subd. 4. new text end

new text begin Child passenger restraint requirements. new text end

new text begin A license holder must comply with
all seat belt and child passenger restraint system requirements under section 169.685.
new text end

new text begin Subd. 5. new text end

new text begin Telephone requirement in licensed child care centers. new text end

new text begin (a) A working telephone
which is capable of making outgoing calls and receiving incoming calls must be located
within the licensed child care center at all times. Staff must have access to a working
telephone while providing care and supervision to children in care, even if the care occurs
outside of the child care facility. A license holder may use a cellular telephone to meet the
requirements of this subdivision.
new text end

new text begin (b) If a cellular telephone is used to satisfy the requirements of this subdivision, the
cellular telephone must be accessible to staff, be stored in a centrally located area when not
in use, and be sufficiently charged for use at all times.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 53.

Minnesota Statutes 2018, section 245A.50, subdivision 1, is amended to read:


Subdivision 1.

Initial training.

(a) License holders, caregivers, and substitutes must
comply with the training requirements in this section.

(b) Helpers who assist with care on a regular basis must complete six hours of training
within one year after the date of initial employment.

(c) Training requirements established under this section that must be completed prior
to initial licensure must be satisfied only by a newly licensed child care provider or by a
child care provider who has not held an active child care license in Minnesota in the previous
12 months. A child care provider deleted text beginwho relocates within the state ordeleted text end who voluntarily cancels
a license or allows the license to lapse for a period of less than 12 months and who seeks
reinstatement of the lapsed or canceled license within 12 months of the lapse or cancellation
must satisfy the annual, ongoing training requirements, and is not required to satisfy the
training requirements that must be completed prior to initial licensure.new text begin A child care provider
who relocates within the state must (1) satisfy the annual, ongoing training requirements
according to the schedules established in this section and (2) not be required to satisfy the
training requirements under this section that the child care provider completed prior to initial
licensure. If a licensed provider moves to a new county, the new county is prohibited from
requiring the provider to complete any orientation class or training for new providers.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 54.

Minnesota Statutes 2018, section 245A.51, subdivision 3, is amended to read:


Subd. 3.

Emergency preparedness plan.

(a) deleted text beginNo later than September 30, 2017,deleted text end A
licensed family child care provider must have a written emergency preparedness plan for
emergencies that require evacuation, sheltering, or other protection of children, such as fire,
natural disaster, intruder, or other threatening situation that may pose a health or safety
hazard to children. The plan must be written on a form developed by the commissioner and
updated at least annually. The plan must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the evacuation,
shelter-in-place, or lockdown, including procedures for reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitate easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text beginand
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesnew text begin; and
new text end

new text begin (8) accommodations for infants and toddlersnew text end.

(b) The license holder must train caregivers before the caregiver provides care and at
least annually on the emergency preparedness plan and document completion of this training.

(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9502.0435, subpart 8. The date and time of the drills must be documented.

(d) The license holder must have the emergency preparedness plan available for review
deleted text begin and posted in a prominent location. The license holder must provide a physical or electronic
copy of the plan to the child's parent or legal guardian upon enrollment
deleted text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 55.

Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Transporting children. new text end

new text begin A license holder must ensure compliance with all seat
belt and child passenger restraint system requirements under section 169.685.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 56.

Minnesota Statutes 2018, section 245A.51, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Telephone requirement. new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0435,
subpart 8, item B, a license holder is not required to post a list of emergency numbers. A
license holder may use a cellular telephone to meet the requirements of Minnesota Rules,
part 9502.0435, subpart 8, if the cellular telephone is sufficiently charged for use at all times.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 57.

new text begin [245A.52] FAMILY CHILD CARE PHYSICAL SPACE REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Means of escape. new text end

new text begin (a)(1) At least one emergency escape route separate
from the main exit from the space must be available in each room used for sleeping by
anyone receiving licensed care, and (2) a basement used for child care. One means of escape
must be a stairway or door leading to the floor of exit discharge. The other must be a door
or window leading directly outside. A window used as an emergency escape route must be
openable without special knowledge.
new text end

new text begin (b) In homes with construction that began before May 2, 2016, the interior of the window
leading directly outside must have a net clear opening area of not less than 4.5 square feet
or 648 square inches and have minimum clear opening dimensions of 20 inches wide and
20 inches high. The opening must be no higher than 48 inches from the floor. The height
to the window may be measured from a platform if a platform is located below the window.
new text end

new text begin (c) In homes with construction that began on or after May 2, 2016, the interior of the
window leading directly outside must have minimum clear opening dimensions of 20 inches
wide and 24 inches high. The net clear opening dimensions shall be the result of normal
operation of the opening. The opening must be no higher than 44 inches from the floor.
new text end

new text begin (d) Additional requirements are dependent on the distance of the openings from the
ground outside the window: (1) windows or other openings with a sill height not more than
44 inches above or below the finished ground level adjacent to the opening (grade-floor
emergency escape and rescue openings) must have a minimum opening of five square feet;
and (2) non-grade floor emergency escape and rescue openings must have a minimum
opening of 5.7 square feet.
new text end

new text begin Subd. 2. new text end

new text begin Door to attached garage. new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0425,
subpart 5, day care residences with an attached garage are not required to have a self-closing
door to the residence. The door to the residence may be a steel insulated door if the door is
at least 1-3/8 inches thick.
new text end

new text begin Subd. 3. new text end

new text begin Heating and venting systems. new text end

new text begin Notwithstanding Minnesota Rules, part
9502.0425, subpart 7, items that can be ignited and support combustion, including but not
limited to plastic, fabric, and wood products must not be located within 18 inches of a gas
or fuel-oil heater or furnace. If a license holder produces manufacturer instructions listing
a smaller distance, then the manufacturer instructions control the distance combustible items
must be from gas, fuel-oil, or solid-fuel burning heaters or furnaces.
new text end

new text begin Subd. 4. new text end

new text begin Fire extinguisher. new text end

new text begin A portable, operational, multipurpose, dry chemical fire
extinguisher with a minimum 2 A 10 BC rating must be located in or near the kitchen and
cooking areas of the residence at all times. The fire extinguisher must be serviced annually
by a qualified inspector. All caregivers must know how to properly use the fire extinguisher.
new text end

new text begin Subd. 5. new text end

new text begin Carbon monoxide and smoke alarms. new text end

new text begin (a) All homes must have an approved
and operational carbon monoxide alarm installed within ten feet of each room used for
sleeping children in care.
new text end

new text begin (b) Smoke alarms that have been listed by the Underwriter Laboratory must be properly
installed and maintained on all levels including basements, but not including crawl spaces
and uninhabitable attics, and in hallways outside rooms used for sleeping children in care.
new text end

new text begin (c) In homes with construction that began on or after May 2, 2016, smoke alarms must
be installed and maintained in each room used for sleeping children in care.
new text end

new text begin Subd. 6. new text end

new text begin Updates. new text end

new text begin After readoption of the Minnesota State Fire Code, the fire marshal
must notify the commissioner of any changes that conflict with this section and Minnesota
Rules, chapter 9502. The state fire marshal must identify necessary statutory changes to
align statutes with the revised code. The commissioner must recommend updates to sections
of chapter 245A that are derived from the Minnesota State Fire Code in the legislative
session following readoption of the code.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 58.

new text begin [245A.53] SUBSTITUTE CAREGIVERS AND REPLACEMENTS IN
FAMILY CHILD CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Total hours allowed. new text end

new text begin Notwithstanding Minnesota Rules, part 9502.0365,
subpart 5, the use of a substitute caregiver in a licensed family child care program must be
limited to a cumulative total of not more than 500 hours annually. The license holder must
document the name, dates, and number of hours of the substitute who provided care.
new text end

new text begin Subd. 2. new text end

new text begin Emergency replacement supervision. new text end

new text begin (a) A license holder may allow an adult
who has not completed the training requirements under this chapter or the background study
requirements under chapter 245C to supervise children in a family child care program in
an emergency. For purposes of this subdivision, an emergency is a situation in which:
new text end

new text begin (1) the license holder has begun operating the family child care program for the day and
for reasons beyond the license holder's control, including, but not limited to a serious illness
or injury, accident, or situation requiring the license holder's immediate attention, the license
holder needs to leave the licensed space and close the program for the day; and
new text end

new text begin (2) the parents or guardians of the children attending the program are contacted to pick
up their children as soon as is practicable.
new text end

new text begin (b) The license holder must make reasonable efforts to minimize the time the emergency
replacement has unsupervised contact with the children in care, not to exceed 24 hours per
emergency incident.
new text end

new text begin (c) The license holder shall not knowingly use a person as an emergency replacement
who has committed an action or has been convicted of a crime that would cause the person
to be disqualified from providing care to children, if a background study was conducted
under chapter 245C.
new text end

new text begin (d) To the extent practicable, the license holder must attempt to arrange for emergency
care by a substitute caregiver before using an emergency replacement.
new text end

new text begin (e) To the extent practicable, the license holder must notify the county licensing agency
within seven days that an emergency replacement was used, and specify the circumstances
that led to the use of the emergency replacement. The county licensing agency must notify
the commissioner within three business days after receiving the license holder's notice that
an emergency replacement was used, and specify the circumstances that led to the use of
the emergency replacement.
new text end

new text begin (f) Notwithstanding the requirements in Minnesota Rules, part 9502.0405, a license
holder is not required to provide the names of persons who may be used as replacements
in emergencies to parents or the county licensing agency.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 59.

Minnesota Statutes 2018, section 245A.66, subdivision 2, is amended to read:


Subd. 2.

Child care centers; risk reduction plan.

(a) Child care centers licensed under
this chapter and Minnesota Rules, chapter 9503, must develop a risk reduction plan that
identifies the general risks to children served by the child care center. The license holder
must establish procedures to minimize identified risks, train staff on the procedures, and
annually review the procedures.

(b) The risk reduction plan must include an assessment of risk to children the center
serves or intends to serve and identify specific risks based on the outcome of the assessment.
The assessment of risk must be based on the following:

(1) an assessment of the risks presented by the physical plant where the licensed services
are provided, including an evaluation of the following factors: the condition and design of
the facility and its outdoor space, bathrooms, storage areas, and accessibility of medications
and cleaning products that are harmful to children when children are not supervised and the
existence of areas that are difficult to supervise; and

(2) an assessment of the risks presented by the environment for each facility and for
each site, including an evaluation of the following factors: the type of grounds and terrain
surrounding the building and the proximity to hazards, busy roads, and publicly accessed
businesses.

(c) The risk reduction plan must include a statement of measures that will be taken to
minimize the risk of harm presented to children for each risk identified in the assessment
required under paragraph (b) related to the physical plant and environment. At a minimum,
the stated measures must include the development and implementation of specific policies
and procedures or reference to existing policies and procedures that minimize the risks
identified.

(d) In addition to any program-specific risks identified in paragraph (b), the plan must
include development and implementation of specific policies and procedures or refer to
existing policies and procedures that minimize the risk of harm or injury to children,
including:

(1) closing children's fingers in doors, including cabinet doors;

(2) leaving children in the community without supervision;

(3) children leaving the facility without supervision;

(4) caregiver dislocation of children's elbows;

(5) burns from hot food or beverages, whether served to children or being consumed by
caregivers, and the devices used to warm food and beverages;

(6) injuries from equipment, such as scissors and glue guns;

(7) sunburn;

(8) feeding children foods to which they are allergic;

(9) children falling from changing tables; and

(10) children accessing dangerous items or chemicals or coming into contact with residue
from harmful cleaning products.

(e) The plan shall prohibit the accessibility of hazardous items to children.

(f) The plan must include specific policies and procedures to ensure adequate supervision
of children at all times as defined under section 245A.02, subdivision 18, with particular
emphasis on:

(1) times when children are transitioned from one area within the facility to another;

(2) nap-time supervision, including infant crib rooms as specified under section 245A.02,
subdivision 18
, which requires that when an infant is placed in a crib to sleep, supervision
occurs when a staff person is within sight or hearing of the infant. When supervision of a
crib room is provided by sight or hearing, the center must have a plan to address the other
supervision components;

(3) child drop-off and pick-up times;

(4) supervision during outdoor play and on community activities, including but not
limited to field trips and neighborhood walks; deleted text beginand
deleted text end

(5) supervision of children in hallwaysdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (6) supervision of school-age children when using the restroom and visiting the child's
personal storage space.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 60.

Minnesota Statutes 2018, section 245A.66, subdivision 3, is amended to read:


Subd. 3.

deleted text beginOrientation todeleted text endnew text begin Yearly review ofnew text end risk reduction plan deleted text beginand annual review of
plan
deleted text end.

deleted text begin (a) The license holder shall ensure that all mandated reporters, as defined in section
626.556, subdivision 3, who are under the control of the license holder, receive an orientation
to the risk reduction plan prior to first providing unsupervised direct contact services, as
defined in section 245C.02, subdivision 11, to children, not to exceed 14 days from the first
supervised direct contact, and annually thereafter. The license holder must document the
orientation to the risk reduction plan in the mandated reporter's personnel records.
deleted text end

deleted text begin (b)deleted text end The license holder must review the risk reduction plan deleted text beginannuallydeleted text endnew text begin each calendar yearnew text end
and document the deleted text beginannualdeleted text end review. When conducting the review, the license holder must
consider incidents that have occurred in the center since the last review, including:

(1) the assessment factors in the plan;

(2) the internal reviews conducted under this section, if any;

(3) substantiated maltreatment findings, if any; and

(4) incidents that caused injury or harm to a child, if any, that occurred since the last
review.

Following any change to the risk reduction plan, the license holder must inform deleted text beginmandated
reporters
deleted text endnew text begin staff personsnew text end, under the control of the license holder, of the changes in the risk
reduction plan, and document that the deleted text beginmandated reportersdeleted text endnew text begin staffnew text end were informed of the changes.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 61.

Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:


new text begin Subd. 5a. new text end

new text begin License-exempt child care center certification holder. new text end

new text begin "License-exempt
child care center certification holder" has the meaning given for "certification holder" in
section 245H.01, subdivision 4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 62.

Minnesota Statutes 2018, section 245C.02, subdivision 6a, is amended to read:


Subd. 6a.

Child care background study subject.

new text begin(a) new text end"Child care background study
subject" means an individual who is affiliated with a licensed child care center, certified
license exempt child care center, licensed family child care program, or legal nonlicensed
child care provider authorized under chapter 119B, andnew text begin who isnew text end:

(1) deleted text beginwho isdeleted text end employed by a child care provider for compensation;

(2) deleted text beginwhose activities involvedeleted text endnew text begin assisting innew text end the deleted text beginsupervisiondeleted text endnew text begin carenew text end of a child for a child care
provider; deleted text beginor
deleted text end

deleted text begin (3) who is required to have a background study under section 245C.03, subdivision 1.
deleted text end

new text begin (3) a person applying for licensure, certification, or enrollment;
new text end

new text begin (4) a controlling individual as defined in section 245A.02, subdivision 5a;
new text end

new text begin (5) an individual 13 years of age or older who lives in the household where the licensed
program will be provided and who is not receiving licensed services from the program;
new text end

new text begin (6) an individual ten to 12 years of age who lives in the household where the licensed
services will be provided when the commissioner has reasonable cause as defined in section
245C.02, subdivision 15;
new text end

new text begin (7) an individual who, without providing direct contact services at a licensed program,
certified program, or program authorized under chapter 119B, may have unsupervised access
to a child receiving services from a program when the commissioner has reasonable cause
as defined in section 245C.02, subdivision 15; or
new text end

new text begin (8) a volunteer, contractor, prospective employee, or other individual who has
unsupervised physical access to a child served by a program and who is not under supervision
by an individual listed in clause (1) or (5), regardless of whether the individual provides
program services.
new text end

new text begin (b) Notwithstanding paragraph (a), an individual who is providing services that are not
part of the child care program is not required to have a background study if:
new text end

new text begin (1) the child receiving services is signed out of the child care program for the duration
that the services are provided;
new text end

new text begin (2) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B has obtained advanced written permission from the parent authorizing the child to
receive the services, which is maintained in the child's record;
new text end

new text begin (3) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B maintains documentation on-site that identifies the individual service provider and
the services being provided; and
new text end

new text begin (4) the licensed child care center, certified license exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B ensures that the service provider does not have unsupervised access to a child not
receiving the provider's services.
new text end

Sec. 63.

Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:


new text begin Subd. 6b. new text end

new text begin Children's residential facility. new text end

new text begin "Children's residential facility" means a
children's residential facility licensed by the commissioner of corrections or the commissioner
of human services under Minnesota Rules, chapter 2960.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
new text end

Sec. 64.

Minnesota Statutes 2018, section 245C.02, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin Substance use disorder treatment field. new text end

new text begin "Substance use disorder treatment
field" means a program exclusively serving individuals 18 years of age and older and that
is required to be:
new text end

new text begin (1) licensed under chapter 245G; or
new text end

new text begin (2) registered under section 157.17 as a board and lodge establishment that predominantly
serves individuals being treated for or recovering from a substance use disorder.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 65.

Minnesota Statutes 2018, section 245C.03, subdivision 1, is amended to read:


Subdivision 1.

Licensed programs.

(a) The commissioner shall conduct a background
study on:

(1) the person or persons applying for a license;

(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;

(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;

(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);

(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;

(7) all controlling individuals as defined in section 245A.02, subdivision 5a; deleted text beginand
deleted text end

(8) new text beginnotwithstanding the other requirements in this subdivision, new text endchild care background
study subjects as defined in section 245C.02, subdivision 6adeleted text begin.deleted text endnew text begin; and
new text end

new text begin (9) notwithstanding clause (3), for children's residential facilities, any adult working in
the facility, whether or not the individual will have direct contact with persons served by
the facility.
new text end

deleted text begin (b) Paragraph (a), clauses (2), (5), and (6), apply to legal nonlicensed child care and
certified license-exempt child care programs.
deleted text end

deleted text begin (c)deleted text endnew text begin (b)new text end For child foster care when the license holder resides in the home where foster
care services are provided, a short-term substitute caregiver providing direct contact services
for a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.

Sec. 66.

Minnesota Statutes 2018, section 245C.05, subdivision 4, is amended to read:


Subd. 4.

Electronic transmission.

(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:

(1) background study information to the commissioner;

(2) background study results to the license holder;

(3) background study results to county and private agencies for background studies
conducted by the commissioner for child foster care; and

(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.

(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.

(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.

new text begin (d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text end

Sec. 67.

Minnesota Statutes 2018, section 245C.05, subdivision 5, is amended to read:


Subd. 5.

Fingerprints and photograph.

(a) Notwithstanding paragraph (b), for
background studies conducted by the commissioner for child foster care,new text begin children's residential
facilities,
new text end adoptions, or a transfer of permanent legal and physical custody of a child, the
subject of the background study, who is 18 years of age or older, shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency for
a national criminal history record check.

(b) For background studies initiated on or after the implementation of NETStudy 2.0,
except as provided under subdivision 5a, every subject of a background study must provide
the commissioner with a set of the background study subject's classifiable fingerprints and
photograph. The photograph and fingerprints must be recorded at the same time by the
commissioner's authorized fingerprint collection vendor and sent to the commissioner
through the commissioner's secure data system described in section 245C.32, subdivision
1a
, paragraph (b).

(c) The fingerprints shall be submitted by the commissioner to the Bureau of Criminal
Apprehension and, when specifically required by law, submitted to the Federal Bureau of
Investigation for a national criminal history record check.

(d) The fingerprints must not be retained by the Department of Public Safety, Bureau
of Criminal Apprehension, or the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text endnew text begin not retain background study
subjects' fingerprints
new text end.

(e) The commissioner's authorized fingerprint collection vendor shall, for purposes of
verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. The authorized fingerprint collection vendor shall retain no more than the name and
date and time the subject's fingerprints were recorded and sent, only as necessary for auditing
and billing activities.

(f) For any background study conducted under this chapter, the subject shall provide the
commissioner with a set of classifiable fingerprints when the commissioner has reasonable
cause to require a national criminal history record check as defined in section 245C.02,
subdivision 15a.

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective July 1, 2019, for background studies
initiated on or after that date.
new text end

Sec. 68.

Minnesota Statutes 2018, section 245C.05, subdivision 5a, is amended to read:


Subd. 5a.

Background study requirements for minors.

(a) A background study
completed under this chapter on a subject who is required to be studied under section
245C.03, subdivision 1, and is 17 years of age or younger shall be completed by the
commissioner for:

(1) a legal nonlicensed child care provider authorized under chapter 119B;

(2) a licensed family child care program; or

(3) a licensed foster care home.

(b) The subject shall submit to the commissioner only the information under subdivision
1, paragraph (a).

(c) A subject who is 17 years of age or younger is required to submit fingerprints and a
photograph, and the commissioner shall conduct a national criminal history record check,
if:

(1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or

(2) under paragraph (a), clauses (1) and (2), the subject is employed by the provider or
supervises children served by the program.

new text begin (d) A subject who is 17 years of age or younger is required to submit
non-fingerprint-based data according to section 245C.08, subdivision 1, paragraph (a),
clause (6), item (iii), and the commissioner shall conduct the check if:
new text end

new text begin (1) the commissioner has reasonable cause to require a national criminal history record
check defined in section 245C.02, subdivision 15a; or
new text end

new text begin (2) the subject is employed by the provider or supervises children served by the program
under paragraph (a), clauses (1) and (2).
new text end

Sec. 69.

Minnesota Statutes 2018, section 245C.08, subdivision 1, is amended to read:


Subdivision 1.

Background studies conducted by Department of Human Services.

(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:

(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);

(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;

(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;

(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;

(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, clause (2);

(6) for a background study related to a child foster care application for licensure,new text begin children's
residential facilities,
new text end a transfer of permanent legal and physical custody of a child under
sections 260C.503 to 260C.515, or adoptions, and for a background study required for
family child care, certified license-exempt child care, child care centers, and legal nonlicensed
child care authorized under chapter 119B, the commissioner shall also review:

(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; deleted text beginand
deleted text end

(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and

new text begin (iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry; and
new text end

(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.

(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.

(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.

(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.

(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective July 1, 2019, for background studies
initiated on or after that date.
new text end

Sec. 70.

Minnesota Statutes 2018, section 245C.08, subdivision 3, is amended to read:


Subd. 3.

Arrest and investigative information.

(a) For any background study completed
under this section, if the commissioner has reasonable cause to believe the information is
pertinent to the disqualification of an individual, the commissioner also may review arrest
and investigative information from:

(1) the Bureau of Criminal Apprehension;

(2) the deleted text begincommissionerdeleted text endnew text begin commissionersnew text end of healthnew text begin and human servicesnew text end;

(3) a county attorney;

(4) a county sheriff;

(5) a county agency;

(6) a local chief of police;

(7) other states;

(8) the courts;

(9) the Federal Bureau of Investigation;

(10) the National Criminal Records Repository; and

(11) criminal records from other states.

(b) new text beginExcept when specifically required by law, new text endthe commissioner is not required to conduct
more than one review of a subject's records from the Federal Bureau of Investigation if a
review of the subject's criminal history with the Federal Bureau of Investigation has already
been completed by the commissioner and there has been no break in the subject's affiliation
with the deleted text beginlicense holder whodeleted text endnew text begin entity thatnew text end initiated the background study.

new text begin (c) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the data obtained is private data and cannot be shared with
county agencies, private agencies, or prospective employers of the background study subject.
new text end

new text begin (d) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the license holder or entity that submitted the study is not
required to obtain a copy of the background study subject's disqualification letter under
section 245C.17, subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for background studies requested on or
after October 1, 2019.
new text end

Sec. 71.

Minnesota Statutes 2018, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 14. new text end

new text begin Children's residential facilities. new text end

new text begin The commissioner shall recover the cost of
background studies initiated by a licensed children's residential facility through a fee of no
more than $51 per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, for background studies
initiated on or after that date.
new text end

Sec. 72.

Minnesota Statutes 2018, section 245C.13, subdivision 2, is amended to read:


Subd. 2.

Direct contact pending completion of background study.

The subject of a
background study may not perform any activity requiring a background study under
paragraph deleted text begin(b)deleted text endnew text begin (c)new text end until the commissioner has issued one of the notices under paragraph (a).

(a) Notices from the commissioner required prior to activity under paragraph (b) include:

(1) a notice of the study results under section 245C.17 stating that:

(i) the individual is not disqualified; or

(ii) more time is needed to complete the study but the individual is not required to be
removed from direct contact or access to people receiving services prior to completion of
the study as provided under section 245C.17, subdivision 1, paragraph (b) or (c). The notice
that more time is needed to complete the study must also indicate whether the individual is
required to be under continuous direct supervision prior to completion of the background
study;

(2) a notice that a disqualification has been set aside under section 245C.23; or

(3) a notice that a variance has been granted related to the individual under section
245C.30.

(b)new text begin For a background study affiliated with a licensed child care center or certified license
exempt child care center, the notice sent under paragraph (a), clause (1), item (ii), must
require the individual to be under continuous direct supervision prior to completion of the
background study except as permitted in subdivision 3.
new text end

new text begin (c)new text end Activities prohibited prior to receipt of notice under paragraph (a) include:

(1) being issued a license;

(2) living in the household where the licensed program will be provided;

(3) providing direct contact services to persons served by a program unless the subject
is under continuous direct supervision; deleted text beginor
deleted text end

(4) having access to persons receiving services if the background study was completed
under section 144.057, subdivision 1, or 245C.03, subdivision 1, paragraph (a), clause (2),
(5), or (6), unless the subject is under continuous direct supervisiondeleted text begin.deleted text endnew text begin; or
new text end

new text begin (5) for licensed child care center and certified license exempt child care centers, providing
direct contact services to persons served by the program.
new text end

Sec. 73.

Minnesota Statutes 2018, section 245C.13, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Other state information. new text end

new text begin If the commissioner has not received criminal, sex
offender, or maltreatment information from another state that is required to be reviewed
under this chapter within ten days of requesting the information, and the lack of the
information is the only reason that a notice is issued under subdivision 2, paragraph (a),
clause (1), item (ii), the commissioner may issue a notice under subdivision 2, paragraph
(a), clause (1), item (i). The commissioner may take action on information received from
other states after issuing a notice under subdivision 2, paragraph (a), clause (1), item (ii).
new text end

Sec. 74.

Minnesota Statutes 2018, section 245C.22, subdivision 4, is amended to read:


Subd. 4.

Risk of harm; set aside.

(a) The commissioner may set aside the disqualification
if the commissioner finds that the individual has submitted sufficient information to
demonstrate that the individual does not pose a risk of harm to any person served by the
applicant, license holder, or other entities as provided in this chapter.

(b) In determining whether the individual has met the burden of proof by demonstrating
the individual does not pose a risk of harm, the commissioner shall consider:

(1) the nature, severity, and consequences of the event or events that led to the
disqualification;

(2) whether there is more than one disqualifying event;

(3) the age and vulnerability of the victim at the time of the event;

(4) the harm suffered by the victim;

(5) vulnerability of persons served by the program;

(6) the similarity between the victim and persons served by the program;

(7) the time elapsed without a repeat of the same or similar event;

(8) documentation of successful completion by the individual studied of training or
rehabilitation pertinent to the event; and

(9) any other information relevant to reconsideration.

(c) If the individual requested reconsideration on the basis that the information relied
upon to disqualify the individual was incorrect or inaccurate and the commissioner determines
that the information relied upon to disqualify the individual is correct, the commissioner
must also determine if the individual poses a risk of harm to persons receiving services in
accordance with paragraph (b).

new text begin (d) For an individual seeking employment in the substance use disorder treatment field,
the commissioner shall set aside the disqualification if the following criteria are met:
new text end

new text begin (1) the individual is not disqualified for a crime of violence as listed under section
624.712, subdivision 5, except for the following crimes: crimes listed under section 152.021,
subdivision 2 or 2a; 152.022, subdivision 2; 152.023, subdivision 2; 152.024; or 152.025;
new text end

new text begin (2) the individual is not disqualified under section 245C.15, subdivision 1;
new text end

new text begin (3) the individual is not disqualified under section 245C.15, subdivision 4, paragraph
(b);
new text end

new text begin (4) the individual provided documentation of successful completion of treatment, at least
one year prior to the date of the request for reconsideration, at a program licensed under
chapter 245G, and has had no disqualifying crimes or conduct under section 245C.15 after
the successful completion of treatment;
new text end

new text begin (5) the individual provided documentation demonstrating abstinence from controlled
substances, as defined in section 152.01, subdivision 4, for the period of one year prior to
the date of the request for reconsideration; and
new text end

new text begin (6) the individual is seeking employment in the substance use disorder treatment field.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 75.

Minnesota Statutes 2018, section 245C.22, subdivision 5, is amended to read:


Subd. 5.

Scope of set-aside.

(a) If the commissioner sets aside a disqualification under
this section, the disqualified individual remains disqualified, but may hold a license and
have direct contact with or access to persons receiving services. Except as provided in
paragraph (b), the commissioner's set-aside of a disqualification is limited solely to the
licensed program, applicant, or agency specified in the set aside notice under section 245C.23.
For personal care provider organizations, the commissioner's set-aside may further be limited
to a specific individual who is receiving services. For new background studies required
under section 245C.04, subdivision 1, paragraph (h), if an individual's disqualification was
previously set aside for the license holder's program and the new background study results
in no new information that indicates the individual may pose a risk of harm to persons
receiving services from the license holder, the previous set-aside shall remain in effect.

(b) If the commissioner has previously set aside an individual's disqualification for one
or more programs or agencies, and the individual is the subject of a subsequent background
study for a different program or agency, the commissioner shall determine whether the
disqualification is set aside for the program or agency that initiated the subsequent
background study. A notice of a set-aside under paragraph (c) shall be issued within 15
working days if all of the following criteria are met:

(1) the subsequent background study was initiated in connection with a program licensed
or regulated under the same provisions of law and rule for at least one program for which
the individual's disqualification was previously set aside by the commissioner;

(2) the individual is not disqualified for an offense specified in section 245C.15,
subdivision 1 or 2;

(3) the commissioner has received no new information to indicate that the individual
may pose a risk of harm to any person served by the program; and

(4) the previous set-aside was not limited to a specific person receiving services.

new text begin (c) Notwithstanding paragraph (b), clause (2), for an individual who is employed in the
substance use disorder field, if the commissioner has previously set aside an individual's
disqualification for one or more programs or agencies in the substance use disorder treatment
field, and the individual is the subject of a subsequent background study for a different
program or agency in the substance use disorder treatment field, the commissioner shall set
aside the disqualification for the program or agency in the substance use disorder treatment
field that initiated the subsequent background study when the criteria under paragraph (b),
clauses (1), (3), and (4), are met and the individual is not disqualified for an offense specified
in section 254C.15, subdivision 1. A notice of a set-aside under paragraph (d) shall be issued
within 15 working days.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end When a disqualification is set aside under paragraph (b), the notice of background
study results issued under section 245C.17, in addition to the requirements under section
245C.17, shall state that the disqualification is set aside for the program or agency that
initiated the subsequent background study. The notice must inform the individual that the
individual may request reconsideration of the disqualification under section 245C.21 on the
basis that the information used to disqualify the individual is incorrect.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 76.

Minnesota Statutes 2018, section 245C.24, subdivision 1, is amended to read:


Subdivision 1.

Minimum disqualification periods.

The disqualification periods under
subdivisions 3 deleted text beginand 4deleted text endnew text begin to 5new text end are the minimum applicable disqualification periods. The
commissioner may determine that an individual should continue to be disqualified from
licensure because the individual continues to pose a risk of harm to persons served by that
individual, even after the minimum disqualification period has passed.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective March 1, 2020.
new text end

Sec. 77.

Minnesota Statutes 2018, section 245C.24, subdivision 2, is amended to read:


Subd. 2.

Permanent bar to set aside a disqualification.

(a) Except as provided in
deleted text begin paragraphdeleted text endnew text begin paragraphsnew text end (b)deleted text begin,deleted text endnew text begin to (e),new text end the commissioner may not set aside the disqualification
of any individual disqualified pursuant to this chapter, regardless of how much time has
passed, if the individual was disqualified for a crime or conduct listed in section 245C.15,
subdivision 1
.

(b) For an individual in the chemical dependency or corrections field who was disqualified
for a crime or conduct listed under section 245C.15, subdivision 1, and whose disqualification
was set aside prior to July 1, 2005, the commissioner must consider granting a variance
pursuant to section 245C.30 for the license holder for a program dealing primarily with
adults. A request for reconsideration evaluated under this paragraph must include a letter
of recommendation from the license holder that was subject to the prior set-aside decision
addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that service.

new text begin (c) If an individual who requires a background study for nonemergency medical
transportation services under section 245C.03, subdivision 12, was disqualified for a crime
or conduct listed under section 245C.15, subdivision 1, and if more than 40 years have
passed since the discharge of the sentence imposed, the commissioner may consider granting
a set aside pursuant to section 245C.22. A request for reconsideration evaluated under this
paragraph must include a letter of recommendation from the employer. This paragraph does
not apply to a person disqualified based on a violation of sections 243.166; 609.185 to
609.205; 609.25; 609.342 to 609.3453; 609.352; 617.23, subdivision 2, clause (1), or 3,
clause (1); 617.246; or 617.247.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 78.

Minnesota Statutes 2018, section 245C.24, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Five-year bar to set aside disqualification; children's residential
facilities.
new text end

new text begin The commissioner shall not set aside the disqualification of an individual in
connection with a license for a children's residential facility who was convicted of a felony
within the past five years for: (1) physical assault or battery; or (2) a drug-related offense.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for background studies initiated on or
after July 1, 2019.
new text end

Sec. 79.

Minnesota Statutes 2018, section 245C.30, subdivision 1, is amended to read:


Subdivision 1.

License holder new text beginand license-exempt child care center certification
holder
new text endvariance.

(a) Except for any disqualification under section 245C.15, subdivision 1,
when the commissioner has not set aside a background study subject's disqualification, and
there are conditions under which the disqualified individual may provide direct contact
services or have access to people receiving services that minimize the risk of harm to people
receiving services, the commissioner may grant a time-limited variance to a license holdernew text begin
or license-exempt child care center certification holder
new text end.

(b) The variance shall state the reason for the disqualification, the services that may be
provided by the disqualified individual, and the conditions with which the license holdernew text begin,
license-exempt child care center certification holder,
new text end or applicant must comply for the
variance to remain in effect.

(c) Except for programs licensed to provide family child care, foster care for children
in the provider's own home, or foster care or day care services for adults in the provider's
own home, the variance must be requested by the license holdernew text begin or license-exempt child
care center certification holder
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 80.

Minnesota Statutes 2018, section 245C.30, subdivision 2, is amended to read:


Subd. 2.

Disclosure of reason for disqualification.

(a) The commissioner may not grant
a variance for a disqualified individual unless the applicantnew text begin, license-exempt child care center
certification holder,
new text end or license holder requests the variance and the disqualified individual
provides written consent for the commissioner to disclose to the applicantnew text begin, license-exempt
child care center certification holder,
new text end or license holder the reason for the disqualification.

(b) This subdivision does not apply to programs licensed to provide family child care
for children, foster care for children in the provider's own home, or foster care or day care
services for adults in the provider's own home. When the commissioner grants a variance
for a disqualified individual in connection with a license to provide the services specified
in this paragraph, the disqualified individual's consent is not required to disclose the reason
for the disqualification to the license holder in the variance issued under subdivision 1,
provided that the commissioner may not disclose the reason for the disqualification if the
disqualification is based on a felony-level conviction for a drug-related offense within the
past five years.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 81.

Minnesota Statutes 2018, section 245C.30, subdivision 3, is amended to read:


Subd. 3.

Consequences for failing to comply with conditions of variance.

When a
license holdernew text begin or license-exempt child care center certification holdernew text end permits a disqualified
individual to provide any services for which the subject is disqualified without complying
with the conditions of the variance, the commissioner may terminate the variance effective
immediately and subject the license holder to a licensing action under sections 245A.06
and 245A.07new text begin or a license-exempt child care center certification holder to an action under
sections 245H.06 and 245H.07
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 82.

Minnesota Statutes 2018, section 245E.02, is amended by adding a subdivision
to read:


new text begin Subd. 1a. new text end

new text begin Provider definitions. new text end

new text begin For the purposes of this section, "provider" includes:
new text end

new text begin (1) individuals or entities meeting the definition of provider in section 245E.01,
subdivision 12; and
new text end

new text begin (2) owners and controlling individuals of entities identified in clause (1).
new text end

Sec. 83.

Minnesota Statutes 2018, section 245G.11, subdivision 7, is amended to read:


Subd. 7.

Care coordination provider qualifications.

(a) Care coordination must be
provided by qualified staff. An individual is qualified to provide care coordination if the
individual:

(1) is skilled in the process of identifying and assessing a wide range of client needs;

(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;

(3) has successfully completed 30 hours of classroom instruction on care coordination
for an individual with substance use disorder;

(4) has either:

(i) a bachelor's degree in one of the behavioral sciences or related fields; or

(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and

(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.

(b) A care coordinator must receive at least one hour of supervision regarding individual
service delivery from an alcohol and drug counselor deleted text beginweeklydeleted text endnew text begin, or a mental health professional
who has substance use treatment and assessments within the scope of their practice, on a
monthly basis
new text end.

Sec. 84.

Minnesota Statutes 2018, section 245G.19, subdivision 4, is amended to read:


Subd. 4.

Additional licensing requirements.

During the times the license holder is
responsible for the supervision of a child, the license holder must meet the following
standards:

(1) child and adult ratios in Minnesota Rules, part 9502.0367;

(2) day care training in section 245A.50;

(3) behavior guidance in Minnesota Rules, part 9502.0395;

(4) activities and equipment in Minnesota Rules, part 9502.0415;

(5) physical environment in Minnesota Rules, part 9502.0425; deleted text beginand
deleted text end

(6) new text beginphysical space requirements in section 245A.52; and
new text end

new text begin (7) new text endwater, food, and nutrition in Minnesota Rules, part 9502.0445, unless the license
holder has a license from the Department of Health.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 85.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Substitute. new text end

new text begin "Substitute" means an adult who is temporarily filling a position
as a staff person for less than 240 hours total in a calendar year due to the absence of a
regularly employed staff person who provides direct contact services to a child.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 86.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Staff person. new text end

new text begin "Staff person" means an employee of a certified center who
provides direct contact services to children.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 87.

Minnesota Statutes 2018, section 245H.01, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Unsupervised volunteer. new text end

new text begin "Unsupervised volunteer" means an individual who:
(1) assists in the care of a child in care; (2) is not under the continuous direct supervision
of a staff person; and (3) is not employed by the certified center.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 88.

Minnesota Statutes 2018, section 245H.03, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Reconsideration of certification denial. new text end

new text begin (a) The applicant may request
reconsideration of the denial by notifying the commissioner by certified mail or personal
service. The request must be made in writing. If sent by certified mail, the request must be
postmarked and sent to the commissioner within 20 calendar days after the applicant received
the order. If a request is made by personal service, it must be received by the commissioner
within 20 calendar days after the applicant received the order. The applicant may submit
with the request for reconsideration a written argument or evidence in support of the request
for reconsideration.
new text end

new text begin (b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 89.

Minnesota Statutes 2018, section 245H.07, is amended to read:


245H.07 DECERTIFICATION.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

(a) The commissioner may decertify a center if a certification
holder:

(1) failed to comply with an applicable law or rule; deleted text beginor
deleted text end

(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rulesdeleted text begin.deleted text endnew text begin; or
new text end

new text begin (3) has authorization to receive child care assistance payments revoked pursuant to
chapter 119B.
new text end

(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.

(c) When a center is decertified, the center is ineligible to receive a child care assistance
paymentnew text begin under chapter 119Bnew text end.

new text begin Subd. 2. new text end

new text begin Reconsideration of decertification. new text end

new text begin (a) The certification holder may request
reconsideration of the decertification by notifying the commissioner by certified mail or
personal service. The request must be made in writing. If sent by certified mail, the request
must be postmarked and sent to the commissioner within 20 calendar days after the
certification holder received the order. If a request is made by personal service, it must be
received by the commissioner within 20 calendar days after the certification holder received
the order. With the request for reconsideration, the certification holder may submit a written
argument or evidence in support of the request for reconsideration.
new text end

new text begin (b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text end

new text begin Subd. 3. new text end

new text begin Decertification due to maltreatment. new text end

new text begin If the commissioner decertifies a center
pursuant to subdivision 1, paragraph (a), clause (1), based on a determination that the center
was responsible for maltreatment, and if the center requests reconsideration of the
decertification according to subdivision 2, paragraph (a), and appeals the maltreatment
determination under section 626.556, subdivision 10i, the final decertification determination
is stayed until the commissioner issues a final decision regarding the maltreatment appeal.
new text end

new text begin Subd. 4. new text end

new text begin Decertification due to revocation of child care assistance. new text end

new text begin If the commissioner
decertifies a center that had payments revoked pursuant to chapter 119B, and if the center
appeals the revocation of the center's authorization to receive child care assistance payments,
the final decertification determination is stayed until the appeal of the center's authorization
under chapter 119B is resolved. If the center also requests reconsideration of the
decertification, the center must do so according to subdivision 2, paragraph (a). The final
decision on reconsideration is stayed until the appeal of the center's authorization under
chapter 119B is resolved.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 to 3 are effective September 30, 2019. Subdivision
4 is effective February 26, 2021.
new text end

Sec. 90.

Minnesota Statutes 2018, section 245H.10, subdivision 1, is amended to read:


Subdivision 1.

deleted text beginDocumentationdeleted text endnew text begin Individuals to be studiednew text end.

(a) The applicant or
certification holder must submit deleted text beginand maintain documentation ofdeleted text end a completed background
study fordeleted text begin:deleted text endnew text begin each child care background study subject as defined in section 245C.02, subdivision
6a.
new text end

deleted text begin (1) each person applying for the certification;
deleted text end

deleted text begin (2) each person identified as a center operator or program operator as defined in section
245H.01, subdivision 3;
deleted text end

deleted text begin (3) each current or prospective staff person or contractor of the certified center who will
have direct contact with a child served by the center;
deleted text end

deleted text begin (4) each volunteer who has direct contact with a child served by the center if the contact
is not under the continuous, direct supervision by an individual listed in clause (1), (2), or
(3); and
deleted text end

deleted text begin (5) each managerial staff person of the certification holder with oversight and supervision
of the certified center.
deleted text end

(b) To be accepted for certification, a background study on every individual deleted text beginin paragraph
(a), clause (1),
deleted text endnew text begin applying for certificationnew text end must be completed under chapter 245C and result
in a not disqualified determination under section 245C.14 or a disqualification that was set
aside under section 245C.22.

Sec. 91.

Minnesota Statutes 2018, section 245H.11, is amended to read:


245H.11 REPORTING.

(a) The certification holder must complynew text begin and must have written policies for staff to
comply
new text end with the reporting requirements for abuse and neglect specified in section 626.556.
A person mandated to report physical or sexual child abuse or neglect occurring within a
certified center shall report the information to the commissioner.

(b) The certification holder must inform the commissioner within 24 hours of:

(1) the death of a child in the program; and

(2) any injury to a child in the program that required treatment by a physician.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 92.

Minnesota Statutes 2018, section 245H.13, subdivision 5, is amended to read:


Subd. 5.

Building and physical premises; free of hazards.

(a) deleted text beginThe certified center
must document compliance with the State Fire Code by providing
deleted text endnew text begin To be accepted for
certification, the applicant must demonstrate compliance with the State Fire Code, section
299F.011, by either:
new text end

new text begin (1) providing new text enddocumentation of a fire marshal inspection completed within the previous
three years by a state fire marshal or a local fire code inspector trained by the state fire
marshaldeleted text begin.deleted text endnew text begin; or
new text end

new text begin (2) complying with the fire marshal inspection requirements according to section
245A.151.
new text end

(b) The certified center must designate a primary indoor and outdoor space used for
child care on a facility site floor plan.

(c) The certified center must ensure the areas used by a child are clean and in good repair,
with structurally sound and functional furniture and equipment that is appropriate to the
age and size of a child who uses the area.

(d) The certified center must ensure hazardous items including but not limited to sharp
objects, medicines, cleaning supplies, poisonous plants, and chemicals are out of reach of
a child.

(e) The certified center must safely handle and dispose of bodily fluids and other
potentially infectious fluids by using gloves, disinfecting surfaces that come in contact with
potentially infectious bodily fluids, and disposing of bodily fluid in a securely sealed plastic
bag.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 93.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Risk reduction plan. new text end

new text begin (a) The certified center must develop a risk reduction
plan that identifies risks to children served by the child care center. The assessment of risk
must include risks presented by (1) the physical plant where the certified services are
provided, including electrical hazards; and (2) the environment, including the proximity to
busy roads and bodies of water.
new text end

new text begin (b) The certification holder must establish policies and procedures to minimize identified
risks. After any change to the risk reduction plan, the certification holder must inform staff
of the change in the risk reduction plan and document that staff were informed of the change.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 94.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Required policies. new text end

new text begin A certified center must have written policies for health and
safety items in subdivisions 1 to 6.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 95.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Behavior guidance. new text end

new text begin The certified center must ensure that staff and volunteers
use positive behavior guidance and do not subject children to:
new text end

new text begin (1) corporal punishment, including but not limited to rough handling, shoving, hair
pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking;
new text end

new text begin (2) humiliation;
new text end

new text begin (3) abusive language;
new text end

new text begin (4) the use of mechanical restraints, including tying;
new text end

new text begin (5) the use of physical restraints other than to physically hold a child when containment
is necessary to protect a child or others from harm; or
new text end

new text begin (6) the withholding or forcing of food and other basic needs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 96.

Minnesota Statutes 2018, section 245H.13, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Supervision. new text end

new text begin Staff must supervise each child at all times. Staff are responsible
for the ongoing activity of each child, appropriate visual or auditory awareness, physical
proximity, and knowledge of activity requirements and each child's needs. Staff must
intervene when necessary to ensure a child's safety. In determining the appropriate level of
supervision of a child, staff must consider: (1) the age of a child; (2) individual differences
and abilities; (3) indoor and outdoor layout of the child care program; and (4) environmental
circumstances, hazards, and risks.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 97.

Minnesota Statutes 2018, section 245H.14, subdivision 1, is amended to read:


Subdivision 1.

First aid and cardiopulmonary resuscitation.

deleted text begin At least one designated
staff person who completed pediatric first aid training and pediatric cardiopulmonary
resuscitation (CPR) training must be present at all times at the program, during field trips,
and when transporting a child. The designated staff person must repeat pediatric first aid
training and pediatric CPR training at least once every two years.
deleted text end

new text begin (a) Before having unsupervised direct contact with a child, but within the first 90 days
of employment for the director and all staff persons, and within 90 days after the first date
of direct contact with a child for substitutes and unsupervised volunteers, each person must
successfully complete pediatric first aid and pediatric cardiopulmonary resuscitation (CPR)
training, unless the training has been completed within the previous two calendar years.
Staff must complete the pediatric first aid and pediatric CPR training at least every other
calendar year and the center must document the training in the staff person's personnel
record.
new text end

new text begin (b) Training completed under this subdivision may be used to meet the in-service training
requirements under subdivision 6.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 98.

Minnesota Statutes 2018, section 245H.14, subdivision 2, is amended to read:


Subd. 2.

Sudden unexpected infant death.

A certified center that cares for an infant
who is younger than one year of age must ensure that new text beginthe director, all new text endstaff personsnew text begin, including
substitutes, unsupervised volunteers,
new text end and new text beginany other new text endvolunteers receive training according
to section 245A.1435 on reducing the risk of sudden unexpected infant death before assisting
in the care of an infant.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 99.

Minnesota Statutes 2018, section 245H.14, subdivision 3, is amended to read:


Subd. 3.

Abusive head trauma.

A certified center that cares for a child deleted text beginthrough four
years of age
deleted text endnew text begin under school agenew text end must ensure thatnew text begin the director and allnew text end staff persons deleted text beginand
volunteers
deleted text endnew text begin, including substitutes and unsupervised volunteers,new text end receive training on abusive
head trauma deleted text beginfrom shaking infants and young childrendeleted text end before assisting in the care of a child
deleted text begin through four years of agedeleted text endnew text begin under school agenew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 100.

Minnesota Statutes 2018, section 245H.14, subdivision 4, is amended to read:


Subd. 4.

Child development.

The certified center must ensure deleted text begineach staff person completes
at least two hours of
deleted text endnew text begin that the director and all staff persons completenew text end child development and
learning training within deleted text begin14deleted text endnew text begin 90new text end days of employment and deleted text beginannuallydeleted text endnew text begin every second calendar yearnew text end
thereafter. new text beginSubstitutes and unsupervised volunteers must complete child development and
learning training within 90 days after the first date of direct contact with a child and every
second calendar year thereafter.
new text endnew text begin The director and staff persons not including substitutes
must complete at least two hours of training on child development. The training for substitutes
and unsupervised volunteers is not required to be of a minimum length.
new text end For purposes of
this subdivision, "child development and learning training" means how a child develops
physically, cognitively, emotionally, and socially and learns as part of the child's family,
culture, and community.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 101.

Minnesota Statutes 2018, section 245H.14, subdivision 5, is amended to read:


Subd. 5.

Orientation.

The certified center must ensure deleted text begineach staff person isdeleted text endnew text begin the director
and all staff persons, substitutes, and unsupervised volunteers are
new text end trained at orientation on
health and safety requirements in sections 245H.11, 245H.13, 245H.14, and 245H.15. The
certified center must provide deleted text beginstaff with andeleted text end orientation within 14 days deleted text beginof employmentdeleted text endnew text begin after
the first date of direct contact with a child
new text end. Before the completion of orientation, deleted text begina staff
person
deleted text endnew text begin these individualsnew text end must be supervised while providing direct care to a child.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 102.

Minnesota Statutes 2018, section 245H.14, subdivision 6, is amended to read:


Subd. 6.

In service.

(a) The certified center must ensure deleted text begineachdeleted text endnew text begin that the director and allnew text end
staff deleted text beginperson isdeleted text endnew text begin persons, including substitutes and unsupervised volunteers, arenew text end trained at
least deleted text beginannuallydeleted text endnew text begin once each calendar yearnew text end on health and safety requirements in sections 245H.11,
245H.13, 245H.14, and 245H.15.

(b) new text beginThe director and new text endeach staff personnew text begin, not including substitutes,new text end must deleted text beginannuallydeleted text end complete
at least six hours of trainingnew text begin each calendar yearnew text end. Training required under paragraph (a) may
be used toward the hourly training requirements of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 103.

Minnesota Statutes 2018, section 245H.15, subdivision 1, is amended to read:


Subdivision 1.

Written emergency plan.

(a) A certified center must have a written
emergency plan for emergencies that require evacuation, sheltering, or other protection of
children, such as fire, natural disaster, intruder, or other threatening situation that may pose
a health or safety hazard to children. The plan must be written on a form developed by the
commissioner and reviewed and updated at least once each calendar year. The annual review
of the emergency plan must be documented.

(b) The plan must include:

(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;

(2) a designated relocation site and evacuation route;

(3) procedures for notifying a child's parent or legal guardian of the relocation and
reunification with families;

(4) accommodations for a child with a disability or a chronic medical condition;

(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;

(6) procedures for continuing operations in the period during and after a crisis; deleted text beginand
deleted text end

(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authoritiesdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) accommodations for infants and toddlers.
new text end

(c) The certification holder must have an emergency plan available for review upon
request by the child's parent or legal guardian.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 30, 2019.
new text end

Sec. 104.

Minnesota Statutes 2018, section 254B.05, subdivision 1, is amended to read:


Subdivision 1.

Licensure required.

(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, or outpatient treatment
services, and are licensed by tribal government are eligible vendors.

(b) On July 1, 2018, or upon federal approval, whichever is later, a licensed professional
in private practice who meets the requirements of section 245G.11, subdivisions 1 and 4,
is an eligible vendor of a comprehensive assessment and assessment summary provided
according to section 245G.05, and treatment services provided according to sections 245G.06
and 245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2.

(c) On July 1, 2018, or upon federal approval, whichever is later, a county is an eligible
vendor for a comprehensive assessment and assessment summary when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and deleted text begin4deleted text endnew text begin 5new text end,
and completed according to the requirements of section 245G.05. A county is an eligible
vendor of care coordination services when provided by an individual who meets the staffing
credentials of section 245G.11, subdivisions 1 and 7, and provided according to the
requirements of section 245G.07, subdivision 1, clause (7).

(d) On July 1, 2018, or upon federal approval, whichever is later, a recovery community
organization that meets certification requirements identified by the commissioner is an
eligible vendor of peer support services.

(e) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.

Sec. 105.

Minnesota Statutes 2018, section 254B.05, subdivision 1b, is amended to read:


Subd. 1b.

Additional vendor requirements.

Vendors must comply with the following
duties:

(1) maintain a provider agreement with the department;

(2) continually comply with the standards in the agreement;

(3) participate in the Drug Alcohol Normative Evaluation System;

(4) submit an annual financial statement which reports functional expenses of chemical
dependency treatment costs in a form approved by the commissioner;

(5) report information about the vendor's current capacity in a manner prescribed by the
commissioner; and

(6) maintain adequate and appropriate insurance coverage necessary to provide chemical
dependency treatment services, and at a minimum:

(i) employee dishonesty in the amount of $10,000 if the vendor has or had custody or
control of money or property belonging to clients; and

(ii) bodily injury and property damage in the amount of $2,000,000 for each occurrencenew text begin,
except that a county or a county joint powers entity who is otherwise an eligible vendor
shall be subject to the limits on liability under section 466.04
new text end.

Sec. 106.

Minnesota Statutes 2018, section 256.046, subdivision 1, is amended to read:


Subdivision 1.

Hearing authority.

A local agency must initiate an administrative fraud
disqualification hearing for individualsdeleted text begin, including child care providers caring for children
receiving child care assistance,
deleted text end accused of wrongfully obtaining assistance or intentional
program violations, in lieu of a criminal action when it has not been pursued, in the Minnesota
family investment program and any affiliated program to include the diversionary work
program and the work participation cash benefit program, child care assistance programs,
general assistance, family general assistance program formerly codified in section 256D.05,
subdivision 1
, clause (15), Minnesota supplemental aid, food stamp programs, MinnesotaCare
for adults without children, and upon federal approval, all categories of medical assistance
and remaining categories of MinnesotaCare except for children through age 18. The
Department of Human Services, in lieu of a local agency, may initiate an administrative
fraud disqualification hearing when the state agency is directly responsible for administration
or investigation of the program for which benefits were wrongfully obtained. The hearing
is subject to the requirements of deleted text beginsectiondeleted text endnew text begin sectionsnew text end 256.045 new text beginand 256.0451 new text endand the requirements
in Code of Federal Regulations, title 7, section 273.16.

Sec. 107.

Minnesota Statutes 2018, section 256.046, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Administrative disqualification of child care providers caring for children
receiving child care assistance.
new text end

new text begin (a) The department or local agency shall pursue an
administrative disqualification, if the child care provider is accused of committing an
intentional program violation, in lieu of a criminal action when it has not been pursued.
Intentional program violations include intentionally making false or misleading statements;
intentionally misrepresenting, concealing, or withholding facts; and repeatedly and
intentionally violating program regulations under chapters 119B and 245E. Intent may be
proven by demonstrating a pattern of conduct that violates program rules under chapters
119B and 245E.
new text end

new text begin (b) To initiate an administrative disqualification, a local agency or the commissioner
must mail written notice by certified mail to the provider against whom the action is being
taken. Unless otherwise specified under chapter 119B or 245E or Minnesota Rules, chapter
3400, a local agency or the commissioner must mail the written notice at least 15 calendar
days before the adverse action's effective date. The notice shall state (1) the factual basis
for the agency's determination, (2) the action the agency intends to take, (3) the dollar amount
of the monetary recovery or recoupment, if known, and (4) the provider's right to appeal
the agency's proposed action.
new text end

new text begin (c) The provider may appeal an administrative disqualification by submitting a written
request to the Department of Human Services, Appeals Division. A provider's request must
be received by the Appeals Division no later than 30 days after the date a local agency or
the commissioner mails the notice.
new text end

new text begin (d) The provider's appeal request must contain the following:
new text end

new text begin (1) each disputed item, the reason for the dispute, and, if applicable, an estimate of the
dollar amount involved for each disputed item;
new text end

new text begin (2) the computation the provider believes to be correct, if applicable;
new text end

new text begin (3) the statute or rule relied on for each disputed item; and
new text end

new text begin (4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
new text end

new text begin (e) On appeal, the issuing agency bears the burden of proof to demonstrate by a
preponderance of the evidence that the provider committed an intentional program violation.
new text end

new text begin (f) The hearing is subject to the requirements of sections 256.045 and 256.0451. The
human services judge may combine a fair hearing and administrative disqualification hearing
into a single hearing if the factual issues arise out of the same or related circumstances and
the provider receives prior notice that the hearings will be combined.
new text end

new text begin (g) A provider found to have committed an intentional program violation and is
administratively disqualified shall be disqualified, for a period of three years for the first
offense and permanently for any subsequent offense, from receiving any payments from
any child care program under chapter 119B.
new text end

new text begin (h) Unless a timely and proper appeal made under this section is received by the
department, the administrative determination of the department is final and binding.
new text end

Sec. 108.

Minnesota Statutes 2018, section 256.98, subdivision 1, is amended to read:


Subdivision 1.

Wrongfully obtaining assistance.

A person who commits any of the
following acts or omissions with intent to defeat the purposes of sections 145.891 to 145.897,
the MFIP program formerly codified in sections 256.031 to 256.0361, the AFDC program
formerly codified in sections 256.72 to 256.871, chapter 256B, 256D, new text begin256I, new text end256J, 256K, or
256L, child care assistance programs, and emergency assistance programs under section
256D.06, is guilty of theft and shall be sentenced under section 609.52, subdivision 3, clauses
(1) to (5):

(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a
willfully false statement or representation, by intentional concealment of any material fact,
or by impersonation or other fraudulent device, assistance or the continued receipt of
assistance, to include child care assistance or vouchers produced according to sections
145.891 to 145.897 and MinnesotaCare services according to sections 256.9365, 256.94,
and 256L.01 to 256L.15, to which the person is not entitled or assistance greater than that
to which the person is entitled;

(2) knowingly aids or abets in buying or in any way disposing of the property of a
recipient or applicant of assistance without the consent of the county agency; or

(3) obtains or attempts to obtain, alone or in collusion with others, the receipt of payments
to which the individual is not entitled as a provider of subsidized child care, or by furnishing
or concurring in a willfully false claim for child care assistance.

The continued receipt of assistance to which the person is not entitled or greater than
that to which the person is entitled as a result of any of the acts, failure to act, or concealment
described in this subdivision shall be deemed to be continuing offenses from the date that
the first act or failure to act occurred.

Sec. 109.

Minnesota Statutes 2018, section 256.98, subdivision 8, is amended to read:


Subd. 8.

Disqualification from program.

(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the work
participation cash benefit program, the food stamp or food support program, the general
assistance program, housing support under chapter 256I, or the Minnesota supplemental
aid program shall be disqualified from that program. In addition, any person disqualified
from the Minnesota family investment program shall also be disqualified from the food
stamp or food support program. The needs of that individual shall not be taken into
consideration in determining the grant level for that assistance unit:

(1) for one year after the first offense;

(2) for two years after the second offense; and

(3) permanently after the third or subsequent offense.

The period of program disqualification shall begin on the date stipulated on the advance
notice of disqualification without possibility of postponement for administrative stay or
administrative hearing and shall continue through completion unless and until the findings
upon which the sanctions were imposed are reversed by a court of competent jurisdiction.
The period for which sanctions are imposed is not subject to review. The sanctions provided
under this subdivision are in addition to, and not in substitution for, any other sanctions that
may be provided for by law for the offense involved. A disqualification established through
hearing or waiver shall result in the disqualification period beginning immediately unless
the person has become otherwise ineligible for assistance. If the person is ineligible for
assistance, the disqualification period begins when the person again meets the eligibility
criteria of the program from which they were disqualified and makes application for that
program.

(b) A family receiving assistance through child care assistance programs under chapter
119B with a family member who is found to be guilty of wrongfully obtaining child care
assistance by a federal court, state court, or an administrative hearing determination or
waiver, through a disqualification consent agreement, as part of an approved diversion plan
under section 401.065, or a court-ordered stay with probationary or other conditions, is
disqualified from child care assistance programs. The disqualifications must be for periods
of one year and two years for the first and second offenses, respectively. Subsequent
violations must result in permanent disqualification. During the disqualification period,
disqualification from any child care program must extend to all child care programs and
must be immediately applied.

(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care services
from the child care assistance program under chapter 119B when the provider is found to
have wrongfully obtained child care assistance by a federal court, state court, or an
administrative hearing determination or waiver under section 256.046, through a
disqualification consent agreement, as part of an approved diversion plan under section
401.065, or a court-ordered stay with probationary or other conditions. The disqualification
must be for a period of deleted text beginone yeardeleted text endnew text begin three yearsnew text end for the first offense deleted text beginand two years for the second
offense
deleted text end. Any subsequent violation must result in permanent disqualification. The
disqualification period must be imposed immediately after a determination is made under
this paragraph. During the disqualification period, the provider is disqualified from receiving
payment from any child care program under chapter 119B.

(d) Any person found to be guilty of wrongfully obtaining MinnesotaCare for adults
without children and upon federal approval, all categories of medical assistance and
remaining categories of MinnesotaCare, except for children through age 18, by a federal or
state court or by an administrative hearing determination, or waiver thereof, through a
disqualification consent agreement, or as part of any approved diversion plan under section
401.065, or any court-ordered stay which carries with it any probationary or other conditions,
is disqualified from that program. The period of disqualification is one year after the first
offense, two years after the second offense, and permanently after the third or subsequent
offense. The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution for, any
other sanctions that may be provided for by law for the offense involved.

Sec. 110.

Minnesota Statutes 2018, section 256.983, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Child care providers; financial misconduct. new text end

new text begin (a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.
new text end

new text begin (b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The county must send notice in accordance with the requirements of section 119B.161,
subdivision 2. If a provider's payment is suspended under this section, the payment suspension
shall remain in effect until: (1) the commissioner, county, or a law enforcement authority
determines that there is insufficient evidence warranting the action and a county, tribe, or
the commissioner does not pursue an additional administrative remedy under chapter 119B
or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and administrative
proceedings related to the provider's alleged misconduct conclude and any appeal rights are
exhausted.
new text end

new text begin (c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.
new text end

new text begin (d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective February 26, 2021.
new text end

Sec. 111.

Minnesota Statutes 2018, section 256B.02, subdivision 7, is amended to read:


Subd. 7.

Vendor of medical care.

(a) "Vendor of medical care" means any person or
persons furnishing, within the scope of the vendor's respective license, any or all of the
following goods or services: medical, surgical, hospital, ambulatory surgical center services,
optical, visual, dental and nursing services; drugs and medical supplies; appliances;
laboratory, diagnostic, and therapeutic services; nursing home and convalescent care;
screening and health assessment services provided by public health nurses as defined in
section 145A.02, subdivision 18; health care services provided at the residence of the patient
if the services are performed by a public health nurse and the nurse indicates in a statement
submitted under oath that the services were actually provided; and such other deleted text beginmedicaldeleted text end
services or supplies provided or prescribed by persons authorized by state law to give such
services and supplies. The term includes, but is not limited to, directors and officers of
corporations or members of partnerships who, either individually or jointly with another or
others, have the legal control, supervision, or responsibility of submitting claims for
reimbursement to the medical assistance program. The term only includes directors and
officers of corporations who personally receive a portion of the distributed assets upon
liquidation or dissolution, and their liability is limited to the portion of the claim that bears
the same proportion to the total claim as their share of the distributed assets bears to the
total distributed assets.

(b) "Vendor of medical care" also includes any person who is credentialed as a health
professional under standards set by the governing body of a federally recognized Indian
tribe authorized under an agreement with the federal government according to United States
Code, title 25, section 450f, to provide health services to its members, and who through a
tribal facility provides covered services to American Indian people within a contract health
service delivery area of a Minnesota reservation, as defined under Code of Federal
Regulations, title 42, section 36.22.

(c) A federally recognized Indian tribe that intends to implement standards for
credentialing health professionals must submit the standards to the commissioner of human
services, along with evidence of meeting, exceeding, or being exempt from corresponding
state standards. The commissioner shall maintain a copy of the standards and supporting
evidence, and shall use those standards to enroll tribal-approved health professionals as
medical assistance providers. For purposes of this section, "Indian" and "Indian tribe" mean
persons or entities that meet the definition in United States Code, title 25, section 450b.

Sec. 112.

Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:


Subd. 21.

Provider enrollment.

(a) If the commissioner or the Centers for Medicare
and Medicaid Services determines that a provider is designated "high-risk," the commissioner
may withhold payment from providers within that category upon initial enrollment for a
90-day period. The withholding for each provider must begin on the date of the first
submission of a claim.

(b) An enrolled provider that is also licensed by the commissioner under chapter 245A,
or is licensed as a home care provider by the Department of Health under chapter 144A and
has a home and community-based services designation on the home care license under
section 144A.484, must designate an individual as the entity's compliance officer. The
compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;

(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

(c) The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.

(d) The commissioner shall terminate or deny the enrollment of any individual or entity
if the individual or entity has been terminated from participation in Medicare or under the
Medicaid program or Children's Health Insurance Program of any other state.new text begin The
commissioner may exempt a rehabilitation agency from termination or denial that would
otherwise be required under this paragraph, if the agency:
new text end

new text begin (1) is unable to retain Medicare certification and enrollment solely due to a lack of billing
to the Medicare program;
new text end

new text begin (2) meets all other applicable Medicare certification requirements based on an on-site
review completed by the commissioner of health; and
new text end

new text begin (3) serves primarily a pediatric population.
new text end

(e) As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

(f) As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.

(g)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable
medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.

(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.

(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.

(h) The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph (a) and as
per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an
amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.

Sec. 113.

Minnesota Statutes 2018, section 256B.064, subdivision 1b, is amended to read:


Subd. 1b.

Sanctions available.

The commissioner may impose the following sanctions
for the conduct described in subdivision 1a: suspension or withholding of payments to a
vendor and suspending or terminating participation in the program, or imposition of a fine
under subdivision 2, paragraph (f). When imposing sanctions under this section, the
commissioner shall consider the nature, chronicity, or severity of the conduct and the effect
of the conduct on the health and safety of persons served by the vendor.new text begin The commissioner
shall suspend a vendor's participation in the program for a minimum of five years if the
vendor is convicted of a crime, received a stay of adjudication, or entered a court-ordered
diversion program for an offense related to a provision of a health service under medical
assistance or health care fraud.
new text end Regardless of imposition of sanctions, the commissioner
may make a referral to the appropriate state licensing board.

Sec. 114.

Minnesota Statutes 2018, section 256B.064, subdivision 2, is amended to read:


Subd. 2.

Imposition of monetary recovery and sanctions.

(a) The commissioner shall
determine any monetary amounts to be recovered and sanctions to be imposed upon a vendor
of medical care under this section. Except as provided in paragraphs (b) and (d), neither a
monetary recovery nor a sanction will be imposed by the commissioner without prior notice
and an opportunity for a hearing, according to chapter 14, on the commissioner's proposed
action, provided that the commissioner may suspend or reduce payment to a vendor of
medical care, except a nursing home or convalescent care facility, after notice and prior to
the hearing if in the commissioner's opinion that action is necessary to protect the public
welfare and the interests of the program.

(b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
withhold or reduce payments to a vendor of medical care without providing advance notice
of such withholding or reduction if either of the following occurs:

(1) the vendor is convicted of a crime involving the conduct described in subdivision
1a; or

(2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. A credible allegation of fraud is an allegation
which has been verified by the state, from any source, including but not limited to:

(i) fraud hotline complaints;

(ii) claims data mining; and

(iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.

Allegations are considered to be credible when they have an indicia of reliability and
the state agency has reviewed all allegations, facts, and evidence carefully and acts
judiciously on a case-by-case basis.

(c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:

(1) state that payments are being withheld according to paragraph (b);

(2) set forth the general allegations as to the nature of the withholding action, but need
not disclose any specific information concerning an ongoing investigation;

(3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period and cite the circumstances under which withholding
will be terminated;

(4) identify the types of claims to which the withholding applies; and

(5) inform the vendor of the right to submit written evidence for consideration by the
commissioner.

The withholding or reduction of payments will not continue after the commissioner
determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
relating to the alleged fraud are completed, unless the commissioner has sent notice of
intention to impose monetary recovery or sanctions under paragraph (a).new text begin Upon conviction
for a crime related to the provision, management, or administration of a health service under
medical assistance, a payment held pursuant to this section by the commissioner or a managed
care organization that contracts with the commissioner under section 256B.035 is forfeited
to the commissioner or managed care organization, regardless of the amount charged in the
criminal complaint or the amount of criminal restitution ordered.
new text end

(d) The commissioner shall suspend or terminate a vendor's participation in the program
without providing advance notice and an opportunity for a hearing when the suspension or
termination is required because of the vendor's exclusion from participation in Medicare.
Within five days of taking such action, the commissioner must send notice of the suspension
or termination. The notice must:

(1) state that suspension or termination is the result of the vendor's exclusion from
Medicare;

(2) identify the effective date of the suspension or termination; and

(3) inform the vendor of the need to be reinstated to Medicare before reapplying for
participation in the program.

(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or sanction is
to be imposed, a vendor may request a contested case, as defined in section 14.02, subdivision
3
, by filing with the commissioner a written request of appeal. The appeal request must be
received by the commissioner no later than 30 days after the date the notification of monetary
recovery or sanction was mailed to the vendor. The appeal request must specify:

(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item;

(2) the computation that the vendor believes is correct;

(3) the authority in statute or rule upon which the vendor relies for each disputed item;

(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and

(5) other information required by the commissioner.

(f) The commissioner may order a vendor to forfeit a fine for failure to fully document
services according to standards in this chapter and Minnesota Rules, chapter 9505. The
commissioner may assess fines if specific required components of documentation are
missing. The fine for incomplete documentation shall equal 20 percent of the amount paid
on the claims for reimbursement submitted by the vendor, or up to $5,000, whichever is
less.new text begin If the commissioner determines that a vendor repeatedly violated this chapter or
Minnesota Rules, chapter 9505, related to the provision of services to program recipients
and the submission of claims for payment, the commissioner may order a vendor to forfeit
a fine based on the nature, severity, and chronicity of the violations, in an amount of up to
$5,000 or 20 percent of the value of the claims, whichever is greater.
new text end

(g) The vendor shall pay the fine assessed on or before the payment date specified. If
the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
recover the amount of the fine. A timely appeal shall stay payment of the fine until the
commissioner issues a final order.

Sec. 115.

Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Vendor mandates on prohibited payments. new text end

new text begin (a) The commissioner shall
maintain and publish a list of each excluded individual and entity that was convicted of a
crime related to the provision, management, or administration of a medical assistance health
service, or suspended or terminated under subdivision 2. Medical assistance payments cannot
be made by a vendor for items or services furnished either directly or indirectly by an
excluded individual or entity, or at the direction of excluded individuals or entities.
new text end

new text begin (b) The vendor must check the exclusion list on a monthly basis and document the date
and time the exclusion list was checked and the name and title of the person who checked
the exclusion list. The vendor must immediately terminate payments to an individual or
entity on the exclusion list.
new text end

new text begin (c) A vendor's requirement to check the exclusion list and to terminate payments to
individuals or entities on the exclusion list applies to each individual or entity on the
exclusion list, even if the named individual or entity is not responsible for direct patient
care or direct submission of a claim to medical assistance.
new text end

new text begin (d) A vendor that pays medical assistance program funds to an individual or entity on
the exclusion list must refund any payment related to either items or services rendered by
an individual or entity on the exclusion list from the date the individual or entity is first paid
or the date the individual or entity is placed on the exclusion list, whichever is later, and a
vendor may be subject to:
new text end

new text begin (1) sanctions under subdivision 2;
new text end

new text begin (2) a civil monetary penalty of up to $25,000 for each determination by the department
that the vendor employed or contracted with an individual or entity on the exclusion list;
and
new text end

new text begin (3) other fines or penalties allowed by law.
new text end

Sec. 116.

Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Notice. new text end

new text begin (a) The notice required under subdivision 2 shall be served by certified
mail at the address submitted to the department by the vendor. Service is complete upon
mailing. The commissioner shall place an affidavit of the certified mailing in the vendor's
file as an indication of the address and the date of mailing.
new text end

new text begin (b) The department shall give notice in writing to a recipient placed in the Minnesota
restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200.
The notice shall be sent by first class mail to the recipient's current address on file with the
department. A recipient placed in the Minnesota restricted recipient program may contest
the placement by submitting a written request for a hearing to the department within 90
days of the notice being mailed.
new text end

Sec. 117.

Minnesota Statutes 2018, section 256B.064, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Immunity; good faith reporters. new text end

new text begin (a) A person who makes a good faith report
is immune from any civil or criminal liability that might otherwise arise from reporting or
participating in the investigation. Nothing in this subdivision affects a vendor's responsibility
for an overpayment established under this subdivision.
new text end

new text begin (b) A person employed by a lead investigative agency who is conducting or supervising
an investigation or enforcing the law according to the applicable law or rule is immune from
any civil or criminal liability that might otherwise arise from the person's actions, if the
person is acting in good faith and exercising due care.
new text end

new text begin (c) For purposes of this subdivision, "person" includes a natural person or any form of
a business or legal entity.
new text end

new text begin (d) After an investigation is complete, the reporter's name must be kept confidential.
The subject of the report may compel disclosure of the reporter's name only with the consent
of the reporter or upon a written finding by a district court that the report was false and there
is evidence that the report was made in bad faith. This subdivision does not alter disclosure
responsibilities or obligations under the Rules of Criminal Procedure, except that when the
identity of the reporter is relevant to a criminal prosecution the district court shall conduct
an in-camera review before determining whether to order disclosure of the reporter's identity.
new text end

Sec. 118.

new text begin [256B.0646] MINNESOTA RESTRICTED RECIPIENT PROGRAM;
PERSONAL CARE ASSISTANCE SERVICES.
new text end

new text begin (a) When a recipient's use of personal care assistance services or community first services
and supports under section 256B.85 results in abusive or fraudulent billing, the commissioner
may place a recipient in the Minnesota restricted recipient program under Minnesota Rules,
part 9505.2165. A recipient placed in the Minnesota restricted recipient program under this
section must: (1) use a designated traditional personal care assistance provider agency; and
(2) obtain a new assessment under section 256B.0911, including consultation with a registered
or public health nurse on the long-term care consultation team pursuant to section 256B.0911,
subdivision 3, paragraph (b), clause (2).
new text end

new text begin (b) A recipient must comply with additional conditions for the use of personal care
assistance services or community first services and supports if the commissioner determines
it is necessary to prevent future misuse of personal care assistance services or abusive or
fraudulent billing. Additional conditions may include but are not limited to restricting service
authorizations for a duration of no more than one month and requiring a qualified professional
to monitor and report services on a monthly basis.
new text end

new text begin (c) A recipient placed in the Minnesota restricted recipient program under this section
may appeal the placement according to section 256.045.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 119.

Minnesota Statutes 2018, section 256B.0651, subdivision 17, is amended to
read:


Subd. 17.

Recipient protection.

(a) Providers of home care services must provide each
recipient with a copy of the home care bill of rights under section 144A.44 at least 30 days
prior to terminating services to a recipient, if the termination results from provider sanctions
under section 256B.064, such as a payment withhold, a suspension of participation, or a
termination of participation. If a home care provider determines it is unable to continue
providing services to a recipient, the provider must notify the recipient, the recipient's
responsible party, and the commissioner 30 days prior to terminating services to the recipient
because of an action under section 256B.064, and must assist the commissioner and lead
agency in supporting the recipient in transitioning to another home care provider of the
recipient's choice.

(b) In the event of a payment withhold from a home care provider, a suspension of
participation, or a termination of participation of a home care provider under section
256B.064, the commissioner may inform the Office of Ombudsman for Long-Term Care
and the lead agencies for all recipients with active service agreements with the provider. At
the commissioner's request, the lead agencies must contact recipients to ensure that the
recipients are continuing to receive needed care, and that the recipients have been given
free choice of provider if they transfer to another home care provider. In addition, the
commissioner or the commissioner's delegate may directly notify recipients who receive
care from the provider that payments have been new text beginor will be new text endwithheld or that the provider's
participation in medical assistance has been new text beginor will be new text endsuspended or terminated, if the
commissioner determines that notification is necessary to protect the welfare of the recipients.
For purposes of this subdivision, "lead agencies" means counties, tribes, and managed care
organizations.

new text begin EFFECTIVE DATE. new text end

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

Sec. 120.

Minnesota Statutes 2018, section 256B.0659, subdivision 12, is amended to
read:


Subd. 12.

Documentation of personal care assistance services provided.

(a) Personal
care assistance services for a recipient must be documented daily by each personal care
assistant, on a time sheet form approved by the commissioner. All documentation may be
web-based, electronic, or paper documentation. The completed form must be submitted on
a monthly basis to the provider and kept in the recipient's health record.

(b) The activity documentation must correspond to the personal care assistance care plan
and be reviewed by the qualified professional.

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

(1) full name of personal care assistant and individual provider number;

(2) provider name and telephone numbers;

(3) full name of recipientnew text begin and either the recipient's medical assistance identification
number or date of birth
new text end;

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

(5) signatures of recipient or the responsible party;

(6) personal signature of the personal care assistant;

(7) any shared care provided, if applicable;

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 121.

Minnesota Statutes 2018, section 256B.27, subdivision 3, is amended to read:


Subd. 3.

Access to medical records.

The commissioner of human services, with the
written consent of the recipient, on file with the local welfare agency, shall be allowed
access to all personal medical records of medical assistance recipients solely for the purposes
of investigating whether or not: (a) a vendor of medical care has submitted a claim for
reimbursement, a cost report or a rate application which is duplicative, erroneous, or false
in whole or in part, or which results in the vendor obtaining greater compensation than the
vendor is legally entitled to; or (b) the medical care was medically necessary. deleted text beginThe vendor
of medical care shall receive notification from the commissioner at least 24 hours before
the commissioner gains access to such records.
deleted text endnew text begin When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate access
without prior notice to the vendor's office during regular business hours and to documentation
and records related to services provided and submission of claims for services provided.
The department shall document in writing the need for immediate access to records related
to a specific investigation. Denying the commissioner access to records is cause for the
vendor's immediate suspension of payment or termination according to section 256B.064.
new text end
The determination of provision of services not medically necessary shall be made by the
commissioner. Notwithstanding any other law to the contrary, a vendor of medical care
shall not be subject to any civil or criminal liability for providing access to medical records
to the commissioner of human services pursuant to this section.

Sec. 122.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 11. new text end

new text begin Home and community-based service billing requirements. new text end

new text begin (a) A home and
community-based service is eligible for reimbursement if:
new text end

new text begin (1) the service is provided according to a federally approved waiver plan as authorized
under sections 256B.0913, 256B.0915, 256B.092, and 256B.49;
new text end

new text begin (2) if applicable, the service is provided on days and times during the days and hours of
operation specified on any license required under chapter 245A or 245D; and
new text end

new text begin (3) the provider complies with subdivisions 12 to 15, if applicable.
new text end

new text begin (b) The provider must maintain documentation that, upon employment and annually
thereafter, staff providing a service have attested to reviewing and understanding the
following statement: "It is a federal crime to provide materially false information on service
billings for medical assistance or services provided under a federally approved waiver plan
as authorized under Minnesota Statutes, sections 256B.0913, 256B.0915, 256B.092, and
256B.49."
new text end

new text begin (c) The department may recover payment according to section 256B.064 and Minnesota
Rules, parts 9505.2160 to 9505.2245, for a service that does not satisfy this subdivision.
new text end

Sec. 123.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 12. new text end

new text begin Home and community-based service documentation requirements. new text end

new text begin (a)
Documentation may be collected and maintained electronically or in paper form by providers
and must be produced upon request by the commissioner.
new text end

new text begin (b) Documentation of a delivered service must be in English and must be legible according
to the standard of a reasonable person.
new text end

new text begin (c) If the service is reimbursed at an hourly or specified minute-based rate, each
documentation of the provision of a service, unless otherwise specified, must include:
new text end

new text begin (1) the date the documentation occurred;
new text end

new text begin (2) the day, month, and year when the service was provided;
new text end

new text begin (3) the start and stop times with a.m. and p.m. designations, except for case management
services as defined under sections 256B.0913, subdivision 7; 256B.0915, subdivision 1a;
256B.092, subdivision 1a; and 256B.49, subdivision 13;
new text end

new text begin (4) the service name or description of the service provided; and
new text end

new text begin (5) the name, signature, and title, if any, of the provider of service. If the service is
provided by multiple staff members, the provider may designate a staff member responsible
for verifying services and completing the documentation required by this paragraph.
new text end

new text begin (d) If the service is reimbursed at a daily rate or does not meet the requirements in
paragraph (c), each documentation of the provision of a service, unless otherwise specified,
must include:
new text end

new text begin (1) the date the documentation occurred;
new text end

new text begin (2) the day, month, and year when the service was provided;
new text end

new text begin (3) the service name or description of the service provided; and
new text end

new text begin (4) the name, signature, and title, if any, of the person providing the service. If the service
is provided by multiple staff, the provider may designate a staff member responsible for
verifying services and completing the documentation required by this paragraph.
new text end

Sec. 124.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 13. new text end

new text begin Waiver transportation documentation and billing requirements. new text end

new text begin (a) A
waiver transportation service must be a waiver transportation service that: (1) is not covered
by medical transportation under the Medicaid state plan; and (2) is not included as a
component of another waiver service.
new text end

new text begin (b) In addition to the documentation requirements in subdivision 12, a waiver
transportation service provider must maintain:
new text end

new text begin (1) odometer and other records pursuant to section 256B.0625, subdivision 17b, paragraph
(b), clause (3), sufficient to distinguish an individual trip with a specific vehicle and driver
for a waiver transportation service that is billed directly by the mile. A common carrier as
defined by Minnesota Rules, part 9505.0315, subpart 1, item B, or a publicly operated transit
system provider are exempt from this clause; and
new text end

new text begin (2) documentation demonstrating that a vehicle and a driver meet the standards determined
by the Department of Human Services on vehicle and driver qualifications in section
256B.0625, subdivision 17, paragraph (c).
new text end

Sec. 125.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 14. new text end

new text begin Equipment and supply documentation requirements. new text end

new text begin (a) In addition to the
requirements in subdivision 12, an equipment and supply services provider must for each
documentation of the provision of a service include:
new text end

new text begin (1) the recipient's assessed need for the equipment or supply;
new text end

new text begin (2) the reason the equipment or supply is not covered by the Medicaid state plan;
new text end

new text begin (3) the type and brand name of the equipment or supply delivered to or purchased by
the recipient, including whether the equipment or supply was rented or purchased;
new text end

new text begin (4) the quantity of the equipment or supply delivered or purchased; and
new text end

new text begin (5) the cost of the equipment or supply if the amount paid for the service depends on
the cost.
new text end

new text begin (b) A provider must maintain a copy of the shipping invoice or a delivery service tracking
log or other documentation showing the date of delivery that proves the equipment or supply
was delivered to the recipient or a receipt if the equipment or supply was purchased by the
recipient.
new text end

Sec. 126.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 15. new text end

new text begin Adult day service documentation and billing requirements. new text end

new text begin (a) In addition
to the requirements in subdivision 12, a provider of adult day services as defined in section
245A.02, subdivision 2a, and licensed under Minnesota Rules, parts 9555.9600 to 9555.9730,
must maintain documentation of:
new text end

new text begin (1) a needs assessment and current plan of care according to section 245A.143,
subdivisions 4 to 7, or Minnesota Rules, part 9555.9700, for each recipient, if applicable;
new text end

new text begin (2) attendance records as specified under section 245A.14, subdivision 14, paragraph
(c), including the date of attendance with the day, month, and year; and the pickup and
drop-off time in hours and minutes with a.m. and p.m. designations;
new text end

new text begin (3) the monthly and quarterly program requirements in Minnesota Rules, part 9555.9710,
subparts 1, items E and H; 3; 4; and 6, if applicable;
new text end

new text begin (4) the name and qualification of each registered physical therapist, registered nurse,
and registered dietitian who provides services to the adult day services or nonresidential
program; and
new text end

new text begin (5) the location where the service was provided. If the location is an alternate location
from the usual place of service, the documentation must include the address, or a description
if the address is not available, of both the origin site and destination site; the length of time
at the alternate location with a.m. and p.m. designations; and a list of participants who went
to the alternate location.
new text end

new text begin (b) A provider must not exceed the provider's licensed capacity. If a provider exceeds
the provider's licensed capacity, the department must recover all Minnesota health care
programs payments from the date the provider exceeded licensed capacity.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 127. new text beginEVALUATION OF GRANT PROGRAMS; PROVEN-EFFECTIVE
PRACTICES.
new text end

new text begin (a) The commissioner of management and budget shall consult with the commissioner
of human services to establish a plan to review the services delivered under grant programs
administered by the commissioner of human services to determine whether the grant programs
prioritize proven-effective or promising practices.
new text end

new text begin (b) In accordance with the plan established in paragraph (a), the commissioner of
management and budget, in consultation with the commissioner of human services, shall
identify services to evaluate using an experimental or quasi-experimental design to provide
information needed to modify or develop grant programs to promote proven-effective
practices to improve the intended outcomes of the grant program.
new text end

new text begin (c) The commissioner of management and budget, in consultation with the commissioner
of human services, shall develop reports for the legislature and other stakeholders to provide
information on incorporating proven-effective practices in program and budget decisions.
The commissioner of management and budget, under Minnesota Statutes, section 15.08,
may obtain additional relevant data to support the evaluation activities under this section.
new text end

new text begin (d) For purposes of this section, the following terms have the meanings given:
new text end

new text begin (1) "proven-effective practice" means a service or practice that offers a high level of
research on effectiveness for at least one outcome of interest, as determined through multiple
evaluations outside of Minnesota or one or more local evaluation in Minnesota. The research
on effectiveness used to determine whether a service is proven-effective must use rigorously
implemented experimental or quasi-experimental designs; and
new text end

new text begin (2) "promising practices" means a service or practice that is supported by research
demonstrating effectiveness for at least one outcome of interest, and includes a single
evaluation that is not contradicted by other studies, but does not meet the full criteria for
the proven-effective designation. The research on effectiveness used to determine whether
a service is a promising practice must use rigorously implemented experimental or
quasi-experimental designs.
new text end

Sec. 128. new text beginDIRECTION TO COMMISSIONER; CORRECTION ORDER
ENFORCEMENT REVIEW.
new text end

new text begin By January 1, 2020, the commissioner of human services shall develop and implement
a process to review licensing inspection results provided under Minnesota Statutes, section
245A.16, subdivision 1, paragraph (h), clause (1), by county to identify trends in correction
order enforcement. The commissioner shall develop guidance and training as needed to
address any imbalance or inaccuracy in correction order enforcement. The commissioner
shall include the results in the annual report on child care under Minnesota Statutes, section
245A.153, provided that the results are limited to summary data as defined in Minnesota
Statutes, section 13.02, subdivision 19.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 129. new text beginDIRECTION TO COMMISSIONER; RESPONSIBILITY FOR FRAUD
INVESTIGATIONS IN PUBLIC PROGRAMS.
new text end

new text begin No later than January 15, 2020, the commissioner of human services, in consultation
with counties, shall report to the chairs and ranking minority members of the legislative
committees and divisions with jurisdiction over human services on recommendations for
legislation that identifies and clarifies the responsibilities of the department and counties
for fraud investigations in public programs administered by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 130. new text beginDIRECTION TO COMMISSIONER; SELF-EMPLOYMENT INCOME
IN PUBLIC ASSISTANCE PROGRAMS.
new text end

new text begin No later than January 15, 2020, the commissioner of human services, in consultation
with counties and other relevant stakeholders, shall report to the chairs and ranking minority
members of the legislative committees and divisions with jurisdiction over human services
with recommendations for legislation on how to count self-employment income for purposes
of determining eligibility for and maintaining the integrity of public assistance programs.
new text end

Sec. 131. new text beginDIRECTION TO COMMISSIONER; SUBSTANCE USE DISORDER
COUNTY STAFF QUALIFICATIONS.
new text end

new text begin The commissioner of human services shall, in consultation with county agencies, identify
specific training, education, and experience requirements that would qualify individuals
employed by a county who are not alcohol and drug counselors to perform comprehensive
assessments and treatment coordination. The commissioner shall provide a list of resources
available to meet the necessary training and education requirements. By December 1, 2019,
the commissioner shall provide a progress update to the chairs and ranking minority members
of the legislative committees with jurisdiction over substance use disorder services and
provide recommendations on any statutory changes needed to implement this section.
new text end

Sec. 132. new text beginFAMILY CHILD CARE TASK FORCE.
new text end

new text begin Subdivision 1. new text end

new text begin Membership. new text end

new text begin (a) The Family Child Care Task Force shall consist of 25
members, appointed as follows:
new text end

new text begin (1) two members representing family child care providers from greater Minnesota,
including one appointed by the speaker of the house and one appointed by the senate majority
leader;
new text end

new text begin (2) two members representing family care providers from the metropolitan area as defined
in Minnesota Statutes, section 473.121, subdivision 2, including one appointed by the speaker
of the house and one appointed by the senate majority leader;
new text end

new text begin (3) one member appointed by the Minnesota Association of Child Care Professionals;
new text end

new text begin (4) one member appointed by the Minnesota Child Care Provider Information Network;
new text end

new text begin (5) two members from the house of representatives, including one appointed by the
speaker of the house and one appointed by the minority leader;
new text end

new text begin (6) two members from the senate, including one appointed by the senate majority leader
and one appointed by the senate minority leader;
new text end

new text begin (7) the commissioner of human services or designee;
new text end

new text begin (8) two members representing Department of Human Services-recognized family child
care associations from greater Minnesota, appointed by the commissioner of human services;
new text end

new text begin (9) two members appointed by the Association of Minnesota Child Care Licensors,
including one from greater Minnesota and one from the metropolitan area, as defined in
Minnesota Statutes, section 473.121, subdivision 2;
new text end

new text begin (10) four parents of children enrolled in family child care programs, appointed by the
commissioner of human services;
new text end

new text begin (11) one member appointed by the Greater Minnesota Partnership;
new text end

new text begin (12) one member appointed by the Minnesota Chamber of Commerce;
new text end

new text begin (13) one member appointed by Child Care Aware of Minnesota;
new text end

new text begin (14) one member appointed by the Minnesota Initiative Foundation;
new text end

new text begin (15) one member appointed by Minnesota's Children's Cabinet; and
new text end

new text begin (16) one member appointed by First Children's Finance.
new text end

new text begin (b) Appointments to the task force must be made by July 15, 2019.
new text end

new text begin Subd. 2. new text end

new text begin Compensation. new text end

new text begin Public members of the task force may be compensated as
provided by Minnesota Statutes, section 15.059, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin The task force shall:
new text end

new text begin (1) identify difficulties that providers face regarding licensing and inspection, including
specific licensing requirements that have led to the closure of family child care programs,
by reviewing previous survey results and conducting follow-up surveys, if necessary;
new text end

new text begin (2) propose regulatory reforms to improve licensing efficiency, including discussion of
criteria that would qualify a provider for an abbreviated licensing review based on statistically
significant key indicators that predict full compliance with all applicable rules and statutes,
and discussion of the development of a risk-based, data driven, tiered violation system with
corresponding enforcement mechanisms that are appropriate to the risk presented by a
violation;
new text end

new text begin (3) review existing variance authority delegated to counties and recommend changes,
if needed;
new text end

new text begin (4) recommend business development and technical assistance resources to promote
provider recruitment and retention, including the potential need for mentors, a family child
care provider network, or shared services;
new text end

new text begin (5) develop recommendations for alternative child care delivery systems that could be
more financially viable in smaller communities with unmet child care capacity needs in
greater Minnesota, which could include new licensure models for large group family child
care or small capacity child care centers;
new text end

new text begin (6) review Parent Aware program participation and identify obstacles and suggested
improvements;
new text end

new text begin (7) review how trainings for licensed family child care providers are offered, provided,
coordinated, and approved, and make a recommendation on the establishment of a family
child care continuing education training committee, to advise on compliance with federal
and state training requirements; and
new text end

new text begin (8) consider methods to improve access to and understanding of the rules and statutes
governing family child care providers.
new text end

new text begin Subd. 4. new text end

new text begin Officers; meetings. new text end

new text begin (a) The task force shall be cochaired by the task force
member from the majority party of the house of representatives and the task force member
from the majority party of the senate, and may elect other officers as necessary.
new text end

new text begin (b) The commissioner of human services shall convene the first meeting by August 15,
2019.
new text end

new text begin (c) The cochairs shall alternate possession of the gavel between meetings.
new text end

new text begin (d) Each meeting shall be moderated by a neutral third-party facilitator.
new text end

new text begin (e) The agenda for each meeting shall be determined by the cochairs, the commissioner
of human services or designee, and the facilitator.
new text end

new text begin (d) Meetings of the task force are subject to the Minnesota Open Meeting Law under
Minnesota Statutes, chapter 13D.
new text end

new text begin Subd. 5. new text end

new text begin Report required. new text end

new text begin The task force shall submit an interim written report by
March 1, 2020, and a final written report by February 1, 2021, to the chairs and ranking
minority members of the committees in the house of representatives and the senate with
jurisdiction over child care. The reports shall explain the task force's findings and
recommendations relating to each of the duties under subdivision 3, and include any draft
legislation necessary to implement the recommendations.
new text end

new text begin Subd. 6. new text end

new text begin Expiration. new text end

new text begin The task force expires upon submission of the final report in
subdivision 5 or February 1, 2021, whichever is later.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 133. new text beginINSTRUCTION TO COMMISSIONER; REVIEW OF CHILD CARE
LICENSING AND BACKGROUND STUDY PROVISIONS.
new text end

new text begin The commissioner of human services shall review existing statutes and rules relating to
child care licensing and background study requirements and propose legislation for the 2020
legislative session that eliminates unnecessary and duplicative record keeping or
documentation requirements for child care providers. The commissioner shall also establish
a process for child care providers to electronically submit requested information to the
commissioner.
new text end

Sec. 134. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Rules, parts 9502.0425, subparts 4, 16, and 17; and 9503.0155, subpart
8,
new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 119B.125, subdivision 8; and 245H.10, subdivision
2,
new text end new text begin are repealed.
new text end

new text begin (c) new text end new text begin Minnesota Rules, part 2960.3030, subpart 3, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraphs (a) and (b) are effective September 30, 2019. Paragraph
(c) is effective October 1, 2019.
new text end

ARTICLE 3

DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2018, section 246.54, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Administrative review of county liability for cost of care. new text end

new text begin (a) The county of
financial responsibility may submit a written request for administrative review by the
commissioner of the county's payment of the cost of care when a delay in discharge of a
client from a regional treatment center, state-operated community-based behavioral health
hospital, or other state-operated facility results from the following actions by the facility:
new text end

new text begin (1) the facility did not provide notice to the county that the facility has determined that
it is clinically appropriate for a client to be discharged;
new text end

new text begin (2) the notice to the county that the facility has determined that it is clinically appropriate
for a client to be discharged was communicated on a holiday or weekend;
new text end

new text begin (3) the required documentation or procedures for discharge were not completed in order
for the discharge to occur in a timely manner; or
new text end

new text begin (4) the facility disagrees with the county's discharge plan.
new text end

new text begin (b) The county of financial responsibility may not appeal the determination that it is
clinically appropriate for a client to be discharged from a regional treatment center,
state-operated community-based behavioral health hospital, or other state-operated facility.
new text end

new text begin (c) The commissioner must evaluate the request for administrative review and determine
if the facility's actions listed in paragraph (a) caused undue delay in discharging the client.
If the commissioner determines that the facility's actions listed in paragraph (a) caused
undue delay in discharging the client, the county's liability must be reduced to the level of
the cost of care for a client whose stay in a facility is determined to be clinically appropriate,
effective on the date of the facility's action or failure to act that caused the delay. The
commissioner's determination under this subdivision is final and not subject to appeal.
new text end

new text begin (d) If a county's liability is reduced pursuant to paragraph (c), a county's liability must
return to the level of the cost of care for a client whose stay in a facility is determined to no
longer be appropriate effective on the date the facility rectifies the action or failure to act
that caused the delay under paragraph (a).
new text end

new text begin (e) Any difference in the county cost of care liability resulting from administrative review
under this subdivision must not be billed to the client or applied to future reimbursement
from the client's estate or relatives.
new text end

Sec. 2.

Minnesota Statutes 2018, section 246B.10, is amended to read:


246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.

new text begin (a) new text endThe civilly committed sex offender's county shall pay to the state a portion of the
cost of care provided in the Minnesota sex offender program to a civilly committed sex
offender who has legally settled in that county.

new text begin (b)new text end A county's payment must be made from the county's own sources of revenue and
payments mustnew text begin:
new text end

new text begin (1) equal ten percent of the cost of care, as determined by the commissioner, for each
day or portion of a day that the civilly committed sex offender spends at the facility for
individuals admitted to the Minnesota sex offender program before August 1, 2011; or
new text end

new text begin (2)new text end equal 25 percent of the cost of care, as determined by the commissioner, for each
day or portion of a daydeleted text begin,deleted text end that the civilly committed sex offendernew text begin:
new text end

new text begin (i) new text endspends at the facilitydeleted text begin.deleted text endnew text begin for individuals admitted to the Minnesota sex offender program
on or after August 1, 2011; or
new text end

new text begin (ii) receives services within a program operated by the Minnesota sex offender program
while on provisional discharge.
new text end

new text begin (c) The county is responsible for paying the state the remaining amountnew text end if payments
received by the state under this chapter exceednew text begin:
new text end

new text begin (1) 90 percent of the cost of care for individuals admitted to the Minnesota sex offender
program before August 1, 2011; or
new text end

new text begin (2)new text end 75 percent of the cost of caredeleted text begin, the county is responsible for paying the state the
remaining amount
deleted text endnew text begin for individuals:
new text end

new text begin (i) admitted to the Minnesota sex offender program on or after August 1, 2011; or
new text end

new text begin (ii) receiving services within a program operated by the Minnesota sex offender program
while on provisional discharge
new text end.

new text begin (d)new text end The county is not entitled to reimbursement from the civilly committed sex offender,
the civilly committed sex offender's estate, or from the civilly committed sex offender's
relatives, except as provided in section 246B.07.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 3. new text beginDIRECTION TO COMMISSIONER; REPORT REQUIRED; DISCHARGE
DELAY REDUCTION.
new text end

new text begin No later than January 1, 2023, the commissioner of human services must submit a report
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services that provides an update on county and state efforts to reduce the number
of days clients spend in state-operated facilities after discharge from the facility has been
determined to be clinically appropriate. The report must also include information on the
fiscal impact of clinically inappropriate stays in these facilities.
new text end

Sec. 4. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, section 246.18, subdivisions 8 and 9, new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Laws 2010, First Special Session chapter 1, article 25, section 3, subdivision 10, new text end new text begin is
repealed.
new text end

ARTICLE 4

CONTINUING CARE FOR OLDER ADULTS

Section 1.

Minnesota Statutes 2018, section 144A.071, subdivision 1a, is amended to read:


Subd. 1a.

Definitions.

For purposes of sections 144A.071 to 144A.073, the following
terms have the meanings given them:

(a) "Attached fixtures" has the meaning given in Minnesota Rules, part 9549.0020,
subpart 6.

(b) deleted text begin"Buildings"deleted text endnew text begin "Building"new text end has the meaning given in deleted text beginMinnesota Rules, part 9549.0020,
subpart 7
deleted text endnew text begin section 256R.261, subdivision 4new text end.

(c) "Capital assets" has the meaning given in section deleted text begin256B.421, subdivision 16deleted text endnew text begin 256R.02,
subdivision 8
new text end.

(d) "Commenced construction" means that all of the following conditions were met: the
final working drawings and specifications were approved by the commissioner of health;
the construction contracts were let; a timely construction schedule was developed, stipulating
dates for beginning, achieving various stages, and completing construction; and all zoning
and building permits were applied for.

(e) "Completion date" means the date on which clearance for the construction project
is issued, or if a clearance for the construction project is not required, the date on which the
construction project assets are available for facility use.

(f) "Construction" means any erection, building, alteration, reconstruction, modernization,
or improvement necessary to comply with the nursing home licensure rules.

(g) "Construction project" means:

(1) a capital asset addition to, or replacement of a nursing home or certified boarding
care home that results in new space or the remodeling of or renovations to existing facility
space; and

(2) the remodeling or renovation of existing facility space the use of which is modified
as a result of the project described in clause (1). This existing space and the project described
in clause (1) must be used for the functions as designated on the construction plans on
completion of the project described in clause (1) for a period of not less than 24 months.

(h) "Depreciation guidelines" deleted text beginmeans the most recent publication of "The Estimated
Useful Lives of Depreciable Hospital Assets," issued by the American Hospital Association,
840 North Lake Shore Drive, Chicago, Illinois, 60611
deleted text endnew text begin has the meaning given in section
256R.261, subdivision 11
new text end.

(i) "New licensed" or "new certified beds" means:

(1) newly constructed beds in a facility or the construction of a new facility that would
increase the total number of licensed nursing home beds or certified boarding care or nursing
home beds in the state; or

(2) newly licensed nursing home beds or newly certified boarding care or nursing home
beds that result from remodeling of the facility that involves relocation of beds but does not
result in an increase in the total number of beds, except when the project involves the upgrade
of boarding care beds to nursing home beds, as defined in section 144A.073, subdivision
1
. "Remodeling" includes any of the type of conversion, renovation, replacement, or
upgrading projects as defined in section 144A.073, subdivision 1.

deleted text begin (j) "Project construction costs" means the cost of the following items that have a
completion date within 12 months before or after the completion date of the project described
in item (g), clause (1):
deleted text end

deleted text begin (1) facility capital asset additions;
deleted text end

deleted text begin (2) replacements;
deleted text end

deleted text begin (3) renovations;
deleted text end

deleted text begin (4) remodeling projects;
deleted text end

deleted text begin (5) construction site preparation costs;
deleted text end

deleted text begin (6) related soft costs; and
deleted text end

deleted text begin (7) the cost of new technology implemented as part of the construction project and
depreciable equipment directly identified to the project, if the construction costs for clauses
(1) to (6) exceed the threshold for additions and replacements stated in section 256B.431,
subdivision 16
. Technology and depreciable equipment shall be included in the project
construction costs unless a written election is made by the facility, to not include it in the
facility's appraised value for purposes of Minnesota Rules, part 9549.0020, subpart 5. Debt
incurred for purchase of technology and depreciable equipment shall be included as allowable
debt for purposes of Minnesota Rules, part 9549.0060, subpart 5, items A and C, unless the
written election is to not include it. Any new technology and depreciable equipment included
in the project construction costs that the facility elects not to include in its appraised value
and allowable debt shall be treated as provided in section 256B.431, subdivision 17,
deleted text end deleted text begin paragraph (b). Written election under this paragraph must be included in the facility's request
for the rate change related to the project, and this election may not be changed.
deleted text end

deleted text begin (k) "Technology" means information systems or devices that make documentation,
charting, and staff time more efficient or encourage and allow for care through alternative
settings including, but not limited to, touch screens, monitors, hand-helds, swipe cards,
motion detectors, pagers, telemedicine, medication dispensers, and equipment to monitor
vital signs and self-injections, and to observe skin and other conditions.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 2.

Minnesota Statutes 2018, section 144A.071, subdivision 2, is amended to read:


Subd. 2.

Moratorium.

The commissioner of health, in coordination with the
commissioner of human services, shall deny each request for new licensed or certified
nursing home or certified boarding care beds except as provided in subdivision 3 or 4a, or
section 144A.073. "Certified bed" means a nursing home bed or a boarding care bed certified
by the commissioner of health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq. Certified beds in facilities which do not
allow medical assistance intake shall be deemed to be decertified for purposes of this section
only.

The commissioner of human services, in coordination with the commissioner of health,
shall deny any request to issue a license under section 252.28 and chapter 245A to a nursing
home or boarding care home, if that license would result in an increase in the medical
assistance reimbursement amount.

In addition, the commissioner of health must not approve any construction project whose
cost exceeds $1,000,000, unless:

(a) any construction costs exceeding $1,000,000 are not added to the facility's appraised
value and are not included in the facility's payment rate for reimbursement under the medical
assistance program; or

(b) the project:

(1) has been approved through the process described in section 144A.073;

(2) meets an exception in subdivision 3 or 4a;

(3) is necessary to correct violations of state or federal law issued by the commissioner
of health;

(4) is necessary to repair or replace a portion of the facility that was damaged by fire,
lightning, ground shifts, or other such hazards, including environmental hazards, provided
that the provisions of subdivision 4a, clause (a), are met; new text beginor
new text end

deleted text begin (5) as of May 1, 1992, the facility has submitted to the commissioner of health written
documentation evidencing that the facility meets the "commenced construction" definition
as specified in subdivision 1a, paragraph (d), or that substantial steps have been taken prior
to April 1, 1992, relating to the construction project. "Substantial steps" require that the
facility has made arrangements with outside parties relating to the construction project and
include the hiring of an architect or construction firm, submission of preliminary plans to
the Department of Health or documentation from a financial institution that financing
arrangements for the construction project have been made; or
deleted text end new text begin new text end

deleted text begin (6)deleted text endnew text begin (5)new text end is being proposed by a licensed nursing facility that is not certified to participate
in the medical assistance program and will not result in new licensed or certified beds.

Prior to the final plan approval of any construction project, the deleted text begincommissionerdeleted text endnew text begin
commissioners
new text end of health new text beginand human services new text endshall be provided with an itemized cost estimate
for the project construction costs. If a construction project is anticipated to be completed in
phases, the total estimated cost of all phases of the project shall be submitted to the
deleted text begin commissionerdeleted text endnew text begin commissionersnew text end and shall be considered as one construction project. Once the
construction project is completed and prior to the final clearance by the deleted text begincommissionerdeleted text endnew text begin
commissioners
new text end, the total project construction costs for the construction project shall be
submitted to the deleted text begincommissionerdeleted text endnew text begin commissionersnew text end. If the final project construction cost exceeds
the dollar threshold in this subdivision, the commissioner of human services shall not
recognize any of the project construction costs or the related financing costs in excess of
this threshold in establishing the facility's property-related payment rate.

The dollar thresholds for construction projects are as follows: for construction projects
other than those authorized in clauses (1) to (6), the dollar threshold is $1,000,000. For
projects authorized after July 1, 1993, under clause (1), the dollar threshold is the cost
estimate submitted with a proposal for an exception under section 144A.073, plus inflation
as calculated according to section 256B.431, subdivision 3f, paragraph (a). For projects
authorized under clauses (2) to (4), the dollar threshold is the itemized estimate project
construction costs submitted to the commissioner of health at the time of final plan approval,
plus inflation as calculated according to section 256B.431, subdivision 3f, paragraph (a).

The commissioner of health shall adopt rules to implement this section or to amend the
emergency rules for granting exceptions to the moratorium on nursing homes under section
144A.073.

Sec. 3.

Minnesota Statutes 2018, section 144A.071, subdivision 3, is amended to read:


Subd. 3.

Exceptions authorizing increase in beds; hardship areas.

(a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the addition of new licensed and Medicare and Medicaid certified nursing home
beds, using the criteria and process set forth in this subdivision.

(b) The commissioner, in cooperation with the commissioner of human services, shall
consider the following criteria when determining that an area of the state is a hardship area
with regard to access to nursing facility services:

(1) a low number of beds per thousand in a specified area using as a standard the beds
per thousand people age 65 and older, in five year age groups, using data from the most
recent census and population projections, weighted by each group's most recent nursing
home utilization, of the county at the 20th percentile, as determined by the commissioner
of human services;

(2) a high level of out-migration for nursing facility services associated with a described
area from the county or counties of residence to other Minnesota counties, as determined
by the commissioner of human services, using as a standard an amount greater than the
out-migration of the county ranked at the 50th percentile;

(3) an adequate level of availability of noninstitutional long-term care services measured
as public spending for home and community-based long-term care services per individual
age 65 and older, in five year age groups, using data from the most recent census and
population projections, weighted by each group's most recent nursing home utilization, as
determined by the commissioner of human services using as a standard an amount greater
than the 50th percentile of counties;

(4) there must be a declaration of hardship resulting from insufficient access to nursing
home beds by local county agencies and area agencies on aging; and

(5) other factors that may demonstrate the need to add new nursing facility beds.

(c) On August 15 of odd-numbered years, the commissioner, in cooperation with the
commissioner of human services, may publish in the State Register a request for information
in which interested parties, using the data provided under section 144A.351, along with any
other relevant data, demonstrate that a specified area is a hardship area with regard to access
to nursing facility services. For a response to be considered, the commissioner must receive
it by November 15. The commissioner shall make responses to the request for information
available to the public and shall allow 30 days for comment. The commissioner shall review
responses and comments and determine if any areas of the state are to be declared hardship
areas.

(d) For each designated hardship area determined in paragraph (c), the commissioner
shall publish a request for proposals in accordance with section 144A.073 and Minnesota
Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
State Register by March 15 following receipt of responses to the request for information.
The request for proposals must specify the number of new beds which may be added in the
designated hardship area, which must not exceed the number which, if added to the existing
number of beds in the area, including beds in layaway status, would have prevented it from
being determined to be a hardship area under paragraph (b), clause (1). Beginning July 1,
2011, the number of new beds approved must not exceed 200 beds statewide per biennium.
After June 30, 2019, the number of new beds that may be approved in a biennium must not
exceed 300 statewide. For a proposal to be considered, the commissioner must receive it
within six months of the publication of the request for proposals. The commissioner shall
review responses to the request for proposals and shall approve or disapprove each proposal
by the following July 15, in accordance with section 144A.073 and Minnesota Rules, parts
4655.1070 to 4655.1098. The commissioner shall base approvals or disapprovals on a
comparison and ranking of proposals using only the criteria in subdivision 4a. Approval of
a proposal expires after 18 months unless the facility has added the new beds using existing
space, subject to approval by the commissioner, or has commenced construction as defined
in subdivision 1a, paragraph (d). If, after the approved beds have been added, fewer than
50 percent of the beds in a facility are newly licensed, the operating payment rates previously
in effect shall remain. If, after the approved beds have been added, 50 percent or more of
the beds in a facility are newly licensed, operatingnew text begin and external fixednew text end payment rates shall
be determined according to deleted text beginMinnesota Rules, part 9549.0057, using the limits under sections
256R.23, subdivision 5, and 256R.24, subdivision 3. External fixed costs payment rates
must be determined according to section 256R.25
deleted text endnew text begin section 256R.21, subdivision 5new text end. Property
payment rates for facilities with beds added under this subdivision must be determined deleted text beginin
the same manner as rate determinations resulting from projects approved and completed
under section 144A.073
deleted text endnew text begin under section 256R.26new text end.

(e) The commissioner may:

(1) certify or license new beds in a new facility that is to be operated by the commissioner
of veterans affairs or when the costs of constructing and operating the new beds are to be
reimbursed by the commissioner of veterans affairs or the United States Veterans
Administration; and

(2) license or certify beds in a facility that has been involuntarily delicensed or decertified
for participation in the medical assistance program, provided that an application for
relicensure or recertification is submitted to the commissioner by an organization that is
not a related organization as defined in section 256R.02, subdivision 43, to the prior licensee
within 120 days after delicensure or decertification.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 4.

Minnesota Statutes 2018, section 144A.071, subdivision 4a, is amended to read:


Subd. 4a.

Exceptions for replacement beds.

It is in the best interest of the state to
ensure that nursing homes and boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain construction projects. Facilities
should be maintained in condition to satisfy the physical and emotional needs of residents
while allowing the state to maintain control over nursing home expenditure growth.

The commissioner of health in coordination with the commissioner of human services,
may approve the renovation, replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:

(a) to license or certify beds in a new facility constructed to replace a facility or to make
repairs in an existing facility that was destroyed or damaged after June 30, 1987, by fire,
lightning, or other hazard provided:

(i) destruction was not caused by the intentional act of or at the direction of a controlling
person of the facility;

(ii) at the time the facility was destroyed or damaged the controlling persons of the
facility maintained insurance coverage for the type of hazard that occurred in an amount
that a reasonable person would conclude was adequate;

(iii) the net proceeds from an insurance settlement for the damages caused by the hazard
are applied to the cost of the new facility or repairs;

(iv) the number of licensed and certified beds in the new facility does not exceed the
number of licensed and certified beds in the destroyed facility; and

(v) the commissioner determines that the replacement beds are needed to prevent an
inadequate supply of beds.

Project construction costs incurred for repairs authorized under this clause shall not be
considered in the dollar threshold amount defined in subdivision 2;

(b) to license or certify beds that are moved from one location to another within a nursing
home facility, provided the total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $1,000,000;

(c) to license or certify beds in a project recommended for approval under section
144A.073;

(d) to license or certify beds that are moved from an existing state nursing home to a
different state facility, provided there is no net increase in the number of state nursing home
beds;

(e) to certify and license as nursing home beds boarding care beds in a certified boarding
care facility if the beds meet the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section 144A.073, and if the cost of any
remodeling of the facility does not exceed $1,000,000. If boarding care beds are licensed
as nursing home beds, the number of boarding care beds in the facility must not increase
beyond the number remaining at the time of the upgrade in licensure. The provisions
contained in section 144A.073 regarding the upgrading of the facilities do not apply to
facilities that satisfy these requirements;

(f) to license and certify up to 40 beds transferred from an existing facility owned and
operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
same location as the existing facility that will serve persons with Alzheimer's disease and
other related disorders. The transfer of beds may occur gradually or in stages, provided the
total number of beds transferred does not exceed 40. At the time of licensure and certification
of a bed or beds in the new unit, the commissioner of health shall delicense and decertify
the same number of beds in the existing facility. As a condition of receiving a license or
certification under this clause, the facility must make a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate as a result of the transfers allowed under this paragraph;

(g) to license and certify nursing home beds to replace currently licensed and certified
boarding care beds which may be located either in a remodeled or renovated boarding care
or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
nursing home facility within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the number of
boarding care beds in the facility or complex are decreased by the number to be licensed as
nursing home beds and further provided that, if the total costs of new construction,
replacement, remodeling, or renovation exceed ten percent of the appraised value of the
facility or $200,000, whichever is less, the facility makes a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate by reason of the new construction, replacement, remodeling,
or renovation. The provisions contained in section 144A.073 regarding the upgrading of
facilities do not apply to facilities that satisfy these requirements;

(h) to license as a nursing home and certify as a nursing facility a facility that is licensed
as a boarding care facility but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the commissioner of health that licensing
the facility as a nursing home and certifying the facility as a nursing facility will result in
a net annual savings to the state general fund of $200,000 or more;

(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing home
beds in a facility that was licensed and in operation prior to January 1, 1992;

(j) to license and certify new nursing home beds to replace beds in a facility acquired
by the Minneapolis Community Development Agency as part of redevelopment activities
in a city of the first class, provided the new facility is located within three miles of the site
of the old facility. Operating and property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434 or chapter 256R;

(k) to license and certify up to 20 new nursing home beds in a community-operated
hospital and attached convalescent and nursing care facility with 40 beds on April 21, 1991,
that suspended operation of the hospital in April 1986. The commissioner of human services
shall provide the facility with the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its existing 40 beds;

(l) to license or certify beds in renovation, replacement, or upgrading projects as defined
in section 144A.073, subdivision 1, so long as the cumulative total costs of the facility's
remodeling projects do not exceed $1,000,000;

(m) to license and certify beds that are moved from one location to another for the
purposes of converting up to five four-bed wards to single or double occupancy rooms in
a nursing home that, as of January 1, 1993, was county-owned and had a licensed capacity
of 115 beds;

(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified nursing
facility located in Minneapolis to layaway all of its licensed and certified nursing home
beds. These beds may be relicensed and recertified in a newly constructed teaching nursing
home facility affiliated with a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency committee on long-term
care planning. The beds on layaway status shall have the same status as voluntarily delicensed
and decertified beds, except that beds on layaway status remain subject to the surcharge in
section 256.9657. This layaway provision expires July 1, 1998;

(o) to allow a project which will be completed in conjunction with an approved
moratorium exception project for a nursing home in southern Cass County and which is
directly related to that portion of the facility that must be repaired, renovated, or replaced,
to correct an emergency plumbing problem for which a state correction order has been
issued and which must be corrected by August 31, 1993;

(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified nursing
facility located in Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified beds by converting three-bed
wards to single or double occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on layaway status remain subject
to the surcharge in section 256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per bed reactivation fee. In
addition, at any time within three years of the effective date of the layaway, the beds on
layaway status may be:

(1) relicensed and recertified upon relocation and reactivation of some or all of the beds
to an existing licensed and certified facility or facilities located in Pine River, Brainerd, or
International Falls; provided that the total project construction costs related to the relocation
of beds from layaway status for any facility receiving relocated beds may not exceed the
dollar threshold provided in subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073;

(2) relicensed and recertified, upon reactivation of some or all of the beds within the
facility which placed the beds in layaway status, if the commissioner has determined a need
for the reactivation of the beds on layaway status.

The property-related payment rate of a facility placing beds on layaway status must be
adjusted by the incremental change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for a facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than three years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(q) to license and certify beds in a renovation and remodeling project to convert 12
four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
home that, as of January 1, 1994, met the following conditions: the nursing home was located
in Ramsey County; had a licensed capacity of 154 beds; and had been ranked among the
top 15 applicants by the 1993 moratorium exceptions advisory review panel. The total
project construction cost estimate for this project must not exceed the cost estimate submitted
in connection with the 1993 moratorium exception process;

(r) to license and certify up to 117 beds that are relocated from a licensed and certified
138-bed nursing facility located in St. Paul to a hospital with 130 licensed hospital beds
located in South St. Paul, provided that the nursing facility and hospital are owned by the
same or a related organization and that prior to the date the relocation is completed the
hospital ceases operation of its inpatient hospital services at that hospital. After relocation,
the nursing facility's status shall be the same as it was prior to relocation. The nursing
facility's property-related payment rate resulting from the project authorized in this paragraph
shall become effective no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting from this project, the allowable
appraised value of the nursing facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed $2,490,000;

(s) to license and certify two beds in a facility to replace beds that were voluntarily
delicensed and decertified on June 28, 1991;

(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed nursing
home and 21-bed boarding care home facility in Minneapolis, notwithstanding the licensure
and certification after July 1, 1995, of the Minneapolis facility as a 147-bed nursing home
facility after completion of a construction project approved in 1993 under section 144A.073,
to be laid away upon 30 days' prior written notice to the commissioner. Beds on layaway
status shall have the same status as voluntarily delicensed or decertified beds except that
they shall remain subject to the surcharge in section 256.9657. The 16 beds on layaway
status may be relicensed as nursing home beds and recertified at any time within five years
of the effective date of the layaway upon relocation of some or all of the beds to a licensed
and certified facility located in Watertown, provided that the total project construction costs
related to the relocation of beds from layaway status for the Watertown facility may not
exceed the dollar threshold provided in subdivision 2 unless the construction project has
been approved through the moratorium exception process under section 144A.073.

The property-related payment rate of the facility placing beds on layaway status must
be adjusted by the incremental change in its rental per diem after recalculating the rental
per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for the facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than five years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(u) to license and certify beds that are moved within an existing area of a facility or to
a newly constructed addition which is built for the purpose of eliminating three- and four-bed
rooms and adding space for dining, lounge areas, bathing rooms, and ancillary service areas
in a nursing home that, as of January 1, 1995, was located in Fridley and had a licensed
capacity of 129 beds;

(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County to
a 160-bed facility in Crow Wing County, provided all the affected beds are under common
ownership;

(w) to license and certify a total replacement project of up to 49 beds located in Norman
County that are relocated from a nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment rates for the new nursing
facility shall be determined based on the interim and settle-up payment provisions of
deleted text begin Minnesota Rules, part 9549.0057,deleted text endnew text begin section 256R.27new text end and the reimbursement provisions of
chapter 256R. Property-related reimbursement rates shall be determined under section
256R.26, taking into account any federal or state flood-related loans or grants provided to
the facility;

(x) to license and certify to the licensee of a nursing home in Polk County that was
destroyed by flood in 1997 replacement projects with a total of up to 129 beds, with at least
25 beds to be located in Polk County and up to 104 beds distributed among up to three other
counties. These beds may only be distributed to counties with fewer than the median number
of age intensity adjusted beds per thousand, as most recently published by the commissioner
of human services. If the licensee chooses to distribute beds outside of Polk County under
this paragraph, prior to distributing the beds, the commissioner of health must approve the
location in which the licensee plans to distribute the beds. The commissioner of health shall
consult with the commissioner of human services prior to approving the location of the
proposed beds. The licensee may combine these beds with beds relocated from other nursing
facilities as provided in section 144A.073, subdivision 3c. The operating payment rates for
the new nursing facilities shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, parts 9549.0010 to 9549.0080. Property-related
reimbursement rates shall be determined under section 256R.26. If the replacement beds
permitted under this paragraph are combined with beds from other nursing facilities, the
rates shall be calculated as the weighted average of rates determined as provided in this
paragraph and section 256R.50;

(y) to license and certify beds in a renovation and remodeling project to convert 13
three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met the following conditions:
the nursing home was located in Ramsey County, was not owned by a hospital corporation,
had a licensed capacity of 64 beds, and had been ranked among the top 15 applicants by
the 1993 moratorium exceptions advisory review panel. The total project construction cost
estimate for this project must not exceed the cost estimate submitted in connection with the
1993 moratorium exception process;

(z) to license and certify up to 150 nursing home beds to replace an existing 285 bed
nursing facility located in St. Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at the existing site. The reduction
in the licensed capacity of the existing facility shall occur during the construction project
as beds are taken out of service due to the construction process. Prior to the start of the
construction process, the facility shall provide written information to the commissioner of
health describing the process for bed reduction, plans for the relocation of residents, and
the estimated construction schedule. The relocation of residents shall be in accordance with
the provisions of law and rule;

(aa) to allow the commissioner of human services to license an additional 36 beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
the total number of licensed and certified beds at the facility does not increase;

(bb) to license and certify a new facility in St. Louis County with 44 beds constructed
to replace an existing facility in St. Louis County with 31 beds, which has resident rooms
on two separate floors and an antiquated elevator that creates safety concerns for residents
and prevents nonambulatory residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;

(cc) to license and certify four beds in a 16-bed certified boarding care home in
Minneapolis to replace beds that were voluntarily delicensed and decertified on or before
March 31, 1992. The licensure and certification is conditional upon the facility periodically
assessing and adjusting its resident mix and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of human services shall retain
the authority to audit the facility at any time and shall require the facility to comply with
any requirements necessary to prevent an institution for mental disease declaration, including
delicensure and decertification of beds, if necessary;

(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 80
beds as part of a renovation project. The renovation must include construction of an addition
to accommodate ten residents with beginning and midstage dementia in a self-contained
living unit; creation of three resident households where dining, activities, and support spaces
are located near resident living quarters; designation of four beds for rehabilitation in a
self-contained area; designation of 30 private rooms; and other improvements;

(ee) to license and certify beds in a facility that has undergone replacement or remodeling
as part of a planned closure under section 256R.40;

(ff) to license and certify a total replacement project of up to 124 beds located in Wilkin
County that are in need of relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of deleted text beginMinnesota Rules, part 9549.0057,deleted text endnew text begin section
256R.27
new text end and the reimbursement provisions of chapter 256R. Property-related reimbursement
rates shall be determined under section 256R.26, taking into account any federal or state
flood-related loans or grants provided to the facility;

(gg) to allow the commissioner of human services to license an additional nine beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
total number of licensed and certified beds at the facility does not increase;

(hh) to license and certify up to 120 new nursing facility beds to replace beds in a facility
in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility and is in Anoka County. Operating
and property rates shall be determined and allowed under chapter 256R and Minnesota
Rules, parts 9549.0010 to 9549.0080; or

(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County that,
as of March 25, 2001, is in the active process of closing, to a 122-licensed bed nonprofit
nursing facility located in the city of Columbia Heights or its affiliate. The transfer is effective
when the receiving facility notifies the commissioner in writing of the number of beds
accepted. The commissioner shall place all transferred beds on layaway status held in the
name of the receiving facility. The layaway adjustment provisions of section 256B.431,
subdivision 30, do not apply to this layaway. The receiving facility may only remove the
beds from layaway for recertification and relicensure at the receiving facility's current site,
or at a newly constructed facility located in Anoka County. The receiving facility must
receive statutory authorization before removing these beds from layaway status, or may
remove these beds from layaway status if removal from layaway status is part of a
moratorium exception project approved by the commissioner under section 144A.073.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 5.

Minnesota Statutes 2018, section 144A.071, subdivision 4c, is amended to read:


Subd. 4c.

Exceptions for replacement beds after June 30, 2003.

(a) The commissioner
of health, in coordination with the commissioner of human services, may approve the
renovation, replacement, upgrading, or relocation of a nursing home or boarding care home,
under the following conditions:

(1) to license and certify an 80-bed city-owned facility in Nicollet County to be
constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
attached to a hospital that is also being replaced. The threshold allowed for this project
under section 144A.073 shall be the maximum amount available to pay the additional
medical assistance costs of the new facility;

(2) to license and certify 29 beds to be added to an existing 69-bed facility in St. Louis
County, provided that the 29 beds must be transferred from active or layaway status at an
existing facility in St. Louis County that had 235 beds on April 1, 2003.

The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
rate at that facility shall not be adjusted as a result of this transfer. The operating payment
rate of the facility adding beds after completion of this project shall be the same as it was
on the day prior to the day the beds are licensed and certified. This project shall not proceed
unless it is approved and financed under the provisions of section 144A.073;

(3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of the new
beds are transferred from a 45-bed facility in Austin under common ownership that is closed
and 15 of the new beds are transferred from a 182-bed facility in Albert Lea under common
ownership; (ii) the commissioner of human services is authorized by the 2004 legislature
to negotiate budget-neutral planned nursing facility closures; and (iii) money is available
from planned closures of facilities under common ownership to make implementation of
this clause budget-neutral to the state. The bed capacity of the Albert Lea facility shall be
reduced to 167 beds following the transfer. Of the 60 beds at the new facility, 20 beds shall
be used for a special care unit for persons with Alzheimer's disease or related dementias;

(4) to license and certify up to 80 beds transferred from an existing state-owned nursing
facility in Cass County to a new facility located on the grounds of the Ah-Gwah-Ching
campus. The operating cost payment rates for the new facility shall be determined based
on the interim and settle-up payment provisions of deleted text beginMinnesota Rules, part 9549.0057,deleted text endnew text begin section
256R.27
new text end and the reimbursement provisions of chapter 256R. The property payment rate for
the first three years of operation shall be $35 per day. For subsequent years, the property
payment rate of $35 per day shall be adjusted for inflation as provided in section 256B.434,
subdivision 4, paragraph (c), as long as the facility has a contract under section 256B.434;

(5) to initiate a pilot program to license and certify up to 80 beds transferred from an
existing county-owned nursing facility in Steele County relocated to the site of a new acute
care facility as part of the county's Communities for a Lifetime comprehensive plan to create
innovative responses to the aging of its population. Upon relocation to the new site, the
nursing facility shall delicense 28 beds. The payment rate for external fixed costs for the
new facility shall be increased by an amount as calculated according to items (i) to (v):

(i) compute the estimated decrease in medical assistance residents served by the nursing
facility by multiplying the decrease in licensed beds by the historical percentage of medical
assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
of 28 beds by multiplying the anticipated decrease in medical assistance residents, determined
in item (i), by the existing facility's weighted average payment rate multiplied by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the nursing facility,
determined in item (i), by the average monthly elderly waiver service costs for individuals
in Steele County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) divide the amount in item (iv) by an amount equal to the relocated nursing facility's
occupancy factor under section 256B.431, subdivision 3f, paragraph (c), multiplied by the
historical percentage of medical assistance resident days; and

(6) to consolidate and relocate nursing facility beds to a new site in Goodhue County
and to integrate these services with other community-based programs and services under a
communities for a lifetime pilot program and comprehensive plan to create innovative
responses to the aging of its population. Two nursing facilities, one for 84 beds and one for
65 beds, in the city of Red Wing licensed on July 1, 2015, shall be consolidated into a newly
renovated 64-bed nursing facility resulting in the delicensure of 85 beds. Notwithstanding
the carryforward of the approval authority in section 144A.073, subdivision 11, the funding
approved in April 2009 by the commissioner of health for a project in Goodhue County
shall not carry forward. The closure of the 85 beds shall not be eligible for a planned closure
rate adjustment under section 256R.40. The construction project permitted in this clause
shall not be eligible for a threshold project rate adjustment under section 256B.434,
subdivision 4f
. The payment rate for external fixed costs for the new facility shall be
increased by an amount as calculated according to items (i) to (vi):

(i) compute the estimated decrease in medical assistance residents served by both nursing
facilities by multiplying the difference between the occupied beds of the two nursing facilities
for the reporting year ending September 30, 2009, and the projected occupancy of the facility
at 95 percent occupancy by the historical percentage of medical assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
by multiplying the anticipated decrease in the medical assistance residents, determined in
item (i), by the hospital-owned nursing facility weighted average payment rate multiplied
by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the facilities, determined
in item (i), by the average monthly elderly waiver service costs for individuals in Goodhue
County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) multiply the amount in item (iv) by 57.2 percent; and

(vi) divide the difference of the amount in item (iv) and the amount in item (v) by an
amount equal to the relocated nursing facility's occupancy factor under section 256B.431,
subdivision 3f, paragraph (c), multiplied by the historical percentage of medical assistance
resident days.

(b) Projects approved under this subdivision shall be treated in a manner equivalent to
projects approved under subdivision 4a.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 6.

Minnesota Statutes 2018, section 144A.071, subdivision 4d, is amended to read:


Subd. 4d.

Consolidation of nursing facilities.

(a) The commissioner of health, in
consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities and
the upgrading of the physical plant of the remaining nursing facility or facilities, the costs
of which exceed the threshold project limit under subdivision 2, clause (a). The
commissioners shall consider the criteria in this section, section 144A.073, and section
256R.40, in approving or rejecting a consolidation proposal. In the event the commissioners
approve the request, the commissioner of human services shall calculate an external fixed
costs rate adjustment according to clauses (1) to (3):

(1) the closure of beds shall not be eligible for a planned closure rate adjustment under
section 256R.40, subdivision 5;

(2) the construction project permitted in this clause shall not be eligible for a threshold
project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception
adjustment under section 144A.073; and

(3) the payment rate for external fixed costs for a remaining facility or facilities shall
be increased by an amount equal to 65 percent of the projected net cost savings to the state
calculated in paragraph (b), divided by the state's medical assistance percentage of medical
assistance dollars, and then divided by estimated medical assistance resident days, as
determined in paragraph (c), of the remaining nursing facility or facilities in the request in
this paragraph. The rate adjustment is effective on the first day of the month of January or
July, whichever date occurs first following both the completion of the construction upgrades
in the consolidation plan and the complete closure of the facility or facilities designated for
closure in the consolidation plan. If more than one facility is receiving upgrades in the
consolidation plan, each facility's date of construction completion must be evaluated
separately.

(b) For purposes of calculating the net cost savings to the state, the commissioner shall
consider clauses (1) to (7):

(1) the annual savings from estimated medical assistance payments from the net number
of beds closed taking into consideration only beds that are in active service on the date of
the request and that have been in active service for at least three years;

(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;

(3) the estimated annual cost of elderly waiver recipients receiving support under housing
support under chapter 256I;

(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;

(5) the annual loss of license surcharge payments on closed beds;

(6) the savings from not paying planned closure rate adjustments that the facilities would
otherwise be eligible for under section 256R.40; and

(7) the savings from not paying external fixed costs payment rate adjustments from
submission of renovation costs that would otherwise be eligible as threshold projects under
section 256B.434, subdivision 4f.

(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance resident
days of the remaining facility or facilities, as reported on the facility's or facilities' most
recent nursing facility statistical and cost report filed before the plan of closure is submitted,
multiplied by 365.

(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy
percentages will be those reported on the facility's or facilities' most recent nursing facility
statistical and cost report filed before the plan of closure is submitted, and the average
payment rates shall be calculated based on the approved payment rates in effect at the time
the consolidation request is submitted.

(e) To qualify for the external fixed costs payment rate adjustment under this subdivision,
the closing facilities shall:

(1) submit an application for closure according to section 256R.40, subdivision 2; and

(2) follow the resident relocation provisions of section 144A.161.

(f) The county or counties in which a facility or facilities are closed under this subdivision
shall not be eligible for designation as a hardship area under subdivision 3 for five years
from the date of the approval of the proposed consolidation. The applicant shall notify the
county of this limitation and the county shall acknowledge this in a letter of support.

new text begin (g) Projects approved on or after March 1, 2020, are not subject to paragraph (a), clauses
(2) and (3), and paragraph (c). The 65 percent projected net cost savings to the state calculated
in paragraph (b) must be applied to the moratorium cost of the project and the remainder
must be added to the moratorium funding under section 144A.073, subdivision 11.
new text end

new text begin (h) Consolidation project applications not approved by the commissioner prior to March
1, 2020, are subject to the moratorium process under section 144A.073, subdivision 2. Upon
request by the applicant, the commissioner may extend this deadline to August 1, 2020, so
long as the facilities, bed numbers, and counties specified in the original application are not
altered. Proposals from facilities seeking approval for a consolidation project prior to March
1, 2020, must be received by the commissioner no later than January 1, 2020. This paragraph
expires August 1, 2020.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 7.

Minnesota Statutes 2018, section 144A.071, subdivision 5a, is amended to read:


Subd. 5a.

Cost estimate of a moratorium exception project.

deleted text begin(a)deleted text end For the purposes of
this section and section 144A.073, the cost estimate of a moratorium exception project shall
include the effects of the proposed project on the costs of the state subsidy for
community-based services, nursing services, and housing in institutional and noninstitutional
settings. The commissioner of health, in cooperation with the commissioner of human
services, shall define the method for estimating these costs in the permanent rule
implementing section 144A.073. The commissioner of human services shall prepare an
estimate of thenew text begin property payment rate to be established upon completion of the project andnew text end
total state annual long-term costs of each moratorium exception proposal.new text begin The property
payment rate estimate shall be based upon the estimated costs and total building valuation
to be used in the total property payment rate calculation under section 256R.26. For the
purposes of determining the actual total property payment rate under section 256R.26 upon
completion of the project, the final building valuation is the lesser of the limited depreciated
replacement cost as determined under section 256R.26, subdivision 3, following a physical
building appraisal or 105 percent of the estimated total building valuation from the
moratorium application.
new text end

deleted text begin (b) The interest rate to be used for estimating the cost of each moratorium exception
project proposal shall be the lesser of either the prime rate plus two percentage points, or
the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan
Mortgage Corporation plus two percentage points as published in the Wall Street Journal
and in effect 56 days prior to the application deadline. If the applicant's proposal uses this
interest rate, the commissioner of human services, in determining the facility's actual
property-related payment rate to be established upon completion of the project must use the
actual interest rate obtained by the facility for the project's permanent financing up to the
maximum permitted under Minnesota Rules, part 9549.0060, subpart 6.
deleted text end

deleted text begin The applicant may choose an alternate interest rate for estimating the project's cost. If
the applicant makes this election, the commissioner of human services, in determining the
facility's actual property-related payment rate to be established upon completion of the
project, must use the lesser of the actual interest rate obtained for the project's permanent
financing or the interest rate which was used to estimate the proposal's project cost. For
succeeding rate years, the applicant is at risk for financing costs in excess of the interest
rate selected.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for projects approved by the commissioner
of health on or after March 1, 2020.
new text end

Sec. 8.

Minnesota Statutes 2018, section 144A.073, subdivision 3c, is amended to read:


Subd. 3c.

deleted text beginCost neutraldeleted text endnew text begin Bednew text end relocation new text beginthreshold new text endprojects.

(a) Notwithstanding
subdivision 3, the commissioner may at any time accept proposals, or amendments to
proposals previously approved under this section, for relocations deleted text beginthat are cost neutral with
respect to state costs as defined in section 144A.071, subdivision 5a
deleted text endnew text begin to existing licensed
nursing facilities when costs are less than the maximum threshold limit determined under
section 256R.267, paragraph (a)
new text end. The commissioner, in consultation with the commissioner
of human services, shall evaluate proposals according to subdivision 4a, clauses (1), (4),
(5), (6), and (8), and other criteria established in rule or law. deleted text beginThe commissioner of human
services shall determine the allowable payment rates of the facility receiving the beds in
accordance with section 256R.50
deleted text endnew text begin The commissioner of human services shall determine the
allowable payment rates of the facility receiving the beds in accordance with section 256R.21.
No part of the source facility rates are transferred to the receiving facility
new text end. The commissioner
shall approve or disapprove a project within 90 days.

(b) deleted text beginFor the purposes of paragraph (a), cost neutrality shall be measured over the first
three 12-month periods of operation after completion of the project.
deleted text endnew text begin Bed relocation threshold
projects seeking reimbursement for costs that exceed the moratorium limit or that result in
a newly constructed or newly licensed building must apply to relocate beds as part of the
competitive moratorium application and review process under subdivisions 2 and 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for project proposals received by the
commissioner of health after January 1, 2020, and approved by the commissioner on or
after March 1, 2020.
new text end

Sec. 9.

Minnesota Statutes 2018, section 144A.073, is amended by adding a subdivision
to read:


new text begin Subd. 16. new text end

new text begin Moratorium exception funding. new text end

new text begin In fiscal year 2020, the commissioner may
approve moratorium exception projects under this section for which the full annualized state
share of medical assistance costs does not exceed $1,250,000 plus any carryover of previous
appropriations for this purpose.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 10.

Minnesota Statutes 2018, section 256B.434, subdivision 1, is amended to read:


Subdivision 1.

deleted text beginAlternative payment demonstration project establisheddeleted text endnew text begin Contractual
agreements
new text end.

deleted text beginThe commissioner of human services shall establish a contractual alternative
payment demonstration project for paying for nursing facility services under the medical
assistance program. A nursing facility may apply to be paid under the contractual alternative
payment demonstration project instead of the cost-based payment system established under
section 256B.431. A nursing facility
deleted text end new text beginA nursing facility located in Minnesota new text endelecting to deleted text beginuse
the alternative payment demonstration project
deleted text end new text beginenroll as a medical assistance provider new text endmust
enter into a contract with the commissioner. Payment rates and procedures deleted text beginfor facilities
electing to use the alternative payment demonstration project
deleted text end are determined and governed
by this section and by the terms of the contract. The commissioner may negotiate different
contract terms for different nursing facilities.

new text begin EFFECTIVE DATE. new text end

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

Sec. 11.

Minnesota Statutes 2018, section 256B.434, subdivision 3, is amended to read:


Subd. 3.

Duration and termination of contracts.

deleted text begin (a) Subject to available resources,
the commissioner may begin to execute contracts with nursing facilities November 1, 1995.
deleted text end

deleted text begin (b)deleted text endnew text begin (a)new text end All contracts entered into under this section are for a term not to exceed four
years. Either party may terminate a contract at any time without cause by providing 90
calendar days advance written notice to the other party. The decision to terminate a contract
is not appealable. deleted text beginNotwithstanding section 16C.05, subdivision 2, paragraph (a), clause (5),
the contract shall be renegotiated for additional terms of up to four years, unless either party
provides written notice of termination.
deleted text end The provisions of the contract shall be renegotiated
at a minimum of every four years by the parties prior to the expiration date of the contract.
The parties may voluntarily deleted text beginrenegotiatedeleted text endnew text begin amendnew text end the terms of the contract at any time by
mutual agreement.

deleted text begin (c)deleted text endnew text begin (b)new text end If a nursing facility fails to comply with the terms of a contract, the commissioner
shall provide reasonable notice regarding the breach of contract and a reasonable opportunity
for the facility to come into compliance. If the facility fails to come into compliance or to
remain in compliance, the commissioner may terminate the contract. deleted text beginIf a contract is
terminated, the contract payment remains in effect for the remainder of the rate year in
which the contract was terminated, but in all other respects the provisions of this section
do not apply to that facility effective the date the contract is terminated. The contract shall
contain a provision governing the transition back to the cost-based reimbursement system
established under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080.
A contract entered into under this section may be amended by mutual agreement of the
parties.
deleted text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 12.

Minnesota Statutes 2018, section 256R.02, subdivision 8, is amended to read:


Subd. 8.

Capital assets.

"Capital assets" means a nursing facility's buildings, deleted text beginattached
fixtures
deleted text endnew text begin fixed equipmentnew text end, land improvements, leasehold improvements, and all additions to
or replacements of those assets used directly for resident care.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 13.

Minnesota Statutes 2018, section 256R.02, subdivision 19, is amended to read:


Subd. 19.

External fixed costs.

"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; property taxes, new text beginspecial new text endassessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018; deleted text beginanddeleted text end Public Employees Retirement Association employer costsnew text begin;
and border city rate adjustments under section 256R.481
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 14.

Minnesota Statutes 2018, section 256R.02, is amended by adding a subdivision
to read:


new text begin Subd. 25a. new text end

new text begin Interim payment rates. new text end

new text begin "Interim payment rates" means the total operating
and external fixed costs payment rates determined by anticipated costs and resident days
reported on an interim cost report as described in section 256R.27.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 15.

Minnesota Statutes 2018, section 256R.02, subdivision 33, is amended to read:


Subd. 33.

Nursing facility.

"Nursing facility" new text beginor "facility" new text endmeans a facility with a medical
assistance provider agreement that is licensed as a nursing home under chapter 144A or as
a boarding care home under sections 144.50 to 144.56.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 16.

Minnesota Statutes 2018, section 256R.02, is amended by adding a subdivision
to read:


new text begin Subd. 47a. new text end

new text begin Settle-up payment rates. new text end

new text begin "Settle-up payment rates" means the total operating
and external fixed costs payment rates determined by actual allowable costs and resident
days reported on a settle-up cost report as described under section 256R.27.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 17.

Minnesota Statutes 2018, section 256R.21, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Total payment rate for new facilities. new text end

new text begin For a new nursing facility created under
section 144A.071, subdivisions 2 and 3, the total payment rate must be determined according
to section 256R.27.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for projects approved by the commissioner
of health on or after March 1, 2020.
new text end

Sec. 18.

Minnesota Statutes 2018, section 256R.25, is amended to read:


256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.

(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
(b) to deleted text begin(n)deleted text endnew text begin (o)new text end.

(b) For a facility licensed as a nursing home, the portion related to the provider surcharge
under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
nursing home and a boarding care home, the portion related to the provider surcharge under
section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
of nursing home beds divided by its total number of licensed beds.

(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
amount of the fee divided by the sum of the facility's resident days.

(d) The portion related to development and education of resident and family advisory
councils under section 144A.33 is $5 per resident day divided by 365.

(e) The portion related to scholarships is determined under section 256R.37.

(f) The portion related to planned closure rate adjustments is as determined under section
256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.

(g) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.

(h) The portion related to single-bed room incentives is as determined under section
256R.41.

(i) The portions related to real estate taxes, special assessments, and payments made in
lieu of real estate taxes directly identified or allocated to the nursing facility are the deleted text beginactualdeleted text endnew text begin
allowable
new text end amounts divided by the sum of the facility's resident days. Allowable costs under
this paragraph for payments made by a nonprofit nursing facility that are in lieu of real
estate taxes shall not exceed the amount which the nursing facility would have paid to a
city or township and county for fire, police, sanitation services, and road maintenance costs
had real estate taxes been levied on that property for those purposes.

(j) The portion related to employer health insurance costs is the allowable costs divided
by the sum of the facility's resident days.

(k) The portion related to the Public Employees Retirement Association is deleted text beginactualdeleted text endnew text begin
allowable
new text end costs divided by the sum of the facility's resident days.

(l) The portion related to quality improvement incentive payment rate adjustments is
the amount determined under section 256R.39.

(m) The portion related to performance-based incentive payments is the amount
determined under section 256R.38.

(n) The portion related to special dietary needs is the amount determined under section
256R.51.

new text begin (o) The portion related to the rate adjustments for border city facilities is the amount
determined under section 256R.481.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020, except paragraph (o) is effective for rate years beginning on or after January
1, 2021.
new text end

Sec. 19.

Minnesota Statutes 2018, section 256R.26, is amended to read:


256R.26 PROPERTY PAYMENT RATE.

new text begin Subdivision 1. new text end

new text begin Determination of the limited undepreciated replacement cost. new text end

deleted text begin The
property payment rate for a nursing facility is the property rate established for the facility
under sections 256B.431 and 256B.434.
deleted text end new text begin A facility's limited URC is the lesser of:
new text end

new text begin (1) the facility's URC from the appraisal; or
new text end

new text begin (2) the product of (i) the number of the facility's licensed beds three months prior to the
beginning of the rate year, (ii) the construction cost per square foot value, and (iii) 1,000
square feet.
new text end

new text begin Subd. 2. new text end

new text begin Determination of limited undepreciated replacement cost ratio. new text end

new text begin A facility's
limited URC ratio is the facility's limited URC as determined in subdivision 1 divided by
the facility's URC.
new text end

new text begin Subd. 3. new text end

new text begin Determination of limited depreciated replacement cost. new text end

new text begin A facility's limited
DRC is the product of the facility's DRC and the facility's limited URC ratio as determined
in subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Determination of land and land improvement value. new text end

new text begin A facility's land and
land improvement value is the facility's limited URC as determined in subdivision 1
multiplied by 0.05.
new text end

new text begin Subd. 5. new text end

new text begin Determination of annual fair rental value. new text end

new text begin A facility's annual fair rental value
is the product of:
new text end

new text begin (1) the sum of the facility's limited DRC as determined in subdivision 3 and the land
and land improvement value as determined in subdivision 4; multiplied by
new text end

new text begin (2) the rental rate.
new text end

new text begin Subd. 6. new text end

new text begin Determination of fair rental value property rate. new text end

new text begin A facility's fair rental value
property rate is the quotient of:
new text end

new text begin (1) the facility's annual fair rental value as determined in subdivision 5; divided by
new text end

new text begin (2) the product of the facility's capacity days and 0.88.
new text end

new text begin Subd. 7. new text end

new text begin Determination of equipment allowance rate. new text end

new text begin A facility's equipment allowance
rate is the quotient of:
new text end

new text begin (1) the product of (i) the equipment allowance per bed value, (ii) the facility's number
of licensed beds, and (iii) the rental rate; divided by
new text end

new text begin (2) the product of the facility's capacity days and 0.88.
new text end

new text begin Subd. 8. new text end

new text begin Determination of total property payment rate. new text end

new text begin Except as provided in
subdivision 9, paragraph (a), a facility's total property payment rate is the sum of the facility's
fair rental value property rate as determined in subdivision 6 and the facility's equipment
allowance rate as determined in subdivision 7.
new text end

new text begin Subd. 9. new text end

new text begin Transition period. new text end

new text begin (a) A facility's property payment rate is the property rate
established for the facility under sections 256B.431 and 256B.434 until the facility's property
rate is transitioned upon completion of any project authorized under section 144A.071,
subdivision 3 or 4d; or 144A.073, subdivision 3, to the fair rental value property rate
calculated under this chapter.
new text end

new text begin (b) Effective the first day of the first month of the calendar quarter after the completion
of the project described in paragraph (a), the commissioner shall transition a facility to the
property payment rate calculated under this chapter. The initial rate year ends on December
31 and may be less than a full 12-month period. The commissioner shall schedule an appraisal
within 90 days of the commissioner receiving notification from the facility that the project
is completed. The commissioner shall apply the property payment rate determined after the
appraisal retroactively to the first day of the first month of the calendar quarter after the
completion of the project.
new text end

new text begin (c) Upon a facility's transition to the fair rental value property rates calculated under this
chapter, the facility's total property payment rate under subdivision 8 shall be the only
payment for costs related to capital assets, including depreciation, interest and lease expenses
for all depreciable assets, including moveable equipment, land improvements, and land.
Facilities with property payment rates established under subdivisions 1 to 8 are not eligible
for planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; and the property rate inflation adjustment
under section 256B.434, subdivision 4. The commissioner shall remove any of these
incentives from the facility's existing rate upon the facility transitioning to the fair rental
value property rates calculated under this chapter.
new text end

new text begin Subd. 10. new text end

new text begin New nursing facilities. new text end

new text begin A nursing facility new to the medical assistance
program must, upon completion of construction of the nursing facility, have the building
and fixed equipment appraised by a property appraisal firm selected by the commissioner
or, if not newly constructed, upon entering the medical assistance program. The commissioner
shall schedule an appraisal within 90 days of notification from the facility that the facility
has become Medicaid certified. The commissioner shall apply the property payment rate
determined after the initial appraisal retroactively to the Medicaid certification date.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 to 10 are effective for rate years beginning on or
after January 1, 2020, for nursing facilities that completed projects authorized after March
1, 2020, under Minnesota Statutes, section 144A.071, subdivision 3 or 4d; or 144A.073,
subdivision 3.
new text end

Sec. 20.

new text begin [256R.261] PROPERTY RATE DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of sections 256R.26 to 256R.267, the terms
in this section have the meanings given unless otherwise provided for in this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Addition. new text end

new text begin "Addition" means an extension, enlargement, or expansion of the
nursing facility for the purpose of increasing the number of licensed beds or improving
resident care.
new text end

new text begin Subd. 3. new text end

new text begin Appraisal. new text end

new text begin "Appraisal" means an evaluation of the nursing facility's physical
real estate conducted by a property appraisal firm selected by the commissioner to establish
the valuation of a building and fixed equipment. An appraisal does not include an evaluation
of moveable equipment, land, or land improvements. An appraisal may include an evaluation
of shared space provided the valuation is subsequently adjusted for any shared area included
in the depreciated replacement cost and undepreciated replacement cost that is not used
exclusively for nursing facility purposes.
new text end

new text begin Subd. 4. new text end

new text begin Building. new text end

new text begin "Building" means the physical plant and fixed equipment used directly
for resident care and licensed under chapter 144A or sections 144.50 to 144.56. Building
excludes buildings or portions of buildings used by central, affiliated, or corporate offices.
new text end

new text begin Subd. 5. new text end

new text begin Capacity days. new text end

new text begin "Capacity days" means the number of licensed beds within the
nursing facility multiplied by 365 days.
new text end

new text begin Subd. 6. new text end

new text begin Construction cost per square foot value. new text end

new text begin "Construction cost per square foot
value" means the RSMeans nursing home cost per square foot of floor area for a 40,000
square foot nursing home with precast concrete and bearing walls multiplied by the
commercial location factor for Minneapolis as indicated in the most recently available
edition of the Square Foot Costs with RSMeans Data, as published by Gordian.
new text end

new text begin Subd. 7. new text end

new text begin Commercial valuation system. new text end

new text begin "Commercial valuation system" means the
commercially available building valuation system selected by the commissioner for use in
all appraisals.
new text end

new text begin Subd. 8. new text end

new text begin Depreciable movable equipment. new text end

new text begin "Depreciable movable equipment" means
the standard movable care equipment and support service equipment generally used in
nursing facilities. Depreciable movable equipment includes equipment specified in the major
movable equipment table of the depreciation guidelines.
new text end

new text begin Subd. 9. new text end

new text begin Depreciated replacement cost or DRC. new text end

new text begin "Depreciated replacement cost" or
"DRC" means the depreciated replacement cost determined by an appraisal using the
commercial valuation system selected by the commissioner. DRC excludes costs related to
parking structures.
new text end

new text begin Subd. 10. new text end

new text begin Depreciation expense. new text end

new text begin "Depreciation expense" means the portion of a capital
asset deemed to be consumed or expired over the life of the asset.
new text end

new text begin Subd. 11. new text end

new text begin Depreciation guidelines. new text end

new text begin "Depreciation guidelines" means the most recent
publication of "Estimated Useful Lives of Depreciable Hospital Assets" issued by the
American Hospital Association.
new text end

new text begin Subd. 12. new text end

new text begin Equipment allowance. new text end

new text begin "Equipment allowance" means the component of the
property payment rate that is a payment for the use of depreciable movable equipment.
new text end

new text begin Subd. 13. new text end

new text begin Equipment allowance per bed value. new text end

new text begin The equipment allowance per bed
value is $10,000 adjusted annually for rate years beginning on or after January 1, 2021, by
the percentage change indicated by the urban consumer price index for Minneapolis-St.
Paul, as published by the Bureau of Labor Statistics (series 1967=100) for the two previous
Julys. The computation for this annual adjustment is based on the data that is publicly
available on November 1 immediately preceding the start of the rate year.
new text end

new text begin Subd. 14. new text end

new text begin Fair rental value system. new text end

new text begin "Fair rental value system" means a system that
establishes a price for the use of a space based on an appraised value of the property. The
price is established without consideration of the actual accounting cost to construct or
remodel the property. The price is the nursing facility value, subject to limits, multiplied
by an established rental rate.
new text end

new text begin Subd. 15. new text end

new text begin Fixed equipment. new text end

new text begin "Fixed equipment" means equipment affixed to the building
and not subject to transfer, including but not limited to wiring, electrical fixtures, plumbing,
elevators, and heating and air conditioning systems.
new text end

new text begin Subd. 16. new text end

new text begin Land improvement. new text end

new text begin "Land improvement" means improvement to the land
surrounding the nursing facility directly used for nursing facility operations as specified in
the land improvements table of the depreciation guidelines, if replacement of the land
improvement is the responsibility of the nursing facility. Land improvement includes
construction of auxiliary buildings including sheds, garages, storage buildings, and parking
structures. Parking structures are a land improvement and included only in the land and
land improvement value under section 256R.26, subdivision 4. Parking structures are not
to be included in either the undepreciated replacement cost or depreciated replacement cost.
new text end

new text begin Subd. 17. new text end

new text begin Rental rate. new text end

new text begin (a) "Rental rate" means the percentage applied to the allowable
value of the building, moveable, and fixed equipment per year in the property payment rate
calculation.
new text end

new text begin (b) The rental rate is the sum of the 20-year treasury bond rate as published in the Federal
Reserve Bulletin using the average for the calendar year preceding the rate year based on
data publicly available on November 1 each year, plus a risk value of three percent.
new text end

new text begin (c) Regardless of the result in paragraph (b), the rental rate must not be less than 7.5
percent or more than 12 percent.
new text end

new text begin Subd. 18. new text end

new text begin Shared area. new text end

new text begin "Shared area" means square footage that a nursing facility shares
with a nonnursing facility operation to provide a support service. The appraisals initially
may include the full value of all shared areas. The undepreciated replacement cost and
depreciated replacement cost established by the appraisals must be adjusted in the final
nursing facility values to reflect only the nursing facility usage. The adjustment must be
based on a Medicare-approved allocation basis for the type of service provided by each
area. Shared areas outside the appraised space must be added to DRC, URC, and related
square footage using the average of each value from the space in the appraisal.
new text end

new text begin Subd. 19. new text end

new text begin Threshold project. new text end

new text begin "Threshold project" means additions to a building or fixed
equipment that are subject to the threshold project limits under section 256R.267, paragraph
(a). Threshold project excludes land, land improvements, and depreciable movable equipment
purchases.
new text end

new text begin Subd. 20. new text end

new text begin Undepreciated replacement cost or URC. new text end

new text begin "Undepreciated replacement cost"
or "URC" means the undepreciated replacement cost determined by the appraisal for building
and fixed equipment using the commercial valuation system and appraisal firm.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 21.

new text begin [256R.265] APPRAISALS AND DETERMINATION OF REPLACEMENT
COSTS.
new text end

new text begin Subdivision 1. new text end

new text begin Selection of valuation system and appraisal firms. new text end

new text begin The commissioner
shall select a commercial valuation system that property appraisal firms selected by the
commissioner must utilize for all nursing facility property appraisals. The commissioner
shall use appraisal reports produced by commissioner-selected appraisal firms using the
commissioner-selected commercial valuation system for the purposes of rate setting under
section 256R.26, subdivisions 1 to 8. The commissioner shall not adjust or substitute any
alternative appraisal of properties.
new text end

new text begin Subd. 2. new text end

new text begin Appraised valuations generally. new text end

new text begin The property appraisal firm selected by the
commissioner shall determine the appraised valuation of a building and fixed equipment.
The appraisal firm shall not include depreciable movable equipment, land, land
improvements, or the physical plant for central office operations in the appraised valuation
of the nursing facility. Appraisals are not intended to exactly reflect market value.
new text end

new text begin Subd. 3. new text end

new text begin Appraisal reports. new text end

new text begin Appraisal firms selected by the commissioner shall produce
a report detailing both the DRC and URC of the nursing facility.
new text end

new text begin Subd. 4. new text end

new text begin Appraised valuations of shared space. new text end

new text begin Selected appraisal firms may include
the full value of all shared areas in an initial appraisal but must adjust the nursing facility
valuation of any shared area included in the square footage, DRC, and URC that are not
used for nursing facility purposes to reflect only the nursing facility usage of shared areas.
Selected appraisal firms shall adjust facility valuation for shared areas using a
Medicare-approved allocation basis for the type of service provided in each area. Shared
areas outside the appraised space must be added to the DRC, URC, and related square
footage using the average of each value from the space in the appraisal.
new text end

new text begin Subd. 5. new text end

new text begin Review and appeal of appraisal reports. new text end

new text begin A nursing facility may appeal a
finding of fact in the appraisal report to the appraiser within 20 calendar days after receipt
of the appraisal report and request revision.
new text end

new text begin Subd. 6. new text end

new text begin Update of replacement costs. new text end

new text begin When a facility's most recent physical appraisal
was completed more than 12 months before the start of the rate year, the appraisal firm shall
use the commercial valuation system to update the most recent DRC and URC of the nursing
facility and the commissioner shall use the updated DRC and URC to determine the total
property payment rate under section 256R.26. Updated DRC and URC are updates only
and not subject to revisions of any of the original valuations or appeal to the appraiser by
the facility.
new text end

new text begin Subd. 7. new text end

new text begin Appraisal frequency. new text end

new text begin After a facility's initial rate year described in section
256R.26, subdivision 9, paragraph (b), the commissioner shall ensure that a selected appraisal
firm conducts a new physical appraisal of the facility at least once every three years using
a commercial valuation system.
new text end

new text begin Subd. 8. new text end

new text begin Limitation on appraisal values. new text end

new text begin After the initial rate year described in section
256R.26, subdivision 9, paragraph (b), the increase in the URC for each subsequent appraisal
shall not exceed $2,000 per bed per year since the most recent physical appraisal, plus any
projects completed under section 256R.267 since the most recent appraisal. Any limitation
to the URC must be applied in the same proportion to the DRC. The commissioner shall
update annually on January 1 the per-bed per-year limit on the increase in the URC in this
subdivision by the annual percent change in the construction cost per square foot value.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 22.

new text begin [256R.267] THRESHOLD PROJECT PROPERTY PAYMENT RATE
INTERIM ADJUSTMENTS.
new text end

new text begin (a) A facility reimbursed under section 256R.26, subdivisions 1 to 8, may receive a
property payment rate interim adjustment for threshold projects the cumulative cost of which
during the three years between physical appraisals is between the following threshold project
cost limits:
new text end

new text begin (1) the lesser of $316,816 or $10,000 per bed in service; and
new text end

new text begin (2) the greater of $1,620,943 or $20,000 per bed in service.
new text end

new text begin The commissioner shall update the threshold project cost limits each January 1 by the annual
percent change in the construction cost per square foot value based on the information that
is publicly available on November 1 immediately preceding the rate year.
new text end

new text begin (b) A facility seeking a property payment rate interim adjustment must request an
adjustment after the threshold project is completed. The nursing facility or the lease holder
must have incurred the threshold project cost subsequent to the facility's last physical
appraisal. The nursing facility must submit to the commissioner all building and fixed
equipment cost data related to the project within 90 days of completing the project.
new text end

new text begin (c) Effective January 1 or July 1, whichever occurs first after a facility completes a
threshold project and requests the property payment rate interim adjustment, the
commissioner shall add the allowable reported threshold project costs to the facility's URC
under section 256R.26, subdivision 1, and to the DRC under section 256R.26, subdivision
3, before calculating an adjusted property payment rate under section 256R.26. The
commissioner shall not include in the facility's limited URC threshold project costs reported
to the commissioner between physical appraisals that exceed the maximum cumulative
project cost limits described in paragraph (a).
new text end

new text begin (d) In subsequent property payment rate calculations following the completion of a
physical appraisal, the commissioner shall eliminate any interim adjustment to the DRC
and URC under paragraph (c).
new text end

new text begin (e) At the option of the commissioner, the commissioner may adjust the appraisal schedule
for a nursing facility that has completed a threshold project.
new text end

new text begin (f) If more or less than three years pass between a facility's physical appraisals, the
commissioner shall prorate the facility's threshold project cost limits accordingly.
new text end

new text begin (g) After the initial rate year project adjustments are allowed once annually based on
the previous project completion date.
new text end

new text begin (h) Two threshold projects may not be conducted at the same time. Purchases for a
second project must be made after the completion date of the first project.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 23.

new text begin [256R.27] INTERIM AND SETTLE-UP PAYMENT RATES.
new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin (a) The commissioner shall determine the interim payment
rates and settle-up payment rates for a newly constructed nursing facility, or a nursing
facility with an increase in licensed capacity of 50 percent or more, according to subdivisions
2 and 3.
new text end

new text begin (b) The nursing facility must submit a written application to the commissioner to receive
interim payment rates. In its application, the nursing facility must state any reasons for
noncompliance with this chapter.
new text end

new text begin (c) The effective date of the interim payment rates is the date the nursing facility is
certified for the medical assistance program.
new text end

new text begin (d) The nursing facility must continue to receive the interim payment rates until the
settle-up payment rates are determined under subdivision 3.
new text end

new text begin (e) For the 15-month period following the settle-up reporting period, the settle-up payment
rates must be determined according to subdivision 3, paragraph (c).
new text end

new text begin (f) The settle-up payment rates are effective retroactively to the beginning of the interim
payment rates and are effective until the end of the interim rate period.
new text end

new text begin (g) The total operating and external fixed costs payment rate for the rate year beginning
January 1 following the 15-month period in paragraph (e) must be determined under this
chapter.
new text end

new text begin Subd. 2. new text end

new text begin Determination of interim payment rates. new text end

new text begin (a) The nursing facility shall submit
an interim cost report in a format similar to the Minnesota Statistical and Cost Report and
other supporting information as required by this chapter for the reporting year in which the
nursing facility plans to begin operation at least 60 days before the first day a resident is
admitted to the newly constructed nursing facility bed. The interim cost report must include
the nursing facility's anticipated interim costs and anticipated interim resident days for each
resident class in the interim cost report. The anticipated interim resident days for each
resident class is multiplied by the weight for that resident class to determine the anticipated
interim standardized days as defined in section 256R.02, subdivision 50, and resident days
as defined in section 256R.02, subdivision 45, for the reporting period.
new text end

new text begin (b) The interim payment rates are determined according to sections 256R.21 to 256R.25,
except that:
new text end

new text begin (1) the anticipated interim costs and anticipated interim resident days reported on the
interim cost report and the anticipated interim standardized days as defined by section
256R.02, subdivision 50, must be used for the interim;
new text end

new text begin (2) the commissioner shall use anticipated interim costs and anticipated interim
standardized days in determining the allowable historical direct care cost per standardized
day as determined under section 256R.23, subdivision 2;
new text end

new text begin (3) the commissioner shall use anticipated interim costs and anticipated interim resident
days in determining the allowable historical other care-related cost per resident day as
determined under section 256R.23, subdivision 3;
new text end

new text begin (4) the commissioner shall use anticipated interim costs and anticipated interim resident
days to determine the allowable historical external fixed costs per day under section 256R.25,
paragraphs (b) to (k);
new text end

new text begin (5) the total care-related payment rate limits established in section 256R.23, subdivision
5, and in effect at the beginning of the interim period must be increased by ten percent; and
new text end

new text begin (6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
new text end

new text begin Subd. 3. new text end

new text begin Determination of settle-up payment rates. new text end

new text begin (a) When the interim payment
rates begin between May 1 and September 30, the nursing facility shall file settle-up cost
reports for the period from the beginning of the interim payment rates through September
30 of the following year.
new text end

new text begin (b) When the interim payment rates begin between October 1 and April 30, the nursing
facility shall file settle-up cost reports for the period from the beginning of the interim
payment rates to the first September 30 following the beginning of the interim payment
rates.
new text end

new text begin (c) The settle-up payment rates are determined according to sections 256R.21 to 256R.25,
except that:
new text end

new text begin (1) the allowable costs and resident days reported on the settle-up cost report and the
standardized days as defined by section 256R.02, subdivision 50, must be used for the
interim and settle-up period;
new text end

new text begin (2) the commissioner shall use the allowable costs and standardized days in clause (1)
to determine the allowable historical direct care cost per standardized day as determined
under section 256R.23, subdivision 2;
new text end

new text begin (3) the commissioner shall use the allowable costs and the allowable resident days to
determine both the allowable historical other care-related cost per resident day as determined
under section 256R.23, subdivision 3;
new text end

new text begin (4) the commissioner shall use the allowable costs and the allowable resident days to
determine the allowable historical external fixed costs per day under section 256R.25,
paragraphs (b) to (k);
new text end

new text begin (5) the total care-related payment limits established in section 256R.23, subdivision 5,
are the limits for the settle-up reporting periods. If the interim period includes more than
one July 1 date, the commissioner shall use the total care-related payment rate limit
established in section 256R.23, subdivision 5, increased by ten percent for the second July
1 date; and
new text end

new text begin (6) the other operating payment rate as determined under section 256R.24 in effect for
the rate year must be used for the other operating cost per day.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2020.
new text end

Sec. 24.

Minnesota Statutes 2018, section 256R.44, is amended to read:


256R.44 RATE ADJUSTMENT FOR PRIVATE ROOMS FOR MEDICAL
NECESSITY.

new text begin (a) new text endThe amount paid for a private room is 111.5 percent of the established total payment
rate for a resident if the resident is a medical assistance recipient and the private room is
considered a medical necessity for the resident or others who are affected by the resident's
condition, except as provided in Minnesota Rules, part 9549.0060, subpart 11, item C.
Conditions requiring a private room must be determined by the resident's attending physician
and submitted to the commissioner for approval or denial by the commissioner on the basis
of medical necessity.

new text begin (b) For a nursing facility with a total property payment rate determined under section
256R.26, subdivision 8, the amount paid for a private room is 111.5 percent of the established
total payment rate for a resident if the resident is a medical assistance recipient and the
private room is considered a medical necessity for the resident or others who are affected
by the resident's condition. Conditions requiring a private room must be determined by the
resident's attending physician and submitted to the commissioner for approval or denial by
the commissioner on the basis of medical necessity.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 25.

new text begin [256R.481] RATE ADJUSTMENTS FOR BORDER CITY FACILITIES.
new text end

new text begin (a) The commissioner shall allow each nonprofit nursing facility located within the
boundaries of the city of Breckenridge or Moorhead prior to January 1, 2015, to apply once
annually for a rate add-on to the facility's external fixed costs payment rate.
new text end

new text begin (b) A facility seeking an add-on to its external fixed costs payment rate under this section
must apply annually to the commissioner to receive the add-on. A facility must submit the
application within 60 calendar days of the effective date of any add-on under this section.
The commissioner may waive the deadlines required by this paragraph under extraordinary
circumstances.
new text end

new text begin (c) The commissioner shall provide the add-on to each eligible facility that applies by
the application deadline.
new text end

new text begin (d) The add-on to the external fixed costs payment rate is the difference on January 1
of the median total payment rate for case mix classification PA1 of the nonprofit facilities
located in an adjacent city in another state and in cities contiguous to the adjacent city minus
the eligible nursing facility's total payment rate for case mix classification PA1 as determined
under section 256R.22, subdivision 4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for rate years beginning on or after
January 1, 2021.
new text end

Sec. 26.

Minnesota Statutes 2018, section 256R.50, subdivision 6, is amended to read:


Subd. 6.

Determination of rate adjustment.

(a) If the amount determined in subdivision
5 is less than or equal to the amount determined in subdivision 4, the commissioner shall
allow a total payment rate equal to the amount used in subdivision 5, clause (3).

(b) If the amount determined in subdivision 5 is greater than the amount determined in
subdivision 4, the commissioner shall allow a rate with a case mix index of 1.0 that when
used in subdivision 5, clause (3), results in the amount determined in subdivision 5 being
equal to the amount determined in subdivision 4.

(c) If the commissioner relies upon provider estimates in subdivision 5, clause (1) or
(2), then annually, for three years after the rates determined in this section take effect, the
commissioner shall determine the accuracy of the alternative factors of medical assistance
case load and the facility average case mix index used in this section and shall reduce the
total payment rate if the factors used result in medical assistance costs exceeding the amount
in subdivision 4. If the actual medical assistance costs exceed the estimates by more than
five percent, the commissioner shall also recover the difference between the estimated costs
in subdivision 5 and the actual costs according to section 256B.0641. The commissioner
may require submission of data from the receiving facility needed to implement this
paragraph.

(d) When beds approved for relocation are put into active service at the destination
facility, rates determined in this section must be adjusted by any adjustment amounts that
were implemented after the date of the letter of approval.

new text begin (e) Rate adjustments determined under this subdivision expire after three full rate years
following the effective date of the rate adjustment. This subdivision expires when the final
rate adjustment determined under this subdivision expires.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 27.

new text begin DIRECTION TO COMMISSIONER; CLEAN ENERGY PILOT PROJECT.
new text end

new text begin (a) The commissioner shall develop a pilot project to reduce overall energy consumption
and evaluate the financial impacts associated with property assessed clean energy (PACE)
approved projects in nursing facilities.
new text end

new text begin (b) Notwithstanding Minnesota Statutes, section 256R.02, subdivision 48a, the
commissioner may make payments to facilities for the allowable costs of special assessments
for approved energy-related program payments authorized under Minnesota Statutes, sections
216C.435 and 216C.436.
new text end

new text begin (c) The commissioner shall approve proposals through a contract which shall specify
the level of payment, provided that each facility demonstrates:
new text end

new text begin (1) completion of a facility-specific energy assessment or energy audit and recommended
energy conservation measures that, in aggregate, meet the cost-effectiveness requirements
of Minnesota Statutes, section 216B.241;
new text end

new text begin (2) a completed PACE application and recommended approval by a PACE program
administrator authorized under Minnesota Statutes, sections 216C.435 and 216C.436; and
new text end

new text begin (3) the facility's reported spending on utilities per resident day since calendar year 2016
is higher than average for similar facilities.
new text end

new text begin (d) Payments to facilities under this section shall be in the form of time-limited rate
adjustments which shall be included in the external fixed costs payment rate under Minnesota
Statutes, section 256R.25. The commissioner shall select from facilities that meet the
requirements of paragraph (c) using a competitive application process.
new text end

new text begin (e) Allowable costs for special assessments for approved energy-related program
payments cannot exceed the amount of debt service for net expenditures for the project and
must meet the cost-effective energy improvements requirements described in Minnesota
Statutes, section 216C.435, subdivision 3a. Any credits or rebates related to the project must
be offset. A project cost is not an allowable cost on the cost report as a special assessment
if it has been or will be used to increase the facility's property rate.
new text end

new text begin (f) The external fixed costs payment rate for the PACE allowable costs shall be reduced
by an amount equal to the utility per diem included in the other operating payment rate
under Minnesota Statutes, section 256R.24, that is associated with the energy project.
new text end

new text begin (g) In fiscal years 2020 and 2021, the commissioner of human services may approve
assessed clean energy pilot projects under this section, for which the cumulative state share
of medical assistance costs does not exceed $125,000.
new text end

new text begin (h) Notwithstanding any other law to the contrary, money available under Minnesota
Statutes, section 144A.073, shall be used to pay the medical assistance cost for the external
fixed rate increase in this section.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 28. new text beginDIRECTION TO COMMISSIONER; ELDERLY WAIVER CUSTOMIZED
LIVING SERVICE PROVIDERS.
new text end

new text begin (a) The commissioner of human services shall develop incentive-based grants to be
available during fiscal years 2020 and 2021 only for elderly waiver customized living service
providers for achieving outcomes specified in a contract. The commissioner may solicit
proposals from providers and implement those that, on a competitive basis, best meet the
state's policy objectives, giving preference to providers that serve at least 75 percent elderly
waiver participants. The commissioner shall limit expenditures under this subdivision to
the amount appropriated for this purpose.
new text end

new text begin (b) In establishing the specified outcomes and related criteria, the commissioner shall
consider the following state policy objectives:
new text end

new text begin (1) provide more efficient, higher quality services;
new text end

new text begin (2) encourage home and community-based services providers to innovate;
new text end

new text begin (3) equip home and community-based services providers with organizational tools and
expertise to improve their quality;
new text end

new text begin (4) incentivize home and community-based services providers to invest in better services;
and
new text end

new text begin (5) disseminate successful performance improvement strategies statewide.
new text end

Sec. 29. new text beginREVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes, the revisor of statutes shall renumber the nursing facility
contracting provisions that are currently coded as section 256B.434, subdivisions 1 and 3,
as amended by this act, as a section in chapter 256R and revise any statutory cross-references
consistent with that recodification.
new text end

Sec. 30. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, section 256B.431, subdivisions 3i, 15, and 16, new text end new text begin are repealed
effective January 1, 2020.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, section 256B.434, subdivisions 6 and 10, new text end new text begin are repealed
effective the day following final enactment.
new text end

new text begin (c) new text end new text begin Minnesota Statutes 2018, section 256R.53, subdivision 2, new text end new text begin is repealed effective January
1, 2021.
new text end

new text begin (d) new text end new text begin Minnesota Rules, parts 9549.0057; and 9549.0060, subpart 14, new text end new text begin are repealed effective
January 1, 2020.
new text end

ARTICLE 5

DISABILITY SERVICES

Section 1.

Minnesota Statutes 2018, section 237.50, subdivision 4a, is amended to read:


Subd. 4a.

Deaf.

"Deaf" means a hearing loss of such severity that the deleted text beginindividualdeleted text endnew text begin personnew text end
must depend primarily upon visual communication such as writing, lip reading, sign language,
and gestures.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 2.

Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:


new text begin Subd. 4c. new text end

new text begin Discounted telecommunications or Internet services. new text end

new text begin "Discounted
telecommunications or Internet services" means private, nonprofit, and public programs
intended to subsidize or reduce the monthly costs of telecommunications or Internet services
for a person who meets a program's eligibility requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 3.

Minnesota Statutes 2018, section 237.50, subdivision 6a, is amended to read:


Subd. 6a.

Hard-of-hearing.

"Hard-of-hearing" means a hearing loss resulting in a
functional limitation, but not to the extent that the deleted text beginindividualdeleted text endnew text begin personnew text end must depend primarily
upon visual communicationnew text begin in all interactionsnew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 4.

Minnesota Statutes 2018, section 237.50, is amended by adding a subdivision to
read:


new text begin Subd. 6b. new text end

new text begin Interconnectivity product. new text end

new text begin "Interconnectivity product" means a device,
accessory, or application for which the primary function is use with a telecommunications
device. Interconnectivity product may include a cell phone amplifier, hearing aid streamer,
Bluetooth-enabled device that connects to a wireless telecommunications device, advanced
communications application for a smartphone, or other applicable technology.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 5.

Minnesota Statutes 2018, section 237.50, subdivision 10a, is amended to read:


Subd. 10a.

Telecommunications device.

"Telecommunications device" means a device
that (1) allows a person with a communication disability to have access to
telecommunications services as defined in subdivision 13, and (2) is specifically selected
by the Department of Human Services for its capacity to allow persons with communication
disabilities to use telecommunications services in a manner that is functionally equivalent
to the ability of deleted text beginan individualdeleted text endnew text begin a personnew text end who does not have a communication disability. A
telecommunications device may include a ring signaler, an amplified telephone, a hands-free
telephone, a text telephone, a captioned telephone, a wireless device, a device that produces
Braille output for use with a telephone, and any other device the Department of Human
Services deems appropriate.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 6.

Minnesota Statutes 2018, section 237.50, subdivision 11, is amended to read:


Subd. 11.

Telecommunications Relay Services.

"Telecommunications Relay Services"
or "TRS" means the telecommunications transmission services required under Federal
Communications Commission regulations at Code of Federal Regulations, title 47, sections
64.604 to 64.606. TRS allows deleted text beginan individualdeleted text endnew text begin a personnew text end who has a communication disability
to use telecommunications services in a manner that is functionally equivalent to the ability
of deleted text beginan individualdeleted text endnew text begin a personnew text end who does not have a communication disability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 7.

Minnesota Statutes 2018, section 237.51, subdivision 1, is amended to read:


Subdivision 1.

Creation.

new text begin(a) new text endThe commissioner of commerce shall:

(1) administer through interagency agreement with the commissioner of human services
a program to distribute telecommunications devices new text beginand interconnectivity productsnew text end to eligible
persons who have communication disabilities; and

(2) contract with one or more qualified vendors that serve persons who have
communication disabilities to provide telecommunications relay services.

new text begin (b) new text endFor purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section 237.54, subdivision
2
, are not telephone companies or telecommunications carriers as defined in section 237.01.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 8.

Minnesota Statutes 2018, section 237.51, subdivision 5a, is amended to read:


Subd. 5a.

Commissioner of human services duties.

(a) In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of human services shall:

(1) define economic hardship, special needs, and household criteria so as to determine
the priority of eligible applicants for initial distribution of devices new text beginand products new text endand to
determine circumstances necessitating provision of more than one telecommunications
device per household;

(2) establish a method to verify eligibility requirements;

(3) establish specifications for telecommunications devices new text beginand interconnectivity productsnew text end
to be provided under section 237.53, subdivision 3;

(4) inform the public and specifically persons who have communication disabilities of
the program; deleted text beginand
deleted text end

(5) provide devices new text beginand products new text endbased on the assessed need of eligible applicantsdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (6) assist a person with completing an application for discounted telecommunications
or Internet services.
new text end

(b) The commissioner may establish an advisory board to advise the department in
carrying out the duties specified in this section and to advise the commissioner of commerce
in carrying out duties under section 237.54. If so established, the advisory board must
include, at a minimum, the following persons:

(1) at least one member who is deaf;

(2) at least one member who has a speech disability;

(3) at least one member who has a physical disability that makes it difficult or impossible
for the person to access telecommunications services; and

(4) at least one member who is hard-of-hearing.

new text begin (c) new text endThe membership terms, compensation, and removal of members and the filling of
membership vacancies are governed by section 15.059. Advisory board meetings shall be
held at the discretion of the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 9.

Minnesota Statutes 2018, section 237.52, subdivision 5, is amended to read:


Subd. 5.

Expenditures.

(a) Money in the fund may only be used for:

(1) expenses of the Department of Commerce, including personnel cost, public relations,
advisory board members' expenses, preparation of reports, and other reasonable expenses
not to exceed ten percent of total program expenditures;

(2) reimbursing the commissioner of human services for purchases made or services
provided pursuant to section 237.53; and

(3) contracting for the provision of TRS required by section 237.54.

(b) All costs directly associated with the establishment of the program, the purchase and
distribution of telecommunications devicesdeleted text begin,deleted text end new text beginand interconnectivity products, new text endand the provision
of TRS are either reimbursable or directly payable from the fund after authorization by the
commissioner of commerce. The commissioner of commerce shall contract with one or
more TRS providers to indemnify the telecommunications service providers for any fines
imposed by the Federal Communications Commission related to the failure of the relay
service to comply with federal service standards. Notwithstanding section 16A.41, the
commissioner may advance money to the TRS providers if the providers establish to the
commissioner's satisfaction that the advance payment is necessary for the provision of the
service. The advance payment may be used only for working capital reserve for the operation
of the service. The advance payment must be offset or repaid by the end of the contract
fiscal year together with interest accrued from the date of payment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 10.

Minnesota Statutes 2018, section 237.53, is amended to read:


237.53 TELECOMMUNICATIONS deleted text beginDEVICEdeleted text endnew text begin DEVICES AND
INTERCONNECTIVITY PRODUCTS
new text end.

Subdivision 1.

Application.

A person applying for a telecommunications devicenew text begin or
interconnectivity product
new text end under this section must apply to the program administrator on a
form prescribed by the Department of Human Services.

Subd. 2.

Eligibility.

To be eligible to obtain a telecommunications devicenew text begin or
interconnectivity product
new text end under this section, a person must:

(1) be able to benefit from and use the equipment for its intended purpose;

(2) have a communication disability;

(3) be a resident of the state;

(4) be a resident in a household that has a median income at or below the applicable
median household income in the state, except a person who is deafblind applying for a
Braille device may reside in a household that has a median income no more than 150 percent
of the applicable median household income in the state; and

(5) be a resident in a household that has telecommunications service or that has made
application for service and has been assigned a telephone number; or a resident in a residential
care facility, such as a nursing home or group home where telecommunications service is
not included as part of overall service provision.

new text begin Subd. 2a. new text end

new text begin Assessment of needs. new text end

new text begin After a person is determined to be eligible for the
program, the commissioner of human services shall assess the person's telecommunications
needs to determine: (1) the type of telecommunications device that provides the person with
functionally equivalent access to telecommunications services; and (2) appropriate
interconnectivity products for the person.
new text end

Subd. 3.

Distribution.

The commissioner of human services shall new text begin(1) new text endpurchase deleted text beginand
distribute
deleted text end a sufficient number of telecommunications devices new text beginand interconnectivity productsnew text end
so that each eligible household receives appropriate devicesnew text begin and productsnew text end as determined
under section 237.51, subdivision 5adeleted text begin. The commissioner of human services shalldeleted text endnew text begin, and (2)new text end
distribute the devices new text beginand products new text endto eligible households free of charge.

Subd. 4.

Training; new text begininformation; new text endmaintenance.

The commissioner of human services
shall maintain the telecommunications devices new text beginand interconnectivity productsnew text end until the
warranty period expires, and provide training, without charge, to first-time users of the
devicesdeleted text begin.deleted text endnew text begin and products. The commissioner shall provide information about assistive
communications devices and products that may benefit a program participant and about
where a person may obtain or purchase assistive communications devices and products.
Assistive communications devices and products include a pocket talker for a person who
is hard-of-hearing, a communication board for a person with a speech disability, a one-to-one
video communication application for a person who is deaf, and other devices and products
designed to facilitate effective communication for a person with a communication disability.
new text end

Subd. 6.

Ownership.

Telecommunications devices new text beginand interconnectivity productsnew text end
purchased pursuant to subdivision 3new text begin, clause (1),new text end are the property of the state of Minnesota.
Policies and procedures for the return of new text begindistributed new text enddevices deleted text beginfrom individuals who withdraw
from the program or whose eligibility status changes
deleted text endnew text begin and productsnew text end shall be determined by
the commissioner of human services.

Subd. 7.

Standards.

The telecommunications devices distributed under this section must
comply with the electronic industries alliance standards and be approved by the Federal
Communications Commission. The commissioner of human services must provide each
eligible person a choice of several models of devices, the retail value of which may not
exceed $600 for a text telephone, and a retail value of $7,000 for a Braille device, or an
amount authorized by the Department of Human Services for all other telecommunications
devices deleted text beginanddeleted text endnew text begin,new text end auxiliary equipmentnew text begin, and interconnectivity productsnew text end it deems cost-effective
and appropriate to distribute according to sections 237.51 to 237.56.

new text begin Subd. 9. new text end

new text begin Discounted telecommunications or Internet services assistance. new text end

new text begin The
commissioner of human services shall assist a person who is applying for telecommunication
devices and products in applying for discounted telecommunications or Internet services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, and must be implemented
by October 1, 2019.
new text end

Sec. 11.

Minnesota Statutes 2018, section 245D.03, subdivision 1, is amended to read:


Subdivision 1.

Applicability.

(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.

(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:

(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end, and elderly waiver plans,
excluding out-of-home respite care provided to children in a family child foster care home
licensed under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care
license holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7,
and 8, or successor provisions; and section 245D.061 or successor provisions, which must
be stipulated in the statement of intended use required under Minnesota Rules, part
2960.3000, subpart 4;

(2) adult companion services as defined under the brain injury, community access for
disability inclusion, new text begincommunity alternative care, new text endand elderly waiver plans, excluding adult
companion services provided under the Corporation for National and Community Services
Senior Companion Program established under the Domestic Volunteer Service Act of 1973,
Public Law 98-288;

(3) personal support as defined under the developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end waiver
plan;

(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end waiver
plans;

(5) night supervision services as defined under the brain injurynew text begin, community access for
disability inclusion, community alternative care, and developmental disabilities
new text end waiver deleted text beginplandeleted text endnew text begin
plans
new text end;

(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end, and elderly
waiver plans, excluding providers licensed by the Department of Health under chapter 144A
and those providers providing cleaning services only; deleted text beginand
deleted text end

(7) individual community living support under section 256B.0915, subdivision 3jdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion, and developmental disability
waiver plans.
new text end

(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:

(1) intervention services, including:

(i) deleted text beginbehavioraldeleted text endnew text begin positivenew text end support services as defined under the brain injury and community
access for disability inclusionnew text begin, community alternative care, and developmental disabilitiesnew text end
waiver plans;

(ii) in-home or out-of-home crisis respite services as defined under thenew text begin brain injury,
community access for disability inclusion, community alternative care, and
new text end developmental
deleted text begin disabilitydeleted text endnew text begin disabilitiesnew text end waiver deleted text beginplandeleted text endnew text begin plansnew text end; and

(iii) specialist services as defined under the currentnew text begin brain injury, community access for
disability inclusion, community alternative care, and
new text end developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end
waiver deleted text beginplandeleted text endnew text begin plansnew text end;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end waiver plan;

(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans;

(iii) semi-independent living services; deleted text beginand
deleted text end

deleted text begin (iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;
deleted text end

new text begin (iv) individualized home support with training services as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans; and
new text end

new text begin (v) individualized home support with family training services as defined under the brain
injury, community alternative care, community access for disability inclusion, and
developmental disability waiver plans;
new text end

(3) residential supports and services, including:

(i) supported living services as defined under the developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end
waiver plan provided in a family or corporate child foster care residence, a family adult
foster care residence, a community residential setting, or a supervised living facility;

(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; deleted text beginand
deleted text end

(iii)new text begin community residential services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans provided in a corporate child foster care residence, a community residential
setting, or a supervised living facility;
new text end

new text begin (iv) family residential services as defined in the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plans
provided in a family child foster care residence or a family adult foster care residence; and
new text end

new text begin (v)new text end residential services provided to more than four persons with developmental disabilities
in a supervised living facility, including ICFs/DD;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii)new text begin day services under sections 252.41 to 252.46, and as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disability waiver plans;
new text end

new text begin (iii)new text end day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end waiver plan; and

deleted text begin (iii)deleted text endnew text begin (iv)new text end prevocational services as defined under the brain injury deleted text beginanddeleted text endnew text begin, community
alternative care,
new text end community access for disability inclusionnew text begin, and developmental disabilitynew text end
waiver plans; and

(5) employment exploration services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental deleted text begindisabilitydeleted text endnew text begin
disabilities
new text end waiver plans;

(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental deleted text begindisabilitydeleted text endnew text begin
disabilities
new text end waiver plans; deleted text beginand
deleted text end

(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental deleted text begindisabilitydeleted text endnew text begin disabilitiesnew text end
waiver plansdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (8) integrated community support as defined under the brain injury and community
access for disability inclusion waiver plans beginning January 1, 2021, and community
alternative care and developmental disability waiver plans beginning January 1, 2023.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 12.

Minnesota Statutes 2018, section 245D.071, subdivision 1, is amended to read:


Subdivision 1.

Requirements for intensive support services.

Except for services
identified in section 245D.03, subdivision 1, paragraph (c), clauses (1) and (2),new text begin item (ii),new text end a
license holder providing intensive support services identified in section 245D.03, subdivision
1
, paragraph (c), must comply with the requirements in this section and section 245D.07,
subdivisions 1
new text begin, 1a,new text end and 3. Services identified in section 245D.03, subdivision 1, paragraph
(c), clauses (1) and (2),new text begin item (ii),new text end must comply with the requirements in section 245D.07,
subdivision 2
.

new text begin EFFECTIVE DATE. new text end

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

Sec. 13.

Minnesota Statutes 2018, section 245D.071, subdivision 5, is amended to read:


Subd. 5.

Service plan review and evaluation.

(a) The license holder must give the
person or the person's legal representative and case manager an opportunity to participate
in the ongoing review and development of the service plan and the methods used to support
the person and accomplish outcomes identified in subdivisions 3 and 4. new text beginAt least once per
year, or within 30 days of a written request by the person, the person's legal representative,
or the case manager,
new text endthe license holder, in coordination with the person's support team or
expanded support team, must meet with the person, the person's legal representative, and
the case manager, and participate in service plan review meetings following stated timelines
established in the person's coordinated service and support plan or coordinated service and
support plan addendum deleted text beginor within 30 days of a written request by the person, the person's
legal representative, or the case manager, at a minimum of once per year
deleted text end. The purpose of
the service plan review is to determine whether changes are needed to the service plan based
on the assessment information, the license holder's evaluation of progress towards
accomplishing outcomes, or other information provided by the support team or expanded
support team.

new text begin (b) At least once per year, the license holder, in coordination with the person's support
team or expanded support team, must meet with the person, the person's legal representative,
and the case manager to discuss how technology might be used to meet the person's desired
outcomes. The coordinated service and support plan addendum must include a summary of
this discussion. The summary must include a statement regarding any decision made related
to the use of technology and a description of any further research that must be completed
before a decision regarding the use of technology can be made. Nothing in this paragraph
requires the coordinated service and support plan addendum to include the use of technology
for the provision of services.
new text end

deleted text begin (b)deleted text endnew text begin (c)new text end The license holder must summarize the person's status and progress toward
achieving the identified outcomes and make recommendations and identify the rationale
for changing, continuing, or discontinuing implementation of supports and methods identified
in subdivision 4 in a report available at the time of the progress review meeting. The report
must be sent at least five working days prior to the progress review meeting if requested by
the team in the coordinated service and support plan or coordinated service and support
plan addendum.

deleted text begin (c)deleted text endnew text begin (d)new text end The license holder must send the coordinated service and support plan addendum
to the person, the person's legal representative, and the case manager by mail within ten
working days of the progress review meeting. Within ten working days of the mailing of
the coordinated service and support plan addendum, the license holder must obtain dated
signatures from the person or the person's legal representative and the case manager to
document approval of any changes to the coordinated service and support plan addendum.

deleted text begin (d)deleted text endnew text begin (e)new text end If, within ten working days of submitting changes to the coordinated service and
support plan and coordinated service and support plan addendum, the person or the person's
legal representative or case manager has not signed and returned to the license holder the
coordinated service and support plan or coordinated service and support plan addendum or
has not proposed written modifications to the license holder's submission, the submission
is deemed approved and the coordinated service and support plan addendum becomes
effective and remains in effect until the legal representative or case manager submits a
written request to revise the coordinated service and support plan addendum.

Sec. 14.

Minnesota Statutes 2018, section 245D.09, subdivision 5, is amended to read:


Subd. 5.

Annual training.

A license holder must provide annual training to direct support
staff on the topics identified in subdivision 4, clauses (3) to (10). If the direct support staff
has a first aid certification, annual training under subdivision 4, clause (9), is not required
as long as the certification remains current. deleted text beginA license holder must provide a minimum of
24 hours of annual training to direct service staff providing intensive services and having
fewer than five years of documented experience and 12 hours of annual training to direct
service staff providing intensive services and having five or more years of documented
experience in topics described in subdivisions 4 and 4a, paragraphs (a) to (f). Training on
relevant topics received from sources other than the license holder may count toward training
requirements. A license holder must provide a minimum of 12 hours of annual training to
direct service staff providing basic services and having fewer than five years of documented
experience and six hours of annual training to direct service staff providing basic services
and having five or more years of documented experience.
deleted text end

Sec. 15.

Minnesota Statutes 2018, section 245D.09, subdivision 5a, is amended to read:


Subd. 5a.

Alternative sources of training.

deleted text begin The commissioner may approve online
training and competency-based assessments in place of a specific number of hours of training
in the topics covered in subdivision 4. The commissioner must provide a list of preapproved
trainings that do not need approval for each individual license holder.
deleted text end

Orientation or training received by the staff person from sources other than the license
holder in the same subjects as identified in subdivision 4 may count toward the orientation
and annual training requirements if received in the 12-month period before the staff person's
date of hire. The license holder must maintain documentation of the training received from
other sources and of each staff person's competency in the required area according to the
requirements in subdivision 3.

Sec. 16.

Minnesota Statutes 2018, section 245D.091, subdivision 2, is amended to read:


Subd. 2.

deleted text beginBehaviordeleted text endnew text begin Positive supportnew text end professional qualifications.

A deleted text beginbehaviordeleted text endnew text begin positive
support
new text end professional providing deleted text beginbehavioraldeleted text endnew text begin positivenew text end support services as identified in section
245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the
following areas as required under the brain injury deleted text beginanddeleted text endnew text begin,new text end community access for disability
inclusionnew text begin, community alternative care, and developmental disabilitiesnew text end waiver plans or
successor plans:

(1) ethical considerations;

(2) functional assessment;

(3) functional analysis;

(4) measurement of behavior and interpretation of data;

(5) selecting intervention outcomes and strategies;

(6) behavior reduction and elimination strategies that promote least restrictive approved
alternatives;

(7) data collection;

(8) staff and caregiver training;

(9) support plan monitoring;

(10) co-occurring mental disorders or neurocognitive disorder;

(11) demonstrated expertise with populations being served; and

(12) must be a:

(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the Board
of Psychology competencies in the above identified areas;

(ii) clinical social worker licensed as an independent clinical social worker under chapter
148D, or a person with a master's degree in social work from an accredited college or
university, with at least 4,000 hours of post-master's supervised experience in the delivery
of clinical services in the areas identified in clauses (1) to (11);

(iii) physician licensed under chapter 147 and certified by the American Board of
Psychiatry and Neurology or eligible for board certification in psychiatry with competencies
in the areas identified in clauses (1) to (11);

(iv) licensed professional clinical counselor licensed under sections 148B.29 to 148B.39
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services who has demonstrated competencies in the areas identified in clauses (1) to (11);

(v) person with a master's degree from an accredited college or university in one of the
behavioral sciences or related fields, with at least 4,000 hours of post-master's supervised
experience in the delivery of clinical services with demonstrated competencies in the areas
identified in clauses (1) to (11); deleted text beginor
deleted text end

(vi)new text begin person with a master's degree or PhD in one of the behavioral sciences or related
fields with demonstrated expertise in positive support services, as determined by the person's
needs as outlined in the person's community support plan; or
new text end

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

Sec. 17.

Minnesota Statutes 2018, section 245D.091, subdivision 3, is amended to read:


Subd. 3.

deleted text beginBehaviordeleted text endnew text begin Positive supportnew text end analyst qualifications.

(a) A deleted text beginbehaviordeleted text endnew text begin positive
support
new text end analyst providing deleted text beginbehavioraldeleted text endnew text begin positivenew text end support services as identified in section
245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the
following areas as required under the brain injury deleted text beginanddeleted text endnew text begin,new text end community access for disability
inclusionnew text begin, community alternative care, and developmental disabilitiesnew text end waiver plans or
successor plans:

(1) have obtained a baccalaureate degree, master's degree, or PhD in a social services
discipline; deleted text beginor
deleted text end

(2) meet the qualifications of a mental health practitioner as defined in section 245.462,
subdivision 17
new text begin; or
new text end

new text begin (3) be a board-certified behavior analyst or board-certified assistant behavior analyst by
the Behavior Analyst Certification Board, Incorporated
new text end.

(b) In addition, a deleted text beginbehaviordeleted text endnew text begin positive supportnew text end analyst must:

(1) have four years of supervised experience deleted text beginworking with individuals who exhibit
challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder
deleted text endnew text begin
conducting functional behavior assessments and designing, implementing, and evaluating
effectiveness of positive practices behavior support strategies for people who exhibit
challenging behaviors as well as co-occurring mental disorders and neurocognitive disorder
new text end;

(2) have received deleted text beginten hours of instruction in functional assessment and functional analysis;deleted text endnew text begin
training prior to hire or within 90 calendar days of hire that includes:
new text end

new text begin (i) ten hours of instruction in functional assessment and functional analysis;
new text end

new text begin (ii) 20 hours of instruction in the understanding of the function of behavior;
new text end

new text begin (iii) ten hours of instruction on design of positive practices behavior support strategies;
new text end

new text begin (iv) 20 hours of instruction preparing written intervention strategies, designing data
collection protocols, training other staff to implement positive practice strategies,
summarizing and reporting program evaluation data, analyzing program evaluation data to
identify design flaws in behavioral interventions or failures in implementation fidelity, and
recommending enhancements based on evaluation data; and
new text end

new text begin (v) eight hours of instruction on principles of person-centered thinking;
new text end

deleted text begin (3) have received 20 hours of instruction in the understanding of the function of behavior;
deleted text end

deleted text begin (4) have received ten hours of instruction on design of positive practices behavior support
strategies;
deleted text end

deleted text begin (5) have received 20 hours of instruction on the use of behavior reduction approved
strategies used only in combination with behavior positive practices strategies;
deleted text end

deleted text begin (6)deleted text endnew text begin (3)new text end be determined by a deleted text beginbehaviordeleted text endnew text begin positive supportnew text end professional to have the training
and prerequisite skills required to provide positive practice strategies as well as behavior
reduction approved and permitted intervention to the person who receives deleted text beginbehavioraldeleted text endnew text begin positivenew text end
support; and

deleted text begin (7)deleted text endnew text begin (4)new text end be under the direct supervision of a deleted text beginbehaviordeleted text endnew text begin positive supportnew text end professional.

new text begin (c) Meeting the qualifications for a positive support professional under subdivision 2
shall substitute for meeting the qualifications listed in paragraph (b).
new text end

Sec. 18.

Minnesota Statutes 2018, section 245D.091, subdivision 4, is amended to read:


Subd. 4.

deleted text beginBehaviordeleted text endnew text begin Positive supportnew text end specialist qualifications.

(a) A deleted text beginbehaviordeleted text endnew text begin positive
support
new text end specialist providing deleted text beginbehavioraldeleted text endnew text begin positivenew text end support services as identified in section
245D.03, subdivision 1, paragraph (c), clause (1), item (i), must have competencies in the
following areas as required under the brain injury deleted text beginanddeleted text endnew text begin,new text end community access for disability
inclusionnew text begin, community alternative care, and developmental disabilitiesnew text end waiver plans or
successor plans:

(1) have an associate's degree in a social services discipline; or

(2) have two years of supervised experience working with individuals who exhibit
challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder.

(b) In addition, a behavior specialist must:

(1) have receivednew text begin training prior to hire or within 90 calendar days of hire that includes:
new text end

new text begin (i)new text end a minimum of four hours of training in functional assessment;

deleted text begin (2) have receiveddeleted text endnew text begin (ii)new text end 20 hours of instruction in the understanding of the function of
behavior;

deleted text begin (3) have receiveddeleted text endnew text begin (iii)new text end ten hours of instruction on design of positive practices behavioral
support strategies;new text begin and
new text end

new text begin (iv) eight hours of instruction on principles of person-centered thinking;
new text end

deleted text begin (4)deleted text endnew text begin (2)new text end be determined by a deleted text beginbehaviordeleted text endnew text begin positive supportnew text end professional to have the training
and prerequisite skills required to provide positive practices strategies as well as behavior
reduction approved intervention to the person who receives deleted text beginbehavioraldeleted text endnew text begin positivenew text end support;
and

deleted text begin (5)deleted text endnew text begin (3)new text end be under the direct supervision of a deleted text beginbehaviordeleted text endnew text begin positive supportnew text end professional.

new text begin (c) Meeting the qualifications for a positive support professional under subdivision 2
shall substitute for meeting the qualifications listed in paragraphs (a) and (b).
new text end

Sec. 19.

new text begin [245D.12] INTEGRATED COMMUNITY SUPPORTS; SETTING
CAPACITY REPORT.
new text end

new text begin (a) The license holder providing integrated community support, as defined in section
245D.03, subdivision 1, paragraph (c), clause (8), must submit a setting capacity report to
the commissioner to ensure the identified location of service delivery meets the criteria of
the home and community-based service requirements as specified in section 256B.492.
new text end

new text begin (b) The license holder shall provide the setting capacity report on the forms and in the
manner prescribed by the commissioner. The report must include:
new text end

new text begin (1) the address of the multifamily housing building where the license holder delivers
integrated community supports and owns, leases, or has a direct or indirect financial
relationship with the property owner;
new text end

new text begin (2) the total number of living units in the multifamily housing building described in
clause (1) where integrated community supports are delivered;
new text end

new text begin (3) the total number of living units in the multifamily housing building described in
clause (1), including the living units identified in clause (2); and
new text end

new text begin (4) the percentage of living units that are controlled by the license holder in the
multifamily housing building by dividing clause (2) by clause (3).
new text end

new text begin (c) Only one license holder may deliver integrated community supports at the address
of the multifamily housing building.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon the date of federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 20.

Minnesota Statutes 2018, section 252.27, subdivision 2a, is amended to read:


Subd. 2a.

Contribution amount.

(a) The natural or adoptive parents of a minor child,
including a child determined eligible for medical assistance without consideration of parental
income, must contribute to the cost of services used by making monthly payments on a
sliding scale based on income, unless the child is married or has been married, parental
rights have been terminated, or the child's adoption is subsidized according to chapter 259A
or through title IV-E of the Social Security Act. The parental contribution is a partial or full
payment for medical services provided for diagnostic, therapeutic, curing, treating, mitigating,
rehabilitation, maintenance, and personal care services as defined in United States Code,
title 26, section 213, needed by the child with a chronic illness or disability.

(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at deleted text begin1.94deleted text endnew text begin 1.65new text end percent of adjusted gross income at 275 percent
of federal poverty guidelines and increases to deleted text begin5.29deleted text endnew text begin 4.5new text end percent of adjusted gross income for
those with adjusted gross income up to 545 percent of federal poverty guidelines;

(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
deleted text begin 5.29deleted text endnew text begin 4.5new text end percent of adjusted gross income;

(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at deleted text begin5.29deleted text endnew text begin 4.5new text end percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to deleted text begin7.05deleted text endnew text begin 5.99new text end percent of adjusted gross income for those
with adjusted gross income up to 975 percent of federal poverty guidelines; and

(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be deleted text begin8.81deleted text endnew text begin 7.49new text end percent of adjusted gross income.

If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.

(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.

(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.

(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.

(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).

(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.

Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:

(1) the parent applied for insurance for the child;

(2) the insurer denied insurance;

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

For purposes of this section, "insurance" has the meaning given in paragraph (h).

A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
including, but not limited to, the insurer's denial of insurance, the written letter or complaint
of the parents, court documents, and the written response of the insurer approving insurance.
The determinations of the commissioner or county agency under this paragraph are not rules
subject to chapter 14.

Sec. 21.

Minnesota Statutes 2018, section 252.275, subdivision 3, is amended to read:


Subd. 3.

Reimbursement.

Counties shall be reimbursed for all expenditures made
pursuant to subdivision 1 at a rate of deleted text begin70deleted text end new text begin85 new text endpercent, up to the allocation determined pursuant
to subdivisions 4 and 4b. However, the commissioner shall not reimburse costs of services
for any person if the costs exceed the state share of the average medical assistance costs for
services provided by intermediate care facilities for a person with a developmental disability
for the same fiscal year, and shall not reimburse costs of a onetime living allowance for any
person if the costs exceed $1,500 in a state fiscal year. The commissioner may make
payments to each county in quarterly installments. The commissioner may certify an advance
of up to 25 percent of the allocation. Subsequent payments shall be made on a reimbursement
basis for reported expenditures and may be adjusted for anticipated spending patterns.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 22.

Minnesota Statutes 2018, section 252.32, subdivision 1a, is amended to read:


Subd. 1a.

Support grants.

(a) Provision of support grants must be limited to families
who require support and whose dependents are under the age of deleted text begin21deleted text endnew text begin 25new text end and who have been
certified deleted text begindisableddeleted text endnew text begin as persons with disabilitiesnew text end under section 256B.055, subdivision 12,
paragraphs (a), (b), (c), (d), and (e). Families who are receiving: home and community-based
waivered services for persons with disabilities authorized under section 256B.092 or 256B.49;
personal care assistance under section 256B.0652; or a consumer support grant under section
256.476 are not eligible for support grants.

new text begin New grant allocations, beginning July 1, 2019, are intended to support families with
dependents age 14 through 24 to support transition-related activities.
new text end

Families whose annual adjusted gross income is $60,000 or more are not eligible for
support grants except in cases where extreme hardship is demonstrated. Beginning in state
fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the
projected change in the average value in the United States Department of Labor Bureau of
Labor Statistics Consumer Price Index (all urban) for that year.

(b) Support grants may be made available as monthly subsidy grants and lump-sum
grants.

(c) Support grants may be issued in the form of cash, voucher, and direct county payment
to a vendor.

(d) Applications for the support grant shall be made by the legal guardian to the county
social service agency. The application shall specify the needs of the families, the form of
the grant requested by the families, and the items and services to be reimbursed.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2019.
new text end

Sec. 23.

Minnesota Statutes 2018, section 252.41, subdivision 3, is amended to read:


Subd. 3.

Day deleted text begintraining and habilitationdeleted text end services for adults with deleted text begindevelopmentaldeleted text end
disabilities.

(a) "Day deleted text begintraining and habilitationdeleted text end services for adults with deleted text begindevelopmentaldeleted text end
disabilities" means services that:

(1) include supervision, training, assistancenew text begin, supportnew text end, deleted text begincenter-baseddeleted text endnew text begin facility-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the deleted text beginindividual service and individual habilitation plansdeleted text endnew text begin coordinated
service and support plan and coordinated service and support plan addendum
new text end required undernew text begin
sections 245D.02, subdivision 4, paragraphs (b) and (c), and 256B.092, subdivision 1b, and
new text end
Minnesota Rules, deleted text beginpartsdeleted text endnew text begin partnew text end 9525.0004 deleted text beginto 9525.0036deleted text endnew text begin, subpart 12new text end, to help an adult reach and
maintain the highest possible level of independence, productivity, and integration into the
community; deleted text beginand
deleted text end

(2)new text begin include day support services, prevocational services, day training and habilitation
services, structured day services, and adult day services as defined in Minnesota's federally
approved disability waiver plans; and
new text end

new text begin (3)new text end are provided by a vendor licensed under sections 245A.01 to 245A.16 deleted text beginanddeleted text endnew text begin, 245D.27
to 245D.31,
new text end 252.28, subdivision 2,new text begin or 252.41 to 252.46, or Minnesota Rules, parts 9525.1200
to 9525.1330,
new text end to provide day deleted text begintraining and habilitationdeleted text end services.

(b) Day deleted text begintraining and habilitationdeleted text end services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.

(c) Day deleted text begintraining and habilitationdeleted text end services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 24.

Minnesota Statutes 2018, section 252.41, subdivision 4, is amended to read:


Subd. 4.

Independence.

"Independence" means the extent to which persons with
deleted text begin developmentaldeleted text end disabilities exert control and choice over their own lives.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 25.

Minnesota Statutes 2018, section 252.41, subdivision 5, is amended to read:


Subd. 5.

Integration.

"Integration" means that persons with deleted text begindevelopmentaldeleted text end disabilities:

(1) use the same community resources that are used by and available to individuals who
are not disabled;

(2) participate in the same community activities in which nondisabled individuals
participate; and

(3) regularly interact and have contact with nondisabled individuals.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 26.

Minnesota Statutes 2018, section 252.41, subdivision 6, is amended to read:


Subd. 6.

Productivity.

"Productivity" means that persons with deleted text begindevelopmentaldeleted text end disabilities:

(1) engage in income-producing work designed to improve their income level,
employment status, or job advancement; or

(2) engage in activities that contribute to a business, household, or community.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 27.

Minnesota Statutes 2018, section 252.41, subdivision 7, is amended to read:


Subd. 7.

Regional center.

"Regional center" means any state-operated facility under
the direct administrative authority of the commissioner that serves persons with
deleted text begin developmentaldeleted text end disabilities.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 28.

Minnesota Statutes 2018, section 252.41, subdivision 9, is amended to read:


Subd. 9.

Vendor.

"Vendor" means a deleted text beginnonprofitdeleted text end legal entity that:

(1) is licensed under sections 245A.01 to 245A.16 deleted text beginanddeleted text endnew text begin, 245D.27 to 245D.31,new text end 252.28,
subdivision 2
,new text begin and 252.41 to 252.46, and Minnesota Rules, parts 9525.1200 to 9525.1330,new text end
to provide day deleted text begintraining and habilitationdeleted text end services to adults with deleted text begindevelopmentaldeleted text end disabilities;
and

(2) does not have a financial interest in the legal entity that provides residential services
to the same person or persons to whom it provides day deleted text begintraining and habilitationdeleted text end services.
This clause does not apply to regional treatment centers, state-operated, community-based
programs operating according to section 252.50 until July 1, 2000, or vendors licensed prior
to April 15, 1983.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 29.

Minnesota Statutes 2018, section 252.42, is amended to read:


252.42 SERVICE PRINCIPLES.

The design and delivery of services eligible for reimbursement should reflect the
following principles:

(1) services must suit a person's chronological age and be provided in the least restrictive
environment possible, consistent with the needs identified in the person's deleted text beginindividual service
and individual habilitation plans under
deleted text endnew text begin coordinated service and support plan and coordinated
service and support plan addendum required under sections 256B.092, subdivision 1b, and
245D.02, subdivision 4, paragraphs (b) and (c), and
new text end Minnesota Rules, parts 9525.0004 deleted text beginto
9525.0036
deleted text endnew text begin, subpart 12new text end;

(2) a person with a deleted text begindevelopmentaldeleted text end disability whose individual deleted text beginservice and individual
habilitation plans
deleted text endnew text begin coordinated service and support plans and coordinated service and support
plan addendums
new text end authorize employment or employment-related activities shall be given the
opportunity to participate in employment and employment-related activities in which
nondisabled persons participate;

(3) a person with a deleted text begindevelopmentaldeleted text end disability participating in work shall be paid wages
commensurate with the rate for comparable work and productivity except as regional centers
are governed by section 246.151;

(4) a person with a deleted text begindevelopmentaldeleted text end disability shall receive services which include services
offered in settings used by the general public and designed to increase the person's active
participation in ordinary community activities;

(5) a person with a deleted text begindevelopmentaldeleted text end disability shall participate in the patterns, conditions,
and rhythms of everyday living and working that are consistent with the norms of the
mainstream of society.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 30.

Minnesota Statutes 2018, section 252.43, is amended to read:


252.43 COMMISSIONER'S DUTIES.

The commissioner shall supervise deleted text begincounty boards'deleted text endnew text begin lead agencies'new text end provision of day deleted text begintraining
and habilitation
deleted text end services to adults with deleted text begindevelopmentaldeleted text end disabilities. The commissioner shall:

(1) determine the need for day deleted text begintraining and habilitationdeleted text end services under section deleted text begin252.28deleted text endnew text begin
256B.4914
new text end;

(2) establish payment rates as provided under section 256B.4914;

(3) adopt rules for the administration and provision of day deleted text begintraining and habilitationdeleted text end
services under deleted text beginsections 252.41 to 252.46 anddeleted text end sections 245A.01 to 245A.16 deleted text beginanddeleted text endnew text begin,new text end 252.28,
subdivision 2
new text begin, or 252.41 to 252.46, or Minnesota Rules, parts 9525.1200 to 9525.1330new text end;

(4) enter into interagency agreements necessary to ensure effective coordination and
provision of day deleted text begintraining and habilitationdeleted text end services;

(5) monitor and evaluate the costs and effectiveness of day deleted text begintraining and habilitationdeleted text end
services; and

(6) provide information and technical help to deleted text begincounty boardsdeleted text endnew text begin lead agenciesnew text end and vendors
in their administration and provision of day deleted text begintraining and habilitationdeleted text end services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 31.

Minnesota Statutes 2018, section 252.44, is amended to read:


252.44 deleted text beginCOUNTYdeleted text endnew text begin LEAD AGENCYnew text end BOARD RESPONSIBILITIES.

When the need for day deleted text begintraining and habilitationdeleted text end services in a countynew text begin or tribenew text end has been
determined under section 252.28, the board of commissioners for that deleted text begincountydeleted text endnew text begin lead agencynew text end
shall:

(1) authorize the delivery of services according to the deleted text beginindividual service and habilitation
plans
deleted text endnew text begin coordinated service and support plans and coordinated service and support plan
addendums
new text end required as part of the deleted text begincounty'sdeleted text endnew text begin lead agency'snew text end provision of case management
services undernew text begin sections 256B.0913, subdivision 8; 256B.0915, subdivision 6; 256B.092,
subdivision 1b; and 256B.49, subdivision 15, and
new text end Minnesota Rules, parts 9525.0004 to
9525.0036deleted text begin. For calendar years for which section 252.46, subdivisions 2 to 10, apply, the
county board shall not authorize a change in service days from the number of days authorized
for the previous calendar year unless there is documentation for the change in the individual
service plan. An increase in service days must also be supported by documentation that the
goals and objectives assigned to the vendor cannot be met more economically and effectively
by other available community services and that without the additional days of service the
individual service plan could not be implemented in a manner consistent with the service
principles in section 252.42
deleted text end;

(2) ensure that transportation is provided or arranged by the vendor in the most efficient
and reasonable way possible; and

(3) monitor and evaluate the cost and effectiveness of the services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 32.

Minnesota Statutes 2018, section 252.45, is amended to read:


252.45 VENDOR'S DUTIES.

Anew text begin day servicenew text end vendor enrolled with the commissioner is responsible for items under
clauses (1), (2), and (3), and extends only to the provision of services that are reimbursable
under state and federal law. A vendor providing day deleted text begintraining and habilitationdeleted text end services shall:

(1) provide the amount and type of services authorized in the individual service plan
undernew text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (b) and (c), and
256B.092, subdivision 1b, and
new text end Minnesota Rules, deleted text beginpartsdeleted text endnew text begin partnew text end 9525.0004 deleted text beginto 9525.0036deleted text endnew text begin, subpart
12
new text end;

(2) design the services to achieve the outcomes assigned to the vendor in the deleted text beginindividual
service plan
deleted text endnew text begin coordinated service and support plan and coordinated service and support plan
addendum required under sections 245D.02, subdivision 4, paragraphs (a) and (b), and
256B.092, subdivision 1b, and Minnesota Rules, part 9525.0004, subpart 12
new text end;

(3) provide or arrange for transportation of persons receiving services to and from service
sites;

(4) enter into agreements with community-based intermediate care facilities for persons
with developmental disabilities to ensure compliance with applicable federal regulations;
and

(5) comply with state and federal law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 33.

Minnesota Statutes 2018, section 256.9365, is amended to read:


256.9365 PURCHASE OF deleted text beginCONTINUATIONdeleted text endnew text begin HEALTH CAREnew text end COVERAGE FOR
deleted text begin AIDS PATIENTSdeleted text endnew text begin PEOPLE LIVING WITH HIVnew text end.

Subdivision 1.

Program established.

The commissioner of human services shall establish
a program to pay deleted text beginprivatedeleted text endnew text begin the cost ofnew text end health plan premiumsnew text begin and cost sharing for prescriptions,
including co-payments, deductibles, and coinsurance
new text end for persons who have contracted human
immunodeficiency virus (HIV) to enable them to continue coverage under new text beginor enroll in new text enda
group or individual health plan. If a person is determined to be eligible under subdivision
2, the commissioner shall pay the deleted text beginportion of the group plan premium for which the individual
is responsible, if the individual is responsible for at least 50 percent of the cost of the
premium, or pay the individual plan premium
deleted text endnew text begin health insurance premiums and prescription
cost sharing, including co-payments and deductibles required under section 256B.0631
new text end.
The commissioner shall not pay for that portion of a premium that is attributable to other
family members or dependentsnew text begin or is paid by the individual's employernew text end.

Subd. 2.

Eligibility requirements.

To be eligible for the program, an applicant must
deleted text begin satisfy the following requirements:deleted text endnew text begin meet all eligibility requirements for Part B of the Ryan
White HIV/AIDS Treatment Extension Act of 2009, Public Law 111-87, and enroll in the
Minnesota Ryan White program.
new text end

deleted text begin (1) the applicant must provide a physician's, advanced practice registered nurse's, or
physician assistant's statement verifying that the applicant is infected with HIV and is, or
within three months is likely to become, too ill to work in the applicant's current employment
because of HIV-related disease;
deleted text end

deleted text begin (2) the applicant's monthly gross family income must not exceed 300 percent of the
federal poverty guidelines, after deducting medical expenses and insurance premiums;
deleted text end

deleted text begin (3) the applicant must not own assets with a combined value of more than $25,000; and
deleted text end

deleted text begin (4) if applying for payment of group plan premiums, the applicant must be covered by
an employer's or former employer's group insurance plan.
deleted text end

Subd. 3.

Cost-effective coverage.

Requirements for the payment of individual plan
premiums under deleted text beginsubdivision 2, clause (5),deleted text endnew text begin this sectionnew text end must be designed to ensure that the
state cost of paying an individual plan premium does not exceed the estimated state cost
that would otherwise be incurred in the medical assistance program. The commissioner
shall purchase the most cost-effective coverage available for eligible individuals.

Sec. 34.

Minnesota Statutes 2018, section 256B.0658, is amended to read:


256B.0658 HOUSING ACCESS GRANTS.

The commissioner of human services shall award through a competitive process contracts
for grants to public and private agencies to support and assist individuals deleted text begineligible for publicly
funded home and community-based services, including state plan home care
deleted text endnew text begin with a disability
as defined in section 256B.051, subdivision 2, paragraph (e)
new text end, to access housing. Grants may
be awarded to agencies that may include, but are not limited to, the following supports:
assessment to ensure suitability of housing, accompanying an individual to look at housing,
filling out applications and rental agreements, meeting with landlords, helping with Section
8 or other program applications, helping to develop a budget, obtaining furniture and
household goods, if necessary, and assisting with any problems that may arise with housing.

Sec. 35.

Minnesota Statutes 2018, section 256B.0659, subdivision 3a, is amended to read:


Subd. 3a.

Assessment; defined.

(a) "Assessment" means a review and evaluation of a
recipient's need for personal care assistance services conducted in person. Assessments for
personal care assistance services shall be conducted by the county public health nurse or a
certified public health nurse under contract with the county except when a long-term care
consultation assessment is being conducted for the purposes of determining a person's
eligibility for home and community-based waiver services including personal care assistance
services according to section 256B.0911. new text beginDuring the transition to MnCHOICES, a certified
assessor may complete the assessment defined in this subdivision.
new text endAn in-person assessment
must include: documentation of health status, determination of need, evaluation of service
effectiveness, identification of appropriate services, service plan development or modification,
coordination of services, referrals and follow-up to appropriate payers and community
resources, completion of required reports, recommendation of service authorization, and
consumer education. Once the need for personal care assistance services is determined under
this section, the county public health nurse or certified public health nurse under contract
with the county is responsible for communicating this recommendation to the commissioner
and the recipient. An in-person assessment must occur at least annually or when there is a
significant change in the recipient's condition or when there is a change in the need for
personal care assistance services. A service update may substitute for the annual face-to-face
assessment when there is not a significant change in recipient condition or a change in the
need for personal care assistance service. A service update may be completed by telephone,
used when there is no need for an increase in personal care assistance services, and used
for two consecutive assessments if followed by a face-to-face assessment. A service update
must be completed on a form approved by the commissioner. A service update or review
for temporary increase includes a review of initial baseline data, evaluation of service
effectiveness, redetermination of service need, modification of service plan and appropriate
referrals, update of initial forms, obtaining service authorization, and on going consumer
education. Assessments or reassessments must be completed on forms provided by the
commissioner within 30 days of a request for home care services by a recipient or responsible
party.

(b) This subdivision expires when notification is given by the commissioner as described
in section 256B.0911, subdivision 3a.

Sec. 36.

Minnesota Statutes 2018, section 256B.0659, subdivision 11, is amended to read:


Subd. 11.

Personal care assistant; requirements.

(a) A personal care assistant must
meet the following requirements:

(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:

(i) supervision by a qualified professional every 60 days; and

(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;

(2) be employed by a personal care assistance provider agency;

(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:

(i) not disqualified under section 245C.14; or

(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;

(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;

(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;

(6) not be a consumer of personal care assistance services;

(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;

(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;

(9) complete training and orientation on the needs of the recipient; and

(10) be limited to providing and being paid for up to 275 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.

(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).

(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.

new text begin (d) Personal care assistance services qualify for the enhanced rate described in subdivision
17a if the personal care assistant providing the services:
new text end

new text begin (1) provides covered services to a recipient who qualifies for 12 or more hours per day
of personal care assistance services; and
new text end

new text begin (2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 37.

Minnesota Statutes 2018, section 256B.0659, subdivision 13, is amended to read:


Subd. 13.

Qualified professional; qualifications.

(a) The qualified professional must
work for a personal care assistance provider agency deleted text beginanddeleted text endnew text begin,new text end meet the definition new text beginof qualified
professional
new text endunder section 256B.0625, subdivision 19cnew text begin, and enroll with the department as
a qualified professional after clearing a background study
new text end. Before a qualified professional
provides services, the personal care assistance provider agency must initiate a background
study on the qualified professional under chapter 245C, and the personal care assistance
provider agency must have received a notice from the commissioner that the qualified
professional:

(1) is not disqualified under section 245C.14; or

(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.

(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:

(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;

(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;

(3) review documentation of personal care assistance services provided;

(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and

(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.

(c) Effective July 1, 2011, the qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.

Sec. 38.

Minnesota Statutes 2018, section 256B.0659, is amended by adding a subdivision
to read:


new text begin Subd. 17a. new text end

new text begin Enhanced rate. new text end

new text begin An enhanced rate of 107.5 percent of the rate paid for
personal care assistance services shall be paid for services provided to persons who qualify
for 12 or more hours of personal care assistance services per day when provided by a personal
care assistant who meets the requirements of subdivision 11, paragraph (d). The enhanced
rate for personal care assistance services includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54, that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of personal
care assistance services per day.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 39.

Minnesota Statutes 2018, section 256B.0659, subdivision 19, is amended to read:


Subd. 19.

Personal care assistance choice option; qualifications; duties.

(a) Under
personal care assistance choice, the recipient or responsible party shall:

(1) recruit, hire, schedule, and terminate personal care assistants according to the terms
of the written agreement required under subdivision 20, paragraph (a);

(2) develop a personal care assistance care plan based on the assessed needs and
addressing the health and safety of the recipient with the assistance of a qualified professional
as needed;

(3) orient and train the personal care assistant with assistance as needed from the qualified
professional;

(4) effective January 1, 2010, supervise and evaluate the personal care assistant with the
qualified professional, who is required to visit the recipient at least every 180 days;

(5) monitor and verify in writing and report to the personal care assistance choice agency
the number of hours worked by the personal care assistant and the qualified professional;

(6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; and

(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.

(b) The personal care assistance choice provider agency shall:

(1) meet all personal care assistance provider agency standards;

(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;

(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
care assistant; and

(4) ensure arm's-length transactions without undue influence or coercion with the recipient
and personal care assistant.

(c) The duties of the personal care assistance choice provider agency are to:

(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation deleted text beginanddeleted text endnew text begin,new text end unemployment insurancenew text begin, and labor market data
required under section 256B.4912, subdivision 1a
new text end;

(2) bill the medical assistance program for personal care assistance services and qualified
professional services;

(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;

(4) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(5) withhold and pay all applicable federal and state taxes;

(6) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;

(8) enroll in the medical assistance program as a personal care assistance choice agency;
and

(9) enter into a written agreement as specified in subdivision 20 before services are
provided.

Sec. 40.

Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

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

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

(2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
revenue in the previous calendar year is up to and including $300,000, the provider agency
must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
bond must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;

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

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

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

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

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

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

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

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

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

(10) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this sectionnew text begin, including the requirements
under subdivision 11, paragraph (d), if enhanced personal care assistance services are
provided and submitted for an enhanced rate under subdivision 17a
new text end;

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

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

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

(14) effective May 15, 2010, documentation that the agency does not burden recipients'
free exercise of their right to choose service providers by requiring personal care assistants
to sign an agreement not to work with any particular personal care assistance recipient or
for another personal care assistance provider agency after leaving the agency and that the
agency is not taking action on any such agreements or requirements regardless of the date
signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner before enrollment of the agency as a provider. Employees
in management and supervisory positions and owners who are active in the day-to-day
operations of an agency who have completed the required training as an employee with a
personal care assistance provider agency do not need to repeat the required training if they
are hired by another agency, if they have completed the training within the past three years.
By September 1, 2010, the required training must be available with meaningful access
according to title VI of the Civil Rights Act and federal regulations adopted under that law
or any guidance from the United States Health and Human Services Department. The
required training must be available online or by electronic remote connection. The required
training must provide for competency testing. Personal care assistance provider agency
billing staff shall complete training about personal care assistance program financial
management. This training is effective July 1, 2009. Any personal care assistance provider
agency enrolled before that date shall, if it has not already, complete the provider training
within 18 months of July 1, 2009. Any new owners or employees in management and
supervisory positions involved in the day-to-day operations are required to complete
mandatory training as a requisite of working for the agency. Personal care assistance provider
agencies certified for participation in Medicare as home health agencies are exempt from
the training required in this subdivision. When available, Medicare-certified home health
agency owners, supervisors, or managers must successfully complete the competency test.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 41.

Minnesota Statutes 2018, section 256B.0659, subdivision 24, is amended to read:


Subd. 24.

Personal care assistance provider agency; general duties.

A personal care
assistance provider agency shall:

(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;

(2) comply with general medical assistance coverage requirements;

(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;

(4) comply with background study requirements;

(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;

(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;

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

(9) deleted text begineffective January 1, 2010,deleted text end document that the agency uses a minimum of 72.5 percent
of the revenue generated by the medical assistance rate for personal care assistance services
for employee personal care assistant wages and benefits. The revenue generated by the
qualified professional and the reasonable costs associated with the qualified professional
shall not be used in making this calculation;

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

(11) enter into a written agreement under subdivision 20 before services are provided;

(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;

(13) provide the recipient with a copy of the home care bill of rights at start of service;
deleted text begin and
deleted text end

(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissionerdeleted text begin.deleted text endnew text begin;
new text end

new text begin (15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; and
new text end

new text begin (16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements
under subdivision 11, paragraph (d).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 42.

Minnesota Statutes 2018, section 256B.0659, subdivision 28, is amended to read:


Subd. 28.

Personal care assistance provider agency; required documentation.

(a)
Required documentation must be completed and kept in the personal care assistance provider
agency file or the recipient's home residence. The required documentation consists of:

(1) employee files, including:

(i) applications for employment;

(ii) background study requests and results;

(iii) orientation records about the agency policies;

(iv) trainings completed with demonstration of competencenew text begin, including verification of
the completion of training required under subdivision 11, paragraph (d), if personal care
assistance services eligible for the enhanced rate are provided and submitted for
reimbursement under subdivision 17a
new text end;

(v) supervisory visits;

(vi) evaluations of employment; and

(vii) signature on fraud statement;

(2) recipient files, including:

(i) demographics;

(ii) emergency contact information and emergency backup plan;

(iii) personal care assistance service plan;

(iv) personal care assistance care plan;

(v) month-to-month service use plan;

(vi) all communication records;

(vii) start of service information, including the written agreement with recipient; and

(viii) date the home care bill of rights was given to the recipient;

(3) agency policy manual, including:

(i) policies for employment and termination;

(ii) grievance policies with resolution of consumer grievances;

(iii) staff and consumer safety;

(iv) staff misconduct; and

(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
resolution of consumer grievances;

(4) time sheets for each personal care assistant along with completed activity sheets for
each recipient served; and

(5) agency marketing and advertising materials and documentation of marketing activities
and costs.

(b) The commissioner may assess a fine of up to $500 on provider agencies that do not
consistently comply with the requirements of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 43.

Minnesota Statutes 2018, section 256B.0911, subdivision 1a, is amended to read:


Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

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

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

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

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

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

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

(6) determination of home and community-based waiver and other service eligibility as
required under sections 256B.0913, 256B.0915, new text begin256B.092,new text end and 256B.49, including level
of care determination for individuals who need an institutional level of care as determined
under subdivision 4e, based on assessment and community support plan development,
appropriate referrals to obtain necessary diagnostic information, and including an eligibility
determination for consumer-directed community supports;

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

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

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

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

(1) service eligibility determination for state plan deleted text beginhome caredeleted text end services identified in:

(i) section 256B.0625, subdivisions deleted text begin7deleted text enddeleted text begin,deleted text end 19adeleted text begin,deleted text end and 19c;

(ii) consumer support grants under section 256.476; or

(iii) section 256B.85;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
deleted text begin determination of eligibility fordeleted text endnew text begin gaining access tonew text end case management services available under
sections 256B.0621, subdivision 2, deleted text beginparagraphdeleted text endnew text begin clausenew text end (4), deleted text beginanddeleted text end 256B.0924new text begin,new text end and Minnesota
Rules, part 9525.0016;

(3) determination deleted text beginof institutional level of care, home and community-based service
waiver, and other service
deleted text end new text beginofnew text end eligibility deleted text beginas required under section deleted text enddeleted text begin, determination
of eligibility for family support grants under section 252.32,
deleted text end new text beginfornew text end semi-independent living
services under section 252.275deleted text begin, and day training and habilitation services under section
deleted text end; and

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

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

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

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

(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives. For the purposes of this section,
"informed choice" means a voluntary choice of services by a person from all available
service options based on accurate and complete information concerning all available service
options and concerning the person's own preferences, abilities, goals, and objectives. In
order for a person to make an informed choice, all available options must be developed and
presented to the person to empower the person to make decisions.

Sec. 44.

Minnesota Statutes 2018, section 256B.0911, subdivision 3a, is amended to read:


Subd. 3a.

Assessment and support planning.

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

(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.

(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, new text beginconversation-based,new text end person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a community support plan that meets
the individual's needs and preferences.

(d) The assessment must be conducted in a face-to-face new text beginconversationalnew text end interview with
the person being assessed deleted text beginanddeleted text endnew text begin.new text end The person's legal representativenew text begin must provide input during
the assessment process and may do so remotely if requested
new text end. At the request of the person,
other individuals may participate in the assessment to provide information on the needs,
strengths, and preferences of the person necessary to develop a community support plan
that ensures the person's health and safety. Except for legal representatives or family members
invited by the person, persons participating in the assessment may not be a provider of
service or have any financial interest in the provision of services. For persons who are to
be assessed for elderly waiver customized living or adult day services under section
256B.0915, with the permission of the person being assessed or the person's designated or
legal representative, the client's current or proposed provider of services may submit a copy
of the provider's nursing assessment or written report outlining its recommendations regarding
the client's care needs. The person conducting the assessment must notify the provider of
the date by which this information is to be submitted. This information shall be provided
to the person conducting the assessment prior to the assessment. For a person who is to be
assessed for waiver services under section 256B.092 or 256B.49, with the permission of
the person being assessed or the person's designated legal representative, the person's current
provider of services may submit a written report outlining recommendations regarding the
person's care needs deleted text beginprepared by a direct service employee with at least 20 hours of service
to that client. The person conducting the assessment or reassessment must notify the provider
of the date by which this information is to be submitted. This information shall be provided
to the person conducting the assessment and the person or the person's legal representative,
and must be considered prior to the finalization of the assessment or reassessment
deleted text endnew text begin the person
completed in consultation with someone who is known to the person and has interaction
with the person on a regular basis. The provider must submit the report at least 60 days
before the end of the person's current service agreement. The certified assessor must consider
the content of the submitted report prior to finalizing the person's assessment or reassessment
new text end.

(e) new text beginThe certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit.
new text end The
person or the person's legal representative must be provided with a written community
support plan within deleted text begin40 calendar days of the assessment visitdeleted text endnew text begin the timelines established by
the commissioner
new text end, regardless of whether the deleted text beginindividualdeleted text end new text beginpersonnew text end is eligible for Minnesota
health care programs.

(f) For a person being assessed for elderly waiver services under section 256B.0915, a
provider who submitted information under paragraph (d) shall receive the final written
community support plan when available and the Residential Services Workbook.

(g) The written community support plan must include:

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

(2) the individual's options and choices to meet identified needs, including all available
options for case management services and providers, including service provided in a
non-disability-specific setting;

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

(4) referral information; and

(5) informal caregiver supports, if applicable.

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

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

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

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

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

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

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

(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);

(5) information about Minnesota health care programs;

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

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

(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. new text beginThe certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated.
new text end

(k) Face-to-face assessment completed as part of eligibility determination for the
alternative care, elderly waiver, new text begindevelopmental disabilities, new text endcommunity access for disability
inclusion, community alternative care, and brain injury waiver programs under sections
256B.0913, 256B.0915, new text begin256B.092, new text endand 256B.49 is valid to establish service eligibility for
no more than 60 calendar days after the date of assessment.

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

(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.

(n) At the time of reassessment, the certified assessor shall assess each person receiving
waiver services currently residing in a community residential setting, or licensed adult foster
care home that is not the primary residence of the license holder, or in which the license
holder is not the primary caregiver, to determine if that person would prefer to be served in
a community-living setting as defined in section 256B.49, subdivision 23. The certified
assessor shall offer the person, through a person-centered planning process, the option to
receive alternative housing and service options.

Sec. 45.

Minnesota Statutes 2018, section 256B.0911, subdivision 3f, is amended to read:


Subd. 3f.

Long-term care reassessments and community support plan updates.

new text begin(a)
Prior to a face-to-face reassessment, the certified assessor must review the person's most
recent assessment.
new text end Reassessments must be tailored using the professional judgment of the
assessor to the person's known needs, strengths, preferences, and circumstances.
Reassessments provide information to support the person's informed choice and opportunities
to express choice regarding activities that contribute to quality of life, as well as information
and opportunity to identify goals related to desired employment, community activities, and
preferred living environment. Reassessments deleted text beginallow fordeleted text end new text beginrequirenew text end a review of new text beginthe most recent
assessment, review of
new text end the current new text begincoordinated service and new text endsupport plan's effectiveness,
monitoring of services, and the development of an updated person-centered community
support plan. Reassessments verify continued eligibility or offer alternatives as warranted
and provide an opportunity for quality assurance of service delivery. Face-to-face deleted text beginassessmentsdeleted text endnew text begin
reassessments
new text end must be conducted annually or as required by federal and state laws and rules.new text begin
For reassessments, the certified assessor and the individual responsible for developing the
coordinated service and support plan must ensure the continuity of care for the person
receiving services and complete the updated community support plan and the updated
coordinated service and support plan no more than 60 days from the reassessment visit.
new text end

new text begin (b) The commissioner shall develop mechanisms for providers and case managers to
share information with the assessor to facilitate a reassessment and support planning process
tailored to the person's current needs and preferences.
new text end

Sec. 46.

Minnesota Statutes 2018, section 256B.0911, is amended by adding a subdivision
to read:


new text begin Subd. 3g. new text end

new text begin Assessments for Rule 185 case management. new text end

new text begin Unless otherwise required by
federal law, the county agency is not required to conduct or arrange for an annual needs
reassessment by a certified assessor. The case manager who works on behalf of the person
to identify the person's needs and to minimize the impact of the disability on the person's
life must instead develop a person-centered service plan based on the person's assessed
needs and preferences. The person-centered service plan must be reviewed annually for
persons with developmental disabilities who are receiving only case management services
under Minnesota Rules, part 9525.0016, and who make an informed choice to decline an
assessment under this section.
new text end

Sec. 47.

Minnesota Statutes 2018, section 256B.0911, subdivision 5, is amended to read:


Subd. 5.

Administrative activity.

(a) The commissioner shall streamline the processes,
including timelines for when assessments need to be completed, required to provide the
services in this section and shall implement integrated solutions to automate the business
processes to the extent necessary for community support plan approval, reimbursement,
program planning, evaluation, and policy development.

(b) The commissioner of human services shall work with lead agencies responsible for
conducting long-term consultation services to modify the MnCHOICES application and
assessment policies to create efficiencies while ensuring federal compliance with medical
assistance and long-term services and supports eligibility criteria.

new text begin (c) The commissioner shall work with lead agencies responsible for conducting long-term
consultation services to develop a set of measurable benchmarks sufficient to demonstrate
quarterly improvement in the average time per assessment and other mutually agreed upon
measures of increasing efficiency. The commissioner shall collect data on these benchmarks
and provide to the lead agencies and the chairs and ranking minority members of the
legislative committees with jurisdiction over human services an annual trend analysis of
the data in order to demonstrate the commissioner's compliance with the requirements of
this subdivision.
new text end

Sec. 48.

Minnesota Statutes 2018, section 256B.0915, subdivision 3a, is amended to read:


Subd. 3a.

Elderly waiver cost limits.

(a) Effective on the first day of the state fiscal
year in which the resident assessment system as described in section 256R.17 for nursing
home rate determination is implemented and the first day of each subsequent state fiscal
year, the monthly limit for the cost of waivered services to an individual elderly waiver
client shall be the monthly limit of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
last day of the previous state fiscal year, adjusted by any legislatively adopted home and
community-based services percentage rate adjustment. If a legislatively authorized increase
is service-specific, the monthly cost limit shall be adjusted based on the overall average
increase to the elderly waiver program.

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

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

(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
the dependency score in eating is three or greater as determined by an assessment performed
under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
applied to all other participants who meet this criteria at reassessment. This monthly limit
shall be increased annually as described in paragraphs (a) and (e).

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

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

(e) Effective January 1, 2018, and each January 1 thereafter, the monthly cost limits for
elderly waiver services in effect on the previous December 31 shall be increased by the
difference between any legislatively adopted home and community-based provider rate
increases effective on January 1 or since the previous January 1 and the average statewide
percentage increase in nursing facility operating payment rates under chapter 256R, effective
the previous January 1. This paragraph shall only apply if the average statewide percentage
increase in nursing facility operating payment rates is greater than any legislatively adopted
home and community-based provider rate increases effective on January 1, or occurring
since the previous January 1.

new text begin (f) The commissioner shall approve an exception to the monthly case mix budget cap
in paragraph (a) to account for the additional cost of providing enhanced rate personal care
assistance services under section 256B.0659 or 256B.85. The exception shall not exceed
107.5 percent of the budget otherwise available to the individual. The exception must be
reapproved on an annual basis at the time of a participant's annual reassessment.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 49.

Minnesota Statutes 2018, section 256B.0915, subdivision 6, is amended to read:


Subd. 6.

Implementation of coordinated service and support plan.

(a) Each elderly
waiver client shall be provided a copy of a written coordinated service and support plan
deleted text begin whichdeleted text endnew text begin thatnew text end:

(1) is developed new text beginwith new text endand signed by the recipient within deleted text beginten working days after the case
manager receives the assessment information and written community support plan as
described in section 256B.0911, subdivision 3a, from the certified assessor
deleted text endnew text begin the timelines
established by the commissioner and section 256B.0911, subdivision 3a, paragraph (e)
new text end;

(2) includes the person's need for service and identification of service needs that will be
or that are met by the person's relatives, friends, and others, as well as community services
used by the general public;

(3) reasonably ensures the health and welfare of the recipient;

(4) identifies the person's preferences for services as stated by the person or the person's
legal guardian or conservator;

(5) reflects the person's informed choice between institutional and community-based
services, as well as choice of services, supports, and providers, including available case
manager providers;

(6) identifies long-range and short-range goals for the person;

(7) identifies specific services and the amount, frequency, duration, and cost of the
services to be provided to the person based on assessed needs, preferences, and available
resources;

(8) includes information about the right to appeal decisions under section 256.045; and

(9) includes the authorized annual and estimated monthly amounts for the services.

(b) In developing the coordinated service and support plan, the case manager should
also include the use of volunteers, religious organizations, social clubs, and civic and service
organizations to support the individual in the community. The lead agency must be held
harmless for damages or injuries sustained through the use of volunteers and agencies under
this paragraph, including workers' compensation liability.

Sec. 50.

Minnesota Statutes 2018, section 256B.092, subdivision 1b, is amended to read:


Subd. 1b.

Coordinated service and support plan.

(a) Each recipient of home and
community-based waivered services shall be provided a copy of the written coordinated
service and support plan deleted text beginwhichdeleted text endnew text begin thatnew text end:

(1) is developed new text beginwith new text endand signed by the recipient within deleted text beginten working days after the case
manager receives the assessment information and written community support plan as
described in section 256B.0911, subdivision 3a, from the certified assessor
deleted text endnew text begin the timelines
established by the commissioner and section 256B.0911, subdivision 3a, paragraph (e)
new text end;

(2) includes the person's need for service, including identification of service needs that
will be or that are met by the person's relatives, friends, and others, as well as community
services used by the general public;

(3) reasonably ensures the health and welfare of the recipient;

(4) identifies the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor, including the person's
choices made on self-directed options and on services and supports to achieve employment
goals;

(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for case
management services and providers;

(6) identifies long-range and short-range goals for the person;

(7) identifies specific services and the amount and frequency of the services to be provided
to the person based on assessed needs, preferences, and available resources. The coordinated
service and support plan shall also specify other services the person needs that are not
available;

(8) identifies the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;

(9) identifies provider responsibilities to implement and make recommendations for
modification to the coordinated service and support plan;

(10) includes notice of the right to request a conciliation conference or a hearing under
section 256.045;

(11) is agreed upon and signed by the person, the person's legal guardian or conservator,
or the parent if the person is a minor, and the authorized county representative;

(12) is reviewed by a health professional if the person has overriding medical needs that
impact the delivery of services; and

(13) includes the authorized annual and monthly amounts for the services.

(b) In developing the coordinated service and support plan, the case manager is
encouraged to include the use of volunteers, religious organizations, social clubs, and civic
and service organizations to support the individual in the community. The lead agency must
be held harmless for damages or injuries sustained through the use of volunteers and agencies
under this paragraph, including workers' compensation liability.

(c) Approved, written, and signed changes to a consumer's services that meet the criteria
in this subdivision shall be an addendum to that consumer's individual service plan.

Sec. 51.

Minnesota Statutes 2018, section 256B.0921, is amended to read:


256B.0921 HOME AND COMMUNITY-BASED SERVICES deleted text beginINCENTIVEdeleted text endnew text begin
INNOVATION
new text end POOL.

The commissioner of human services shall develop an initiative to provide incentives
for innovation in: (1) achieving integrated competitive employment; (2) achieving integrated
competitive employment for youth under age 25 upon their graduation from school; (3)
living in the most integrated setting; and (4) other outcomes determined by the commissioner.
The commissioner shall seek requests for proposals and shall contract with one or more
entities to provide incentive payments for meeting identified outcomes.

Sec. 52.

Minnesota Statutes 2018, section 256B.49, subdivision 13, is amended to read:


Subd. 13.

Case management.

(a) Each recipient of a home and community-based waiver
shall be provided case management services by qualified vendors as described in the federally
approved waiver application. The case management service activities provided must include:

(1) finalizing the written coordinated service and support plan within deleted text beginten working days
after the case manager receives the plan from the certified assessor
deleted text endnew text begin the timelines established
by the commissioner and section 256B.0911, subdivision 3a, paragraph (e)
new text end;

(2) informing the recipient or the recipient's legal guardian or conservator of service
options;

(3) assisting the recipient in the identification of potential service providers and available
options for case management service and providers, including services provided in a
non-disability-specific setting;

(4) assisting the recipient to access services and assisting with appeals under section
256.045; and

(5) coordinating, evaluating, and monitoring of the services identified in the service
plan.

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including:

(1) finalizing the coordinated service and support plan;

(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved coordinated service and support plan; and

(3) adjustments to the coordinated service and support plan.

(c) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. Case management services must not
be provided to a recipient by a private agency that has any financial interest in the provision
of any other services included in the recipient's coordinated service and support plan. For
purposes of this section, "private agency" means any agency that is not identified as a lead
agency under section 256B.0911, subdivision 1a, paragraph (e).

(d) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

Sec. 53.

Minnesota Statutes 2018, section 256B.49, subdivision 14, is amended to read:


Subd. 14.

Assessment and reassessment.

(a) Assessments and reassessments shall be
conducted by certified assessors according to section 256B.0911, subdivision 2b. The
certified assessor, with the permission of the recipient or the recipient's designated legal
representative, may invite other individuals to attend the assessment. With the permission
of the recipient or the recipient's designated legal representative, the recipient's current
provider of services may submit a written report outlining their recommendations regarding
the recipient's care needs prepared by a direct service employee deleted text beginwith at least 20 hours of
service to that client. The certified assessor must notify the provider of the date by which
this information is to be submitted. This information shall be provided to the certified
assessor and the person or the person's legal representative and must be considered prior to
the finalization of the assessment or reassessment
deleted text endnew text begin who is familiar with the person. The
provider must submit the report at least 60 days before the end of the person's current service
agreement. The certified assessor must consider the content of the submitted report prior
to finalizing the person's assessment or reassessment
new text end.

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

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

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

Sec. 54.

Minnesota Statutes 2018, section 256B.4912, is amended by adding a subdivision
to read:


new text begin Subd. 1a. new text end

new text begin Annual labor market reporting. new text end

new text begin (a) As determined by the commissioner, a
provider of home and community-based services for the elderly under sections 256B.0913
and 256B.0915, home and community-based services for people with developmental
disabilities under section 256B.092, and home and community-based services for people
with disabilities under section 256B.49 shall submit data to the commissioner on the
following:
new text end

new text begin (1) number of direct-care staff;
new text end

new text begin (2) wages of direct-care staff;
new text end

new text begin (3) hours worked by direct-care staff;
new text end

new text begin (4) overtime wages of direct-care staff;
new text end

new text begin (5) overtime hours worked by direct-care staff;
new text end

new text begin (6) benefits paid and accrued by direct-care staff;
new text end

new text begin (7) direct-care staff retention rates;
new text end

new text begin (8) direct-care staff job vacancies;
new text end

new text begin (9) amount of travel time paid;
new text end

new text begin (10) program vacancy rates; and
new text end

new text begin (11) other related data requested by the commissioner.
new text end

new text begin (b) The commissioner may adjust reporting requirements for a self-employed direct-care
staff.
new text end

new text begin (c) For the purposes of this subdivision, "direct-care staff" means employees, including
self-employed individuals and individuals directly employed by a participant in a
consumer-directed service delivery option, providing direct service provision to people
receiving services under this section. Direct-care staff does not include executive, managerial,
or administrative staff.
new text end

new text begin (d) This subdivision also applies to a provider of personal care assistance services under
section 256B.0625, subdivision 19a; community first services and supports under section
256B.85; nursing services and home health services under section 256B.0625, subdivision
6a; home care nursing services under section 256B.0625, subdivision 7; or day training and
habilitation services for residents of intermediate care facilities for persons with
developmental disabilities under section 256B.501.
new text end

new text begin (e) This subdivision also applies to financial management services providers for
participants who directly employ direct-care staff through consumer support grants under
section 256.476; the personal care assistance choice program under section 256B.0657,
subdivisions 18 to 20; community first services and supports under section 256B.85; and
the consumer-directed community supports option available under the alternative care
program, the brain injury waiver, the community alternative care waiver, the community
access for disability inclusion waiver, the developmental disabilities waiver, the elderly
waiver, and the Minnesota senior health option, except financial management services
providers are not required to submit the data listed in paragraph (a), clauses (7) to (11).
new text end

new text begin (f) The commissioner shall ensure that data submitted under this subdivision is not
duplicative of data submitted under any other section of this chapter or any other chapter.
new text end

new text begin (g) A provider shall submit the data annually on a date specified by the commissioner.
The commissioner shall give a provider at least 30 calendar days to submit the data. If a
provider fails to submit the requested data by the date specified by the commissioner, the
commissioner may delay medical assistance reimbursement until the requested data is
submitted.
new text end

new text begin (h) Individually identifiable data submitted to the commissioner in this section are
considered private data on an individual, as defined by section 13.02, subdivision 12.
new text end

new text begin (i) The commissioner shall analyze data annually for workforce assessments and how
the data impact service access.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 55.

Minnesota Statutes 2018, section 256B.4913, subdivision 4a, is amended to read:


Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).

(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:

(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the weighted
average authorized rate for the provider number in the county of service, effective December
1, 2013; or

(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or

(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:

(1) 0.5 percent from the historical rate for the implementation period;

(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);

(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);

(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);

(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4);new text begin and
new text end

(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. deleted text beginThe commissioner shall, upon enactment, seek federal approval for the
addition of this banding period; and
deleted text end

deleted text begin (7) one percent from the rate in effect in clause (6) for the 12-month period immediately
following the time period of clause (6).
deleted text end

(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.

(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.

(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:

(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;

(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and

(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).

(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.

new text begin EFFECTIVE DATE. new text end

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

Sec. 56.

Minnesota Statutes 2018, section 256B.4914, subdivision 2, is amended to read:


Subd. 2.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.

(b) "Commissioner" means the commissioner of human services.

new text begin (c) "Comparable occupations" means the occupations, excluding direct care staff, as
represented by the Bureau of Labor Statistics standard occupational classification codes
that have the same classification for:
new text end

new text begin (1) typical education needed for entry;
new text end

new text begin (2) work experience in a related occupation; and
new text end

new text begin (3) typical on-the-job training competency as the most predominant classification for
direct care staff.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.

deleted text begin (d)deleted text endnew text begin (e)new text end "Customized living tool" means a methodology for setting service rates that
delineates and documents the amount of each component service included in a recipient's
customized living service plan.

new text begin (f) "Direct care staff" means employees providing direct service to people receiving
services under this section. Direct care staff excludes executive, managerial, and
administrative staff.
new text end

deleted text begin (e)deleted text endnew text begin (g)new text end "Disability waiver rates system" means a statewide system that establishes rates
that are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.

deleted text begin (f)deleted text endnew text begin (h)new text end "Individual staffing" means the time spent as a one-to-one interaction specific to
an individual recipient by staff to provide direct support and assistance with activities of
daily living, instrumental activities of daily living, and training to participants, and is based
on the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.

deleted text begin (g)deleted text endnew text begin (i)new text end "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.

deleted text begin (h)deleted text endnew text begin (j)new text end "Median" means the amount that divides distribution into two equal groups,
one-half above the median and one-half below the median.

deleted text begin (i)deleted text endnew text begin (k)new text end "Payment or rate" means reimbursement to an eligible provider for services
provided to a qualified individual based on an approved service authorization.

deleted text begin (j)deleted text endnew text begin (l)new text end "Rates management system" means a web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.

deleted text begin (k)deleted text endnew text begin (m)new text end "Recipient" means a person receiving home and community-based services
funded under any of the disability waivers.

deleted text begin (l)deleted text endnew text begin (n)new text end "Shared staffing" means time spent by employees, not defined under paragraph
(f), providing or available to provide more than one individual with direct support and
assistance with activities of daily living as defined under section 256B.0659, subdivision
1
, paragraph (b); instrumental activities of daily living as defined under section 256B.0659,
subdivision 1, paragraph (i); ancillary activities needed to support individual services; and
training to participants, and is based on the requirements in each individual's coordinated
service and support plan under section 245D.02, subdivision 4b; any coordinated service
and support plan addendum under section 245D.02, subdivision 4c; an assessment tool; and
provider observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.

deleted text begin (m)deleted text endnew text begin (o)new text end "Staffing ratio" means the number of recipients a service provider employee
supports during a unit of service based on a uniform assessment tool, provider observation,
case history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.

deleted text begin (n)deleted text endnew text begin (p)new text end "Unit of service" means the following:

(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;

(2) for day services under subdivision 7:

(i) for day training and habilitation services, a unit of service is either:

(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or

(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and

(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;

(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;

new text begin (iii) for day support services, a unit of service is 15 minutes; and
new text end

deleted text begin (iii)deleted text endnew text begin (iv)new text end for prevocational services, a unit of service is a day or deleted text beginan hourdeleted text endnew text begin 15 minutesnew text end. A
day unit of service is six or more hours of time spent providing direct service;

(3) for unit-based services with programming under subdivision 8:

(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and

(ii) for all other services, a unit of service is 15 minutes; and

(4) for unit-based services without programming under subdivision 9, a unit of service
is 15 minutes.

Sec. 57.

Minnesota Statutes 2018, section 256B.4914, subdivision 3, as amended by Laws
2019, chapter 50, article 2, section 1, is amended to read:


Subd. 3.

Applicable services.

Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:

(1) 24-hour customized living;

(2) adult day deleted text begincaredeleted text endnew text begin servicesnew text end;

(3) adult day deleted text begincaredeleted text endnew text begin servicesnew text end bath;

deleted text begin (4) behavioral programming;
deleted text end

deleted text begin (5)deleted text endnew text begin (4)new text end companion services;

new text begin (5) community residential services;
new text end

(6) customized living;

new text begin (7) day support services;
new text end

deleted text begin (7)deleted text endnew text begin (8)new text end day training and habilitation;

new text begin (9) employment development services;
new text end

new text begin (10) employment exploration services;
new text end

new text begin (11) employment support services;
new text end

new text begin (12) family residential services;
new text end

deleted text begin (8)deleted text endnew text begin (13)new text end housing access coordination;

deleted text begin (9)deleted text endnew text begin (14)new text end independent living skills;

new text begin (15) individualized home supports;
new text end

new text begin (16) individualized home supports with family training;
new text end

new text begin (17) individualized home supports with training;
new text end

deleted text begin (10)deleted text endnew text begin (18)new text end in-home family support;

new text begin (19) integrated community supports;
new text end

deleted text begin (11)deleted text endnew text begin (20)new text end night supervision;

deleted text begin (12)deleted text endnew text begin (21)new text end personal support;

new text begin (22) positive support services;
new text end

deleted text begin (13)deleted text endnew text begin (23)new text end prevocational services;

deleted text begin (14) residential care services;
deleted text end

deleted text begin (15)deleted text endnew text begin (24)new text end residential support services;

deleted text begin (16)deleted text endnew text begin (25)new text end respite services;

deleted text begin (17)deleted text endnew text begin (26)new text end structured day services;

deleted text begin (18)deleted text endnew text begin (27)new text end supported living services;

deleted text begin (19)deleted text endnew text begin (28)new text end transportation services;new text begin and
new text end

deleted text begin (20) individualized home supports;
deleted text end

deleted text begin (21) independent living skills specialist services;
deleted text end

deleted text begin (22) employment exploration services;
deleted text end

deleted text begin (23) employment development services;
deleted text end

deleted text begin (24) employment support services; and
deleted text end

deleted text begin (25)deleted text endnew text begin (29)new text end other services as approved by the federal government in the state home and
community-based services plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 58.

Minnesota Statutes 2018, section 256B.4914, subdivision 4, is amended to read:


Subd. 4.

Data collection for rate determination.

(a) Rates for applicable home and
community-based waivered services, including rate exceptions under subdivision 12, are
set by the rates management system.

deleted text begin (b) Data for services under section 256B.4913, subdivision 4a, shall be collected in a
manner prescribed by the commissioner.
deleted text end

deleted text begin (c)deleted text endnew text begin (b)new text end Data and information in the rates management system may be used to calculate
an individual's rate.

deleted text begin (d)deleted text endnew text begin (c)new text end Service providers, with information from the community support plan and
oversight by lead agencies, shall provide values and information needed to calculate an
individual's rate into the rates management system. The determination of service levels must
be part of a discussion with members of the support team as defined in section 245D.02,
subdivision 34
. This discussion must occur prior to the final establishment of each individual's
rate. The values and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

(6) information to document variable levels of service qualification for variable levels
of reimbursement in each framework;

(7) shared or individualized arrangements for unit-based services, including the staffing
ratio;

(8) number of trips and miles for transportation services; and

(9) service hours provided through monitoring technology.

deleted text begin (e)deleted text endnew text begin (d)new text end Updates to individual data must include:

(1) data for each individual that is updated annually when renewing service plans; and

(2) requests by individuals or lead agencies to update a rate whenever there is a change
in an individual's service needs, with accompanying documentation.

deleted text begin (f)deleted text endnew text begin (e)new text end Lead agencies shall review and approve all services reflecting each individual's
needs, and the values to calculate the final payment rate for services with variables under
subdivisions 6, 7, 8, and 9 for each individual. Lead agencies must notify the individual and
the service provider of the final agreed-upon values and rate, and provide information that
is identical to what was entered into the rates management system. If a value used was
mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead
agencies to correct it. Lead agencies must respond to these requests. When responding to
the request, the lead agency must consider:

(1) meeting the health and welfare needs of the individual or individuals receiving
services by service site, identified in their coordinated service and support plan under section
245D.02, subdivision 4b, and any addendum under section 245D.02, subdivision 4c;

(2) meeting the requirements for staffing under subdivision 2, paragraphs deleted text begin(f)deleted text endnew text begin (h)new text end, deleted text begin(i)deleted text endnew text begin (n)new text end,
and deleted text begin(m)deleted text endnew text begin (o)new text end; and meeting or exceeding the licensing standards for staffing required under
section 245D.09, subdivision 1; and

(3) meeting the staffing ratio requirements under subdivision 2, paragraph deleted text begin(n)deleted text endnew text begin (o)new text end, and
meeting or exceeding the licensing standards for staffing required under section 245D.31.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 59.

Minnesota Statutes 2018, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index and standard component values.

(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

new text begin (2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);
new text end

deleted text begin (2)deleted text endnew text begin (3)new text end for day services, new text beginday support services, and prevocational services, new text end20 percent of
the median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage
for psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for
social and human services aide (SOC code 21-1093);

deleted text begin (3)deleted text endnew text begin (4)new text end for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;

deleted text begin (4)deleted text endnew text begin (5)new text end for deleted text beginbehavior programdeleted text endnew text begin positive supportsnew text end analyst staff, 100 percent of the median
wage for mental health counselors (SOC code 21-1014);

deleted text begin (5)deleted text endnew text begin (6)new text end for deleted text beginbehavior programdeleted text endnew text begin positive supportsnew text end professional staff, 100 percent of the
median wage for clinical counseling and school psychologist (SOC code 19-3031);

deleted text begin (6)deleted text endnew text begin (7)new text end for deleted text beginbehavior programdeleted text endnew text begin positive supportsnew text end specialist staff, 100 percent of the median
wage for psychiatric technicians (SOC code 29-2053);

deleted text begin (7)deleted text endnew text begin (8)new text end for supportive living services staff, 20 percent of the median wage for nursing
assistant (SOC code 31-1014); 20 percent of the median wage for psychiatric technician
(SOC code 29-2053); and 60 percent of the median wage for social and human services
aide (SOC code 21-1093);

deleted text begin (8)deleted text endnew text begin (9)new text end for housing access coordination staff, 100 percent of the median wage for
community and social services specialist (SOC code 21-1099);

deleted text begin (9)deleted text endnew text begin (10)new text end for in-home family support new text beginand individualized home supports with family
training
new text endstaff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30
percent of the median wage for community social service specialist (SOC code 21-1099);
40 percent of the median wage for social and human services aide (SOC code 21-1093);
and ten percent of the median wage for psychiatric technician (SOC code 29-2053);

deleted text begin (10)deleted text endnew text begin (11)new text end for individualized home supports new text beginwith training new text endservices staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);

deleted text begin (11)deleted text endnew text begin (12)new text end for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

deleted text begin (12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);
deleted text end

deleted text begin (13) for supported employment staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
deleted text end

deleted text begin (14)deleted text endnew text begin (13)new text end for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

deleted text begin (15)deleted text endnew text begin (14)new text end for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

deleted text begin (16)deleted text endnew text begin (15)new text end for employment development services staff, 50 percent of the median wage
for education, guidance, school, and vocational counselors (SOC code 21-1012); and 50
percent of the median wage for community and social services specialist (SOC code
21-1099);

new text begin (16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);
new text end

(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);

(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);

(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);

(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of deleted text beginbehaviordeleted text endnew text begin
positive supports
new text end professional, deleted text beginbehaviordeleted text endnew text begin positive supportsnew text end analyst, and deleted text beginbehaviordeleted text endnew text begin positive
supports
new text end specialists, which is 100 percent of the median wage for clinical counseling and
school psychologist (SOC code 19-3031);

(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and

(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).

(b) Component values for deleted text beginresidentialdeleted text endnew text begin corporate foster care services, corporate supportive
living services daily, community residential services, and integrated community
new text end support
services are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end general administrative support ratio: 13.25 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end program-related expense ratio: 1.3 percent; and

deleted text begin (6)deleted text endnew text begin (7)new text end absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end general administrative support ratio: 3.3 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end program-related expense ratio: 1.3 percent; and

deleted text begin (6)deleted text endnew text begin (7)new text end absence factor: 1.7 percent.

(d) Component values for day deleted text beginservices for all servicesdeleted text endnew text begin training and habilitation, day
support services, and prevocational services
new text end are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end program plan support ratio: 5.6 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end client programming and support ratio: ten percent;

deleted text begin (6)deleted text endnew text begin (7)new text end general administrative support ratio: 13.25 percent;

deleted text begin (7)deleted text endnew text begin (8)new text end program-related expense ratio: 1.8 percent; and

deleted text begin (8)deleted text endnew text begin (9)new text end absence and utilization factor ratio: 9.4 percent.

new text begin (e) Component values for adult day services are:
new text end

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

new text begin (2) supervisory span of control ratio: 11 percent;
new text end

new text begin (3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end

new text begin (4) employee-related cost ratio: 23.6 percent;
new text end

new text begin (5) program plan support ratio: 5.6 percent;
new text end

new text begin (6) client programming and support ratio: 7.4 percent;
new text end

new text begin (7) general administrative support ratio: 13.25 percent;
new text end

new text begin (8) program-related expense ratio: 1.8 percent; and
new text end

new text begin (9) absence and utilization factor ratio: 9.4 percent.
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end Component values for unit-based services with programming are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end program plan supports ratio: 15.5 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end client programming and supports ratio: 4.7 percent;

deleted text begin (6)deleted text endnew text begin (7)new text end general administrative support ratio: 13.25 percent;

deleted text begin (7)deleted text endnew text begin (8)new text end program-related expense ratio: 6.1 percent; and

deleted text begin (8)deleted text endnew text begin (9)new text end absence and utilization factor ratio: 3.9 percent.

deleted text begin (f)deleted text endnew text begin (g)new text end Component values for unit-based services without programming except respite
are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end program plan support ratio: 7.0 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end client programming and support ratio: 2.3 percent;

deleted text begin (6)deleted text endnew text begin (7)new text end general administrative support ratio: 13.25 percent;

deleted text begin (7)deleted text endnew text begin (8)new text end program-related expense ratio: 2.9 percent; and

deleted text begin (8)deleted text endnew text begin (9)new text end absence and utilization factor ratio: 3.9 percent.

deleted text begin (g)deleted text endnew text begin (h)new text end Component values for unit-based services without programming for respite are:

new text begin (1) competitive workforce factor: 4.7 percent;
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end supervisory span of control ratio: 11 percent;

deleted text begin (2)deleted text endnew text begin (3)new text end employee vacation, sick, and training allowance ratio: 8.71 percent;

deleted text begin (3)deleted text endnew text begin (4)new text end employee-related cost ratio: 23.6 percent;

deleted text begin (4)deleted text endnew text begin (5)new text end general administrative support ratio: 13.25 percent;

deleted text begin (5)deleted text endnew text begin (6)new text end program-related expense ratio: 2.9 percent; and

deleted text begin (6)deleted text endnew text begin (7)new text end absence and utilization factor ratio: 3.9 percent.

deleted text begin (h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system.
deleted text endnew text begin (i)new text end On July 1, 2022, and every deleted text beginfivedeleted text endnew text begin
two
new text end years thereafter, the commissioner shall update the base wage index in paragraph (a)
based on deleted text beginthe most recently availabledeleted text end wage data by SOC from the Bureau of Labor Statisticsnew text begin
available 30 months and one day prior to the scheduled update
new text end. The commissioner shall
publish these updated values and load them into the rate management system.

new text begin (j) Beginning February 1, 2021, and every two years thereafter, the commissioner shall
report to the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over health and human services policy and finance an analysis of the
competitive workforce factor. The report must include recommendations to update the
competitive workforce factor using:
new text end

new text begin (1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
new text end

new text begin (2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
new text end

new text begin (3) workforce data as required under subdivision 10a, paragraph (g).
new text end

new text begin The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
new text end

deleted text begin (i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f), clause (5); subdivision
6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17), for changes in the
Consumer Price Index. The commissioner will adjust these values higher or lower by the
percentage change in the Consumer Price Index-All Items, United States city average
(CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall publish these
updated values and load them into the rate management system.
deleted text endnew text begin (k)new text end On July 1, 2022, and
every deleted text beginfivedeleted text endnew text begin twonew text end years thereafter, the commissioner shall update the framework components
in paragraph (d), clause deleted text begin(5)deleted text endnew text begin (6)new text end; new text beginparagraph (e), clause (6); new text endparagraph deleted text begin(e)deleted text endnew text begin (f)new text end, clause deleted text begin(5)deleted text endnew text begin (6)new text end;
and paragraph deleted text begin(f)deleted text endnew text begin (g)new text end, clause deleted text begin(5)deleted text endnew text begin (6)new text end; subdivision 6,new text begin paragraphs (b),new text end clauses deleted text begin(8)deleted text endnew text begin (9)new text end and deleted text begin(9)deleted text endnew text begin
(10), and (e), clause (10)
new text end; and subdivision 7, clauses deleted text begin(10)deleted text endnew text begin (11)new text end, deleted text begin(16)deleted text endnew text begin (17)new text end, and deleted text begin(17)deleted text endnew text begin (18)new text end, for
changes in the Consumer Price Index. The commissioner shall adjust these values higher
or lower by the percentage change in the CPI-U from the date of the previous update to the
deleted text begin date of thedeleted text end data deleted text beginmost recentlydeleted text end available new text begin30 months and one day new text endprior to the scheduled update.
The commissioner shall publish these updated values and load them into the rate management
system.

new text begin (l) Upon the implementation of the updates under paragraphs (i) and (k), rate adjustments
authorized under section 256B.439, subdivision 7; Laws 2013, chapter 108, article 7, section
60; and Laws 2014, chapter 312, article 27, section 75, shall be removed from service rates
calculated under this section.
new text end

new text begin (m) Any rate adjustments applied to the service rates calculated under this section outside
of the cost components and rate methodology specified in this section shall be removed
from rate calculations upon implementation of the updates under paragraphs (i) and (k).
new text end

deleted text begin (j)deleted text endnew text begin (n)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, or upon federal approval,
except:
new text end

new text begin (1) paragraph (b), clause (1); paragraph (c), clause (1); paragraph (d), clause (1);
paragraph (f), clause (1); paragraph (g), clause (1); and paragraph (h), clause (1), are effective
January 1, 2020, or upon federal approval, whichever is later;
new text end

new text begin (2) paragraphs (i) and (k) are effective July 1, 2022, or upon federal approval, whichever
is later; and
new text end

new text begin (3) paragraph (l) is effective retroactively from July 1, 2018.
new text end

new text begin The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained or denied.
new text end

Sec. 60.

Minnesota Statutes 2018, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a) deleted text beginPayments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:
deleted text endnew text begin For purposes of this subdivision, residential support services
includes 24-hour customized living services, community residential services, customized
living services, family residential services, foster care services, integrated community
supports, and supportive living services daily.
new text end

new text begin (b) Payments for community residential services, corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services
must be calculated as follows:
new text end

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5deleted text begin. This is defined as the direct-care ratedeleted text end;

new text begin (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
new text end

deleted text begin (3)deleted text endnew text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin(2)deleted text endnew text begin (3)new text enddeleted text begin. This is defined as the customized direct-care ratedeleted text end;

deleted text begin (4)deleted text endnew text begin (5)new text end multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the appropriate staff wages deleted text beginin
subdivision 5, paragraph (a), or the customized direct-care rate
deleted text end;

deleted text begin (5)deleted text endnew text begin (6)new text end multiply the number of shared and individual direct staff hours provided on site
or through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause deleted text begin(1)deleted text endnew text begin (2)new text end, and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);

deleted text begin (6)deleted text endnew text begin (7)new text end combine the results of clauses deleted text begin(4) anddeleted text end (5) new text beginand (6)new text end, excluding any shared and
individual direct staff hours provided through monitoring technology, and multiply the
result by one plus the employee vacation, sick, and training allowance ratio in subdivision
5, paragraph (b), clause deleted text begin(2)deleted text endnew text begin (3)new text end. This is defined as the direct staffing cost;

deleted text begin (7)deleted text endnew text begin (8)new text end for employee-related expenses, multiply the direct staffing cost, excluding any
shared and individual direct staff hours provided through monitoring technology, by one
plus the employee-related cost ratio in subdivision 5, paragraph (b), clause deleted text begin(3)deleted text endnew text begin (4)new text end;

deleted text begin (8)deleted text endnew text begin (9)new text end for client programming and supports, the commissioner shall add $2,179; and

deleted text begin (9)deleted text endnew text begin (10)new text end for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

deleted text begin (b)deleted text endnew text begin (c)new text end The total rate must be calculated using the following steps:

(1) subtotal paragraph deleted text begin(a)deleted text endnew text begin (b)new text end, clauses deleted text begin(7) to (9)deleted text endnew text begin (8) to (10)new text end, and the direct staffing cost
of any shared and individual direct staff hours provided through monitoring technology that
was excluded in clause deleted text begin(7)deleted text endnew text begin (8)new text end;

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

deleted text begin (c)deleted text endnew text begin (d)new text end The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.

new text begin (e) Payments for integrated community support services must be calculated as follows:
new text end

new text begin (1) the base shared staffing shall be eight hours divided by the number of people receiving
support in the integrated community support setting;
new text end

new text begin (2) the individual staffing hours shall be the average number of direct support hours
provided directly to the service recipient;
new text end

new text begin (3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;
new text end

new text begin (4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
new text end

new text begin (5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);
new text end

new text begin (6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;
new text end

new text begin (7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);
new text end

new text begin (8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;
new text end

new text begin (9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
new text end

new text begin (10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
new text end

new text begin (f) The total rate must be calculated as follows:
new text end

new text begin (1) add the results of paragraph (e), clauses (9) and (10);
new text end

new text begin (2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
new text end

new text begin (3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
new text end

new text begin (4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
new text end

new text begin (g) The payment methodology for customized living and 24-hour customized living
services must be the customized living tool. The commissioner shall revise the customized
living tool to reflect the services and activities unique to disability-related recipient needs
and adjust for regional differences in the cost of providing services.
new text end

deleted text begin (d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
deleted text end

deleted text begin (e)deleted text endnew text begin (h)new text end The number of days authorized for all individuals enrolling deleted text beginafter January 1, 2014,deleted text end
in residential services must include every day that services start and end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later, except paragraphs (e) to (g) are effective January 1, 2021, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 61.

Minnesota Statutes 2018, section 256B.4914, subdivision 7, is amended to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day deleted text begincaredeleted text endnew text begin servicesnew text end, day treatment and habilitation, new text beginday support services,
new text end prevocational services, and structured day services must be calculated as follows:

(1) determine the number of units of service and staffing ratio to meet a recipient's needs:

(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and

(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

new text begin (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);
new text end

deleted text begin (3)deleted text endnew text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin(2)deleted text endnew text begin (3)new text enddeleted text begin. This is defined as the customized direct-care ratedeleted text end;

deleted text begin (4)deleted text endnew text begin (5)new text end multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage deleted text beginin subdivision 5, paragraph (a), or the customized direct-care ratedeleted text end;

deleted text begin (5)deleted text endnew text begin (6)new text end multiply the number of day direct staff hours by the product of the supervision
span of control ratio in subdivision 5, paragraph (d), clause deleted text begin(1)deleted text endnew text begin (2)new text end, and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);

deleted text begin (6)deleted text endnew text begin (7)new text end combine the results of clauses deleted text begin(4) anddeleted text end (5)new text begin and (6)new text end, and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
(d), clause deleted text begin(2)deleted text endnew text begin (3)new text end. This is defined as the direct staffing rate;

deleted text begin (7)deleted text endnew text begin (8)new text end for program plan support, multiply the result of clause deleted text begin(6)deleted text endnew text begin (7)new text end by one plus the
program plan support ratio in subdivision 5, paragraph (d), clause deleted text begin(4)deleted text endnew text begin (5)new text end;

deleted text begin (8)deleted text endnew text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin(7)deleted text endnew text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph (d), clause deleted text begin(3)deleted text endnew text begin (4)new text end;

deleted text begin (9)deleted text endnew text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin(8)deleted text endnew text begin (9)new text end by
one plus the client programming and support ratio in subdivision 5, paragraph (d), clause
deleted text begin (5)deleted text endnew text begin (6)new text end;

deleted text begin (10)deleted text endnew text begin (11)new text end for program facility costs, add $19.30 per week with consideration of staffing
ratios to meet individual needs;

deleted text begin (11)deleted text endnew text begin (12)new text end for adult day bath services, add $7.01 per 15 minute unit;

deleted text begin (12)deleted text endnew text begin (13)new text end this is the subtotal rate;

deleted text begin (13)deleted text endnew text begin (14)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

deleted text begin (14)deleted text endnew text begin (15)new text end divide the result of clause deleted text begin(12)deleted text endnew text begin (13)new text end by one minus the result of clause deleted text begin(13)deleted text endnew text begin (14)new text end.
This is the total payment amount;

deleted text begin (15)deleted text endnew text begin (16)new text end adjust the result of clause deleted text begin(14)deleted text endnew text begin (15)new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services;

deleted text begin (16)deleted text endnew text begin (17)new text end for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

deleted text begin (17)deleted text endnew text begin (18)new text end for transportation provided as part of day training and habilitation for an
individual who does require a lift, add:

(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;

(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;

(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or

(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later, except the service name changes are effective January 1, 2021, or upon
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end

Sec. 62.

Minnesota Statutes 2018, section 256B.4914, subdivision 8, is amended to read:


Subd. 8.

Payments for unit-based services with programming.

Payments for unit-based
services with programming, including deleted text beginbehavior programmingdeleted text endnew text begin employment exploration
services, employment development services
new text end, housing access coordination, new text beginindividualized
home supports with family training, individualized home supports with training,
new text endin-home
family support, independent living skills training, deleted text beginindependent living skills specialist services,
individualized home supports, hourly supported living services, employment exploration
services, employment development services, supported employment, and employment
support
deleted text endnew text begin and hourly supported livingnew text end services provided to an individual outside of any day
or residential service plan must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:

(1) determine the number of units of service to meet a recipient's needs;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

new text begin (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (f), clause (1);
new text end

deleted text begin (3)deleted text endnew text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin(2)deleted text endnew text begin (3)new text enddeleted text begin. This is defined as the customized direct-care ratedeleted text end;

deleted text begin (4)deleted text endnew text begin (5)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text beginin
subdivision 5, paragraph (a), or the customized direct-care rate
deleted text end;

deleted text begin (5)deleted text endnew text begin (6)new text end multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph deleted text begin(e)deleted text endnew text begin (f)new text end, clause deleted text begin(1)deleted text endnew text begin (2)new text end, and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);

deleted text begin (6)deleted text endnew text begin (7)new text end combine the results of clauses deleted text begin(4) anddeleted text end (5)new text begin and (6)new text end, and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
deleted text begin (e)deleted text endnew text begin (f)new text end, clause deleted text begin(2)deleted text endnew text begin (3)new text end. This is defined as the direct staffing rate;

deleted text begin (7)deleted text endnew text begin (8)new text end for program plan support, multiply the result of clause deleted text begin(6)deleted text endnew text begin (7)new text end by one plus the
program plan supports ratio in subdivision 5, paragraph deleted text begin(e)deleted text endnew text begin (f)new text end, clause deleted text begin(4)deleted text endnew text begin (5)new text end;

deleted text begin (8)deleted text endnew text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin(7)deleted text endnew text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph deleted text begin(e)deleted text endnew text begin (f)new text end, clause deleted text begin(3)deleted text endnew text begin (4)new text end;

deleted text begin (9)deleted text endnew text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin(8)deleted text endnew text begin (9)new text end by
one plus the client programming and supports ratio in subdivision 5, paragraph deleted text begin(e)deleted text endnew text begin (f)new text end, clause
deleted text begin (5)deleted text endnew text begin (6)new text end;

deleted text begin (10)deleted text endnew text begin (11)new text end this is the subtotal rate;

deleted text begin (11)deleted text endnew text begin (12)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

deleted text begin (12)deleted text endnew text begin (13)new text end divide the result of clause deleted text begin(10)deleted text endnew text begin (11)new text end by one minus the result of clause deleted text begin(11)deleted text endnew text begin (12)new text end.
This is the total payment amount;

deleted text begin (13)deleted text endnew text begin (14)new text end for deleted text beginsupporteddeleted text end employment new text beginexploration services new text endprovided in a shared manner,
divide the total payment amount in clause deleted text begin(12)deleted text endnew text begin (13)new text end by the number of service recipients, not
to exceed deleted text beginthreedeleted text endnew text begin fivenew text end. For employment support services provided in a shared manner, divide
the total payment amount in clause deleted text begin(12)deleted text endnew text begin (13)new text end by the number of service recipients, not to
exceed six. For independent living skills training deleted text beginanddeleted text endnew text begin,new text end individualized home supportsnew text begin with
training, and individualized home supports with family training
new text end provided in a shared manner,
divide the total payment amount in clause deleted text begin(12)deleted text endnew text begin (13)new text end by the number of service recipients, not
to exceed two; and

deleted text begin (14)deleted text endnew text begin (15)new text end adjust the result of clause deleted text begin(13)deleted text endnew text begin (14)new text end by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 63.

Minnesota Statutes 2018, section 256B.4914, subdivision 9, is amended to read:


Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, including new text beginindividualized home supports, new text endnight
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plan must be calculated as follows unless the services are
authorized separately under subdivision 6 or 7:

(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

new text begin (3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (g), clause (1);
new text end

deleted text begin (3)deleted text endnew text begin (4)new text end for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause deleted text begin(2)deleted text endnew text begin (3)new text enddeleted text begin. This is defined as the customized direct care ratedeleted text end;

deleted text begin (4)deleted text endnew text begin (5)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text beginin
subdivision 5 or the customized direct care rate
deleted text end;

deleted text begin (5)deleted text endnew text begin (6)new text end multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph deleted text begin(f)deleted text endnew text begin (g)new text end, clause deleted text begin(1)deleted text endnew text begin (2)new text end, and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);

deleted text begin (6)deleted text endnew text begin (7)new text end combine the results of clauses deleted text begin(4) anddeleted text end (5)new text begin and (6)new text end, and multiply the result by one
plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
deleted text begin (f)deleted text endnew text begin (g)new text end, clause deleted text begin(2)deleted text endnew text begin (3)new text end. This is defined as the direct staffing rate;

deleted text begin (7)deleted text endnew text begin (8)new text end for program plan support, multiply the result of clause deleted text begin(6)deleted text endnew text begin (7)new text end by one plus the
program plan support ratio in subdivision 5, paragraph deleted text begin(f)deleted text endnew text begin (g)new text end, clause deleted text begin(4)deleted text endnew text begin (5)new text end;

deleted text begin (8)deleted text endnew text begin (9)new text end for employee-related expenses, multiply the result of clause deleted text begin(7)deleted text endnew text begin (8)new text end by one plus
the employee-related cost ratio in subdivision 5, paragraph deleted text begin(f)deleted text endnew text begin (g)new text end, clause deleted text begin(3)deleted text endnew text begin (4)new text end;

deleted text begin (9)deleted text endnew text begin (10)new text end for client programming and supports, multiply the result of clause deleted text begin(8)deleted text endnew text begin (9)new text end by
one plus the client programming and support ratio in subdivision 5, paragraph deleted text begin(f)deleted text endnew text begin (g)new text end, clause
deleted text begin (5)deleted text endnew text begin (6)new text end;

deleted text begin (10)deleted text endnew text begin (11)new text end this is the subtotal rate;

deleted text begin (11)deleted text endnew text begin (12)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

deleted text begin (12)deleted text endnew text begin (13)new text end divide the result of clause deleted text begin(10)deleted text endnew text begin (11)new text end by one minus the result of clause deleted text begin(11)deleted text endnew text begin (12)new text end.
This is the total payment amount;

deleted text begin (13)deleted text endnew text begin (14)new text end for respite services, determine the number of day units of service to meet an
individual's needs;

deleted text begin (14)deleted text endnew text begin (15)new text end personnel hourly wage rates must be based on the 2009 Bureau of Labor
Statistics Minnesota-specific rate or rates derived by the commissioner as provided in
subdivision 5;

new text begin (16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph (h), clause (1);
new text end

deleted text begin (15)deleted text endnew text begin (17)new text end for a recipient requiring deaf and hard-of-hearing customization under
subdivision 12, add the customization rate provided in subdivision 12 to the result of clause
deleted text begin (14)deleted text endnew text begin (16)new text enddeleted text begin. This is defined as the customized direct care ratedeleted text end;

deleted text begin (16)deleted text endnew text begin (18)new text end multiply the number of direct staff hours by the appropriate staff wage deleted text beginin
subdivision 5, paragraph (a)
deleted text end;

deleted text begin (17)deleted text endnew text begin (19)new text end multiply the number of direct staff hours by the product of the supervisory
span of control ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause deleted text begin(1)deleted text endnew text begin (2)new text end, and the appropriate
supervision wage in subdivision 5, paragraph (a), clause (21);

deleted text begin (18)deleted text endnew text begin (20)new text end combine the results of clauses deleted text begin(16)deleted text endnew text begin (18)new text end and deleted text begin(17)deleted text endnew text begin (19)new text end, and multiply the result
by one plus the employee vacation, sick, and training allowance ratio in subdivision 5,
paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause deleted text begin(2)deleted text endnew text begin (3)new text end. This is defined as the direct staffing rate;

deleted text begin (19)deleted text endnew text begin (21)new text end for employee-related expenses, multiply the result of clause deleted text begin(18)deleted text endnew text begin (20)new text end by one
plus the employee-related cost ratio in subdivision 5, paragraph deleted text begin(g)deleted text endnew text begin (h)new text end, clause deleted text begin(3)deleted text endnew text begin (4)new text end;

deleted text begin (20)deleted text endnew text begin (22)new text end this is the subtotal rate;

deleted text begin (21)deleted text endnew text begin (23)new text end sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;

deleted text begin (22)deleted text endnew text begin (24)new text end divide the result of clause deleted text begin(20)deleted text endnew text begin (22)new text end by one minus the result of clause deleted text begin(21)deleted text endnew text begin (23)new text end.
This is the total payment amount; deleted text beginand
deleted text end

new text begin (25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
new text end

new text begin (26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
new text end

deleted text begin (23)deleted text endnew text begin (27)new text end adjust the result of clauses deleted text begin(12) and (22)deleted text endnew text begin (13), (25), and (26)new text end by a factor to be
determined by the commissioner to adjust for regional differences in the cost of providing
services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later, except the service name change is effective January 1, 2021, or upon
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end

Sec. 64.

Minnesota Statutes 2018, section 256B.4914, subdivision 10, is amended to read:


Subd. 10.

Updating payment values and additional information.

deleted text begin (a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.
deleted text end

deleted text begin (b) No later than July 1, 2014,deleted text endnew text begin (a)new text end The commissioner shall, within available resources,
deleted text begin begin todeleted text end conduct research and gather data and information from existing state systems or
other outside sources on the following items:

(1) differences in the underlying cost to provide services and care across the state; and

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

deleted text begin (c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a
. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018.
deleted text end

deleted text begin (d)deleted text endnew text begin (b)new text end No later than July 1, 2014, the commissioner, in consultation with stakeholders,
shall begin the review and evaluation of the following values already in subdivisions 6 to
9, or issues that impact all services, including, but not limited to:

(1) values for transportation rates;

(2) values for services where monitoring technology replaces staff time;

(3) values for indirect services;

(4) values for nursing;

(5) values for the facility use rate in day services, and the weightings used in the day
service ratios and adjustments to those weightings;

(6) values for workers' compensation as part of employee-related expenses;

(7) values for unemployment insurance as part of employee-related expenses;

(8)new text begin direct care workforce labor market measures;
new text end

new text begin (9)new text end any changes in state or federal law with a direct impact on the underlying cost of
providing home and community-based services; deleted text beginand
deleted text end

deleted text begin (9)deleted text endnew text begin (10)new text end outcome measures, determined by the commissioner, for home and
community-based services rates determined under this sectiondeleted text begin.deleted text endnew text begin; and
new text end

new text begin (11) different competitive workforce factors by service, as determined under subdivision
5, paragraph (j).
new text end

deleted text begin (e)deleted text endnew text begin (c)new text end The commissioner shall report to the chairs and the ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs deleted text begin(b) to (d)deleted text endnew text begin (a)
and (b)
new text end on deleted text beginthe following dates:
deleted text end

deleted text begin (1) January 15, 2015, with preliminary results and data;
deleted text end

deleted text begin (2) January 15, 2016, with a status implementation update, and additional data and
summary information;
deleted text end

deleted text begin (3) January 15, 2017, with the full report; and
deleted text end

deleted text begin (4)deleted text end January 15, deleted text begin2020deleted text endnew text begin 2021new text end, with deleted text beginanotherdeleted text endnew text begin anew text end full report, and a full report once every four
years thereafter.

deleted text begin (f) The commissioner shall implement a regional adjustment factor to all rate calculations
in subdivisions 6 to 9, effective no later than January 1, 2015.
deleted text endnew text begin (d)new text end Beginning deleted text beginJuly 1, 2017deleted text endnew text begin
July 1, 2022
new text end, the commissioner shall renew analysis and implement changes to the regional
adjustment factors deleted text beginwhen adjustments required under subdivision 5, paragraph (h), occurdeleted text endnew text begin
once every six years
new text end. Prior to implementation, the commissioner shall consult with
stakeholders on the methodology to calculate the adjustment.

deleted text begin (g)deleted text endnew text begin (e)new text end The commissioner shall provide a public notice via LISTSERV in October of
each year deleted text beginbeginning October 1, 2014,deleted text end containing information detailing legislatively approved
changes in:

(1) calculation values including derived wage rates and related employee and
administrative factors;

(2) service utilization;

(3) county and tribal allocation changes; and

(4) information on adjustments made to calculation values and the timing of those
adjustments.

The information in this notice must be effective January 1 of the following year.

deleted text begin (h)deleted text endnew text begin (f)new text end When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
deleted text begin or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f),
deleted text end then individual staffing hours
shall be used.

deleted text begin (i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.
deleted text end

deleted text begin (j) Beginning July 1, 2017,deleted text endnew text begin (g)new text end The commissioner shall collect transportation and trip
information for all day services through the rates management system.

new text begin (h) The commissioner, in consultation with stakeholders, shall study value-based models
and outcome-based payment strategies for fee-for-service home and community-based
services and report to the legislative committees with jurisdiction over the disability waiver
rate system by October 1, 2020, with recommended strategies to: (1) promote new models
of care, services, and reimbursement structures that require more efficient use of public
dollars while improving the outcomes most valued by the individuals served; (2) assist
clients and their families in evaluating options and stretching individual budget funds; (3)
support individualized, person-centered planning and individual budget choices; and (4)
create a broader range of client options geographically or targeted at culturally competent
models for racial and ethnic minority groups.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment, except
the amendment to paragraph (f) is effective January 1, 2020.
new text end

Sec. 65.

Minnesota Statutes 2018, section 256B.4914, subdivision 10a, is amended to
read:


Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9 reflect the cost to provide the
service. As determined by the commissioner, in consultation with stakeholders identified
in deleted text beginsection 256B.4913,deleted text end subdivision deleted text begin5deleted text endnew text begin 17new text end, a provider enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner to support
research on the cost of providing services that have rates determined by the disability waiver
rates system. Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.

(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.

(d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders identified in deleted text beginsection 256B.4913,deleted text end subdivision deleted text begin5deleted text endnew text begin 17new text end, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, deleted text begin2020deleted text endnew text begin 2021new text end. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph deleted text begin(e)deleted text endnew text begin (c)new text end. The commissioner shall release cost data in an aggregate
form, and cost data from individual providers shall not be released except as provided for
in current law.

(e) The commissioner, in consultation with stakeholders identified in deleted text beginsection 256B.4913,deleted text end
subdivision deleted text begin5deleted text endnew text begin 17new text end, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (a).

new text begin (f) By December 31, 2020, providers paid with rates calculated under subdivision 5,
paragraph (b), shall identify additional revenues from the competitive workforce factor and
prepare a written distribution plan for the revenues. A provider shall make the provider's
distribution plan available and accessible to all direct care staff for a minimum of one
calendar year. Upon request, a provider shall submit the written distribution plan to the
commissioner.
new text end

new text begin (g) Providers enrolled to provide services with rates determined under section 256B.4914,
subdivision 3, shall submit labor market data to the commissioner annually on or before
November 1, including but not limited to:
new text end

new text begin (1) number of direct care staff;
new text end

new text begin (2) wages of direct care staff;
new text end

new text begin (3) overtime wages of direct care staff;
new text end

new text begin (4) hours worked by direct care staff;
new text end

new text begin (5) overtime hours worked by direct care staff;
new text end

new text begin (6) benefits provided to direct care staff;
new text end

new text begin (7) direct care staff job vacancies; and
new text end

new text begin (8) direct care staff retention rates.
new text end

new text begin (h) The commissioner shall publish annual reports on provider and state-level labor
market data, including but not limited to the data obtained under paragraph (g).
new text end

new text begin (i) The commissioner may temporarily suspend payments to the provider if data requested
under paragraph (g) is not received 90 days after the required submission date. Withheld
payments shall be made once data is received by the commissioner.
new text end

new text begin (j) Providers who receive payment under this section for less than 25 percent of their
clients in the year prior to the report may attest to the commissioner in a manner determined
by the commissioner that they are declining to provide the data required under paragraph
(g) and will not be subject to the payment suspension in paragraph (i).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment except
paragraph (g) is effective November 1, 2019, and paragraph (h) is effective February 1,
2020.
new text end

Sec. 66.

Minnesota Statutes 2018, section 256B.4914, subdivision 14, is amended to read:


Subd. 14.

Exceptions.

(a) In a format prescribed by the commissioner, lead agencies
must identify individuals with exceptional needs that cannot be met under the disability
waiver rate system. The commissioner shall use that information to evaluate and, if necessary,
approve an alternative payment rate for those individuals. Whether granted, denied, or
modified, the commissioner shall respond to all exception requests in writing. The
commissioner shall include in the written response the basis for the action and provide
notification of the right to appeal under paragraph (h).

(b) Lead agencies must act on an exception request within 30 days and notify the initiator
of the request of their recommendation in writing. A lead agency shall submit all exception
requests along with its recommendation to the commissioner.

(c) An application for a rate exception may be submitted for the following criteria:

(1) an individual has service needs that cannot be met through additional units of service;

(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 is so insufficient
that it has resulted in an individual receiving a notice of discharge from the individual's
provider; or

(3) an individual's service needs, including behavioral changes, require a level of service
which necessitates a change in provider or which requires the current provider to propose
service changes beyond those currently authorized.

(d) Exception requests must include the following information:

(1) the service needs required by each individual that are not accounted for in subdivisions
6, 7, 8, and 9;

(2) the service rate requested and the difference from the rate determined in subdivisions
6, 7, 8, and 9;

(3) a basis for the underlying costs used for the rate exception and any accompanying
documentation; and

(4) any contingencies for approval.

(e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.

(f) Individual disability waiver recipients, an interested party, or the license holder that
would receive the rate exception increase may request that a lead agency submit an exception
request. A lead agency that denies such a request shall notify the individual waiver recipient,
interested party, or license holder of its decision and the reasons for denying the request in
writing no later than 30 days after the request has been made and shall submit its denial to
the commissioner in accordance with paragraph (b). The reasons for the denial must be
based on the failure to meet the criteria in paragraph (c).

(g) The commissioner shall determine whether to approve or deny an exception request
no more than 30 days after receiving the request. If the commissioner denies the request,
the commissioner shall notify the lead agency and the individual disability waiver recipient,
the interested party, and the license holder in writing of the reasons for the denial.

(h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. When the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall issue
a temporary stay of demission, when requested by the disability waiver recipient, consistent
with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary
stay shall remain in effect until the lead agency can provide an informed choice of
appropriate, alternative services to the disability waiver.

(i) Providers may petition lead agencies to update values that were entered incorrectly
or erroneously into the rate management system, based on past service level discussions
and determination in subdivision 4, without applying for a rate exception.

(j) The starting date for the rate exception will be the later of the date of the recipient's
change in support or the date of the request to the lead agency for an exception.

(k) The commissioner shall track all exception requests received and their dispositions.
The commissioner shall issue quarterly public exceptions statistical reports, including the
number of exception requests received and the numbers granted, denied, withdrawn, and
pending. The report shall include the average amount of time required to process exceptions.

deleted text begin (l) No later than January 15, 2016, the commissioner shall provide research findings on
the estimated fiscal impact, the primary cost drivers, and common population characteristics
of recipients with needs that cannot be met by the framework rates.
deleted text end

deleted text begin (m) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a process to determine eligibility for rate exceptions for
individuals with rates determined under the methodology in section 256B.4913, subdivision
4a. Determination of eligibility for an exception will occur as annual service renewals are
completed.
deleted text end

deleted text begin (n)deleted text endnew text begin (l)new text end Approved rate exceptions deleted text beginwill be implemented at such time that the individual's
rate is no longer banded and
deleted text end remain in effect in all cases until an individual's needs change
as defined in paragraph (c).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 67.

Minnesota Statutes 2018, section 256B.4914, subdivision 15, is amended to read:


Subd. 15.

County or tribal allocations.

(a) deleted text beginUpon implementation of the disability waiver
rates management system on January 1, 2014,
deleted text end The commissioner shall establish a method
of tracking and reporting the fiscal impact of the disability waiver rates management system
on individual lead agencies.

(b) deleted text beginBeginning January 1, 2014,deleted text end The commissioner shall make annual adjustments to
lead agencies' home and community-based waivered service budget allocations to adjust
for rate differences and the resulting impact on county allocations upon implementation of
the disability waiver rates system.

(c) Lead agencies exceeding their allocations shall be subject to the provisions under
sections 256B.0916, subdivision 11, and 256B.49, subdivision 26.

Sec. 68.

Minnesota Statutes 2018, section 256B.4914, is amended by adding a subdivision
to read:


new text begin Subd. 17. new text end

new text begin Stakeholder consultation and county training. new text end

new text begin (a) The commissioner shall
continue consultation at regular intervals with the existing stakeholder group established
as part of the rate-setting methodology process and others, to gather input, concerns, and
data, to assist in the implementation of the rate payment system, and to make pertinent
information available to the public through the department's website.
new text end

new text begin (b) The commissioner shall offer training at least annually for county personnel
responsible for administering the rate-setting framework in a manner consistent with this
section.
new text end

new text begin (c) The commissioner shall maintain an online instruction manual explaining the
rate-setting framework. The manual shall be consistent with this section, and shall be
accessible to all stakeholders including recipients, representatives of recipients, county or
tribal agencies, and license holders.
new text end

new text begin (d) The commissioner shall not defer to the county or tribal agency on matters of technical
application of the rate-setting framework, and a county or tribal agency shall not set rates
in a manner that conflicts with this section.
new text end

Sec. 69.

Minnesota Statutes 2018, section 256B.5014, is amended to read:


256B.5014 deleted text beginFINANCIALdeleted text end REPORTINGnew text begin REQUIREMENTSnew text end.

new text begin Subdivision 1. new text end

new text begin Financial reporting. new text end

All facilities shall maintain financial records and
shall provide annual income and expense reports to the commissioner of human services
on a form prescribed by the commissioner no later than April 30 of each year in order to
receive medical assistance payments. The reports for the reporting year ending December
31 must include:

(1) salaries and related expenses, including program salaries, administrative salaries,
other salaries, payroll taxes, and fringe benefits;

(2) general operating expenses, including supplies, training, repairs, purchased services
and consultants, utilities, food, licenses and fees, real estate taxes, insurance, and working
capital interest;

(3) property related costs, including depreciation, capital debt interest, rent, and leases;
and

(4) total annual resident days.

new text begin Subd. 2. new text end

new text begin Labor market reporting. new text end

new text begin All intermediate care facilities shall comply with
the labor market reporting requirements described in section 256B.4912, subdivision 1a.
new text end

Sec. 70.

Minnesota Statutes 2018, section 256B.85, subdivision 3, is amended to read:


Subd. 3.

Eligibility.

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

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

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

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

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

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

(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and

(2) is not a participant under a family support grant under section 252.32.

new text begin (c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 71.

Minnesota Statutes 2018, section 256B.85, is amended by adding a subdivision
to read:


new text begin Subd. 7a. new text end

new text begin Enhanced rate. new text end

new text begin An enhanced rate of 107.5 percent of the rate paid for CFSS
must be paid for services provided to persons who qualify for 12 or more hours of CFSS
per day when provided by a support worker who meets the requirements of subdivision 16,
paragraph (e). The enhanced rate for CFSS includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54 that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of CFSS
per day.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 72.

Minnesota Statutes 2018, section 256B.85, subdivision 10, is amended to read:


Subd. 10.

Agency-provider and FMS provider qualifications and duties.

(a)
Agency-providers identified in subdivision 11 and FMS providers identified in subdivision
13a shall:

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

(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;

(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;

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

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

(6) directly provide services and not use a subcontractor or reporting agent;

(7) meet the financial requirements established by the commissioner for financial
solvency;

(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health care
programs provider; and

(9) have an office located in Minnesota.

(b) In conducting general duties, agency-providers and FMS providers shall:

(1) pay support workers based upon actual hours of services provided;

(2) pay for worker training and development services based upon actual hours of services
provided or the unit cost of the training session purchased;

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

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

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

(6) report maltreatment as required under sections 626.556 and 626.557; deleted text beginand
deleted text end

new text begin (7) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a;
new text end

deleted text begin (7)deleted text endnew text begin (8)new text end comply with any data requests from the department consistent with the Minnesota
Government Data Practices Act under chapter 13deleted text begin.deleted text endnew text begin; and
new text end

new text begin (9) maintain documentation for the requirements under subdivision 16, paragraph (e),
clause (2), to qualify for an enhanced rate under this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 73.

Minnesota Statutes 2018, section 256B.85, subdivision 11, is amended to read:


Subd. 11.

Agency-provider model.

(a) The agency-provider model includes services
provided by support workers and staff providing worker training and development services
who are employed by an agency-provider that meets the criteria established by the
commissioner, including required training.

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

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

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

(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated
by the medical assistance payment for CFSS for support worker wages and benefitsnew text begin, except
all of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits
new text end. The agency-provider must document how this requirement is being met. The
revenue generated by the worker training and development services and the reasonable costs
associated with the worker training and development services must not be used in making
this calculation.

(f) The agency-provider model must be used by individuals who are restricted by the
Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to
9505.2245.

(g) Participants purchasing goods under this model, along with support worker services,
must:

(1) specify the goods in the CFSS service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider, case manager, or
care coordinator; and

(2) use the FMS provider for the billing and payment of such goods.

Sec. 74.

Minnesota Statutes 2018, section 256B.85, subdivision 12, is amended to read:


Subd. 12.

Requirements for enrollment of CFSS agency-providers.

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

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

(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid
revenue in the previous calendar year is greater than $300,000, the agency-provider must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;

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

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

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

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

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

(i) a copy of the CFSS agency-provider's time sheet; and

(ii) a copy of the participant's individual CFSS service delivery plan;

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

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

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

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

(13) documentation that the agency-provider will use at least the following percentages
of revenue generated from the medical assistance rate paid for CFSS services for CFSS
support worker wages and benefits: 72.5 percent of revenue from CFSS providersnew text begin, except
100 percent of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits
new text end. The revenue generated by the worker training and development services and the
reasonable costs associated with the worker training and development services shall not be
used in making this calculation; and

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

(b) CFSS agency-providers shall provide to the commissioner the information specified
in paragraph (a).

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

(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:

(1) list the materials and information the agency-provider is required to submit;

(2) provide instructions on submitting information to the commissioner; and

(3) provide a due date by which the commissioner must receive the requested information.

Agency-providers shall submit all required documentation for annual review within 30 days
of notification from the commissioner. If an agency-provider fails to submit all the required
documentation, the commissioner may take action under subdivision 23a.

Sec. 75.

Minnesota Statutes 2018, section 256B.85, subdivision 16, is amended to read:


Subd. 16.

Support workers requirements.

(a) Support workers shall:

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

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

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

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

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

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

(5) complete employer-directed training and orientation on the participant's individual
needs;

(6) maintain the privacy and confidentiality of the participant; and

(7) not independently determine the medication dose or time for medications for the
participant.

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

(1) does not meet the requirements in paragraph (a);

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

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

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

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

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

(d) A support worker must not provide or be paid for more than 275 hours of CFSS per
month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.

new text begin (e) CFSS qualify for an enhanced rate if the support worker providing the services:
new text end

new text begin (1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for 12 or more hours per day of CFSS; and
new text end

new text begin (2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 76.

Minnesota Statutes 2018, section 256I.03, subdivision 8, is amended to read:


Subd. 8.

Supplementary services.

"Supplementary services" means housing support
services provided to individuals in addition to room and board including, but not limited
to, oversight and up to 24-hour supervision, medication reminders, assistance with
transportation, arranging for meetings and appointments, and arranging for medical and
social servicesnew text begin, and services identified in section 256I.03, subdivision 12new text end.

Sec. 77.

Minnesota Statutes 2018, section 256I.04, subdivision 2b, is amended to read:


Subd. 2b.

Housing support agreements.

(a) Agreements between agencies and providers
of housing support must be in writing on a form developed and approved by the commissioner
and must specify the name and address under which the establishment subject to the
agreement does business and under which the establishment, or service provider, if different
from the group residential housing establishment, is licensed by the Department of Health
or the Department of Human Services; the specific license or registration from the
Department of Health or the Department of Human Services held by the provider and the
number of beds subject to that license; the address of the location or locations at which
group residential housing is provided under this agreement; the per diem and monthly rates
that are to be paid from housing support funds for each eligible resident at each location;
the number of beds at each location which are subject to the agreement; whether the license
holder is a not-for-profit corporation under section 501(c)(3) of the Internal Revenue Code;
and a statement that the agreement is subject to the provisions of sections 256I.01 to 256I.06
and subject to any changes to those sections.

(b) Providers are required to verify the following minimum requirements in the
agreement:

(1) current license or registration, including authorization if managing or monitoring
medications;

(2) all staff who have direct contact with recipients meet the staff qualifications;

(3) the provision of housing support;

(4) the provision of supplementary services, if applicable;

(5) reports of adverse events, including recipient death or serious injury; deleted text beginand
deleted text end

(6) submission of residency requirements that could result in recipient evictiondeleted text begin.deleted text endnew text begin; and
new text end

new text begin (7) confirmation that the provider will not limit or restrict the number of hours an
applicant or recipient chooses to be employed, as specified in subdivision 5.
new text end

(c) Agreements may be terminated with or without cause by the commissioner, the
agency, or the provider with two calendar months prior notice. The commissioner may
immediately terminate an agreement under subdivision 2d.

Sec. 78.

Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision
to read:


new text begin Subd. 2h. new text end

new text begin Required supplementary services. new text end

new text begin Providers of supplementary services shall
ensure that recipients have, at a minimum, assistance with services as identified in the
recipient's professional statement of need under section 256I.03, subdivision 12. Providers
of supplementary services shall maintain case notes with the date and description of services
provided to individual recipients.
new text end

Sec. 79.

Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Employment. new text end

new text begin A provider is prohibited from limiting or restricting the number
of hours an applicant or recipient is employed.
new text end

Sec. 80.

Laws 2017, First Special Session chapter 6, article 1, section 44, is amended to
read:


Sec. 44. EXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
BUDGET METHODOLOGY EXCEPTION.

(a) No later than September 30, 2017, if necessary, the commissioner of human services
shall submit an amendment to the Centers for Medicare and Medicaid Services for the home
and community-based services waivers authorized under Minnesota Statutes, sections
256B.092 and 256B.49, to expand the exception to the consumer-directed community
supports budget methodology under Laws 2015, chapter 71, article 7, section 54, to provide
up to 30 percent more funds for either:

(1) consumer-directed community supports participants who have a coordinated service
and support plan which identifies the need for an increased amount of services or supports
under consumer-directed community supports than the amount they are currently receiving
under the consumer-directed community supports budget methodology:

(i) to increase the amount of time a person works or otherwise improves employment
opportunities;

(ii) to plan a transition to, move to, or live in a setting described in Minnesota Statutes,
section 256D.44, subdivision 5, deleted text beginparagraph (f), clause (1), item (ii), ordeleted text end paragraph (g)new text begin, clause
(1), item (iii)
new text end; or

(iii) to develop and implement a positive behavior support plan; or

(2) home and community-based waiver participants who are currently using licensed
providers for (i) employment supports or services during the day; or (ii) residential services,
either of which cost more annually than the person would spend under a consumer-directed
community supports plan for any or all of the supports needed to meet the goals identified
in paragraph (a), clause (1), items (i), (ii), and (iii).

(b) The exception under paragraph (a), clause (1), is limited to those persons who can
demonstrate that they will have to discontinue using consumer-directed community supports
and accept other non-self-directed waiver services because their supports needed for the
goals described in paragraph (a), clause (1), items (i), (ii), and (iii), cannot be met within
the consumer-directed community supports budget limits.

(c) The exception under paragraph (a), clause (2), is limited to those persons who can
demonstrate that, upon choosing to become a consumer-directed community supports
participant, the total cost of services, including the exception, will be less than the cost of
current waiver services.

Sec. 81.

Laws 2017, First Special Session chapter 6, article 1, section 45, is amended to
read:


Sec. 45.

CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
METHODOLOGY deleted text beginEXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
CRISIS RESIDENTIAL SETTINGS
deleted text end.

new text begin Subdivision 1. new text end

new text begin Exception for persons leaving institutions and crisis residential
settings.
new text end

(a) By September 30, 2017, the commissioner shall establish an institutional and
crisis bed consumer-directed community supports budget exception process in the home
and community-based services waivers under Minnesota Statutes, sections 256B.092 and
256B.49. This budget exception process shall be available for any individual who:

(1) is not offered available and appropriate services within 60 days since approval for
discharge from the individual's current institutional setting; and

(2) requires services that are more expensive than appropriate services provided in a
noninstitutional setting using the consumer-directed community supports option.

(b) Institutional settings for purposes of this exception include intermediate care facilities
for persons with developmental disabilities; nursing facilities; acute care hospitals; Anoka
Metro Regional Treatment Center; Minnesota Security Hospital; and crisis beds. The budget
exception shall be limited to no more than the amount of appropriate services provided in
a noninstitutional setting as determined by the lead agency managing the individual's home
and community-based services waiver. The lead agency shall notify the Department of
Human Services of the budget exception.

new text begin Subd. 2. new text end

new text begin Shared services. new text end

new text begin (a) Medical assistance payments for shared services under
consumer-directed community supports are limited to this subdivision.
new text end

new text begin (b) For purposes of this subdivision, "shared services" means services provided at the
same time by the same direct care worker for individuals who have entered into an agreement
to share consumer-directed community support services.
new text end

new text begin (c) Shared services may include services in the personal assistance category as outlined
in the consumer-directed community supports community support plan and shared services
agreement, except:
new text end

new text begin (1) services for more than three individuals provided by one worker at one time;
new text end

new text begin (2) use of more than one worker for the shared services; and
new text end

new text begin (3) a child care program licensed under chapter 245A or operated by a local school
district or private school.
new text end

new text begin (d) The individuals or, as needed, their representatives shall develop the plan for shared
services when developing or amending the consumer-directed community supports plan,
and must follow the consumer-directed community supports process for approval of the
plan by the lead agency. The plan for shared services in an individual's consumer-directed
community supports plan shall include the intention to utilize shared services based on
individuals' needs and preferences.
new text end

new text begin (e) Individuals sharing services must use the same financial management services
provider.
new text end

new text begin (f) Individuals whose consumer-directed community supports community support plans
include the intention to utilize shared services must also jointly develop, with the support
of their representatives as needed, a shared services agreement. This agreement must include:
new text end

new text begin (1) the names of the individuals receiving shared services;
new text end

new text begin (2) the individuals' representative, if identified in their consumer-directed community
supports plans, and their duties;
new text end

new text begin (3) the names of the case managers;
new text end

new text begin (4) the financial management services provider;
new text end

new text begin (5) the shared services that must be provided;
new text end

new text begin (6) the schedule for shared services;
new text end

new text begin (7) the location where shared services must be provided;
new text end

new text begin (8) the training specific to each individual served;
new text end

new text begin (9) the training specific to providing shared services to the individuals identified in the
agreement;
new text end

new text begin (10) instructions to follow all required documentation for time and services provided;
new text end

new text begin (11) a contingency plan for each of the individuals that accounts for service provision
and billing in the absence of one of the individuals in a shared services setting due to illness
or other circumstances;
new text end

new text begin (12) signatures of all parties involved in the shared services; and
new text end

new text begin (13) agreement by each of the individuals who are sharing services on the number of
shared hours for services provided.
new text end

new text begin (g) Any individual or any individual's representative may withdraw from participating
in a shared services agreement at any time.
new text end

new text begin (h) The lead agency for each individual must authorize the use of the shared services
option based on the criteria that the shared service is appropriate to meet the needs, health,
and safety of each individual for whom they provide case management or care coordination.
new text end

new text begin (i) Nothing in this subdivision must be construed to reduce the total authorized
consumer-directed community supports budget for an individual.
new text end

new text begin (j) No later than September 30, 2019, the commissioner of human services shall:
new text end

new text begin (1) submit an amendment to the Centers for Medicare and Medicaid Services for the
home and community-based services waivers authorized under Minnesota Statutes, sections
256B.0913, 256B.0915, 256B.092, and 256B.49, to allow for a shared services option under
consumer-directed community supports; and
new text end

new text begin (2) with stakeholder input, develop guidance for shared services in consumer-directed
community-supports within the Community Based Services Manual. Guidance must include:
new text end

new text begin (i) recommendations for negotiating payment for one-to-two and one-to-three services;
and
new text end

new text begin (ii) a template of the shared services agreement.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2019, or upon federal approval,
whichever is later, except for subdivision 2, paragraph (j), which is effective the day
following final enactment. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end

Sec. 82.

Laws 2017, First Special Session chapter 6, article 3, section 49, is amended to
read:


Sec. 49. ELECTRONIC deleted text beginSERVICE DELIVERY DOCUMENTATION SYSTEMdeleted text endnew text begin
VISIT VERIFICATION
new text end.

Subdivision 1.

Documentation; establishment.

The commissioner of human services
shall establish implementation requirements and standards for deleted text beginandeleted text end electronic deleted text beginservice delivery
documentation system
deleted text endnew text begin visit verificationnew text end to comply with the 21st Century Cures Act, Public
Law 114-255. Within available appropriations, the commissioner shall take steps to comply
with the electronic visit verification requirements in the 21st Century Cures Act, Public
Law 114-255.

Subd. 2.

Definitions.

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

(b) "Electronic deleted text beginservice delivery documentationdeleted text endnew text begin visit verificationnew text end" means the electronic
documentation of the:

(1) type of service performed;

(2) individual receiving the service;

(3) date of the service;

(4) location of the service delivery;

(5) individual providing the service; and

(6) time the service begins and ends.

(c) "Electronic deleted text beginservice delivery documentationdeleted text endnew text begin visit verificationnew text end system" means a system
that provides electronic deleted text beginservice delivery documentationdeleted text endnew text begin verification of servicesnew text end that complies
with the 21st Century Cures Act, Public Law 114-255, and the requirements of subdivision
3.

(d) "Service" means one of the following:

(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
subdivision 19a
, and provided according to Minnesota Statutes, section 256B.0659; deleted text beginor
deleted text end

(2) community first services and supports under Minnesota Statutes, section 256B.85new text begin;
new text end

new text begin (3) home health services under Minnesota Statutes, section 256B.0625, subdivision 6a;
or
new text end

new text begin (4) other medical supplies and equipment or home and community-based services that
are required to be electronically verified by the 21st Century Cures Act, Public Law 114-255
new text end.

Subd. 3.

Requirements.

(a) In developing implementation requirements for deleted text beginandeleted text end electronic
deleted text begin service delivery documentation systemdeleted text endnew text begin visit verificationnew text end, the commissioner shall deleted text beginconsider
electronic visit verification systems and other electronic service delivery documentation
methods. The commissioner shall convene stakeholders that will be impacted by an electronic
service delivery system, including service providers and their representatives, service
recipients and their representatives, and, as appropriate, those with expertise in the
development and operation of an electronic service delivery documentation system, to
deleted text end ensure
that the requirements:

(1) are minimally administratively and financially burdensome to a provider;

(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;

(3) consider existing best practices and use of electronic deleted text beginservice delivery documentationdeleted text endnew text begin
visit verification
new text end;

(4) are conducted according to all state and federal laws;

(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and

(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.

(b) The commissioner shall make training available to providers on the electronic deleted text beginservice
delivery documentation
deleted text endnew text begin visit verificationnew text end system requirements.

(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic deleted text beginservice delivery documentationdeleted text endnew text begin
visit verification
new text end requirements on program integrity.

new text begin (d) The commissioner shall make a state-selected electronic visit verification system
available to providers of services.
new text end

new text begin Subd. 3a. new text end

new text begin Provider requirements. new text end

new text begin (a) A provider of services may select any electronic
visit verification system that meets the requirements established by the commissioner.
new text end

new text begin (b) All electronic visit verification systems used by providers to comply with the
requirements established by the commissioner must provide data to the commissioner in a
format and at a frequency to be established by the commissioner.
new text end

new text begin (c) Providers must implement the electronic visit verification systems required under
this section by a date established by the commissioner to be set after the state-selected
electronic visit verification systems for personal care services and home health services are
in production. For purposes of this paragraph, "personal care services" and "home health
services" have the meanings given in United States Code, title 42, section 1396b(l)(5).
Reimbursement rates for providers must not be reduced as a result of federal action to reduce
the federal medical assistance percentage under the 21st Century Cures Act, Public Law
114-255.
new text end

deleted text begin Subd. 4. deleted text end

deleted text begin Legislative report. deleted text end

deleted text begin (a) The commissioner shall submit a report by January 15,
2018, to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services with recommendations, based on the requirements of
subdivision 3, to establish electronic service delivery documentation system requirements
and standards. The report shall identify:
deleted text end

deleted text begin (1) the essential elements necessary to operationalize a base-level electronic service
delivery documentation system to be implemented by January 1, 2019; and
deleted text end

deleted text begin (2) enhancements to the base-level electronic service delivery documentation system to
be implemented by January 1, 2019, or after, with projected operational costs and the costs
and benefits for system enhancements.
deleted text end

deleted text begin (b) The report must also identify current regulations on service providers that are either
inefficient, minimally effective, or will be unnecessary with the implementation of an
electronic service delivery documentation system.
deleted text end

Sec. 83. new text beginINDIVIDUAL PROVIDERS OF DIRECT SUPPORT SERVICES.
new text end

new text begin The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota, submitted to the Legislative Coordinating
Commission on March 11, 2019, is ratified.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 84. new text beginRATE INCREASE FOR DIRECT SUPPORT SERVICES PROVIDERS
WORKFORCE NEGOTIATIONS.
new text end

new text begin (a) Effective July 1, 2019, if the labor agreement between the state of Minnesota and
the Service Employees International Union Healthcare Minnesota under Minnesota Statutes,
section 179A.54, is approved pursuant to Minnesota Statutes, section 3.855, the commissioner
of human services shall:
new text end

new text begin (1) increase reimbursement rates, individual budgets, grants, or allocations by 2.37
percent for services provided on or after July 1, 2019, to implement the minimum hourly
wage, holiday, and paid time off provisions of that agreement; and
new text end

new text begin (2) for services provided on or after July 1, 2019, to eligible service recipients, provide
an enhanced rate of 7.5 percent for personal care assistance and community first services
and supports and an enhanced budget increased by 7.5 percent for consumer-directed
community supports and the consumer support grant. Eligible service recipients are persons
identified by the state through assessment who are eligible for at least 12 hours of personal
care assistance each day and are served by workers who have completed designated training
approved by the commissioner. The enhanced rate and enhanced budget includes, and is
not in addition to, any previously implemented enhanced rates or enhanced budgets for
eligible service recipients.
new text end

new text begin (b) The rate changes described in this section apply to direct support services provided
through a covered program, as defined in Minnesota Statutes, section 256B.0711, subdivision
1.
new text end

Sec. 85. new text beginDIRECTION TO COMMISSIONER; INTERAGENCY AGREEMENTS.
new text end

new text begin By October 1, 2019, the Department of Commerce, Public Utilities Commission, and
Department of Human Services must amend all interagency agreements necessary to
implement sections 1 to 10.
new text end

Sec. 86. new text beginDISABILITY WAIVER RECONFIGURATION.
new text end

new text begin Subdivision 1. new text end

new text begin Intent. new text end

new text begin It is the intent of the legislature to reform the medical assistance
waiver programs for people with disabilities to simplify administration of the programs,
incentivize inclusive person-centered supports, enhance each person's personal authority
over the person's service choice, align benefits across waivers, encourage equity across
programs and populations, and promote long-term sustainability of needed services. To the
maximum extent possible, the disability waiver reconfiguration must maintain service
stability and continuity of care, while promoting the most independent and integrated
supports of each person's choosing in both short- and long-term planning.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin By January 15, 2021, the commissioner of human services shall submit
a report to the members of the legislative committees with jurisdiction over human services
on any necessary waivers, state plan amendments, requests for new funding or realignment
of existing funds, any changes to state statute or rule, and any other federal authority
necessary to implement this section. The report must include information about the
commissioner's work to collect feedback and input from providers, persons accessing home
and community-based services waivers and their families, and client advocacy organizations.
new text end

new text begin Subd. 3. new text end

new text begin Proposal. new text end

new text begin By January 15, 2021, the commissioner shall develop a proposal to
reconfigure the medical assistance waivers provided in sections 256B.092 and 256B.49.
The proposal shall include all necessary plans for implementing two home and
community-based services waiver programs, as authorized under section 1915(c) of the
Social Security Act that serve persons who are determined to require the levels of care
provided in a nursing home, a hospital, a neurobehavioral hospital, or an intermediate care
facility for persons with developmental disabilities. Before submitting the final report to
the legislature, the commissioner shall publish a draft report with sufficient time for interested
persons to offer additional feedback.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 87. new text beginDIRECTION TO COMMISSIONER OF HUMAN SERVICES; DIRECT
CARE WORKFORCE RATE METHODOLOGY STUDY.
new text end

new text begin The commissioner of human services, in consultation with stakeholders, shall evaluate
the feasibility of developing a rate methodology for the personal care assistance program
under Minnesota Statutes, section 256B.0659, and community first services and supports
under Minnesota Statutes, section 256B.85, similar to the disability waiver rate system
under Minnesota Statutes, section 256B.4914, including determining the component values
and factors to include in such a rate methodology; consider aligning any rate methodology
with the collective bargaining agreement and negotiation cycle under Minnesota Statutes,
section 179A.54; recommend strategies for ensuring adequate, competitive wages for direct
care workers; develop methods and determine the necessary resources for the commissioner
to more consistently collect and audit data from the direct care industry; and report
recommendations, including proposed draft legislation, to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services policy and
finance by February 1, 2020.
new text end

Sec. 88. new text beginDIRECTION TO COMMISSIONER OF HUMAN SERVICES; TEFRA
OPTION IMPROVEMENT MEASURES.
new text end

new text begin (a) The commissioner of human services shall, using existing appropriations, develop
content to be included on the MNsure website explaining the TEFRA option under medical
assistance for applicants who indicate during the application process that a child in the
family has a disability.
new text end

new text begin (b) The commissioner shall develop a cover letter explaining the TEFRA option under
medical assistance, as well as the application and renewal process, to be disseminated with
the DHS-6696A form to applicants who may qualify for medical assistance under the TEFRA
option. The commissioner shall provide the content and the form to the executive director
of MNsure for inclusion on the MNsure website. The commissioner shall also develop and
implement education and training for lead agency staff statewide to improve understanding
of the medical assistance TEFRA enrollment and renewal processes and procedures.
new text end

new text begin (c) The commissioner shall convene a stakeholder group that shall consider improvements
to the TEFRA option enrollment and renewal processes, including but not limited to revisions
to, or the development of, application and renewal paperwork specific to the TEFRA option;
possible technology solutions; and county processes.
new text end

new text begin (d) The stakeholder group must include representatives from the Department of Human
Services Health Care Division, MNsure, representatives from at least two counties in the
metropolitan area and from at least one county in greater Minnesota, the Arc Minnesota,
Gillette Children's Specialty Healthcare, the Autism Society of Minnesota, Proof Alliance,
the Minnesota Consortium for Citizens with Disabilities, and other interested stakeholders
as identified by the commissioner of human services.
new text end

new text begin (e) The stakeholder group shall submit a report of the group's recommended
improvements and any associated costs to the commissioner by December 31, 2020. The
group shall also provide copies of the report to each stakeholder group member. The
commissioner shall provide a copy of the report to the legislative committees with jurisdiction
over medical assistance.
new text end

Sec. 89. new text beginDIRECTION TO COMMISSIONER; RESIDENTIAL SERVICES RATE
METHODOLOGY.
new text end

new text begin The commissioner of human services shall develop a new rate methodology for residential
services, reimbursed under Minnesota Statutes, section 256B.4914, in which the service
provider lives in the setting where the service is provided based on levels of support needs.
The commissioner shall submit recommendations to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over human services for the
new rate methodology by January 1, 2020.
new text end

Sec. 90. new text beginDAY TRAINING AND HABILITATION DISABILITY WAIVER RATE
SYSTEM TRANSITION GRANTS.
new text end

new text begin (a) The commissioner of human services shall establish annual grants to day training
and habilitation providers that are projected to experience a funding gap upon the full
implementation of Minnesota Statutes, section 256B.4914.
new text end

new text begin (b) In order to be eligible for a grant under this section, a day training and habilitation
disability waiver provider must:
new text end

new text begin (1) serve at least 100 waiver service participants;
new text end

new text begin (2) be projected to receive a reduction in annual revenue from medical assistance for
day services during the first year of full implementation of disability waiver rate system
framework rates under Minnesota Statutes, section 256B.4914, of at least 15 percent and
at least $300,000 compared to the annual medical assistance revenue for day services the
provider received during the last full year during which banded rates under Minnesota
Statutes, section 256B.4913, subdivision 4a, were effective; and
new text end

new text begin (3) agree to develop, submit, and implement a sustainability plan as provided in paragraph
new text end

new text begin (c) A recipient of a grant under this section must develop a sustainability plan in
partnership with the commissioner of human services. The sustainability plan must include:
new text end

new text begin (1) a review of all the provider's costs and an assessment of whether the provider is
implementing available cost-control options appropriately;
new text end

new text begin (2) a review of all the provider's revenue and an assessment of whether the provider is
leveraging available resources appropriately; and
new text end

new text begin (3) a practical strategy for closing the funding gap described in paragraph (b), clause
(2).
new text end

new text begin (d) The commissioner of human services shall provide technical assistance and financial
management advice to grant recipients as they develop and implement their sustainability
plans.
new text end

new text begin (e) In order to be eligible for an annual grant renewal, a grant recipient must demonstrate
to the commissioner of human services that it made a good faith effort to close the revenue
gap described in paragraph (b), clause (2).
new text end

Sec. 91. new text beginDIRECTION TO COMMISSIONER; BI AND CADI WAIVER
CUSTOMIZED LIVING SERVICES PROVIDER LOCATED IN HENNEPIN
COUNTY.
new text end

new text begin (a) The commissioner of human services shall allow a housing with services establishment
located in Minneapolis that provides customized living and 24-hour customized living
services for clients enrolled in the brain injury (BI) or community access for disability
inclusion (CADI) waiver and had a capacity to serve 66 clients as of July 1, 2017, to transfer
service capacity of up to 66 clients to no more than three new housing with services
establishments located in Hennepin County.
new text end

new text begin (b) Notwithstanding Minnesota Statutes, section 256B.492, the commissioner shall
determine that the new housing with services establishments described under paragraph (a)
meet the BI and CADI waiver customized living and 24-hour customized living size
limitation exception for clients receiving those services at the new housing with services
establishments described under paragraph (a).
new text end

Sec. 92. new text beginDIRECTION TO COMMISSIONER OF HUMAN SERVICES;
RECOMMENDATIONS TO INCREASE USE OF TECHNOLOGY.
new text end

new text begin (a) The commissioner shall appoint under Minnesota Statutes, section 256.01, subdivision
6, a Minnesota Technology First Advisory Task Force to advise the commissioner on
strategies to increase the use of supportive technology in services and programs the
commissioner administers for persons with disabilities to enable them to live more
independently in community settings, work in competitive integrated environments,
participate in inclusive community activities, and increase quality of life. The advisory task
force must include:
new text end

new text begin (1) one representative of the Department of Human Services;
new text end

new text begin (2) two representatives of the counties;
new text end

new text begin (3) one representative of the Associations of Residential Resources in Minnesota;
new text end

new text begin (4) one representative from the Minnesota Organization for Habilitation and
Rehabilitation;
new text end

new text begin (5) one representative of the Disability Law Center;
new text end

new text begin (6) one representative of the Arc Minnesota;
new text end

new text begin (7) one representative from STAR Services;
new text end

new text begin (8) one representative from the Traumatic Brain Injury Advisory Committee;
new text end

new text begin (9) one representative from NAMI Minnesota;
new text end

new text begin (10) one representative from Advocating Change Together;
new text end

new text begin (11) two individuals with disabilities accessing supportive technology; and
new text end

new text begin (12) one parent advocate.
new text end

new text begin Meetings will be held quarterly and hosted by the department. Subcommittees may be
developed as necessary by the commissioner. Advisory task force meetings are subject to
the Open Meeting Law under Minnesota Statutes, chapter 13D.
new text end

new text begin (b) The advisory task force will provide an annual written report with recommendations
to the commissioner by June 30 of each year of its existence, beginning June 30, 2020.
new text end

new text begin (c) Persons with disabilities and family members of persons with disabilities are eligible
for compensation for participation in this task force.
new text end

new text begin (d) The advisory task force expires on June 30, 2021.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 93. new text beginREVISOR INSTRUCTION.
new text end

new text begin (a) The revisor of statutes shall change the term "developmental disability waiver" or
similar terms to "developmental disabilities waiver" or similar terms wherever they appear
in Minnesota Statutes. The revisor shall also make technical and other necessary changes
to sentence structure to preserve the meaning of the text.
new text end

new text begin (b) The revisor of statutes, in consultation with the House Research Department, Office
of Senate Counsel, Research and Fiscal Analysis, and Department of Human Services, shall
prepare legislation for the 2020 legislative session to codify existing session laws governing
consumer-directed community supports in Minnesota Statutes, chapter 256B.
new text end

new text begin (c) The revisor of statutes shall codify Laws 2017, First Special Session chapter 6, article
3, section 49, as amended in this act, in Minnesota Statutes, chapter 256B.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective July 1, 2020.
new text end

Sec. 94. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, section 256B.0705, new text end new text begin is repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 252.431; and 252.451, new text end new text begin are repealed.
new text end

new text begin (c) new text end new text begin Minnesota Statutes 2018, sections 252.41, subdivision 8; and 256B.4913, subdivisions
4a, 5, 6, and 7,
new text end new text begin are repealed.
new text end

new text begin (d) new text end new text begin Minnesota Statutes 2018, section 256I.05, subdivision 3, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (b) is effective September 1, 2019. Paragraphs (a) and
(c) are effective January 1, 2020. Paragraph (d) is effective July 1, 2019.
new text end

ARTICLE 6

CHEMICAL AND MENTAL HEALTH

Section 1.

Minnesota Statutes 2018, section 13.851, is amended by adding a subdivision
to read:


new text begin Subd. 12. new text end

new text begin Mental health screening. new text end

new text begin The treatment of data collected by a sheriff or local
corrections agency related to individuals who may have a mental illness is governed by
section 641.15, subdivision 3a.
new text end

Sec. 2.

Minnesota Statutes 2018, section 245.4889, subdivision 1, is amended to read:


Subdivision 1.

Establishment and authority.

(a) The commissioner is authorized to
make grants from available appropriations to assist:

(1) counties;

(2) Indian tribes;

(3) children's collaboratives under section 124D.23 or 245.493; or

(4) mental health service providers.

(b) The following services are eligible for grants under this section:

(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;

(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;

(3) respite care services for children with severe emotional disturbances who are at risk
of out-of-home placement;

(4) children's mental health crisis services;

(5) mental health services for people from cultural and ethnic minorities;

(6) children's mental health screening and follow-up diagnostic assessment and treatment;

(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;

(8) school-linked mental health servicesdeleted text begin, including transportation for children receiving
school-linked mental health services when school is not in session
deleted text endnew text begin under section 245.4901new text end;

(9) building evidence-based mental health intervention capacity for children birth to age
five;

(10) suicide prevention and counseling services that use text messaging statewide;

(11) mental health first aid training;

(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;

(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;

(14) early childhood mental health consultation;

(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;

(16) psychiatric consultation for primary care practitioners; and

(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grants.

(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.

new text begin (d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

new text begin [245.4901] SCHOOL-LINKED MENTAL HEALTH GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of human services shall establish a
school-linked mental health grant program to provide early identification and intervention
for students with mental health needs and to build the capacity of schools to support students
with mental health needs in the classroom.
new text end

new text begin Subd. 2. new text end

new text begin Eligible applicants. new text end

new text begin An eligible applicant for school-linked mental health grants
is an entity that is:
new text end

new text begin (1) certified under Minnesota Rules, parts 9520.0750 to 9520.0870;
new text end

new text begin (2) a community mental health center under section 256B.0625, subdivision 5;
new text end

new text begin (3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
new text end

new text begin (4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
new text end

new text begin (5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section 245I.16, subdivision 2, or two alcohol and drug counselors licensed or
exempt from licensure under chapter 148F who are qualified to provide clinical services to
children and families.
new text end

new text begin Subd. 3. new text end

new text begin Allowable grant activities and related expenses. new text end

new text begin (a) Allowable grant activities
and related expenses may include but are not limited to:
new text end

new text begin (1) identifying and diagnosing mental health conditions of students;
new text end

new text begin (2) delivering mental health treatment and services to students and their families,
including via telemedicine consistent with section 256B.0625, subdivision 3b;
new text end

new text begin (3) supporting families in meeting their child's needs, including navigating health care,
social service, and juvenile justice systems;
new text end

new text begin (4) providing transportation for students receiving school-linked mental health services
when school is not in session;
new text end

new text begin (5) building the capacity of schools to meet the needs of students with mental health
concerns, including school staff development activities for licensed and nonlicensed staff;
and
new text end

new text begin (6) purchasing equipment, connection charges, on-site coordination, set-up fees, and
site fees in order to deliver school-linked mental health services via telemedicine.
new text end

new text begin (b) Grantees shall obtain all available third-party reimbursement sources as a condition
of receiving a grant. For purposes of this grant program, a third-party reimbursement source
excludes a public school as defined in section 120A.20, subdivision 1. Grantees shall serve
students regardless of health coverage status or ability to pay.
new text end

new text begin Subd. 4. new text end

new text begin Data collection and outcome measurement. new text end

new text begin Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked mental
health grant program.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2018, section 245.735, subdivision 3, is amended to read:


Subd. 3.

Certified community behavioral health clinics.

(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs) deleted text beginto be eligible for the prospective payment system in paragraph (f)deleted text end. Entities that
choose to be CCBHCs must:

(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;

(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionalsnew text begin and licensed alcohol and drug counselorsnew text end,
and staff who are culturally and linguistically trained to deleted text beginservedeleted text endnew text begin meetnew text end the needs of the deleted text beginclinic's
patient
deleted text end populationnew text begin the clinic servesnew text end;

(3) ensure that clinic services are available and accessible to deleted text beginpatientsdeleted text endnew text begin individuals and
families
new text end of all ages and genders and that crisis management services are available 24 hours
per day;

(4) establish fees for clinic services for deleted text beginnonmedical assistance patientsdeleted text endnew text begin individuals who
are not enrolled in medical assistance
new text end using a sliding fee scale that ensures that services to
patients are not denied or limited due to deleted text begina patient'sdeleted text endnew text begin an individual'snew text end inability to pay for services;

(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;

(6) provide crisis mental health new text beginand substance use new text endservices, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; deleted text beginpatient-centereddeleted text endnew text begin person- and family-centerednew text end treatment planning; outpatient
mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veterans;

(7) provide coordination of care across settings and providers to ensure seamless
transitions for deleted text beginpatientsdeleted text endnew text begin individuals being servednew text end across the full spectrum of health services,
including acute, chronic, and behavioral needs. Care coordination may be accomplished
through partnerships or formal contracts with:

(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and

(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;

(8) be certified as mental health clinics under section 245.69, subdivision 2;

deleted text begin (9) be certified to provide integrated treatment for co-occurring mental illness and
substance use disorders in adults or children under Minnesota Rules, chapter 9533, effective
July 1, 2017;
deleted text end

deleted text begin (10)deleted text endnew text begin (9)new text end comply with standards relating to mental health services in Minnesota Rules,
parts 9505.0370 to 9505.0372new text begin, and section 256B.0671new text end;

deleted text begin (11)deleted text endnew text begin (10)new text end be licensed to provide deleted text beginchemical dependencydeleted text endnew text begin substance use disordernew text end treatment
under chapter 245G;

deleted text begin (12)deleted text endnew text begin (11)new text end be certified to provide children's therapeutic services and supports under section
256B.0943;

deleted text begin (13)deleted text endnew text begin (12)new text end be certified to provide adult rehabilitative mental health services under section
256B.0623;

deleted text begin (14)deleted text endnew text begin (13)new text end be enrolled to provide mental health crisis response services under deleted text beginsectiondeleted text end
new text begin sectionsnew text end 256B.0624 new text beginand 256B.0944new text end;

deleted text begin (15)deleted text endnew text begin (14)new text end be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;

deleted text begin (16)deleted text endnew text begin (15)new text end comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926; deleted text beginand
deleted text end

deleted text begin (17)deleted text endnew text begin (16)new text end provide services that comply with the evidence-based practices described in
paragraph (e)deleted text begin.deleted text endnew text begin; and
new text end

new text begin (17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
new text end

(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.

(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under deleted text beginparagraph (f)deleted text endnew text begin section
256B.0625, subdivision 5m,
new text end for those services without a county contract or county approval.
There is no county share when medical assistance pays the CCBHC prospective payment.
As part of the certification process in paragraph (a), the commissioner shall require a letter
of support from the CCBHC's host county confirming that the CCBHC and the county or
counties it serves have an ongoing relationship to facilitate access and continuity of care,
especially for individuals who are uninsured or who may go on and off medical assistance.

(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision.new text begin For the CCBHC that is certified but not approved for
prospective payment under section 256B.0625, subdivision 5m, the commissioner may
grant a variance under this paragraph if the variance does not increase the state share of
costs.
new text end

(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.

deleted text begin (f) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by certified
community behavioral health clinics, in accordance with guidance issued by the Centers
for Medicare and Medicaid Services. During the operation of the demonstration project,
payments shall comply with federal requirements for an enhanced federal medical assistance
percentage. The commissioner may include quality bonus payment in the prospective
payment system based on federal criteria and on a clinic's provision of the evidence-based
practices in paragraph (e). The prospective payment system does not apply to MinnesotaCare.
Implementation of the prospective payment system is effective July 1, 2017, or upon federal
approval, whichever is later.
deleted text end

deleted text begin (g) The commissioner shall seek federal approval to continue federal financial
participation in payment for CCBHC services after the federal demonstration period ends
for clinics that were certified as CCBHCs during the demonstration period and that continue
to meet the CCBHC certification standards in paragraph (a). Payment for CCBHC services
shall cease effective July 1, 2019, if continued federal financial participation for the payment
of CCBHC services cannot be obtained.
deleted text end

deleted text begin (h) The commissioner may certify at least one CCBHC located in an urban area and at
least one CCBHC located in a rural area, as defined by federal criteria. To the extent allowed
by federal law, the commissioner may limit the number of certified clinics so that the
projected claims for certified clinics will not exceed the funds budgeted for this purpose.
The commissioner shall give preference to clinics that:
deleted text end

deleted text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated; and
deleted text end

deleted text begin (2) enhance the state's ability to meet the federal priorities to be selected as a CCBHC
demonstration state.
deleted text end

deleted text begin (i)deleted text endnew text begin (f)new text end The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2018, section 245F.05, subdivision 2, is amended to read:


Subd. 2.

Admission criteria.

For an individual to be admitted to a withdrawal
management program, the program must make a determination that the program services
are appropriate to the needs of the individual. A program may only admit individuals deleted text beginwho
meet the admission criteria and
deleted text end who, at the time of admissiondeleted text begin:deleted text endnew text begin, meet the criteria for admission
as determined by current American Society of Addiction Medicine standards for appropriate
level of withdrawal management.
new text end

deleted text begin (1) are impaired as the result of intoxication;
deleted text end

deleted text begin (2) are experiencing physical, mental, or emotional problems due to intoxication or
withdrawal from alcohol or other drugs;
deleted text end

deleted text begin (3) are being held under apprehend and hold orders under section 253B.07, subdivision
2b;
deleted text end

deleted text begin (4) have been committed under chapter 253B and need temporary placement;
deleted text end

deleted text begin (5) are held under emergency holds or peace and health officer holds under section
253B.05, subdivision 1 or 2; or
deleted text end

deleted text begin (6) need to stay temporarily in a protective environment because of a crisis related to
substance use disorder. Individuals satisfying this clause may be admitted only at the request
of the county of fiscal responsibility, as determined according to section 256G.02, subdivision
4. Individuals admitted according to this clause must not be restricted to the facility.
deleted text end

Sec. 6.

Minnesota Statutes 2018, section 245G.01, subdivision 8, is amended to read:


Subd. 8.

Client.

"Client" means an individual accepted by a license holder for assessment
or treatment of a substance use disorder. An individual remains a client until the license
holder no longer provides or intends to provide the individual with treatment service.new text begin Client
also includes the meaning of patient under section 144.651, subdivision 2.
new text end

Sec. 7.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 10a. new text end

new text begin Day of service initiation. new text end

new text begin "Day of service initiation" means the day the
license holder begins the provision of a treatment service identified in section 245G.07.
new text end

Sec. 8.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 13a. new text end

new text begin Group counseling. new text end

new text begin "Group counseling" means a professionally led
psychotherapeutic substance use disorder treatment that is delivered in an interactive group
setting.
new text end

Sec. 9.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:


new text begin Subd. 20a. new text end

new text begin Person-centered. new text end

new text begin "Person-centered" means a client actively participates in
the client's treatment planning of services. This includes a client making meaningful and
informed choices about the client's own goals, objectives, and the services the client receives
in collaboration with the client's identified natural supports.
new text end

Sec. 10.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision
to read:


new text begin Subd. 20b. new text end

new text begin Staff or staff member. new text end

new text begin "Staff" or "staff member" means an individual who
works under the direction of the license holder regardless of the individual's employment
status including but not limited to an intern, consultant, individual who works part time, or
individual who does not provide direct care services.
new text end

Sec. 11.

Minnesota Statutes 2018, section 245G.01, subdivision 21, is amended to read:


Subd. 21.

Student intern.

"Student intern" means an individual who is new text beginenrolled in a
program specializing in alcohol and drug counseling or mental health counseling at an
accredited educational institution and is
new text endauthorized by a licensing board to provide services
under supervision of a licensed professional.

Sec. 12.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision
to read:


new text begin Subd. 28. new text end

new text begin Treatment week. new text end

new text begin "Treatment week" means the seven-day period that the
program identified in the program's policy and procedure manual as the day of the week
that the treatment program week starts and ends for the purpose of identifying the nature
and number of treatment services an individual receives weekly.
new text end

Sec. 13.

Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision
to read:


new text begin Subd. 29. new text end

new text begin Volunteer. new text end

new text begin "Volunteer" means an individual who, under the direction of the
license holder, provides services or an activity to a client without compensation.
new text end

Sec. 14.

Minnesota Statutes 2018, section 245G.04, is amended to read:


245G.04 deleted text beginINITIAL SERVICES PLANdeleted text endnew text begin SERVICE INITIATIONnew text end.

new text begin Subdivision 1. new text end

new text begin Initial services plan. new text end

deleted text begin(a)deleted text end The license holder must complete an initial
services plan deleted text beginondeleted text endnew text begin within 24 hours ofnew text end the day of service initiation. The plan must new text beginbe
person-centered and client-specific,
new text endaddress the client's immediate health and safety concerns,
new text begin and new text endidentify the new text begintreatment new text endneedsnew text begin of the clientnew text end to be addressed deleted text beginin the first treatment session,
and make treatment suggestions for the client
deleted text end during the time between deleted text beginintakedeleted text endnew text begin the day of
service initiation
new text end and deleted text begincompletiondeleted text endnew text begin developmentnew text end of the individual treatment plan.

new text begin Subd. 2. new text end

new text begin Vulnerable adult status. new text end

deleted text begin(b) The initial services plan must include a
determination of
deleted text end new text begin(a) Within 24 hours of the day of service initiation, a nonresidential program
must determine
new text endwhether a client is a vulnerable adult as defined in section 626.5572,
subdivision 21
. An adult client of a residential program is a vulnerable adult.

new text begin (b)new text end An individual abuse prevention plan, according to sections 245A.65, subdivision 2,
paragraph (b), and 626.557, subdivision 14, paragraph (b), is required for a client who meets
the definition of vulnerable adult.

Sec. 15.

Minnesota Statutes 2018, section 245G.05, is amended to read:


245G.05 COMPREHENSIVE ASSESSMENT AND ASSESSMENT SUMMARY.

Subdivision 1.

Comprehensive assessment.

(a) A comprehensive assessment of the
client's substance use disorder must be administered face-to-face by an alcohol and drug
counselor within three calendar days deleted text beginafterdeleted text endnew text begin from the day ofnew text end service initiation for a residential
program or deleted text beginduring the initial session for all other programsdeleted text endnew text begin within three calendar days on
which a treatment session has been provided of the day of service initiation for a client in
a nonresidential program
new text end. If the comprehensive assessment is not completed deleted text beginduring the
initial session,
deleted text end new text beginwithin the required time frame, new text endthe deleted text beginclient-centereddeleted text endnew text begin person-centerednew text end reason
for the delaynew text begin and the planned completion datenew text end must be documented in the client's file deleted text beginand
the planned completion date
deleted text end. new text beginThe comprehensive assessment is complete upon a qualified
staff member's dated signature.
new text endIf the client received a comprehensive assessment that
authorized the treatment service, an alcohol and drug counselor new text beginmay use the comprehensive
assessment for requirements of this subdivision but
new text endmust new text begindocument a new text endreview deleted text beginthedeleted text end new text beginof the
comprehensive
new text endassessmentnew text begin and update the comprehensive assessment as clinically necessarynew text end
to deleted text begindeterminedeleted text endnew text begin ensurenew text end compliance with this subdivisiondeleted text begin, includingdeleted text endnew text begin withinnew text end applicable timelines.
deleted text begin If available, the alcohol and drug counselor may use current information provided by a
referring agency or other source as a supplement. Information gathered more than 45 days
before the date of admission is not considered current.
deleted text end The comprehensive assessment must
include sufficient information to complete the assessment summary according to subdivision
2 and the individual treatment plan according to section 245G.06. The comprehensive
assessment must include information about the client's needs that relate to substance use
and personal strengths that support recovery, including:

(1) age, sex, cultural background, sexual orientation, living situation, economic status,
and level of education;

(2) new text begina description of the new text endcircumstances new text beginon the day new text endof service initiation;

(3) new text begina list of new text endprevious attempts at treatment for substance misuse or substance use disorder,
compulsive gambling, or mental illness;

(4) new text begina list of new text endsubstance use history including amounts and types of substances used,
frequency and duration of use, periods of abstinence, and circumstances of relapse, if any.
For each substance used within the previous 30 days, the information must include the date
of the most recent use and new text beginaddress the absence or presence of new text endprevious withdrawal symptoms;

(5) specific problem behaviors exhibited by the client when under the influence of
substances;

(6) deleted text beginfamily statusdeleted text endnew text begin the client's desire for family involvement in the treatment programnew text end,
family historynew text begin of substance use and misusenew text end, deleted text beginincludingdeleted text end history or presence of physical or
sexual abuse, new text beginand new text endlevel of family supportdeleted text begin, and substance misuse or substance use disorder
of a family member or significant other
deleted text end;

(7) physical new text beginand medical new text endconcerns or diagnoses, deleted text beginthe severity of the concerns, anddeleted text endnew text begin current
medical treatment needed or being received related to the diagnoses, and
new text end whether the
concerns deleted text beginare being addressed by adeleted text endnew text begin need to be referred to an appropriatenew text end health care
professional;

(8) mental health history deleted text beginand psychiatric statusdeleted text end, including symptomsdeleted text begin, disability,deleted text endnew text begin and the
effect on the client's ability to function;
new text end current new text beginmental health new text endtreatment deleted text beginsupports,deleted text endnew text begin;new text end and
psychotropic medication needed to maintain stabilitydeleted text begin;deleted text endnew text begin.new text end The assessment must utilize screening
tools approved by the commissioner pursuant to section 245.4863 to identify whether the
client screens positive for co-occurring disorders;

(9) arrests and legal interventions related to substance use;

(10) new text begina description of how the client's use affected the client's new text endability to function
appropriately in work and educational settings;

(11) ability to understand written treatment materials, including rules and the client's
rights;

(12) new text begina description of any new text endrisk-taking behavior, including behavior that puts the client at
risk of exposure to blood-borne or sexually transmitted diseases;

(13) social network in relation to expected support for recovery deleted text beginanddeleted text endnew text begin;
new text end

new text begin (14)new text end leisure time activities that are associated with substance use;

deleted text begin (14)deleted text endnew text begin (15)new text end whether the client is pregnant and, if so, the health of the unborn child and the
client's current involvement in prenatal care;

deleted text begin (15)deleted text endnew text begin (16)new text end whether the client recognizes deleted text beginproblemsdeleted text endnew text begin needsnew text end related to substance use and is
willing to follow treatment recommendations; and

deleted text begin (16) collateraldeleted text endnew text begin (17)new text end informationnew text begin from a collateral contact may be included, but is not
required
new text end. deleted text beginIf the assessor gathered sufficient information from the referral source or the client
to apply the criteria in Minnesota Rules, parts 9530.6620 and 9530.6622, a collateral contact
is not required.
deleted text end

(b) If the client is identified as having opioid use disorder or seeking treatment for opioid
use disorder, the program must provide educational information to the client concerning:

(1) risks for opioid use disorder and dependence;

(2) treatment options, including the use of a medication for opioid use disorder;

(3) the risk of and recognizing opioid overdose; and

(4) the use, availability, and administration of naloxone to respond to opioid overdose.

(c) The commissioner shall develop educational materials that are supported by research
and updated periodically. The license holder must use the educational materials that are
approved by the commissioner to comply with this requirement.

(d) If the comprehensive assessment is completed to authorize treatment service for the
client, at the earliest opportunity during the assessment interview the assessor shall determine
if:

(1) the client is in severe withdrawal and likely to be a danger to self or others;

(2) the client has severe medical problems that require immediate attention; or

(3) the client has severe emotional or behavioral symptoms that place the client or others
at risk of harm.

If one or more of the conditions in clauses (1) to (3) are present, the assessor must end the
assessment interview and follow the procedures in the program's medical services plan
under section 245G.08, subdivision 2, to help the client obtain the appropriate services. The
assessment interview may resume when the condition is resolved.

Subd. 2.

Assessment summary.

(a) An alcohol and drug counselor must complete an
assessment summary within three calendar days deleted text beginafterdeleted text endnew text begin from the day ofnew text end service initiation for
a residential program and within three deleted text beginsessionsdeleted text end deleted text beginfor all other programsdeleted text endnew text begin calendar days on
which a treatment session has been provided from the day of service initiation for a client
in a nonresidential program. The comprehensive assessment summary is complete upon a
qualified staff member's dated signature
new text end. If the comprehensive assessment is used to authorize
the treatment service, the alcohol and drug counselor must prepare an assessment summary
on the same date the comprehensive assessment is completed. If the comprehensive
assessment and assessment summary are to authorize treatment services, the assessor must
determine appropriate services for the client using the dimensions in Minnesota Rules, part
9530.6622, and document the recommendations.

(b) An assessment summary must include:

(1) a risk description according to section 245G.05 for each dimension listed in paragraph
(c);

(2) a narrative summary supporting the risk descriptions; and

(3) a determination of whether the client has a substance use disorder.

(c) An assessment summary must contain information relevant to treatment service
planning and recorded in the dimensions in clauses (1) to (6). The license holder must
consider:

(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with
withdrawal symptoms and current state of intoxication;

(2) Dimension 2, biomedical conditions and complications; the degree to which any
physical disorder of the client would interfere with treatment for substance use, and the
client's ability to tolerate any related discomfort. The license holder must determine the
impact of continued deleted text beginchemicaldeleted text endnew text begin substancenew text end use on the unborn child, if the client is pregnant;

(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications;
the degree to which any condition or complication is likely to interfere with treatment for
substance use or with functioning in significant life areas and the likelihood of harm to self
or others;

(4) Dimension 4, readiness for change; the support necessary to keep the client involved
in treatment service;

(5) Dimension 5, relapse, continued use, and continued problem potential; the degree
to which the client recognizes relapse issues and has the skills to prevent relapse of either
substance use or mental health problems; and

(6) Dimension 6, recovery environment; whether the areas of the client's life are
supportive of or antagonistic to treatment participation and recovery.

Sec. 16.

Minnesota Statutes 2018, section 245G.06, subdivision 1, is amended to read:


Subdivision 1.

General.

Each client must have deleted text beginandeleted text endnew text begin a person-centerednew text end individual treatment
plan developed by an alcohol and drug counselor within deleted text beginsevendeleted text endnew text begin tennew text end days new text beginfrom the day new text endof
service initiation for a residential program and within deleted text beginthree sessions for all other programsdeleted text endnew text begin
five calendar days on which a treatment session has been provided from the day of service
initiation for a client in a nonresidential program. Opioid treatment programs must complete
the individual treatment plan within 21 days from the day of service initiation
new text end. deleted text beginThe client
must have active, direct involvement in selecting the anticipated outcomes of the treatment
process and developing the treatment plan.
deleted text end The individual treatment plan must be signed
by the client and the alcohol and drug counselor and document the client's involvement in
the development of the plan. deleted text beginThe plan may be a continuation of the initial services plan
required in section 245G.04.
deleted text endnew text begin The individual treatment plan is developed upon the qualified
staff member's dated signature.
new text end Treatment planning must include ongoing assessment of
client needs. An individual treatment plan must be updated based on new information
gathered about the client's conditionnew text begin, the client's level of participation,new text end and on whether
methods identified have the intended effect. A change to the plan must be signed by the
client and the alcohol and drug counselor. deleted text beginThe plan must provide for the involvement of
the client's family and people selected by the client as important to the success of treatment
at the earliest opportunity, consistent with the client's treatment needs and written consent.
deleted text endnew text begin
If the client chooses to have family or others involved in treatment services, the client's
individual treatment plan must include how the family or others will be involved in the
client's treatment.
new text end

Sec. 17.

Minnesota Statutes 2018, section 245G.06, subdivision 2, is amended to read:


Subd. 2.

Plan contents.

An individual treatment plan must be recorded in the six
dimensions listed in section 245G.05, subdivision 2, paragraph (c), must address each issue
identified in the assessment summary, prioritized according to the client's needs and focus,
and must include:

(1) specific new text begingoals and new text endmethods to address each identified neednew text begin in the comprehensive
assessment summary
new text end, including amount, frequency, and anticipated duration of treatment
service. The methods must be appropriate to the client's language, reading skills, cultural
background, and strengths;

(2) resources to refer the client to when the client's needs are to be addressed concurrently
by another provider; and

(3) goals the client must reach to complete treatment and terminate services.

Sec. 18.

Minnesota Statutes 2018, section 245G.06, subdivision 4, is amended to read:


Subd. 4.

Service discharge summary.

(a) An alcohol and drug counselor must write a
new text begin service new text enddischarge summary for each client. The new text beginservice discharge new text endsummary must be
completed within five days of the client's service termination deleted text beginor within five days from the
client's or program's decision to terminate services, whichever is earlier
deleted text end.new text begin A copy of the
client's service discharge summary must be provided to the client upon the client's request.
new text end

(b) The service discharge summary must be recorded in the six dimensions listed in
section 245G.05, subdivision 2, paragraph (c), and include the following information:

(1) the client's issues, strengths, and needs while participating in treatment, including
services provided;

(2) the client's progress toward achieving each goal identified in the individual treatment
plan;

(3) a risk description according to section 245G.05; deleted text beginand
deleted text end

(4) the reasons for and circumstances of service termination. If a program discharges a
client at staff request, the reason for discharge and the procedure followed for the decision
to discharge must be documented and comply with the deleted text beginprogram's policies on staff-initiated
client discharge. If a client is discharged at staff request, the program must give the client
crisis and other referrals appropriate for the client's needs and offer assistance to the client
to access the services.
deleted text endnew text begin requirements in section 245G.14, subdivision 3, clause (3);
new text end

deleted text begin (c) For a client who successfully completes treatment, the summary must also include:
deleted text end

deleted text begin (1)deleted text end new text begin(5) new text endthe client's living arrangements at service termination;

deleted text begin (2)deleted text end new text begin(6) new text endcontinuing care recommendations, including transitions between more or less
intense services, or more frequent to less frequent services, and referrals made with specific
attention to continuity of care for mental health, as needed;new text begin and
new text end

deleted text begin (3)deleted text end new text begin(7) new text endservice termination diagnosisdeleted text begin; anddeleted text endnew text begin.
new text end

deleted text begin (4) the client's prognosis.
deleted text end

Sec. 19.

Minnesota Statutes 2018, section 245G.07, is amended to read:


245G.07 TREATMENT SERVICE.

Subdivision 1.

Treatment service.

(a) A deleted text beginlicense holderdeleted text end new text beginlicensed residential treatment
program
new text endmust offer the deleted text beginfollowingdeleted text end treatment servicesnew text begin in clauses (1) to (5) to each clientnew text end,
unless clinically inappropriate and the justifying clinical rationale is documenteddeleted text begin:deleted text endnew text begin. A
nonresidential treatment program must offer all treatment services in clauses (1) to (5) and
document in the individual treatment plan the specific services for which a client has an
assessed need and the plan to provide the services:
new text end

(1) individual and group counseling to help the client identify and address needs related
to substance use and develop strategies to avoid harmful substance use after discharge and
to help the client obtain the services necessary to establish a lifestyle free of the harmful
effects of substance use disorder;

(2) client education strategies to avoid inappropriate substance use and health problems
related to substance use and the necessary lifestyle changes to regain and maintain health.
Client education must include information on tuberculosis education on a form approved
by the commissioner, the human immunodeficiency virus according to section 245A.19,
other sexually transmitted diseases, drug and alcohol use during pregnancy, and hepatitisdeleted text begin.deleted text end
deleted text begin A licensed alcohol and drug counselor must be present during an educational groupdeleted text end;

(3) a service to help the client integrate gains made during treatment into daily living
and to reduce the client's reliance on a staff member for support;

(4) a service to address issues related to co-occurring disorders, including client education
on symptoms of mental illness, the possibility of comorbidity, and the need for continued
medication compliance while recovering from substance use disorder. A group must address
co-occurring disorders, as needed. When treatment for mental health problems is indicated,
the treatment must be integrated into the client's individual treatment plan;new text begin and
new text end

deleted text begin (5) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided one-to-one by an individual in recovery. Peer support services include
education, advocacy, mentoring through self-disclosure of personal recovery experiences,
attending recovery and other support groups with a client, accompanying the client to
appointments that support recovery, assistance accessing resources to obtain housing,
employment, education, and advocacy services, and nonclinical recovery support to assist
the transition from treatment into the recovery community; and
deleted text end

deleted text begin (6) on July 1, 2018, or upon federal approval, whichever is later, caredeleted text endnew text begin (5) treatmentnew text end
coordination provided new text beginone-to-one new text endby an individual who meets the staff qualifications in
section 245G.11, subdivision 7. deleted text beginCaredeleted text endnew text begin Treatmentnew text end coordination services include:

(i) assistance in coordination with significant others to help in the treatment planning
process whenever possible;

(ii) assistance in coordination with and follow up for medical services as identified in
the treatment plan;

(iii) facilitation of referrals to substance use disorder services as indicated by a client's
medical provider, comprehensive assessment, or treatment plan;

(iv) facilitation of referrals to mental health services as identified by a client's
comprehensive assessment or treatment plan;

(v) assistance with referrals to economic assistance, social services, housing resources,
and prenatal care according to the client's needs;

(vi) life skills advocacy and support accessing treatment follow-up, disease management,
and education services, including referral and linkages to long-term services and supports
as needed; and

(vii) documentation of the provision of deleted text begincaredeleted text endnew text begin treatmentnew text end coordination services in the client's
file.

(b) A treatment service provided to a client must be provided according to the individual
treatment plan and must consider cultural differences and special needs of a client.

Subd. 2.

Additional treatment service.

A license holder may provide or arrange the
following additional treatment service as a part of the client's individual treatment plan:

(1) relationship counseling provided by a qualified professional to help the client identify
the impact of the client's substance use disorder on others and to help the client and persons
in the client's support structure identify and change behaviors that contribute to the client's
substance use disorder;

(2) therapeutic recreation to allow the client to participate in recreational activities
without the use of mood-altering chemicals and to plan and select leisure activities that do
not involve the inappropriate use of chemicals;

(3) stress management and physical well-being to help the client reach and maintain an
appropriate level of health, physical fitness, and well-being;

(4) living skills development to help the client learn basic skills necessary for independent
living;

(5) employment or educational services to help the client become financially independent;

(6) socialization skills development to help the client live and interact with others in a
positive and productive manner; deleted text beginand
deleted text end

(7) room, board, and supervision at the treatment site to provide the client with a safe
and appropriate environment to gain and practice new skillsnew text begin; and
new text end

new text begin (8) peer recovery support services provided one-to-one by an individual in recovery
qualified according to section 245G.11, subdivision 8. Peer support services include
education; advocacy; mentoring through self-disclosure of personal recovery experiences;
attending recovery and other support groups with a client; accompanying the client to
appointments that support recovery; assistance accessing resources to obtain housing,
employment, education, and advocacy services; and nonclinical recovery support to assist
the transition from treatment into the recovery community
new text end.

Subd. 3.

Counselors.

deleted text beginAdeleted text end new text beginAllnew text end treatment deleted text beginservicedeleted text end new text beginservicesnew text end, deleted text beginincluding therapeutic recreationdeleted text end
new text begin except peer recovery support services and treatment coordinationnew text end, must be provided by an
alcohol and drug counselor new text beginqualifiednew text end according to section 245G.11new text begin, subdivision 5new text end, unless
the individual providing the service is specifically qualified according to the accepted
credential required to provide the service. deleted text beginTherapeutic recreation does not include planned
leisure activities.
deleted text endnew text begin The commissioner shall maintain a current list of professionals qualified
to provide treatment services.
new text end

Subd. 4.

Location of service provision.

The license holder may provide services at any
of the license holder's licensed locations or at another suitable location including a school,
government building, medical or behavioral health facility, or social service organization,
upon notification and approval of the commissioner. If services are provided off site from
the licensed site, the reason for the provision of services remotely must be documented.new text begin
The license holder may provide additional services under subdivision 2, clauses (2) to (5),
off-site if the license holder includes a policy and procedure detailing the off-site location
as a part of the treatment service description and the program abuse prevention plan.
new text end

Sec. 20.

Minnesota Statutes 2018, section 245G.08, subdivision 3, is amended to read:


Subd. 3.

Standing order protocol.

A license holder that maintains a supply of naloxone
available for emergency treatment of opioid overdose must have a written standing order
protocol by a physician who is licensed under chapter 147, that permits the license holder
to maintain a supply of naloxone on sitedeleted text begin, anddeleted text endnew text begin. A license holdernew text end must require staff to undergo
deleted text begin specificdeleted text end training in deleted text beginadministration of naloxonedeleted text endnew text begin the specific mode of administration used at
the program, which may include intranasal administration, intramuscular injection, or both
new text end.

Sec. 21.

Minnesota Statutes 2018, section 245G.10, subdivision 4, is amended to read:


Subd. 4.

Staff requirement.

It is the responsibility of the license holder to determine
an acceptable group size based on each client's needs deleted text beginexcept that treatment services provided
in a
deleted text endnew text begin. new text endGroup new text begincounseling new text endshall not exceed 16 clients. deleted text beginA counselor in an opioid treatment
program must not supervise more than 50 clients.
deleted text end The license holder must maintain a record
that documents compliance with this subdivision.

Sec. 22.

Minnesota Statutes 2018, section 245G.11, subdivision 7, is amended to read:


Subd. 7.

deleted text beginCaredeleted text endnew text begin Treatmentnew text end coordination provider qualifications.

(a) deleted text beginCaredeleted text endnew text begin Treatmentnew text end
coordination must be provided by qualified staff. An individual is qualified to provide deleted text begincaredeleted text endnew text begin
treatment
new text end coordination if the individualdeleted text begin:deleted text endnew text begin meets the qualifications of an alcohol and drug
counselor under subdivision 5 or if the individual:
new text end

(1) is skilled in the process of identifying and assessing a wide range of client needs;

(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;

(3) has successfully completed 30 hours of classroom instruction on deleted text begincaredeleted text endnew text begin treatmentnew text end
coordination for an individual with substance use disorder;

(4) has either:

(i) a bachelor's degree in one of the behavioral sciences or related fields; or

(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and

(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.

(b) A deleted text begincaredeleted text endnew text begin treatmentnew text end coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor deleted text beginweeklydeleted text end new text beginmonthlynew text end.

Sec. 23.

Minnesota Statutes 2018, section 245G.11, subdivision 8, is amended to read:


Subd. 8.

Recovery peer qualifications.

A recovery peer must:

(1) have a high school diploma or its equivalent;

(2) have a minimum of one year in recovery from substance use disorder;

(3) hold a current credential from deleted text begina certification body approved by the commissioner
that demonstrates
deleted text endnew text begin the Minnesota Certification Board, the Upper Midwest Indian Council
on Addictive Disorders, or the National Association for Alcoholism and Drug Abuse
Counselors. An individual may also receive a credential from a tribal nation when providing
peer recovery support services in a tribally licensed program. The credential must demonstrate
new text end
skills and training in the domains of ethics and boundaries, advocacy, mentoring and
education, and recovery and wellness support; and

(4) receive ongoing supervision in areas specific to the domains of the recovery peer's
role by an alcohol and drug counselor deleted text beginor an individual with a certification approved by the
commissioner
deleted text end.

Sec. 24.

Minnesota Statutes 2018, section 245G.12, is amended to read:


245G.12 PROVIDER POLICIES AND PROCEDURES.

A license holder must develop a written policies and procedures manual, indexed
according to section 245A.04, subdivision 14, paragraph (c), that provides staff members
immediate access to all policies and procedures and provides a client and other authorized
parties access to all policies and procedures. The manual must contain the following
materials:

(1) assessment and treatment planning policies, including screening for mental health
concerns and treatment objectives related to the client's identified mental health concerns
in the client's treatment plan;

(2) policies and procedures regarding HIV according to section 245A.19;

(3) the license holder's methods and resources to provide information on tuberculosis
and tuberculosis screening to each client and to report a known tuberculosis infection
according to section 144.4804;

(4) personnel policies according to section 245G.13;

(5) policies and procedures that protect a client's rights according to section 245G.15;

(6) a medical services plan according to section 245G.08;

(7) emergency procedures according to section 245G.16;

(8) policies and procedures for maintaining client records according to section 245G.09;

(9) procedures for reporting the maltreatment of minors according to section 626.556,
and vulnerable adults according to sections 245A.65, 626.557, and 626.5572;

(10) a description of treatment servicesdeleted text begin, including the amount and type of services
deleted text enddeleted text begin provideddeleted text endnew text begin that: (i) includes the amount and type of services provided; (ii) identifies which
services meet the definition of group counseling under section 245G.01, subdivision 13a;
and (iii) defines the program's treatment week
new text end;

(11) the methods used to achieve desired client outcomes;

(12) the hours of operation; and

(13) the target population served.

Sec. 25.

Minnesota Statutes 2018, section 245G.13, subdivision 1, is amended to read:


Subdivision 1.

Personnel policy requirements.

A license holder must have written
personnel policies that are available to each staff member. The personnel policies must:

(1) ensure that staff member retention, promotion, job assignment, or pay are not affected
by a good faith communication between a staff member and the department, the Department
of Health, the ombudsman for mental health and developmental disabilities, law enforcement,
or a local agency for the investigation of a complaint regarding a client's rights, health, or
safety;

(2) contain a job description for each staff member position specifying responsibilities,
degree of authority to execute job responsibilities, and qualification requirements;

(3) provide for a job performance evaluation based on standards of job performance
conducted on a regular and continuing basis, including a written annual review;

(4) describe behavior that constitutes grounds for disciplinary action, suspension, or
dismissal, including policies that address staff member problematic substance use and the
requirements of section 245G.11, subdivision 1, policies prohibiting personal involvement
with a client in violation of chapter 604, and policies prohibiting client abuse described in
sections 245A.65, 626.556, 626.557, and 626.5572;

(5) identify how the program will identify whether behaviors or incidents are problematic
substance use, including a description of how the facility must address:

(i) receiving treatment for substance use within the period specified for the position in
the staff qualification requirements, including medication-assisted treatment;

(ii) substance use that negatively impacts the staff member's job performance;

(iii) deleted text beginchemicaldeleted text endnew text begin substancenew text end use that affects the credibility of treatment services with a client,
referral source, or other member of the community;

(iv) symptoms of intoxication or withdrawal on the job; and

(v) the circumstances under which an individual who participates in monitoring by the
health professional services program for a substance use or mental health disorder is able
to provide services to the program's clients;

(6) include a chart or description of the organizational structure indicating lines of
authority and responsibilities;

(7) include orientation within 24 working hours of starting for each new staff member
based on a written plan that, at a minimum, must provide training related to the staff member's
specific job responsibilities, policies and procedures, client confidentiality, HIV minimum
standards, and client needs; and

(8) include policies outlining the license holder's response to a staff member with a
behavior problem that interferes with the provision of treatment service.

Sec. 26.

Minnesota Statutes 2018, section 245G.15, subdivision 1, is amended to read:


Subdivision 1.

Explanation.

A client has the rights identified in sections 144.651,
148F.165, and 253B.03, as applicable. The license holder must give each client deleted text beginatdeleted text endnew text begin on the
day of
new text end service initiation a written statement of the client's rights and responsibilities. A staff
member must review the statement with a client at that time.

Sec. 27.

Minnesota Statutes 2018, section 245G.15, subdivision 2, is amended to read:


Subd. 2.

Grievance procedure.

deleted text beginAtdeleted text endnew text begin On the day ofnew text end service initiation, the license holder
must explain the grievance procedure to the client or the client's representative. The grievance
procedure must be posted in a place visible to clients, and made available upon a client's or
former client's request. The grievance procedure must require that:

(1) a staff member helps the client develop and process a grievance;

(2) current telephone numbers and addresses of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health Office of Health Facilities Complaints; and the Board
of Behavioral Health and Therapy, when applicable, be made available to a client; and

(3) a license holder responds to the client's grievance within three days of a staff member's
receipt of the grievance, and the client may bring the grievance to the highest level of
authority in the program if not resolved by another staff member.

Sec. 28.

Minnesota Statutes 2018, section 245G.18, subdivision 3, is amended to read:


Subd. 3.

Staff ratios.

deleted text beginAt least 25 percent of a counselor's scheduled work hours must
be allocated to indirect services, including documentation of client services, coordination
of services with others, treatment team meetings, and other duties.
deleted text end A counseling group
consisting entirely of adolescents must not exceed 16 adolescents. It is the responsibility of
the license holder to determine an acceptable group size based on the needs of the clients.

Sec. 29.

Minnesota Statutes 2018, section 245G.18, subdivision 5, is amended to read:


Subd. 5.

Program requirements.

In addition to the requirements specified in the client's
treatment plan under section 245G.06, programs serving an adolescent must include:

(1) coordination with the school system to address the client's academic needs;

(2) when appropriate, a plan that addresses the client's leisure activities without deleted text beginchemicaldeleted text endnew text begin
substance
new text end use; and

(3) a plan that addresses family involvement in the adolescent's treatment.

Sec. 30.

Minnesota Statutes 2018, section 245G.22, subdivision 1, is amended to read:


Subdivision 1.

Additional requirements.

(a) An opioid treatment program licensed
under this chapter must alsonew text begin: (1)new text end comply with the requirements of this section and Code of
Federal Regulations, title 42, part 8deleted text begin. When federal guidance or interpretations are issued on
federal standards or requirements also required under this section, the federal guidance or
interpretations shall apply.
deleted text endnew text begin; (2) be registered as a narcotic treatment program with the Drug
Enforcement Administration; (3) be accredited through an accreditation body approved by
the Division of Pharmacologic Therapy of the Center for Substance Abuse Treatment; (4)
be certified through the Division of Pharmacologic Therapy of the Center for Substance
Abuse Treatment; and (5) hold a license from the Minnesota Board of Pharmacy or equivalent
agency.
new text end

(b) Where a standard in this section differs from a standard in an otherwise applicable
administrative rule or statute, the standard of this section applies.

Sec. 31.

Minnesota Statutes 2018, section 245G.22, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.

(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.

(d) "Medical director" means a deleted text beginphysiciandeleted text endnew text begin practitionernew text end licensed to practice medicine in
the jurisdiction that the opioid treatment program is located who assumes responsibility for
administering all medical services performed by the program, either by performing the
services directly or by delegating specific responsibility to deleted text begin(1) authorized program physicians;
(2) advanced practice registered nurses, when approved by variance by the State Opioid
Treatment Authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration; or (3) health care professionals functioning under the
medical director's direct supervision
deleted text endnew text begin a practitioner of the opioid treatment programnew text end.

(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.

(f) "Minnesota health care programs" has the meaning given in section 256B.0636.

(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.

(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.

new text begin (i) "Practitioner" means a staff member holding a current, unrestricted license to practice
medicine issued by the Board of Medical Practice or nursing issued by the Board of Nursing
and is currently registered with the Drug Enforcement Administration to order or dispense
controlled substances in Schedules II to V under the Controlled Substances Act, United
States Code, title 21, part B, section 821. Practitioner includes an advanced practice registered
nurse and physician assistant if the staff member receives a variance by the state opioid
treatment authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration.
new text end

deleted text begin (i)deleted text endnew text begin (j)new text end "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.

Sec. 32.

Minnesota Statutes 2018, section 245G.22, subdivision 3, is amended to read:


Subd. 3.

Medication orders.

Before the program may administer or dispense a medication
used for the treatment of opioid use disorder:

(1) a client-specific order must be received from an appropriately credentialed deleted text beginphysiciandeleted text endnew text begin
practitioner
new text end who is enrolled as a Minnesota health care programs provider and meets all
applicable provider standards;

(2) the signed order must be documented in the client's record; and

(3) if the deleted text beginphysiciandeleted text endnew text begin practitionernew text end that issued the order is not able to sign the order when
issued, the unsigned order must be entered in the client record at the time it was received,
and the deleted text beginphysiciandeleted text endnew text begin practitionernew text end must review the documentation and sign the order in the
client's record within 72 hours of the medication being ordered. The license holder must
report to the commissioner any medication error that endangers a client's health, as
determined by the medical director.

Sec. 33.

Minnesota Statutes 2018, section 245G.22, subdivision 4, is amended to read:


Subd. 4.

High dose requirements.

A client being administered or dispensed a dose
beyond that set forth in subdivision 6, paragraph (a), deleted text beginclause (1),deleted text end that exceeds 150 milligrams
of methadone or 24 milligrams of buprenorphine daily, and for each subsequent increase,
must meet face-to-face with a prescribing deleted text beginphysiciandeleted text endnew text begin practitionernew text end. The meeting must occur
before the administration or dispensing of the increased medication dose.

Sec. 34.

Minnesota Statutes 2018, section 245G.22, subdivision 6, is amended to read:


Subd. 6.

Criteria for unsupervised use.

(a) To limit the potential for diversion of
medication used for the treatment of opioid use disorder to the illicit market, medication
dispensed to a client for unsupervised use shall be subject to the deleted text beginfollowingdeleted text end requirementsdeleted text begin:deleted text endnew text begin
of this subdivision.
new text end

deleted text begin (1)deleted text end Any client in an opioid treatment program may receive a single unsupervised use
dose for a day that the clinic is closed for business, including Sundays and state and federal
holidaysdeleted text begin; anddeleted text endnew text begin.
new text end

deleted text begin (2) other treatment program decisions on dispensing medications used for the treatment
of opioid use disorder to a client for unsupervised use shall be determined by the medical
director.
deleted text end

(b) deleted text beginIn determining whether a client may be permitted unsupervised use of medications,
a physician
deleted text endnew text begin A practitionernew text end with authority to prescribe must deleted text beginconsiderdeleted text endnew text begin review and documentnew text end
the criteria in this paragraphdeleted text begin. The criteria in this paragraph must also be considereddeleted text endnew text begin and
paragraph (c)
new text end when determining whether dispensing medication for a client's unsupervised
use is appropriate to new text beginimplement, new text endincreasenew text begin,new text end or deleted text begintodeleted text end extend the amount of time between visits
to the program. The criteria are:

(1) absence of recent abuse of drugs including but not limited to opioids, non-narcotics,
and alcohol;

(2) regularity of program attendance;

(3) absence of serious behavioral problems at the program;

(4) absence of known recent criminal activity such as drug dealing;

(5) stability of the client's home environment and social relationships;

(6) length of time in comprehensive maintenance treatment;

(7) reasonable assurance that unsupervised use medication will be safely stored within
the client's home; and

(8) whether the rehabilitative benefit the client derived from decreasing the frequency
of program attendance outweighs the potential risks of diversion or unsupervised use.

(c) The determination, including the basis of the determination must be documented in
the client's medical record.

Sec. 35.

Minnesota Statutes 2018, section 245G.22, subdivision 7, is amended to read:


Subd. 7.

Restrictions for unsupervised use of methadone hydrochloride.

(a) If a
deleted text begin physician with authority to prescribedeleted text endnew text begin medical director or prescribing practitioner assesses
and
new text end determines that a client meets the criteria in subdivision 6 and may be dispensed a
medication used for the treatment of opioid addiction, the restrictions in this subdivision
must be followed when the medication to be dispensed is methadone hydrochloride.new text begin The
results of the assessment must be contained in the client file.
new text end

(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.

(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.

(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.

(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.

(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.

(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.

Sec. 36.

Minnesota Statutes 2018, section 245G.22, subdivision 15, is amended to read:


Subd. 15.

Nonmedication treatment services; documentation.

(a) The program must
offer at least 50 consecutive minutes of individual or group therapy treatment services as
defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first
ten weeks following deleted text beginadmissiondeleted text end new text beginthe day of service initiationnew text end, and at least 50 consecutive
minutes per month thereafter. As clinically appropriate, the program may offer these services
cumulatively and not consecutively in increments of no less than 15 minutes over the required
time period, and for a total of 60 minutes of treatment services over the time period, and
must document the reason for providing services cumulatively in the client's record. The
program may offer additional levels of service when deemed clinically necessary.

(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days new text beginfrom the day new text endof service initiation.

(c) Notwithstanding the requirements of individual treatment plans set forth in section
245G.06:

(1) treatment plan contents for a maintenance client are not required to include goals
the client must reach to complete treatment and have services terminated;

(2) treatment plans for a client in a taper or detox status must include goals the client
must reach to complete treatment and have services terminated; new text beginand
new text end

(3) for the deleted text begininitialdeleted text end ten weeks deleted text beginafter admissiondeleted text end new text beginfollowing the day of service initiationnew text end for
all new admissions, readmissions, and transfers, deleted text beginprogress notesdeleted text endnew text begin a weekly treatment plan
review
new text end must be deleted text beginentered in a client's file at deleted text enddeleted text beginleast weekly and be recorded in each of the six
dimensions upon the development of
deleted text end new text begindocumented oncenew text end the treatment plan deleted text beginand thereafterdeleted text endnew text begin is
completed
new text end. Subsequently, the counselor must document deleted text beginprogressdeleted text endnew text begin treatment plan reviewsnew text end in
the six dimensions at least once monthly or, when clinical need warrants, more frequentlydeleted text begin;
and
deleted text endnew text begin.
new text end

deleted text begin (4) upon the development of the treatment plan and thereafter, treatment plan reviews
must occur weekly, or after each treatment service, whichever is less frequent, for the first
ten weeks after the treatment plan is developed. Following the first ten weeks of treatment
plan reviews, reviews may occur monthly, unless the client's needs warrant more frequent
revisions or documentation.
deleted text end

Sec. 37.

Minnesota Statutes 2018, section 245G.22, subdivision 16, is amended to read:


Subd. 16.

Prescription monitoring program.

(a) The program must develop and
maintain a policy and procedure that requires the ongoing monitoring of the data from the
prescription monitoring program (PMP) for each client. The policy and procedure must
include how the program meets the requirements in paragraph (b).

(b) deleted text beginIfdeleted text endnew text begin Whennew text end a medication used for the treatment of substance use disorder is administered
or dispensed to a client, the license holder deleted text beginshall bedeleted text endnew text begin isnew text end subject to the following requirements:

(1) upon admission to deleted text begina methadone clinic outpatientdeleted text endnew text begin an opioidnew text end treatment program, a
client must be notified in writing that the commissioner of human services and the medical
director must monitor the PMP to review the prescribed controlled drugs a client received;

(2) the medical director or the medical director's delegate must review the data from the
PMP described in section 152.126 before the client is ordered any controlled substance, as
defined under section 152.126, subdivision 1, paragraph (c), including medications used
for the treatment of opioid addiction, and the medical director's or the medical director's
delegate's subsequent reviews of the PMP data must occur at least every 90 days;

(3) a copy of the PMP data reviewed must be maintained in the client's filenew text begin along with
the licensed practitioner's decision for frequency of ongoing PMP checks
new text end;

(4) when the PMP data contains a recent history of multiple prescribers or multiple
prescriptions for controlled substances, the physician's review of the data and subsequent
actions must be documented in the client's file within 72 hours and must contain the deleted text beginmedicaldeleted text end
deleted text begin director'sdeleted text end new text beginlicensed practitioner'snew text end determination of whether or not the prescriptions place the
client at risk of harm and the actions to be taken in response to the PMP findings. The
provider must conduct subsequent reviews of the PMP on a monthly basis; and

(5) if at any time the deleted text beginmedical directordeleted text endnew text begin licensed practitionernew text end believes the use of the
controlled substances places the client at risk of harm, the program must seek the client's
consent to discuss the client's opioid treatment with other prescribers and must seek the
client's consent for the other prescriber to disclose to the opioid treatment program's deleted text beginmedicaldeleted text end
deleted text begin directordeleted text end new text beginlicensed practitionernew text end the client's condition that formed the basis of the other
prescriptions. If the information is not obtained within seven days, the medical director
must document whether or not changes to the client's medication dose or number of
unsupervised use doses are necessary until the information is obtained.

(c) The commissioner shall collaborate with the Minnesota Board of Pharmacy to develop
and implement an electronic system for the commissioner to routinely access the PMP data
to determine whether any client enrolled in an opioid addiction treatment program licensed
according to this section was prescribed or dispensed a controlled substance in addition to
that administered or dispensed by the opioid addiction treatment program. When the
commissioner determines there have been multiple prescribers or multiple prescriptions of
controlled substances for a client, the commissioner shall:

(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and

(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.

(d) If determined necessary, the commissioner shall seek a federal waiver of, or exception
to, any applicable provision of Code of Federal Regulations, title 42, section 2.34 (c), before
implementing this subdivision.

Sec. 38.

Minnesota Statutes 2018, section 245G.22, subdivision 17, is amended to read:


Subd. 17.

Policies and procedures.

(a) A license holder must develop and maintain the
policies and procedures required in this subdivision.

(b) For a program that is not open every day of the year, the license holder must maintain
a policy and procedure that deleted text beginpermits a client to receive a singledeleted text endnew text begin covers requirements under
section 245G.22, subdivisions 6 and 7.
new text end Unsupervised use of medication used for the treatment
of opioid use disorder for days that the program is closed for business, includingdeleted text begin,deleted text end but not
limited todeleted text begin,deleted text end Sundays and state and federal holidays deleted text beginas required under subdivision 6, paragraph
(a), clause (1)
deleted text endnew text begin, must meet the requirements under section 245G.22, subdivisions 6 and 7new text end.

(c) The license holder must maintain a policy and procedure that includes specific
measures to reduce the possibility of diversion. The policy and procedure must:

(1) specifically identify and define the responsibilities of the medical and administrative
staff for performing diversion control measures; and

(2) include a process for contacting no less than five percent of clients who have
unsupervised use of medication, excluding clients approved solely under subdivision 6,
paragraph (a), deleted text beginclause (1),deleted text end to require clients to physically return to the program each month.
The system must require clients to return to the program within a stipulated time frame and
turn in all unused medication containers related to opioid use disorder treatment. The license
holder must document all related contacts on a central log and the outcome of the contact
for each client in the client's record.new text begin The medical director must be informed of each outcome
that results in a situation in which a possible diversion issue was identified.
new text end

(d) Medication used for the treatment of opioid use disorder must be ordered,
administered, and dispensed according to applicable state and federal regulations and the
standards set by applicable accreditation entities. If a medication order requires assessment
by the person administering or dispensing the medication to determine the amount to be
administered or dispensed, the assessment must be completed by an individual whose
professional scope of practice permits an assessment. For the purposes of enforcement of
this paragraph, the commissioner has the authority to monitor the person administering or
dispensing the medication for compliance with state and federal regulations and the relevant
standards of the license holder's accreditation agency and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07, based on the commissioner's
determination of noncompliance.

new text begin (e) A counselor in an opioid treatment program must not supervise more than 50 clients.
new text end

Sec. 39.

Minnesota Statutes 2018, section 245G.22, subdivision 19, is amended to read:


Subd. 19.

Placing authorities.

A program must provide certain notification and
client-specific updates to placing authorities for a client who is enrolled in Minnesota health
care programs. At the request of the placing authority, the program must provide
client-specific updates, including but not limited to informing the placing authority of
positive drug deleted text beginscreeningsdeleted text endnew text begin testingsnew text end and changes in medications used for the treatment of opioid
use disorder ordered for the client.

Sec. 40.

Minnesota Statutes 2018, section 254A.03, subdivision 3, is amended to read:


Subd. 3.

Rules for substance use disorder care.

(a) The commissioner of human
services shall establish by rule criteria to be used in determining the appropriate level of
chemical dependency care for each recipient of public assistance seeking treatment for
substance misuse or substance use disorder. Upon federal approval of a comprehensive
assessment as a Medicaid benefit, or on July 1, 2018, whichever is later, and notwithstanding
the criteria in Minnesota Rules, parts 9530.6600 to 9530.6655, an eligible vendor of
comprehensive assessments under section 254B.05 may determine and approve the
appropriate level of substance use disorder treatment for a recipient of public assistance.
The process for determining an individual's financial eligibility for the consolidated chemical
dependency treatment fund or determining an individual's enrollment in or eligibility for a
publicly subsidized health plan is not affected by the individual's choice to access a
comprehensive assessment for placement.

(b) The commissioner shall develop and implement a utilization review process for
publicly funded treatment placements to monitor and review the clinical appropriateness
and timeliness of all publicly funded placements in treatment.

new text begin (c) If a screen result is positive for alcohol or substance misuse, a brief screening for
alcohol or substance use disorder that is provided to a recipient of public assistance within
a primary care clinic, hospital, or other medical setting or school setting establishes medical
necessity and approval for an initial set of substance use disorder services identified in
section 254B.05, subdivision 5. The initial set of services approved for a recipient whose
screen result is positive may include any combination of up to four hours of individual or
group substance use disorder treatment, two hours of substance use disorder treatment
coordination, or two hours of substance use disorder peer support services provided by a
qualified individual according to chapter 245G. A recipient must obtain an assessment
pursuant to paragraph (a) to be approved for additional treatment services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end

Sec. 41.

Minnesota Statutes 2018, section 254A.19, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Assessment via telemedicine. new text end

new text begin Notwithstanding Minnesota Rules, part
9530.6615, subpart 3, item A, a chemical use assessment may be conducted via telemedicine.
new text end

Sec. 42.

Minnesota Statutes 2018, section 254B.02, subdivision 1, is amended to read:


Subdivision 1.

Chemical dependency treatment allocation.

The chemical dependency
treatment appropriation shall be placed in a special revenue account. deleted text beginThe commissioner
shall annually transfer funds from the chemical dependency fund to pay for operation of
the drug and alcohol abuse normative evaluation system and to pay for all costs incurred
by adding two positions for licensing of chemical dependency treatment and rehabilitation
programs located in hospitals for which funds are not otherwise appropriated.
deleted text end The deleted text beginremainder
of the
deleted text end money in the special revenue account must be used according to the requirements in
this chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 43.

Minnesota Statutes 2018, section 254B.03, subdivision 2, is amended to read:


Subd. 2.

Chemical dependency fund payment.

(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state that would be required to be
licensed as a chemical dependency program if the program were in the state. Out of state
vendors must also provide the commissioner with assurances that the program complies
substantially with state licensing requirements and possesses all licenses and certifications
required by the host state to provide chemical dependency treatment. Vendors receiving
payments from the chemical dependency fund must not require co-payment from a recipient
of benefits for services provided under this subdivision. The vendor is prohibited from using
the client's public benefits to offset the cost of services paid under this section. The vendor
shall not require the client to use public benefits for room or board costs. This includes but
is not limited to cash assistance benefits under chapters 119B, 256D, and 256J, or SNAP
benefits. Retention of SNAP benefits is a right of a client receiving services through the
consolidated chemical dependency treatment fund or through state contracted managed care
entities. Payment from the chemical dependency fund shall be made for necessary room
and board costs provided by vendors deleted text begincertified according todeleted text end new text beginmeeting the criteria under new text endsection
254B.05new text begin, subdivision 1anew text end, or in a community hospital licensed by the commissioner of health
according to sections 144.50 to 144.56 to a client who is:

(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and

(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.

(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.

(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 44.

Minnesota Statutes 2018, section 254B.03, subdivision 4, is amended to read:


Subd. 4.

Division of costs.

(a) Except for services provided by a county under section
254B.09, subdivision 1, or services provided under section 256B.69, the county shall, out
of local money, pay the state for 22.95 percent of the cost of chemical dependency services,
deleted text begin includingdeleted text endnew text begin except fornew text end those services provided to persons deleted text begineligible fordeleted text endnew text begin enrolled innew text end medical
assistance under chapter 256Bnew text begin and room and board services under section 254B.05,
subdivision 5, paragraph (b), clause (12)
new text end. Counties may use the indigent hospitalization
levy for treatment and hospital payments made under this section.

(b) 22.95 percent of any state collections from private or third-party pay, less 15 percent
for the cost of payment and collections, must be distributed to the county that paid for a
portion of the treatment under this section.

deleted text begin (c) For fiscal year 2017 only, the 22.95 percentages under paragraphs (a) and (b) are
equal to 20.2 percent.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 45.

Minnesota Statutes 2018, section 254B.04, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

new text begin(a)new text end Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, deleted text beginand persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 5, and 6, or
deleted text end who meet the
income standards of section 256B.056, subdivision 4,new text begin and are not enrolled in medical
assistance,
new text end are entitled to chemical dependency fund services. State money appropriated
for this paragraph must be placed in a separate account established for this purpose.

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

new text begin (c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
(12).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 46.

Minnesota Statutes 2018, section 254B.04, is amended by adding a subdivision
to read:


new text begin Subd. 2c. new text end

new text begin Eligibility to receive peer recovery support and treatment service
coordination.
new text end

new text begin Notwithstanding Minnesota Rules, part 9530.6620, subpart 6, a placing
authority may authorize peer recovery support and treatment service coordination for a
person who scores a severity of one or more in dimension 4, 5, or 6, under Minnesota Rules,
part 9530.6622. Authorization for peer recovery support and treatment service coordination
under this subdivision does not need to be provided in conjunction with treatment services
under Minnesota Rules, part 9530.6622, subpart 4, 5, or 6.
new text end

Sec. 47.

Minnesota Statutes 2018, section 254B.05, subdivision 1, is amended to read:


Subdivision 1.

Licensure required.

(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, or outpatient treatment
services, and are licensed by tribal government are eligible vendors.

(b) deleted text beginOn July 1, 2018, or upon federal approval, whichever is later,deleted text end A licensed professional
in private practice who meets the requirements of section 245G.11, subdivisions 1 and 4,
is an eligible vendor of a comprehensive assessment and assessment summary provided
according to section 245G.05, and treatment services provided according to sections 245G.06
and 245G.07, subdivision 1, paragraphs (a), clauses (1) to deleted text begin(5)deleted text endnew text begin (4)new text end, and (b); and subdivision
2.

(c) deleted text beginOn July 1, 2018, or upon federal approval, whichever is later,deleted text end A county is an eligible
vendor for a comprehensive assessment and assessment summary when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and deleted text begin4deleted text end new text begin5new text end,
and completed according to the requirements of section 245G.05. A county is an eligible
vendor of care coordination services when provided by an individual who meets the staffing
credentials of section 245G.11, subdivisions 1 and 7, and provided according to the
requirements of section 245G.07, subdivision 1, new text beginparagraph (a), new text endclause deleted text begin(7)deleted text endnew text begin (5)new text end.

(d) deleted text beginOn July 1, 2018, or upon federal approval, whichever is later,deleted text end A recovery community
organization that meets certification requirements identified by the commissioner is an
eligible vendor of peer support services.

(e) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.

Sec. 48.

Minnesota Statutes 2018, section 254B.05, subdivision 1a, is amended to read:


Subd. 1a.

Room and board provider requirements.

(a) Effective January 1, 2000,
vendors of room and board are eligible for chemical dependency fund payment if the vendor:

(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;

(2) is determined to meet applicable health and safety requirements;

(3) is not a jail or prison;

(4) is not concurrently receiving funds under chapter 256I for the recipient;

(5) admits individuals who are 18 years of age or older;

(6) is registered as a board and lodging or lodging establishment according to section
157.17;

(7) has awake staff on site 24 hours per day;

(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);

(9) has emergency behavioral procedures that meet the requirements of section 245G.16;

(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;

(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;

(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;

(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;

(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2
; and

(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.

(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).

new text begin (c) Licensed programs providing intensive residential treatment services or residential
crisis stabilization services pursuant to section 256B.0622 or 256B.0624 are eligible vendors
of room and board and are exempt from paragraph (a), clauses (6) to (15).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 49.

Minnesota Statutes 2018, section 254B.05, subdivision 5, is amended to read:


Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.

(b) Eligible substance use disorder treatment services include:

(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;

(2) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05deleted text begin, and
Minnesota Rules, part 9530.6422
deleted text end;

(3) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause deleted text begin(6)deleted text endnew text begin
(5)
new text end;

(4) deleted text beginon July 1, 2018, or upon federal approval, whichever is later,deleted text end peer recovery support
services provided according to section 245G.07, subdivision deleted text begin1, paragraph (a)deleted text endnew text begin 2new text end, clause deleted text begin(5)deleted text endnew text begin
(8)
new text end;

(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;

(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;

(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;

(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;

(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;

(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;

(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and

(12) room and board facilities that meet the requirements of subdivision 1a.

(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:

(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;

(ii) is governed with significant input from individuals of that specific background; and

(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;

(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and

(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.

(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).

(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.

new text begin (g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
new text end

Sec. 50.

Minnesota Statutes 2018, section 254B.06, subdivision 1, is amended to read:


Subdivision 1.

State collections.

The commissioner is responsible for all collections
from persons determined to be partially responsible for the cost of care of an eligible person
receiving services under Laws 1986, chapter 394, sections 8 to 20. The commissioner may
initiate, or request the attorney general to initiate, necessary civil action to recover the unpaid
cost of care. The commissioner may collect all third-party payments for chemical dependency
services provided under Laws 1986, chapter 394, sections 8 to 20, including private insurance
and federal Medicaid and Medicare financial participation. deleted text beginThe commissioner shall deposit
in a dedicated account a percentage of collections to pay for the cost of operating the chemical
dependency consolidated treatment fund invoice processing and vendor payment system,
billing, and collections.
deleted text end The remaining receipts must be deposited in the chemical dependency
fund.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 51.

Minnesota Statutes 2018, section 254B.06, subdivision 2, is amended to read:


Subd. 2.

Allocation of collections.

deleted text begin(a) The commissioner shall allocate all federal
financial participation collections to a special revenue account.
deleted text end The commissioner shall
allocate 77.05 percent of patient payments and third-party payments to the special revenue
account and 22.95 percent to the county financially responsible for the patient.

deleted text begin (b) For fiscal year 2017 only, the commissioner's allocation to the special revenue account
shall be increased from 77.05 percent to 79.8 percent and the county financial responsibility
shall be reduced from 22.95 percent to 20.2 percent.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a) is effective July 1, 2020, and paragraph (b) is
effective July 1, 2019.
new text end

Sec. 52.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 5m. new text end

new text begin Certified community behavioral health clinic services. new text end

new text begin (a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
new text end

new text begin (b) The commissioner shall establish standards and methodologies for a prospective
payment system for medical assistance payments for services delivered by a CCBHC, in
accordance with guidance issued by the Centers for Medicare and Medicaid Services. The
commissioner shall include a quality bonus payment in the prospective payment system
based on federal criteria.
new text end

new text begin (c) To the extent allowed by federal law, the commissioner may limit the number of
CCBHCs for the prospective payment system in paragraph (b) to ensure that the projected
claims do not exceed the money appropriated for this purpose. The commissioner shall
apply the following priorities, in the order listed, to give preference to clinics that:
new text end

new text begin (1) provide a comprehensive range of services and evidence-based practices for all age
groups, with services being fully coordinated and integrated;
new text end

new text begin (2) are certified as CCBHCs during the federal section 223 CCBHC demonstration
period;
new text end

new text begin (3) receive CCBHC grants from the United States Department of Health and Human
Services; or
new text end

new text begin (4) focus on serving individuals in tribal areas and other underserved communities.
new text end

new text begin (d) Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:
new text end

new text begin (1) the commissioner shall rebase CCBHC rates at least every three years;
new text end

new text begin (2) the commissioner shall provide for a 60-day appeals process of the rebasing;
new text end

new text begin (3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
new text end

new text begin (4) the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
new text end

new text begin (5) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments;
new text end

new text begin (6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services; and
new text end

new text begin (7) the prospective payment rate for each CCBHC shall be adjusted annually by the
Medicare Economic Index as defined for the federal section 223 CCBHC demonstration.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end

Sec. 53.

Minnesota Statutes 2018, section 256B.0625, subdivision 24, is amended to read:


Subd. 24.

Other medical or remedial care.

Medical assistance covers any other medical
or remedial care licensed and recognized under state law unless otherwise prohibited by
lawdeleted text begin, except licensed chemical dependency treatment programs or primary treatment or
extended care treatment units in hospitals that are covered under chapter 254B. The
commissioner shall include chemical dependency services in the state medical assistance
plan for federal reporting purposes, but payment must be made under chapter 254B
deleted text end. The
commissioner shall publish in the State Register a list of elective surgeries that require a
second medical opinion before medical assistance reimbursement, and the criteria and
standards for deciding whether an elective surgery should require a second medical opinion.
The list and criteria and standards are not subject to the requirements of sections 14.01 to
14.69.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 54.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 24a. new text end

new text begin Substance use disorder services. new text end

new text begin Medical assistance covers substance use
disorder treatment services according to section 254B.05, subdivision 5, except for room
and board.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 55.

Minnesota Statutes 2018, section 256B.0625, subdivision 43, is amended to read:


Subd. 43.

Mental health provider travel time.

new text begin(a) new text endMedical assistance covers provider
travel time if a deleted text beginrecipient's individual treatment plandeleted text endnew text begin recipientnew text end requires the provision of mental
health services outside of the provider's deleted text beginnormaldeleted text end new text beginusual new text endplace of business. deleted text beginThis does not include
any travel time which is included in other billable services, and is only covered when the
mental health service being provided to a recipient is covered under medical assistance.
deleted text end

new text begin (b) Medical assistance covers under this subdivision the time a provider is in transit to
provide a covered mental health service to a recipient at a location that is not the provider's
usual place of business. A provider must travel the most direct route available. Mental health
provider travel time does not include time for scheduled or unscheduled stops, meal breaks,
or vehicle maintenance or repair, including refueling or vehicle emergencies. Recipient
transportation is not covered under this subdivision.
new text end

new text begin (c) Mental health provider travel time under this subdivision is only covered when the
mental health service being provided is covered under medical assistance and only when
the covered mental health service is delivered and billed. Mental health provider travel time
is not covered when the mental health service being provided otherwise includes provider
travel time or when the service is site based.
new text end

new text begin (d) A provider must document each trip for which the provider seeks reimbursement
under this subdivision in a compiled travel record. Required documentation may be collected
and maintained electronically or in paper form but must be made available and produced
upon request by the commissioner. The travel record must be written in English and must
be legible according to the standard of a reasonable person. The recipient's individual
identification number must be on each page of the record. The reason the provider must
travel to provide services must be included in the record, if not otherwise documented in
the recipient's individual treatment plan. Each entry in the record must document:
new text end

new text begin (1) start and stop time (with a.m. and p.m. notations);
new text end

new text begin (2) printed name of the recipient;
new text end

new text begin (3) date the entry is made;
new text end

new text begin (4) date the service is provided;
new text end

new text begin (5) origination site and destination site;
new text end

new text begin (6) who provided the service;
new text end

new text begin (7) the electronic source used to calculate driving directions and distance between
locations; and
new text end

new text begin (8) the medically necessary mental health service delivered.
new text end

new text begin (e) Mental health providers identified by the commissioner to have submitted a fraudulent
report may be excluded from participation in Minnesota health care programs.
new text end

Sec. 56.

Minnesota Statutes 2018, section 256B.0625, subdivision 45a, is amended to
read:


Subd. 45a.

Psychiatric residential treatment facility services for persons younger
than 21 years of age.

(a) Medical assistance covers psychiatric residential treatment facility
services, according to section 256B.0941, for persons younger than 21 years of age.
Individuals who reach age 21 at the time they are receiving services are eligible to continue
receiving services until they no longer require services or until they reach age 22, whichever
occurs first.

(b) For purposes of this subdivision, "psychiatric residential treatment facility" means
a facility other than a hospital that provides psychiatric services, as described in Code of
Federal Regulations, title 42, sections 441.151 to 441.182, to individuals under age 21 in
an inpatient setting.

(c) The commissioner shall enroll up to 150 certified psychiatric residential treatment
facility services beds deleted text beginat up to six sitesdeleted text end. new text beginThe commissioner may enroll an additional 80
certified psychiatric residential treatment facility services beds beginning July 1, 2020, and
an additional 70 certified psychiatric residential treatment facility services beds beginning
July 1, 2023.
new text end The commissioner shall select psychiatric residential treatment facility services
providers through a request for proposals process. Providers of state-operated services may
respond to the request for proposals.new text begin The commissioner shall prioritize programs that
demonstrate the capacity to serve children and youth with aggressive and risky behaviors
toward themselves or others, multiple diagnoses, neurodevelopmental disorders, or complex
trauma related issues.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 57.

Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:


Subd. 57.

Payment for Part B Medicare crossover claims.

(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.

(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.

(c) Excluded from this limitation are payments to federally qualified health centers deleted text beginanddeleted text endnew text begin,new text end
rural health clinicsnew text begin, and CCBHCs subject to the prospective payment system under
subdivision 5m
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin Contingent upon federal approval, this section is effective July
1, 2019. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained or denied.
new text end

Sec. 58.

Minnesota Statutes 2018, section 256B.0757, subdivision 1, is amended to read:


Subdivision 1.

Provision of coverage.

(a) The commissioner shall provide medical
assistance coverage of health home services for eligible individuals with chronic conditions
who select a designated provider as the individual's health home.

(b) The commissioner shall implement this section in compliance with the requirements
of the state option to provide health homes for enrollees with chronic conditions, as provided
under the Patient Protection and Affordable Care Act, Public Law 111-148, sections 2703
and 3502. Terms used in this section have the meaning provided in that act.

(c) The commissioner shall establish health homes to serve populations with serious
mental illness who meet the eligibility requirements described under subdivision 2deleted text begin, clause
(4)
deleted text end. The health home services provided by health homes shall focus on both the behavioral
and the physical health of these populations.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 59.

Minnesota Statutes 2018, section 256B.0757, subdivision 2, is amended to read:


Subd. 2.

Eligible individual.

new text begin (a) The commissioner may elect to develop health home
models in accordance with United States Code, title 42, section 1396w-4.
new text end

new text begin (b) new text endAn individual is eligible for health home services under this section if the individual
is eligible for medical assistance under this chapter and has deleted text beginat least:
deleted text end

deleted text begin (1) two chronic conditions;
deleted text end

deleted text begin (2) one chronic condition and is at risk of having a second chronic condition;
deleted text end

deleted text begin (3) one serious and persistent mental health condition; or
deleted text end

deleted text begin (4)deleted text end a condition that meets the definition new text beginof mental illness as described new text endin section 245.462,
subdivision 20
, paragraph (a), or new text beginemotional disturbance as defined in section new text end245.4871,
subdivision 15
, clause (2)deleted text begin; and has a current diagnostic assessment as defined in Minnesota
Rules, part 9505.0372, subpart 1, item B or C, as performed or reviewed by a mental health
professional employed by or under contract with the behavioral health home
deleted text end. The
commissioner shall establish criteria for determining continued eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 60.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 2a. new text end

new text begin Discharge criteria. new text end

new text begin (a) An individual may be discharged from behavioral
health home services if:
new text end

new text begin (1) the behavioral health home services provider is unable to locate, contact, and engage
the individual for a period of greater than three months after persistent efforts by the
behavioral health home services provider; or
new text end

new text begin (2) the individual is unwilling to participate in behavioral health home services as
demonstrated by the individual's refusal to meet with the behavioral health home services
provider, or refusal to identify the individual's health and wellness goals or the activities or
support necessary to achieve these goals.
new text end

new text begin (b) Before discharge from behavioral health home services, the behavioral health home
services provider must offer a face-to-face meeting with the individual, the individual's
identified supports, and the behavioral health home services provider to discuss options
available to the individual, including maintaining behavioral health home services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 61.

Minnesota Statutes 2018, section 256B.0757, subdivision 4, is amended to read:


Subd. 4.

Designated provider.

deleted text begin(a)deleted text end Health home services are voluntary and an eligible
individual may choose any designated provider. The commissioner shall establish designated
providers to serve as health homes and provide the services described in subdivision 3 to
individuals eligible under subdivision 2. The commissioner shall apply for grants as provided
under section 3502 of the Patient Protection and Affordable Care Act to establish health
homes and provide capitated payments to designated providers. For purposes of this section,
"designated provider" means a provider, clinical practice or clinical group practice, rural
clinic, community health center, community mental health center, or any other entity that
is determined by the commissioner to be qualified to be a health home for eligible individuals.
This determination must be based on documentation evidencing that the designated provider
has the systems and infrastructure in place to provide health home services and satisfies the
qualification standards established by the commissioner in consultation with stakeholders
and approved by the Centers for Medicare and Medicaid Services.

deleted text begin (b) The commissioner shall develop and implement certification standards for designated
providers under this subdivision.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 62.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 4a. new text end

new text begin Behavioral health home services provider requirements. new text end

new text begin A behavioral
health home services provider must:
new text end

new text begin (1) be an enrolled Minnesota Health Care Programs provider;
new text end

new text begin (2) provide a medical assistance covered primary care or behavioral health service;
new text end

new text begin (3) utilize an electronic health record;
new text end

new text begin (4) utilize an electronic patient registry that contains data elements required by the
commissioner;
new text end

new text begin (5) demonstrate the organization's capacity to administer screenings approved by the
commissioner for substance use disorder or alcohol and tobacco use;
new text end

new text begin (6) demonstrate the organization's capacity to refer an individual to resources appropriate
to the individual's screening results;
new text end

new text begin (7) have policies and procedures to track referrals to ensure that the referral met the
individual's needs;
new text end

new text begin (8) conduct a brief needs assessment when an individual begins receiving behavioral
health home services. The brief needs assessment must be completed with input from the
individual and the individual's identified supports. The brief needs assessment must address
the individual's immediate safety and transportation needs and potential barriers to
participating in behavioral health home services;
new text end

new text begin (9) conduct a health wellness assessment within 60 days after intake that contains all
required elements identified by the commissioner;
new text end

new text begin (10) conduct a health action plan that contains all required elements identified by the
commissioner. The plan must be completed within 90 days after intake and must be updated
at least once every six months, or more frequently if significant changes to an individual's
needs or goals occur;
new text end

new text begin (11) agree to cooperate with and participate in the state's monitoring and evaluation of
behavioral health home services; and
new text end

new text begin (12) obtain the individual's written consent to begin receiving behavioral health home
services using a form approved by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 63.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 4b. new text end

new text begin Behavioral health home provider training and practice transformation
requirements.
new text end

new text begin (a) The behavioral health home services provider must ensure that all staff
delivering behavioral health home services receive adequate preservice and ongoing training,
including:
new text end

new text begin (1) training approved by the commissioner that describes the goals and principles of
behavioral health home services; and
new text end

new text begin (2) training on evidence-based practices to promote an individual's ability to successfully
engage with medical, behavioral health, and social services to achieve the individual's health
and wellness goals.
new text end

new text begin (b) The behavioral health home services provider must ensure that staff are capable of
implementing culturally responsive services, as determined by the individual's culture,
beliefs, values, and language as identified in the individual's health wellness assessment.
new text end

new text begin (c) The behavioral health home services provider must participate in the department's
practice transformation activities to support continued skill and competency development
in the provision of integrated medical, behavioral health, and social services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 64.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 4c. new text end

new text begin Behavioral health home staff qualifications. new text end

new text begin (a) A behavioral health home
services provider must maintain staff with required professional qualifications appropriate
to the setting.
new text end

new text begin (b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.
new text end

new text begin (c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6).
new text end

new text begin (d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner as defined
in section 245.462, subdivision 17, or a community health worker as defined in section
256B.0625, subdivision 49.
new text end

new text begin (e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
new text end

new text begin (1) a peer support specialist as defined in section 256B.0615;
new text end

new text begin (2) a family peer support specialist as defined in section 256B.0616;
new text end

new text begin (3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
new text end

new text begin (4) a mental health rehabilitation worker as defined in section 256B.0623, subdivision
5, clause (4);
new text end

new text begin (5) a community paramedic as defined in section 144E.28, subdivision 9;
new text end

new text begin (6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
new text end

new text begin (7) a community health worker as defined in section 256B.0625, subdivision 49.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 65.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 4d. new text end

new text begin Behavioral health home service delivery standards. new text end

new text begin (a) A behavioral health
home services provider must meet the following service delivery standards:
new text end

new text begin (1) establish and maintain processes to support the coordination of an individual's primary
care, behavioral health, and dental care;
new text end

new text begin (2) maintain a team-based model of care, including regular coordination and
communication between behavioral health home services team members;
new text end

new text begin (3) use evidence-based practices that recognize and are tailored to the medical, social,
economic, behavioral health, functional impairment, cultural, and environmental factors
affecting the individual's health and health care choices;
new text end

new text begin (4) use person-centered planning practices to ensure the individual's health action plan
accurately reflects the individual's preferences, goals, resources, and optimal outcomes for
the individual and the individual's identified supports;
new text end

new text begin (5) use the patient registry to identify individuals and population subgroups requiring
specific levels or types of care and provide or refer the individual to needed treatment,
intervention, or services;
new text end

new text begin (6) utilize the Department of Human Services Partner Portal to identify past and current
treatment or services and identify potential gaps in care;
new text end

new text begin (7) deliver services consistent with the standards for frequency and face-to-face contact
required by the commissioner;
new text end

new text begin (8) ensure that a diagnostic assessment is completed for each individual receiving
behavioral health home services within six months of the start of behavioral health home
services;
new text end

new text begin (9) deliver services in locations and settings that meet the needs of the individual;
new text end

new text begin (10) provide a central point of contact to ensure that individuals and the individual's
identified supports can successfully navigate the array of services that impact the individual's
health and well-being;
new text end

new text begin (11) have capacity to assess an individual's readiness for change and the individual's
capacity to integrate new health care or community supports into the individual's life;
new text end

new text begin (12) offer or facilitate the provision of wellness and prevention education on
evidenced-based curriculums specific to the prevention and management of common chronic
conditions;
new text end

new text begin (13) help an individual set up and prepare for medical, behavioral health, social service,
or community support appointments, including accompanying the individual to appointments
as appropriate, and providing follow-up with the individual after these appointments;
new text end

new text begin (14) offer or facilitate the provision of health coaching related to chronic disease
management and how to navigate complex systems of care to the individual, the individual's
family, and identified supports;
new text end

new text begin (15) connect an individual, the individual's family, and identified supports to appropriate
support services that help the individual overcome access or service barriers, increase
self-sufficiency skills, and improve overall health;
new text end

new text begin (16) provide effective referrals and timely access to services; and
new text end

new text begin (17) establish a continuous quality improvement process for providing behavioral health
home services.
new text end

new text begin (b) The behavioral health home services provider must also create a plan, in partnership
with the individual and the individual's identified supports, to support the individual after
discharge from a hospital, residential treatment program, or other setting. The plan must
include protocols for:
new text end

new text begin (1) maintaining contact between the behavioral health home services team member, the
individual, and the individual's identified supports during and after discharge;
new text end

new text begin (2) linking the individual to new resources as needed;
new text end

new text begin (3) reestablishing the individual's existing services and community and social supports;
and
new text end

new text begin (4) following up with appropriate entities to transfer or obtain the individual's service
records as necessary for continued care.
new text end

new text begin (c) If the individual is enrolled in a managed care plan, a behavioral health home services
provider must:
new text end

new text begin (1) notify the behavioral health home services contact designated by the managed care
plan within 30 days of when the individual begins behavioral health home services; and
new text end

new text begin (2) adhere to the managed care plan communication and coordination requirements
described in the behavioral health home services manual.
new text end

new text begin (d) Before terminating behavioral health home services, the behavioral health home
services provider must:
new text end

new text begin (1) provide a 60-day notice of termination of behavioral health home services to all
individuals receiving behavioral health home services, the commissioner, and managed care
plans, if applicable; and
new text end

new text begin (2) refer individuals receiving behavioral health home services to a new behavioral
health home services provider.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 66.

Minnesota Statutes 2018, section 256B.0757, is amended by adding a subdivision
to read:


new text begin Subd. 4e. new text end

new text begin Behavioral health home provider variances. new text end

new text begin (a) The commissioner may
grant a variance to specific requirements under subdivisions 4a, 4b, 4c, or 4d for a behavioral
health home services provider according to this subdivision.
new text end

new text begin (b) The commissioner may grant a variance if the commissioner finds that:
new text end

new text begin (1) failure to grant the variance would result in hardship or injustice to the applicant;
new text end

new text begin (2) the variance would be consistent with the public interest; and
new text end

new text begin (3) the variance would not reduce the level of services provided to individuals served
by the organization.
new text end

new text begin (c) The commissioner may grant a variance from one or more requirements to permit
an applicant to offer behavioral health home services of a type or in a manner that is
innovative, if the commissioner finds that the variance does not impede the achievement of
the criteria in subdivisions 4a, 4b, 4c, or 4d and may improve the behavioral health home
services provided by the applicant.
new text end

new text begin (d) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 67.

new text begin [256B.0759] SUBSTANCE USE DISORDER DEMONSTRATION PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall develop and implement a medical
assistance demonstration project to test reforms of Minnesota's substance use disorder
treatment system to ensure individuals with substance use disorders have access to a full
continuum of high quality care.
new text end

new text begin Subd. 2. new text end

new text begin Provider participation. new text end

new text begin Substance use disorder treatment providers may elect
to participate in the demonstration project and meet the requirements of subdivision 3. To
participate, a provider must notify the commissioner of the provider's intent to participate
in a format required by the commissioner and enroll as a demonstration project provider.
new text end

new text begin Subd. 3. new text end

new text begin Provider standards. new text end

new text begin (a) The commissioner shall establish requirements for
participating providers that are consistent with the federal requirements of the demonstration
project.
new text end

new text begin (b) A participating residential provider must obtain applicable licensure under chapters
245F and 245G or other applicable standards for the services provided and must:
new text end

new text begin (1) deliver services in accordance with standards published by the commissioner pursuant
to paragraph (d);
new text end

new text begin (2) maintain formal patient referral arrangements with providers delivering step-up or
step-down levels of care in accordance with ASAM standards; and
new text end

new text begin (3) provide or arrange for medication-assisted treatment services if requested by a client
for whom an effective medication exists.
new text end

new text begin (c) A participating outpatient provider must obtain applicable licensure under chapter
245G or other applicable standards for the services provided and must:
new text end

new text begin (1) deliver services in accordance with standards published by the commissioner pursuant
to paragraph (d); and
new text end

new text begin (2) maintain formal patient referral arrangements with providers delivering step-up or
step-down levels of care in accordance with ASAM standards.
new text end

new text begin (d) If the provider standards under chapter 245G or other applicable standards conflict
or are duplicative, the commissioner may grant variances to the standards if the variances
do not conflict with federal requirements. The commissioner shall publish service
components, service standards, and staffing requirements for participating providers that
are consistent with ASAM standards and federal requirements by October 1, 2020.
new text end

new text begin Subd. 4. new text end

new text begin Provider payment rates. new text end

new text begin (a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirements and provide evidence
of formal referral arrangements with providers delivering step-up or step-down levels of
care.
new text end

new text begin (b) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clause (8), provided on or after January 1, 2020, payment rates must be increased by
15 percent over the rates in effect on December 31, 2020.
new text end

new text begin (c) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clauses (1), (6), (7), and (10), provided on or after January 1, 2021, payment rates must
be increased by ten percent over the rates in effect on December 31, 2020.
new text end

new text begin Subd. 5. new text end

new text begin Federal approval. new text end

new text begin The commissioner shall seek federal approval to implement
the demonstration project under this section and to receive federal financial participation.
new text end

Sec. 68.

Minnesota Statutes 2018, section 256I.04, subdivision 1, is amended to read:


Subdivision 1.

Individual eligibility requirements.

An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), or (c).

(a) The individual is aged, blind, or is over 18 years of age with a disability as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2
, is less than the monthly rate specified in the agency's agreement with the
provider of housing support in which the individual resides.

(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of housing support in which the
individual resides.

(c) The individual deleted text beginreceives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.
deleted text endnew text begin lacks a fixed, adequate, nighttime residence
upon discharge from a residential behavioral health treatment program, as determined by
treatment staff from the residential behavioral health treatment program. An individual is
eligible under this paragraph for up to three months, including a full or partial month from
the individual's move-in date at a setting approved for housing support following discharge
from treatment, plus two full months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2020.
new text end

Sec. 69.

Minnesota Statutes 2018, section 256I.04, subdivision 2f, is amended to read:


Subd. 2f.

Required services.

new text begin(a) new text endIn licensed and registered settings under subdivision
2a, providers shall ensure that participants have at a minimum:

(1) food preparation and service for three nutritional meals a day on site;

(2) a bed, clothing storage, linen, bedding, laundering, and laundry supplies or service;

(3) housekeeping, including cleaning and lavatory supplies or service; and

(4) maintenance and operation of the building and grounds, including heat, water, garbage
removal, electricity, telephone for the site, cooling, supplies, and parts and tools to repair
and maintain equipment and facilities.

new text begin (b) In addition, when providers serve participants described in subdivision 1, paragraph
(c), the providers are required to assist the participants in applying for continuing housing
support payments before the end of the eligibility period.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
new text end

Sec. 70.

Minnesota Statutes 2018, section 256I.06, subdivision 8, is amended to read:


Subd. 8.

Amount of housing support payment.

(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 1c, paragraph (d).

(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.

(c) For an individual who receives deleted text beginlicensed residential crisis stabilization services under
section 256B.0624, subdivision 7,
deleted text endnew text begin housing support payments under section 256I.04,
subdivision 1, paragraph (c),
new text end the amount ofnew text begin thenew text end housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective September 1, 2019.
new text end

Sec. 71.

Minnesota Statutes 2018, section 256K.45, subdivision 2, is amended to read:


Subd. 2.

Homeless youth report.

The commissioner shall prepare a biennial report,
beginning in February 2015, which provides meaningful information to the legislative
committees having jurisdiction over the issue of homeless youth, that includes, but is not
limited to: (1) a list of the areas of the state with the greatest need for services and housing
for homeless youth, and the level and nature of the needs identified; (2) details about grants
madenew text begin, including shelter-linked youth mental health grants under section 256K.46new text end; (3) the
distribution of funds throughout the state based on population need; (4) follow-up
information, if available, on the status of homeless youth and whether they have stable
housing two years after services are provided; and (5) any other outcomes for populations
served to determine the effectiveness of the programs and use of funding.

Sec. 72.

new text begin [256K.46] SHELTER-LINKED YOUTH MENTAL HEALTH GRANT
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment and authority. new text end

new text begin (a) The commissioner shall award grants
to provide mental health services to homeless or sexually exploited youth. To be eligible,
housing providers must partner with community-based mental health practitioners to provide
a continuum of mental health services, including short-term crisis response, support for
youth in longer-term housing settings, and ongoing relationships to support youth in other
housing arrangements in the community for homeless or sexually exploited youth.
new text end

new text begin (b) The commissioner shall consult with the commissioner of management and budget
to identify evidence-based mental health services for youth and give priority in awarding
grants to proposals that include evidence-based mental health services for youth.
new text end

new text begin (c) The commissioner may make two-year grants under this section.
new text end

new text begin (d) Money appropriated for this section must be expended on activities described under
subdivision 4, technical assistance, and capacity building to meet the greatest need on a
statewide basis. The commissioner shall provide outreach, technical assistance, and program
development support to increase capacity of new and existing service providers to better
meet needs statewide, particularly in areas where shelter-linked youth mental health services
have not been established, especially in greater Minnesota.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Commissioner" means the commissioner of human services, unless otherwise
indicated.
new text end

new text begin (c) "Housing provider" means a shelter, housing program, or other entity providing
services under the Homeless Youth Act in section 256K.45 and the Safe Harbor for Sexually
Exploited Youth Act in section 145.4716.
new text end

new text begin (d) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17.
new text end

new text begin (e) "Youth" has the meanings given for "homeless youth," "youth at risk for
homelessness," and "runaway" in section 256K.45, subdivision 1a, "sexually exploited
youth" in section 260C.007, subdivision 31, and "youth eligible for services" in section
145.4716, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin An eligible applicant for shelter-linked youth mental health grants
under subdivision 1 is a housing provider that:
new text end

new text begin (1) demonstrates that the provider received targeted trauma training focused on sexual
exploitation and adolescent experiences of homelessness; and
new text end

new text begin (2) partners with a community-based mental health practitioner who has demonstrated
experience or access to training regarding adolescent development and trauma-informed
responses.
new text end

new text begin Subd. 4. new text end

new text begin Allowable grant activities. new text end

new text begin (a) Grant recipients may conduct the following
activities with community-based mental health practitioners:
new text end

new text begin (1) develop programming to prepare youth to receive mental health services;
new text end

new text begin (2) provide on-site mental health services, including group skills and therapy sessions.
Grant recipients are encouraged to use evidence-based mental health services;
new text end

new text begin (3) provide mental health case management, as defined in section 256B.0625, subdivision
20; and
new text end

new text begin (4) consult, train, and educate housing provider staff regarding mental health. Grant
recipients are encouraged to provide staff with access to a mental health crisis line 24 hours
a day, seven days a week.
new text end

new text begin (b) Only after promoting and assisting participants with obtaining health insurance
coverage for which the participant is eligible, and only after mental health practitioners bill
covered services to medical assistance or health plan companies, grant recipients may use
grant funds to fill gaps in insurance coverage for mental health services.
new text end

new text begin (c) Grant funds may be used for purchasing equipment, connection charges, on-site
coordination, set-up fees, and site fees to deliver shelter-linked youth mental health services
defined in this subdivision via telemedicine consistent with section 256B.0625, subdivision
3b.
new text end

new text begin Subd. 5. new text end

new text begin Reporting. new text end

new text begin Grant recipients shall report annually on the use of shelter-linked
youth mental health grants to the commissioner by December 31, beginning in 2020. Each
report shall include the name and location of the grant recipient, the amount of each grant,
the youth mental health services provided, and the number of youth receiving services. The
commissioner shall determine the form required for the reports and may specify additional
reporting requirements. The commissioner shall include the shelter-linked youth mental
health services program in the biennial report required under section 256K.45, subdivision
2.
new text end

Sec. 73.

Minnesota Statutes 2018, section 641.15, subdivision 3a, is amended to read:


Subd. 3a.

Intake procedure; approved mental health screening.

new text begin(a)new text end As part of its
intake procedure for new deleted text beginprisonersdeleted text endnew text begin inmatesnew text end, the sheriff or local corrections shall use a mental
health screening tool approved by the commissioner of corrections in consultation with the
commissioner of human services and local corrections staff to identify persons who may
have mental illness.

new text begin (b) Names of persons who have screened positive or may have a mental illness may be
shared with the local county social services agency. The jail may refer an offender to county
personnel of the welfare system, as defined in section 13.46, subdivision 1, paragraph (c),
in order to arrange for services upon discharge and may share private data on the offender
as necessary to:
new text end

new text begin (1) provide assistance in filling out an application for medical assistance or
MinnesotaCare;
new text end

new text begin (2) make a referral for case management as provided under section 245.467, subdivision
4;
new text end

new text begin (3) provide assistance in obtaining a state photo identification;
new text end

new text begin (4) secure a timely appointment with a psychiatrist or other appropriate community
mental health provider;
new text end

new text begin (5) provide prescriptions for a 30-day supply of all necessary medications; or
new text end

new text begin (6) coordinate behavioral health services.
new text end

new text begin (c) Notwithstanding section 138.17, if an offender is referred to a government entity
within the welfare system pursuant to paragraph (b), and the offender refuses all services
from the entity, the entity must, within 15 days of the refusal, destroy all private data on
the offender that it created or received because of the referral.
new text end

Sec. 74.

Laws 2017, First Special Session chapter 6, article 8, section 71, the effective
date, as amended by Laws 2019, chapter 12, section 1, is amended to read:


EFFECTIVE DATE.

This section is effective for services provided on July 1, 2017,
deleted text begin through June 30, 2019, and expires July 1, 2019deleted text endnew text begin and thereafternew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 75.

Laws 2017, First Special Session chapter 6, article 8, section 72, the effective
date, as amended by Laws 2019, chapter 12, section 2, is amended to read:


EFFECTIVE DATE.

This section is effective for services provided on July 1, 2017,
deleted text begin through June 30, 2019, and expires July 1, 2019deleted text endnew text begin and thereafternew text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 76. new text beginDIRECTION TO COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PROGRAM SYSTEMS IMPROVEMENT.
new text end

new text begin The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment associations, and other relevant
stakeholders, shall develop a plan, proposed timeline, and summary of necessary resources
to make systems improvements to minimize the regulatory paperwork for substance use
disorder programs licensed under Minnesota Statutes, chapter 245A, and regulated under
Minnesota Statutes, chapters 245F and 245G, and Minnesota Rules, parts 2960.0580 to
2960.0700. The plan shall include procedures to ensure that continued input from all
stakeholders is considered and that the planned systems improvements maximize client
benefits and utility for providers, regulatory agencies, and payers.
new text end

Sec. 77. new text beginCOMMUNITY COMPETENCY RESTORATION TASK FORCE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin The Community Competency Restoration Task
Force is established to evaluate and study community competency restoration programs and
develop recommendations to address the needs of individuals deemed incompetent to stand
trial.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin (a) The Community Competency Restoration Task Force consists
of the following members, appointed as follows:
new text end

new text begin (1) a representative appointed by the governor's office;
new text end

new text begin (2) the commissioner of human services or designee;
new text end

new text begin (3) the commissioner of corrections or designee;
new text end

new text begin (4) a representative from direct care and treatment services with experience in competency
evaluations, appointed by the commissioner of human services;
new text end

new text begin (5) a representative appointed by the designated State Protection and Advocacy system;
new text end

new text begin (6) the ombudsman for mental health and developmental disabilities;
new text end

new text begin (7) a representative appointed by the Minnesota Hospital Association;
new text end

new text begin (8) a representative appointed by the Association of Minnesota Counties;
new text end

new text begin (9) two representatives appointed by the Minnesota Association of County Social Service
Administrators: one from the seven-county metropolitan area, as defined under Minnesota
Statutes, section 473.121, subdivision 2, and one from outside the seven-county metropolitan
area;
new text end

new text begin (10) a representative appointed by the Minnesota Board of Public Defense;
new text end

new text begin (11) a representative appointed by the Minnesota County Attorneys Association;
new text end

new text begin (12) a representative appointed by the Minnesota Chiefs of Police Association;
new text end

new text begin (13) a representative appointed by the Minnesota Psychiatric Society;
new text end

new text begin (14) a representative appointed by the Minnesota Psychological Association;
new text end

new text begin (15) a representative appointed by the State Court Administrator;
new text end

new text begin (16) a representative appointed by the Minnesota Association of Community Mental
Health Programs;
new text end

new text begin (17) a representative appointed by the Minnesota Sheriffs' Association;
new text end

new text begin (18) a representative appointed by the Minnesota Sentencing Guidelines Commission;
new text end

new text begin (19) a jail administrator appointed by the commissioner of corrections;
new text end

new text begin (20) a representative from an organization providing reentry services appointed by the
commissioner of corrections;
new text end

new text begin (21) a representative from a mental health advocacy organization appointed by the
commissioner of human services;
new text end

new text begin (22) a person with direct experience with competency restoration appointed by the
commissioner of human services;
new text end

new text begin (23) representatives from organizations representing racial and ethnic groups
overrepresented in the justice system appointed by the commissioner of corrections; and
new text end

new text begin (24) a crime victim appointed by the commissioner of corrections.
new text end

new text begin (b) Appointments to the task force must be made no later than July 15, 2019, and members
of the task force may be compensated as provided under Minnesota Statutes, section 15.059,
subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin The task force must:
new text end

new text begin (1) identify current services and resources available for individuals in the criminal justice
system who have been found incompetent to stand trial;
new text end

new text begin (2) analyze current trends of competency referrals by county and the impact of any
diversion projects or stepping-up initiatives;
new text end

new text begin (3) analyze selected case reviews and other data to identify risk levels of those individuals,
service usage, housing status, and health insurance status prior to being jailed;
new text end

new text begin (4) research how other states address this issue, including funding and structure of
community competency restoration programs, and jail-based programs; and
new text end

new text begin (5) develop recommendations to address the growing number of individuals deemed
incompetent to stand trial including increasing prevention and diversion efforts, providing
a timely process for reducing the amount of time individuals remain in the criminal justice
system, determining how to provide and fund competency restoration services in the
community, and defining the role of the counties and state in providing competency
restoration.
new text end

new text begin Subd. 4. new text end

new text begin Officers; meetings. new text end

new text begin (a) The commissioner of human services shall convene
the first meeting of the task force no later than August 1, 2019.
new text end

new text begin (b) The task force must elect a chair and vice-chair from among its members and may
elect other officers as necessary.
new text end

new text begin (c) The task force is subject to the Minnesota Open Meeting Law under Minnesota
Statutes, chapter 13D.
new text end

new text begin Subd. 5. new text end

new text begin Staff. new text end

new text begin (a) The commissioner of human services must provide staff assistance
to support the task force's work.
new text end

new text begin (b) The task force may utilize the expertise of the Council of State Governments Justice
Center.
new text end

new text begin Subd. 6. new text end

new text begin Report required. new text end

new text begin (a) By February 1, 2020, the task force shall submit a report
on its progress and findings to the chairs and ranking minority members of the legislative
committees with jurisdiction over mental health and corrections.
new text end

new text begin (b) By February 1, 2021, the task force must submit a written report including
recommendations to address the growing number of individuals deemed incompetent to
stand trial to the chairs and ranking minority members of the legislative committees with
jurisdiction over mental health and corrections.
new text end

new text begin Subd. 7. new text end

new text begin Expiration. new text end

new text begin The task force expires upon submission of the report in subdivision
6, paragraph (b), or February 1, 2021, whichever is later.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 78. new text beginDIRECTION TO COMMISSIONER; IMPROVING SCHOOL-LINKED
MENTAL HEALTH GRANT PROGRAM.
new text end

new text begin (a) The commissioner of human services, in collaboration with the commissioner of
education, representatives from the education community, mental health providers, and
advocates, shall assess the school-linked mental health grant program under Minnesota
Statutes, section 245.4901, and develop recommendations for improvements. The assessment
must include but is not limited to the following:
new text end

new text begin (1) promoting stability among current grantees and school partners;
new text end

new text begin (2) assessing the minimum number of full-time equivalents needed per school site to
effectively carry out the program;
new text end

new text begin (3) developing a funding formula that promotes sustainability and consistency across
grant cycles;
new text end

new text begin (4) reviewing current data collection and evaluation; and
new text end

new text begin (5) analyzing the impact on outcomes when a school has a school-linked mental health
program, a multi-tier system of supports, and sufficient school support personnel to meet
the needs of students.
new text end

new text begin (b) The commissioner shall provide a report of the findings of the assessment and
recommendations, including any necessary statutory changes, to the legislative committees
with jurisdiction over mental health and education by January 15, 2020.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 79. new text beginDIRECTION TO COMMISSIONER; CCBHC RATE METHODOLOGY.
new text end

new text begin (a) The commissioner of human services shall develop recommendations for a rate
methodology that reflects each CCBHC's reasonable cost of providing the services described
in Minnesota Statutes, section 245.735, subdivision 3, consistent with applicable federal
requirements. In developing the rate methodology, the commissioner shall consider guidance
issued by the Centers for Medicare and Medicaid Services for the Section 223 Demonstration
Program for CCBHC and costs associated with the following:
new text end

new text begin (1) a new CCBHC service that is not incorporated in the baseline prospective payment
system rate, or a deletion of a CCBHC service that is incorporated in the baseline rate;
new text end

new text begin (2) a change in service due to amended regulatory requirements or rules;
new text end

new text begin (3) a change in types of services due to a change in applicable technology and medical
practice utilized by the clinic;
new text end

new text begin (4) a change in the scope of a project approved by the commissioner; and
new text end

new text begin (5) a Minnesota-specific quality incentive program for CCBHCs that achieve target
performance on select quality measures. The commissioner shall develop the quality incentive
program, in consultation with stakeholders, with the following requirements:
new text end

new text begin (i) the same terms of performance must apply to all CCBHCs;
new text end

new text begin (ii) quality payments must be in addition to the prospective payment rate and must not
exceed an amount equal to five percent of total medical assistance payments for CCBHC
services provided during the applicable time period; and
new text end

new text begin (iii) the quality measures must be consistent with measures used by the commissioner
for other health care programs.
new text end

new text begin (b) By February 15, 2020, the commissioner of human services shall consult with CCBHC
providers to develop the rate methodology under paragraph (a). The commissioner shall
report to the chairs and ranking minority members of the legislative committees with
jurisdiction over mental health services and medical assistance on the recommendations to
the CCBHC rate methodology including any necessary statutory updates required for federal
approval.
new text end

new text begin (c) The commissioner shall consult with CCBHCs and other providers receiving a
prospective payment system rate to study a rate methodology that eliminates potential
duplication of payment for CCBHC providers who also receive a separate prospective
payment system rate. By February 15, 2021, the commissioner shall report to the chairs and
ranking minority members of the legislative committees with jurisdiction over mental health
services and medical assistance on findings and recommendations related to the rate
methodology study under this paragraph, including any necessary statutory updates to
implement recommendations.
new text end

Sec. 80. new text beginSPECIALIZED MENTAL HEALTH COMMUNITY SUPERVISION PILOT
PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Authorization. new text end

new text begin The commissioner of human services shall award a grant
to Anoka County to develop and implement a pilot project from July 1, 2019, to June 30,
2021, to evaluate the impact of a coordinated, multidisciplinary service delivery approach
for offenders with mental illness who are on probation, parole, supervised release, or pretrial
status in Anoka County.
new text end

new text begin Subd. 2. new text end

new text begin Pilot project goals and design. new text end

new text begin (a) The pilot project must provide enhanced
assessment, case management, treatment services, and community supervision for offenders
with mental illness who have symptoms or behavior resulting in heightened risk to harm
themselves or others, to recidivate, to commit violations of supervision, or to face
incarceration or reincarceration.
new text end

new text begin (b) The goals of the pilot project are to:
new text end

new text begin (1) improve mental health service delivery and supervision coordination through
establishment of a multidisciplinary caseload management team that must include at least
one probation officer and social services professional who share case management
responsibilities;
new text end

new text begin (2) provide expedited assessment, diagnosis, and community-based treatment and
programming for acute symptom and behavior management;
new text end

new text begin (3) enhance community supervision through a specialized caseload and team specifically
trained to work with individuals with mental illness;
new text end

new text begin (4) offer community-based mental health treatment and programming alternatives to
incarceration if available and appropriate;
new text end

new text begin (5) reduce incarceration related to unmanaged mental illness and technical violations;
new text end

new text begin (6) eliminate or reduce duplication of services between county social services and
corrections; and
new text end

new text begin (7) improve collaboration among, and reduce barriers between, criminal justice system
partners, county social services, and community service providers.
new text end

new text begin Subd. 3. new text end

new text begin Target population. new text end

new text begin The target population of the pilot project is:
new text end

new text begin (1) adult offenders on probation, parole, supervised release, or pretrial status in Anoka
County who have been assessed with significant or unmanaged mental illness or acute
symptoms that pose a risk to harm themselves or others, or increase their risk to recidivate
or commit technical violations of supervision;
new text end

new text begin (2) adult offenders who receive county social service case management for mental illness
while under correctional supervision in Anoka County; and
new text end

new text begin (3) adult offenders incarcerated in jail in Anoka County who have significant or
unmanaged mental illness and may be safely treated in a community setting under
correctional supervision.
new text end

new text begin Subd. 4. new text end

new text begin Evaluation and report. new text end

new text begin By October 1, 2021, Anoka County must report to the
commissioner of human services on the impact and outcomes of the project.
new text end

Sec. 81. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, section 254B.03, subdivision 4a, new text end new text begin is repealed.
new text end

ARTICLE 7

HEALTH CARE

Section 1.

Minnesota Statutes 2018, section 13.69, subdivision 1, is amended to read:


Subdivision 1.

Classifications.

(a) The following government data of the Department
of Public Safety are private data:

(1) medical data on driving instructors, licensed drivers, and applicants for parking
certificates and special license plates issued to physically disabled persons;

(2) other data on holders of a disability certificate under section 169.345, except that (i)
data that are not medical data may be released to law enforcement agencies, and (ii) data
necessary for enforcement of sections 169.345 and 169.346 may be released to parking
enforcement employees or parking enforcement agents of statutory or home rule charter
cities and towns;

(3) Social Security numbers in driver's license and motor vehicle registration records,
except that Social Security numbers must be provided to the Department of Revenue for
purposes of tax administration, the Department of Labor and Industry for purposes of
workers' compensation administration and enforcement, the judicial branch for purposes of
debt collection, and the Department of Natural Resources for purposes of license application
administrationnew text begin, and except that the last four digits of the Social Security number must be
provided to the Department of Human Services for purposes of recovery of Minnesota health
care program benefits paid
new text end; and

(4) data on persons listed as standby or temporary custodians under section 171.07,
subdivision 11
, except that the data must be released to:

(i) law enforcement agencies for the purpose of verifying that an individual is a designated
caregiver; or

(ii) law enforcement agencies who state that the license holder is unable to communicate
at that time and that the information is necessary for notifying the designated caregiver of
the need to care for a child of the license holder.

The department may release the Social Security number only as provided in clause (3)
and must not sell or otherwise provide individual Social Security numbers or lists of Social
Security numbers for any other purpose.

(b) The following government data of the Department of Public Safety are confidential
data: data concerning an individual's driving ability when that data is received from a member
of the individual's family.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 2.

Minnesota Statutes 2018, section 16A.724, subdivision 2, is amended to read:


Subd. 2.

Transfers.

(a) Notwithstanding section 295.581, to the extent available resources
in the health care access fund exceed expenditures in that fund, effective for the biennium
beginning July 1, 2007, the commissioner of management and budget shall transfer the
excess funds from the health care access fund to the general fund on June 30 of each year,
provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the
amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal
biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet
the rate increase required under deleted text beginLaws 2003, First Special Session chapter 14, article 13C,
section 2, subdivision 6
deleted text endnew text begin section 256B.04, subdivision 25new text end.

(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if
necessary, the commissioner shall reduce these transfers from the health care access fund
to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer
sufficient funds from the general fund to the health care access fund to meet annual
MinnesotaCare expenditures.

Sec. 3.

Minnesota Statutes 2018, section 62Q.184, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

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

(b) "Clinical practice guideline" means a systematically developed statement to assist
health care providers and enrollees in making decisions about appropriate health care services
for specific clinical circumstances and conditions developed independently of a health plan
company, pharmaceutical manufacturer, or any entity with a conflict of interest.new text begin A clinical
practice guideline also includes a preferred drug list developed in accordance with section
256B.0625.
new text end

(c) "Clinical review criteria" means the written screening procedures, decision abstracts,
clinical protocols, and clinical practice guidelines used by a health plan company to determine
the medical necessity and appropriateness of health care services.

(d) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, but
deleted text begin does not include a managed care organization ordeleted text endnew text begin also includes anew text end county-based purchasing
plan participating in a public program under chapter 256B or 256Ldeleted text begin, ordeleted text end new text beginand new text endan integrated
health partnership under section 256B.0755.

(e) "Step therapy protocol" means a protocol or program that establishes the specific
sequence in which prescription drugs for a specified medical condition, including
self-administered and physician-administered drugs, are medically appropriate for a particular
enrollee and are covered under a health plan.

(f) "Step therapy override" means that the step therapy protocol is overridden in favor
of coverage of the selected prescription drug of the prescribing health care provider because
at least one of the conditions of subdivision 3, paragraph (a), exists.

Sec. 4.

Minnesota Statutes 2018, section 62Q.184, subdivision 3, is amended to read:


Subd. 3.

Step therapy override process; transparency.

(a) When coverage of a
prescription drug for the treatment of a medical condition is restricted for use by a health
plan company through the use of a step therapy protocol, enrollees and prescribing health
care providers shall have access to a clear, readily accessible, and convenient process to
request a step therapy override. The process shall be made easily accessible on the health
plan company's website. A health plan company may use its existing medical exceptions
process to satisfy this requirement. A health plan company shall grant an override to the
step therapy protocol if at least one of the following conditions exist:

(1) the prescription drug required under the step therapy protocol is contraindicated
pursuant to the pharmaceutical manufacturer's prescribing information for the drug or, due
to a documented adverse event with a previous use or a documented medical condition,
including a comorbid condition, is likely to do any of the following:

(i) cause an adverse reaction to the enrollee;

(ii) decrease the ability of the enrollee to achieve or maintain reasonable functional
ability in performing daily activities; or

(iii) cause physical or mental harm to the enrollee;

(2) the enrollee has had a trial of the required prescription drug covered by their current
or previous health plan, or another prescription drug in the same pharmacologic class or
with the same mechanism of action, and was adherent during such trial for a period of time
sufficient to allow for a positive treatment outcome, and the prescription drug was
discontinued by the enrollee's health care provider due to lack of effectiveness, or an adverse
event. This clause does not prohibit a health plan company from requiring an enrollee to
try another drug in the same pharmacologic class or with the same mechanism of action if
that therapy sequence is supported by the evidence-based and peer-reviewed clinical practice
guideline, Food and Drug Administration label, or pharmaceutical manufacturer's prescribing
informationnew text begin. This clause does not apply to the commissioner of human services or a managed
care plan, county-based purchasing plan, or integrated health partnership administering a
pharmacy benefit under chapter 256B or 256L
new text end; deleted text beginor
deleted text end

new text begin (3) for the fee-for-service system administered by the commissioner of human services,
or a managed care plan, county-based purchasing plan, or integrated health partnership
administering a pharmacy benefit under chapter 256B or 256L, the enrollee has had a trial
of the required prescription drug covered by their current or previous health plan, or a drug
in the same pharmacological class with the same mechanism of action, and was adherent
during such trial for a period of time sufficient to allow for a positive treatment outcome,
and the prescription drug was discontinued by the enrollee's health care provider due to lack
of effectiveness, or an adverse event, or the prescriber submits an evidence-based and
peer-reviewed clinical practice guideline supporting the use of the requested drug over the
required prescription drug. This clause does not prohibit a managed care plan, county-based
purchasing plan, or integrated health partnership from requiring an enrollee to try another
drug in the same pharmacologic class with the same mechanism of action if that therapy
sequence is supported by the evidence-based and peer-reviewed clinical practice guideline,
Food and Drug Administration label, or pharmaceutical manufacturer's prescribing
information; or
new text end

deleted text begin (3)deleted text endnew text begin (4)new text end the enrollee is currently receiving a positive therapeutic outcome on a prescription
drug for the medical condition under consideration if, while on their current health plan or
the immediately preceding health plan, the enrollee received coverage for the prescription
drug and the enrollee's prescribing health care provider gives documentation to the health
plan company that the change in prescription drug required by the step therapy protocol is
expected to be ineffective or cause harm to the enrollee based on the known characteristics
of the specific enrollee and the known characteristics of the required prescription drug.

(b) Upon granting a step therapy override, a health plan company shall authorize coverage
for the prescription drug if the prescription drug is a covered prescription drug under the
enrollee's health plan.

(c) The enrollee, or the prescribing health care provider if designated by the enrollee,
may appeal the denial of a step therapy override by a health plan company using the
complaint procedure under sections 62Q.68 to 62Q.73new text begin or 256.045new text end.

(d) In a denial of an override request and any subsequent appeal, a health plan company's
decision must specifically state why the step therapy override request did not meet the
condition under paragraph (a) cited by the prescribing health care provider in requesting
the step therapy override and information regarding the procedure to request external review
of the denial pursuant to section 62Q.73. A denial of a request for a step therapy override
that is upheld on appeal is a final adverse determination for purposes of section 62Q.73 and
is eligible for a request for external review by an enrollee pursuant to section 62Q.73.

(e) A health plan company shall respond to a step therapy override request or an appeal
within five days of receipt of a complete request. In cases where exigent circumstances
exist, a health plan company shall respond within 72 hours of receipt of a complete request.
If a health plan company does not send a response to the enrollee or prescribing health care
provider if designated by the enrollee within the time allotted, the override request or appeal
is granted and binding on the health plan company.

(f) Step therapy override requests must be accessible to and submitted by health care
providers, and accepted by group purchasers electronically through secure electronic
transmission, as described under section 62J.497, subdivision 5.

(g) Nothing in this section prohibits a health plan company from:

(1) requesting relevant documentation from an enrollee's medical record in support of
a step therapy override request; or

(2) requiring an enrollee to try a generic equivalent drug pursuant to section 151.21, or
a biosimilar, as defined under United States Code, chapter 42, section 262(i)(2), prior to
providing coverage for the equivalent branded prescription drug.

(h) This section shall not be construed to allow the use of a pharmaceutical sample for
the primary purpose of meeting the requirements for a step therapy override.

Sec. 5.

Minnesota Statutes 2018, section 245A.02, subdivision 5a, is amended to read:


Subd. 5a.

Controlling individual.

(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:

(1) each officer of the organization, including the chief executive officer and chief
financial officer;

(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);

(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph deleted text begin(b)deleted text endnew text begin (g)new text end; and

(4) each managerial official whose responsibilities include the direction of the
management or policies of a program.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:

(i) whose securities are exempt under section 80A.45, clause (6); or

(ii) whose transactions are exempt under section 80A.46, clause (2);

(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or

(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 6.

Minnesota Statutes 2018, section 245D.081, subdivision 3, is amended to read:


Subd. 3.

Program management and oversight.

(a) The license holder must designate
a managerial staff person or persons to provide program management and oversight of the
services provided by the license holder. The designated manager is responsible for the
following:

(1) maintaining a current understanding of the licensing requirements sufficient to ensure
compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph
(e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph deleted text begin(b)deleted text endnew text begin
(g)
new text end;

(2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;

(3) ensuring the program implements corrective action identified as necessary by the
program following review of incident and emergency reports according to the requirements
in section 245D.11, subdivision 2, clause (7). An internal review of incident reports of
alleged or suspected maltreatment must be conducted according to the requirements in
section 245A.65, subdivision 1, paragraph (b);

(4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress deleted text begintowardsdeleted text endnew text begin
toward
new text end accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring
and protecting each person's rights as identified in section 245D.04;

(5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;

(6) ensuring corrective action is taken when ordered by the commissioner and that the
terms and conditions of the license and any variances are met; and

(7) evaluating the information identified in clauses (1) to (6) to develop, document, and
implement ongoing program improvements.

(b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision 2,
paragraph (b), and have a minimum of three years of supervisory level experience in a
program providing direct support services to persons with disabilities or persons age 65 and
older.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 7.

Minnesota Statutes 2018, section 256.043, as added by Laws 2019, chapter 63,
article 1, section 8, is amended to read:


256.043 OPIATE EPIDEMIC RESPONSE ACCOUNT.

Subdivision 1.

Establishment.

The opiate epidemic response account is established in
the special revenue fund in the state treasury. The registration fees assessed by the Board
of Pharmacy under section 151.066 and the license fees identified in section 151.065,
subdivision 7
, paragraphs (b) and (c), shall be deposited into the account. Beginning in
fiscal year 2021, new text beginfor each fiscal year, new text endthe funds in the account deleted text beginare appropriated each fiscal
year to the commissioner of human services, unless otherwise specified in law
deleted text endnew text begin shall be
administered according to this section
new text end.

Subd. 2.

Transfers from account to state agencies.

(a) deleted text beginBeginning in fiscal year 2021,deleted text end
The commissioner deleted text beginof human servicesdeleted text end shall transfer the following amounts deleted text begineach fiscal year
from the account
deleted text end to the agencies specified in this subdivision.

(b) $126,000 to the Board of Pharmacy for the collection of the registration fees under
section 151.066.

(c) $672,000 to the commissioner of public safety for the Bureau of Criminal
Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies and $288,000
is for special agent positions focused on drug interdiction and drug trafficking.

Subd. 3.

Appropriations from account.

(a) After the transfers described in subdivision
2, and the appropriations in article 3, section 1, paragraphs (e), (f), (g), and (h) are made,
$249,000 deleted text beginshall be allocated by the commissionerdeleted text end new text beginis appropriated new text endfor the provision of
administrative services to the Opiate Epidemic Response Advisory Council and for the
administration of the grants awarded under paragraph (c).

(b) After the transfers in subdivision 2 and the deleted text beginallocation of fundsdeleted text end new text beginappropriations new text endin
paragraph (a) are made, 50 percent of the remaining amount deleted text beginshall be distributed by the
commissioner to
deleted text endnew text begin is appropriated to the commissioner for distribution tonew text end county social service
and tribal social service agencies to provide child protection services to children and families
who are affected by addiction. The commissioner shall distribute this money proportionally
to counties and tribal social service agencies based on out-of-home placement episodes
where parental drug abuse is the primary reason for the out-of-home placement using data
from the previous calendar year. County and tribal social service agencies receiving funds
from the opiate epidemic response account must annually report to the commissioner on
how the funds were used to provide child protection services, including measurable outcomes,
as determined by the commissioner. County social service agencies and tribal social service
agencies must not use funds received under this paragraph to supplant current state or local
funding received for child protection services for children and families who are affected by
addiction.

(c) After making the transfers in subdivision 2 and the deleted text beginallocation of fundsdeleted text end new text beginappropriations
new text end in paragraphs (a) and (b), new text beginthe remaining funds in the account are appropriated to new text endthe
commissioner deleted text beginshalldeleted text endnew text begin tonew text end award grants as specified by the Opiate Epidemic Response Advisory
Council in accordance with section 256.042, unless otherwise appropriated by the legislature.

Subd. 4.

Settlement; sunset.

(a) If the state receives a total sum of $250,000,000 either
as a result of a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or resulting from a court order in litigation brought by the
attorney general of the state on behalf of the state or a state agency, against one or more
opioid manufacturers or opioid wholesale drug distributors related to alleged violations of
consumer fraud laws in the marketing, sale, or distribution of opioids in this state, or other
alleged illegal actions that contributed to the excessive use of opioids, or from the fees
collected under section 151.065, subdivisions 1 and 3, and section 151.066, that are deposited
into the opiate epidemic response account established in section 256.043, or from a
combination of both, the fees specified in section 151.065, subdivision 1, clause (16), and
section 151.065, subdivision 3, clause (14), shall be reduced to $5,260, and the opiate
registration fee in section 151.066, subdivision 3, shall be repealed.

(b) The commissioner of management and budget shall inform the board of pharmacy,
the governor, and the legislature when the amount specified in paragraph (a) has been
reached. The board shall apply the reduced license fee for the next licensure period.

(c) Notwithstanding paragraph (a), the reduction of the license fee in section 151.065,
subdivisions 1
and 3, and the repeal of the registration fee in section 151.066 shall not occur
before July 1, 2024.

Sec. 8.

Minnesota Statutes 2018, section 256.962, subdivision 5, is amended to read:


Subd. 5.

Incentive program.

Beginning January 1, 2008, the commissioner shall establish
an incentive program for organizations and licensed insurance producers under chapter 60K
that directly identify and assist potential enrollees in filling out and submitting an application.
For each applicant who is successfully enrolled in MinnesotaCare or medical assistance,
the commissioner, within the available appropriation, shall pay the organization or licensed
insurance producer a deleted text begin$25deleted text endnew text begin $70new text end application assistance bonus. The organization or licensed
insurance producer may provide an applicant a gift certificate or other incentive upon
enrollment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 9.

Minnesota Statutes 2018, section 256.969, subdivision 2b, is amended to read:


Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
that the total aggregate payments under the rebased system are equal to the total aggregate
payments that were made for the same number and types of services in the base year. Separate
budget neutrality calculations shall be determined for payments made to critical access
hospitals and payments made to hospitals paid under the DRG system. Only the rate increases
or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during
the entire base period shall be incorporated into the budget neutrality calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, deleted text beginthrough the next two rebasing
periods
deleted text end the commissioner may make additional adjustments to the rebased rates, and when
evaluating whether additional adjustments should be made, the commissioner shall consider
the impact of the rates on the following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year and the next base year. Changes in costs
between base years shall be measured using the lower of the hospital cost index defined in
subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and

(6) geographic location.

Sec. 10.

Minnesota Statutes 2018, section 256.969, subdivision 3a, is amended to read:


Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical assistance program
must not be submitted until the recipient is discharged. However, the commissioner shall
establish monthly interim payments for inpatient hospitals that have individual patient
lengths of stay over 30 days regardless of diagnostic category. Except as provided in section
256.9693, medical assistance reimbursement for treatment of mental illness shall be
reimbursed based on diagnostic classifications. Individual hospital payments established
under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third-party
and recipient liability, for discharges occurring during the rate year shall not exceed, deleted text beginin
aggregate
deleted text endnew text begin on a per claim basisnew text end, the charges for the medical assistance covered inpatient
services paid for the same period of time to the hospital. Services that have rates established
under subdivision 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and may
merge the payment rates while maintaining separate provider numbers. The operating and
property base rates per admission or per day shall be derived from the best Medicare and
claims data available when rates are established. The commissioner shall determine the best
Medicare and claims data, taking into consideration variables of recency of the data, audit
disposition, settlement status, and the ability to set rates in a timely manner. The
commissioner shall notify hospitals of payment rates 30 days prior to implementation. The
rate setting data must reflect the admissions data used to establish relative values. The
commissioner may adjust base year cost, relative value, and case mix index data to exclude
the costs of services that have been discontinued by October 1 of the year preceding the
rate year or that are paid separately from inpatient services. Inpatient stays that encompass
portions of two or more rate years shall have payments established based on payment rates
in effect at the time of admission unless the date of admission preceded the rate year in
effect by six months or more. In this case, operating payment rates for services rendered
during the rate year in effect and established based on the date of admission shall be adjusted
to the rate year in effect by the hospital cost index.

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for inpatient services is reduced
by .5 percent from the current statutory rates.

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services before
third-party liability and spenddown, is reduced five percent from the current statutory rates.
Mental health services within diagnosis related groups 424 to 432 or corresponding
APR-DRGs, and facilities defined under subdivision 16 are excluded from this paragraph.

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
the current statutory rates. Mental health services within diagnosis related groups 424 to
432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded
from this paragraph. Payments made to managed care plans shall be reduced for services
provided on or after January 1, 2006, to reflect this reduction.

(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision
16 are excluded from this paragraph. Payments made to managed care plans shall be reduced
for services provided on or after January 1, 2009, through June 30, 2009, to reflect this
reduction.

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.9
percent from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after July 1, 2009, through June 30, 2011, to reflect this reduction.

(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for inpatient
services before third-party liability and spenddown, is reduced 1.79 percent from the current
statutory rates. Mental health services with diagnosis related groups 424 to 432 or
corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded from
this paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2011, to reflect this reduction.

(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total payment
for fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced one percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after October 1, 2009, to reflect this reduction.

(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total payment
for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.96 percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2011, to reflect this reduction.

(j) Effective for discharges on and after November 1, 2014, from hospitals paid under
subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
and must not be applied to each claim.

(k) Effective for discharges on and after July 1, 2015, from hospitals paid under
subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
must be incorporated into the rates and must not be applied to each claim.

(l) Effective for discharges on and after July 1, 2017, from hospitals paid under
subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
incorporated into the rates and must not be applied to each claim.

Sec. 11.

Minnesota Statutes 2018, section 256.969, subdivision 9, is amended to read:


Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.

(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.

(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:

(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;

(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;

(3) a hospital that has received payment from the fee-for-service program for at least 20
transplant services in the base year shall receive a factor of 0.0435;

(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;

(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than deleted text beginthreedeleted text endnew text begin two
and one-half
new text end standard deviations above the mean shall receive a factor of 0.2300; and

(6) a hospital that has a medical assistance utilization rate in the base year that is at least
deleted text begin threedeleted text endnew text begin two and one-halfnew text end standard deviations above the statewide mean utilization rate shall
receive a factor of 0.3711.

(e) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that
have a medical assistance utilization rate that is at least one standard deviation above the
mean.

new text begin (f) An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed $1,500,000.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, except paragraph (f) is
effective for discharges on or after July 1, 2019.
new text end

Sec. 12.

Minnesota Statutes 2018, section 256.969, subdivision 17, is amended to read:


Subd. 17.

Out-of-state hospitals in local trade areas.

Out-of-state hospitals that are
located within a Minnesota local trade area and that have deleted text beginmore than 20deleted text end admissions in the
base year or years shall have rates established using the same procedures and methods that
apply to Minnesota hospitals. For this subdivision and subdivision 18, local trade area means
a county contiguous to Minnesota and located in a metropolitan statistical area as determined
by Medicare for October 1 prior to the most current rebased rate year. Hospitals that are
not required by law to file information in a format necessary to establish rates shall have
rates established based on the commissioner's estimates of the information. Relative values
of the diagnostic categories shall not be redetermined under this subdivision until required
by statute. Hospitals affected by this subdivision shall then be included in determining
relative values. However, hospitals that have rates established based upon the commissioner's
estimates of information shall not be included in determining relative values. This subdivision
is effective for hospital fiscal years beginning on or after July 1, 1988. A hospital shall
provide the information necessary to establish rates under this subdivision at least 90 days
before the start of the hospital's fiscal year.

Sec. 13.

Minnesota Statutes 2018, section 256.969, subdivision 19, is amended to read:


Subd. 19.

Metabolic disorder testing of medical assistance recipients.

Medical
assistance inpatient payment rates must include the cost incurred by hospitals to pay the
Department of Health for metabolic disorder testing of newborns who are medical assistance
recipients, if the cost is not recognized by another payment source.new text begin This payment increase
remains in effect until the increase is fully recognized in the base year cost under subdivision
2b.
new text end

Sec. 14.

Minnesota Statutes 2018, section 256B.04, subdivision 14, is amended to read:


Subd. 14.

Competitive bidding.

(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:

(1) eyeglasses;

(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;

(3) hearing aids and supplies; and

(4) durable medical equipment, including but not limited to:

(i) hospital beds;

(ii) commodes;

(iii) glide-about chairs;

(iv) patient lift apparatus;

(v) wheelchairs and accessories;

(vi) oxygen administration equipment;

(vii) respiratory therapy equipment;

(viii) electronic diagnostic, therapeutic and life-support systems;

(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; and

(6) drugs.

(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.

(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation deleted text beginfor special transportation servicesdeleted text end under the provisions of chapter 16Cnew text begin for
special transportation services or incontinence products and related supplies
new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 15.

Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:


Subd. 21.

Provider enrollment.

(a)new text begin The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E. A provider must enroll each provider-controlled location where direct services are
provided. The commissioner may deny a provider's incomplete application if a provider
fails to respond to the commissioner's request for additional information within 60 days of
the request. The commissioner must conduct a background study under chapter 245C,
including a review of databases in section 245C.08, subdivision 1, paragraph (a), clauses
(1) to (5), for a provider described in this paragraph. The background study requirement
may be satisfied if the commissioner conducted a fingerprint-based background study on
the provider that includes a review of databases in section 245C.08, subdivision 1, paragraph
(a), clauses (1) to (5).
new text end

new text begin (b) The commissioner shall revalidate each: (1) provider under this subdivision at least
once every five years; and (2) personal care assistance agency under this subdivision once
every three years.
new text end

new text begin (c) The commissioner shall conduct revalidation as follows:
new text end

new text begin (1) provide 30-day notice of the revalidation due date including instructions for
revalidation and a list of materials the provider must submit;
new text end

new text begin (2) if a provider fails to submit all required materials by the due date, notify the provider
of the deficiency within 30 days after the due date and allow the provider an additional 30
days from the notification date to comply; and
new text end

new text begin (3) if a provider fails to remedy a deficiency within the 30-day time period, give 60-day
notice of termination and immediately suspend the provider's ability to bill. The provider
does not have the right to appeal suspension of ability to bill.
new text end

new text begin (d) If a provider fails to comply with any individual provider requirement or condition
of participation, the commissioner may suspend the provider's ability to bill until the provider
comes into compliance. The commissioner's decision to suspend the provider is not subject
to an administrative appeal.
new text end

new text begin (e) Correspondence and notifications, including notifications of termination and other
actions, may be delivered electronically to a provider's MN-ITS mailbox. This paragraph
does not apply to correspondences and notifications related to background studies.
new text end

new text begin (f)new text end If the commissioner or the Centers for Medicare and Medicaid Services determines
that a provider is designated "high-risk," the commissioner may withhold payment from
providers within that category upon initial enrollment for a 90-day period. The withholding
for each provider must begin on the date of the first submission of a claim.

deleted text begin (b)deleted text endnew text begin (g)new text end An enrolled provider that is also licensed by the commissioner under chapter
245A, or is licensed as a home care provider by the Department of Health under chapter
144A and has a home and community-based services designation on the home care license
under section 144A.484, must designate an individual as the entity's compliance officer.
The compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;

(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

deleted text begin (c)deleted text endnew text begin (h)new text end The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.

deleted text begin (d)deleted text endnew text begin (i)new text end The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or under
the Medicaid program or Children's Health Insurance Program of any other state.

deleted text begin (e)deleted text endnew text begin (j)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

deleted text begin (f)deleted text endnew text begin (k)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.

deleted text begin (g)deleted text endnew text begin (l)new text end(1) Upon initial enrollment, reenrollment, and notification of revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.

(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.

(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.

deleted text begin (h)deleted text endnew text begin (m)new text end The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph deleted text begin(a)deleted text endnew text begin (f)new text end and
as per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in
an amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 16.

Minnesota Statutes 2018, section 256B.04, subdivision 22, is amended to read:


Subd. 22.

Application fee.

(a) The commissioner must collect and retain federally
required nonrefundable application fees to pay for provider screening activities in accordance
with Code of Federal Regulations, title 42, section 455, subpart E. The enrollment application
must be made under the procedures specified by the commissioner, in the form specified
by the commissioner, and accompanied by deleted text beginan applicationdeleted text end new text beginthenew text end fee described in paragraph
(b), or a request for a hardship exception as described in the specified procedures. deleted text beginApplicationdeleted text end
new text begin Thenew text end fees must be deposited in the provider screening account in the special revenue fund.
Amounts in the provider screening account are appropriated to the commissioner for costs
associated with the provider screening activities required in Code of Federal Regulations,
title 42, section 455, subpart E. deleted text beginThe commissioner shall conduct screening activities as
required by Code of Federal Regulations, title 42, section 455, subpart E, and as otherwise
provided by law, to include database checks, unannounced pre- and postenrollment site
visits, fingerprinting, and criminal background studies. The commissioner must revalidate
all providers under this subdivision at least once every five years.
deleted text end

(b) The application fee under this subdivision is $532 for the calendar year 2013. For
calendar year 2014 and subsequent years, the fee:

(1) is adjusted by the percentage change to the Consumer Price Index for all urban
consumers, United States city average, for the 12-month period ending with June of the
previous year. The resulting fee must be announced in the Federal Register;

(2) is effective from January 1 to December 31 of a calendar year;

(3) is required on the submission of an initial application, an application to establish a
new practice location, an application for reenrollment when the provider is not enrolled at
the time of application of reenrollment, or at revalidation when required by federal regulation;
and

(4) must be in the amount in effect for the calendar year during which the application
for enrollment, new practice location, or reenrollment is being submitted.

(c) The deleted text beginapplicationdeleted text end fee under this subdivision cannot be charged to:

(1) providers who are enrolled in Medicare or who provide documentation of payment
of the fee to, and enrollment with, another state, unless the commissioner is required to
rescreen the provider;

(2) providers who are enrolled but are required to submit new applications for purposes
of reenrollment;

(3) a provider who enrolls as an individual; and

(4) group practices and clinics that bill on behalf of individually enrolled providers
within the practice who have reassigned their billing privileges to the group practice or
clinic.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 17.

Minnesota Statutes 2018, section 256B.04, is amended by adding a subdivision
to read:


new text begin Subd. 25. new text end

new text begin Medical assistance and MinnesotaCare payment increase. new text end

new text begin (a) The
commissioner shall increase medical assistance and MinnesotaCare fee-for-service payments
by an amount equal to the tax rate defined for hospitals, surgical centers, or health care
providers under sections 295.50 to 295.57 for all services subject to those taxes.
new text end

new text begin (b) The commissioner shall reflect in the total payments made to managed care
organizations, county-based purchasing plans, and other participating entities contracted
with the commissioner under section 256B.69, the cost of: (1) payments made to providers
for the tax on the services outlined in paragraph (a); and (2) the taxes imposed under sections
297I.05, subdivision 5, and 256.9657, subdivision 3, on premium revenue paid by the state
for medical assistance and the MinnesotaCare program. Any increase based on clause (2)
must be reflected in provider rates paid by the managed care organization, county-based
purchasing plan, or other participating entity, unless the managed care organization,
county-based purchasing plan, or other participating entity is a staff model health plan
company.
new text end

Sec. 18.

Minnesota Statutes 2018, section 256B.055, subdivision 2, is amended to read:


Subd. 2.

Subsidized foster children.

Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676new text begin, and for a child who is not eligible for
Title IV-E of the Social Security Act but who is determined eligible for foster care or kinship
assistance under chapter 256N
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 19.

Minnesota Statutes 2018, section 256B.056, subdivision 1, is amended to read:


Subdivision 1.

Residency.

new text begin(a) new text endTo be eligible for medical assistance, a person must reside
in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota, in
accordance with Code of Federal Regulations, title 42, section 435.403.

new text begin (b) The commissioner shall identify individuals who are enrolled in medical assistance
and who are absent from the state for more than 30 consecutive days, but who continue to
qualify for medical assistance in accordance with paragraph (a).
new text end

new text begin (c) If the individual is absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota in accordance with paragraph (a), any covered service
provided to the individual must be paid through the fee-for-service system and not through
the managed care capitated rate payment system under section 256B.69 or 256L.12.
new text end

Sec. 20.

Minnesota Statutes 2018, section 256B.056, subdivision 3, is amended to read:


Subd. 3.

Asset limitations for certain individuals.

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

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

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

(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;

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

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

(6) deleted text beginwhen a person enrolled in medical assistance under section 256B.057, subdivision
9
, is age 65 or older and has been enrolled during each of the 24 consecutive
deleted text enddeleted text beginmonths deleted text enddeleted text beginbefore
the person's 65th birthday, the assets owned by the person and the person's spouse must be
disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d), when
determining eligibility for medical assistance under section 256B.055, subdivision 7.
deleted text endnew text begin a
designated employment incentives asset account is disregarded when determining eligibility
for medical assistance for a person age 65 years or older under section 256B.055, subdivision
7. An employment incentives asset account must only be designated by a person who has
been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9.
new text end The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9
, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; and

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 21.

Minnesota Statutes 2018, section 256B.056, subdivision 5c, is amended to read:


Subd. 5c.

Excess income standard.

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

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years shall equalnew text begin:
new text end

new text begin (1)new text end 81 percent of the federal poverty guidelinesnew text begin; and
new text end

new text begin (2) effective July 1, 2022, 100 percent of the federal poverty guidelinesnew text end.

Sec. 22.

Minnesota Statutes 2018, section 256B.056, subdivision 7a, is amended to read:


Subd. 7a.

Periodic renewal of eligibility.

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

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

(c) An enrollee who is terminated for failure to complete the renewal process may
subsequently submit the renewal form and required information within four months after
the date of termination and have coverage reinstated without a lapse, if otherwise eligible
under this chapter.new text begin The local agency may close the enrollee's case file if the required
information is not submitted within four months of termination.
new text end

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

Sec. 23.

Minnesota Statutes 2018, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar weeknew text begin, except as provided
in paragraph (f)
new text end. Telemedicine services shall be paid at the full allowable rate.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.

(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, deleted text beginanddeleted text end a mental health practitioner defined
under section 245.462, subdivision 17, or 245.4871, subdivision 26, working under the
general supervision of a mental health professionalnew text begin, and a community health worker who
meets the criteria under subdivision 49, paragraph (a)
new text end; "health care provider" is defined
under section 62A.671, subdivision 3; and "originating site" is defined under section 62A.671,
subdivision 7
.

new text begin (f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
new text end

new text begin (1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
new text end

new text begin (2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
new text end

Sec. 24.

Minnesota Statutes 2018, section 256B.0625, subdivision 13, is amended to read:


Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5
, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals. deleted text beginOver-the-counter medications
must be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained
in the manufacturer's original package; (2) the number of dosage units required to complete
the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
from a system using retrospective billing, as provided under subdivision 13e, paragraph
(b).
deleted text end

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 25.

Minnesota Statutes 2018, section 256B.0625, subdivision 13e, is amended to
read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall
be the lower of the deleted text beginactual acquisitiondeleted text endnew text begin ingredientnew text end costs of the drugs deleted text beginor the maximum allowable
cost by the commissioner
deleted text end plus the deleted text beginfixeddeleted text endnew text begin professionalnew text end dispensing fee; or the usual and
customary price charged to the public. new text beginThe usual and customary price means the lowest
price charged by the provider to a patient who pays for the prescription by cash, check, or
charge account and includes prices the pharmacy charges to a patient enrolled in a
prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain.
new text endThe amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any new text beginthird-party new text endprovider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The deleted text beginpharmacydeleted text endnew text begin professionalnew text end dispensing fee
shall be deleted text begin$3.65deleted text endnew text begin $10.48new text end for deleted text beginlegend prescription drugs, except thatdeleted text endnew text begin prescriptions filled with
legend drugs meeting the definition of "covered outpatient drugs" according to United States
Code, title 42, section 1396r-8(k)(2).
new text end The dispensing fee for intravenous solutions deleted text beginwhichdeleted text endnew text begin
that
new text end must be compounded by the pharmacist shall be deleted text begin$8deleted text endnew text begin $10.48new text end per bagdeleted text begin, $14 per bag for
cancer chemotherapy products, and $30 per bag for total parenteral nutritional products
dispensed in one liter quantities, or $44 per bag for total parenteral nutritional products
dispensed in quantities greater than one liter
deleted text end. new text begin The professional dispensing fee for
prescriptions filled with over-the-counter drugs meeting the definition of covered outpatient
drugs shall be $10.48 for dispensed quantities equal to or greater than the number of units
contained in the manufacturer's original package. The professional dispensing fee shall be
prorated based on the percentage of the package dispensed when the pharmacy dispenses
a quantity less than the number of units contained in the manufacturer's original package.
new text end The pharmacy dispensing fee for new text beginprescribed new text endover-the-counter drugs new text beginnot meeting the definition
of covered outpatient drugs
new text endshall be $3.65deleted text begin, except that the fee shall be $1.31 for
retrospectively billing pharmacies when billing for quantities less than the number of units
contained in the manufacturer's original package. Actual acquisition cost includes quantity
and other special discounts except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner at wholesale acquisition cost plus four percent
for independently owned pharmacies located in a designated rural area within Minnesota,
and at wholesale acquisition cost plus two percent for all other pharmacies. A pharmacy is
"independently owned" if it is one of four or fewer pharmacies under the same ownership
nationally. A "designated rural area" means an area defined as a small rural area or isolated
rural area according to the four-category classification of the Rural Urban Commuting Area
system developed for the United States Health Resources and Services Administration.
Effective January 1, 2014, the actual acquisition
deleted text endnew text begin for quantities equal to or greater than the
number of units contained in the manufacturer's original package and shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The National
Average Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost
of a drug. For drugs for which a NADAC is not reported, the commissioner shall estimate
the ingredient cost at the wholesale acquisition cost minus two percent. The ingredient
new text end cost
of a drug deleted text beginacquired throughdeleted text endnew text begin for a provider participating innew text end the federal 340B Drug Pricing
Program shall be deleted text beginestimated by the commissioner at wholesale acquisition cost minus 40
percent
deleted text endnew text begin either the 340B Drug Pricing Program ceiling price established by the Health
Resources and Services Administration or NADAC, whichever is lower
new text end. Wholesale
acquisition cost is defined as the manufacturer's list price for a drug or biological to
wholesalers or direct purchasers in the United States, not including prompt pay or other
discounts, rebates, or reductions in price, for the most recent month for which information
is available, as reported in wholesale price guides or other publications of drug or biological
pricing data. The maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable todeleted text begin, butdeleted text endnew text begin the actual acquisition cost of the drug
product and
new text end no higher thandeleted text begin, the maximum amount paid by other third-party payors in this
state who have maximum allowable cost programs
deleted text endnew text begin the NADAC of the generic productnew text end.
Establishment of the amount of payment for drugs shall not be subject to the requirements
of the Administrative Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.

(c) deleted text beginAn additional dispensing fee of $.30 may be added to the dispensing fee paid to
pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
when a unit dose blister card system, approved by the department, is used. Under this type
of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister card must be identified
on the claim to the department. The unit dose blister card containing the drug must meet
the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
of unused drugs to the pharmacy for reuse.
deleted text end A pharmacy provider using packaging that meets
the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the
department for the actual acquisition cost of all unused drugs that are eligible for reuse,
unless the pharmacy is using retrospective billing. The commissioner may permit the drug
clozapine to be dispensed in a quantity that is less than a 30-day supply.

(d) deleted text beginWhenever a maximum allowable cost has been set fordeleted text endnew text begin If a pharmacy dispensesnew text end a
multisource drug, deleted text beginpayment shall be the lower of the usual and customary price charged to
the public or
deleted text endnew text begin the ingredient cost shall be the NADAC of the generic product ornew text end the maximum
allowable cost established by the commissioner unless prior authorization for the brand
name product has been granted according to the criteria established by the Drug Formulary
Committee as required by subdivision 13f, paragraph (a), and the prescriber has indicated
"dispense as written" on the prescription in a manner consistent with section 151.21,
subdivision 2
.

(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
deleted text begin Effective January 1, 2014,deleted text end The commissioner shall discount the payment rate for drugs
obtained through the federal 340B Drug Pricing Program by deleted text begin20deleted text endnew text begin 28.6new text end percent. The payment
for drugs administered in an outpatient setting shall be made to the administering facility
or practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
outpatient setting is not eligible for direct reimbursement.

(f) The commissioner may deleted text beginnegotiate lower reimbursementdeleted text endnew text begin establish maximum allowable
cost
new text end rates for specialty pharmacy products deleted text beginthan the ratesdeleted text endnew text begin that are lower than the ingredient
cost formulas
new text end specified in paragraph (a). The commissioner may require individuals enrolled
in the health care programs administered by the department to obtain specialty pharmacy
products from providers with whom the commissioner has negotiated lower reimbursement
rates. Specialty pharmacy products are defined as those used by a small number of recipients
or recipients with complex and chronic diseases that require expensive and challenging drug
regimens. Examples of these conditions include, but are not limited to: multiple sclerosis,
HIV/AIDS, transplantation, hepatitis C, growth hormone deficiency, Crohn's Disease,
rheumatoid arthritis, and certain forms of cancer. Specialty pharmaceutical products include
injectable and infusion therapies, biotechnology drugs, antihemophilic factor products,
high-cost therapies, and therapies that require complex care. The commissioner shall consult
with the Formulary Committee to develop a list of specialty pharmacy products subject to
deleted text begin this paragraphdeleted text endnew text begin maximum allowable cost reimbursementnew text end. In consulting with the Formulary
Committee in developing this list, the commissioner shall take into consideration the
population served by specialty pharmacy products, the current delivery system and standard
of care in the state, and access to care issues. The commissioner shall have the discretion
to adjust the deleted text beginreimbursement ratedeleted text endnew text begin maximum allowable costnew text end to prevent access to care issues.

(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.

new text begin (h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for all responding pharmacies to measure the
mean, mean weighted by total prescription volume, mean weighted by medical assistance
prescription volume, median, median weighted by total prescription volume, and median
weighted by total medical assistance prescription volume. The commissioner shall post a
copy of the final cost of dispensing survey report on the department's website. The initial
survey must be completed no later than January 1, 2021, and repeated every three years.
The commissioner shall provide a summary of the results of each cost of dispensing survey
and provide recommendations for any changes to the dispensing fee to the chairs and ranking
members of the legislative committees with jurisdiction over medical assistance pharmacy
reimbursement.
new text end

new text begin (i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, or upon federal approval,
whichever is later. Paragraph (i) expires if federal approval is denied. The commissioner
of human services shall inform the revisor of statutes when federal approval is obtained or
denied.
new text end

Sec. 26.

Minnesota Statutes 2018, section 256B.0625, subdivision 13f, is amended to read:


Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.

deleted text begin (d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.
deleted text end

deleted text begin (e)deleted text endnew text begin (d)new text end The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2
.

deleted text begin (f)deleted text endnew text begin (e)new text end Notwithstanding this subdivision, the commissioner may automatically require
prior authorization, for a period not to exceed 180 days, for any drug that is approved by
the United States Food and Drug Administration on or after July 1, 2005. The 180-day
period begins no later than the first day that a drug is available for shipment to pharmacies
within the state. The Formulary Committee shall recommend to the commissioner general
criteria to be used for the prior authorization of the drugs, but the committee is not required
to review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.

new text begin (f) Prior authorization under this subdivision shall comply with section 62Q.184.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment, except
that paragraph (f) is effective July 1, 2019.
new text end

Sec. 27.

Minnesota Statutes 2018, section 256B.0625, subdivision 17, is amended to read:


Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and deleted text beginin consultation with the Minnesota Department of
Transportation
deleted text endnew text begin all drivers must be individually enrolled with the commissioner and reported
on the claim as the individual who provided the service
new text end. All nonemergency medical
transportation providers shall bill for nonemergency medical transportation services in
accordance with Minnesota health care programs criteria. Publicly operated transit systems,
volunteers, and not-for-hire vehicles are exempt from the requirements outlined in this
paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician or a medical
or mental health professional to certify that the recipient requires nonemergency medical
transportation services. Nonemergency medical transportation providers shall perform
driver-assisted services for eligible individuals, when appropriate. Driver-assisted service
includes passenger pickup at and return to the individual's residence or place of business,
assistance with admittance of the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.

(k) The commissioner shall:

(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;

(4) $13 for the base rate and $1.30 per mile for assisted transport;

(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
new text end

Sec. 28.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 17d. new text end

new text begin Transportation services oversight. new text end

new text begin The commissioner shall contract with
a vendor or dedicate staff to oversee providers of nonemergency medical transportation
services pursuant to the commissioner's authority in section 256B.04 and Minnesota Rules,
parts 9505.2160 to 9505.2245.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 29.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 17e. new text end

new text begin Transportation provider termination. new text end

new text begin (a) A terminated nonemergency
medical transportation provider, including all named individuals on the current enrollment
disclosure form and known or discovered affiliates of the nonemergency medical
transportation provider, is not eligible to enroll as a nonemergency medical transportation
provider for five years following the termination.
new text end

new text begin (b) After the five-year period in paragraph (a), if a provider seeks to reenroll as a
nonemergency medical transportation provider, the provider must be placed on a one-year
probation period. During a provider's probation period the commissioner shall complete
unannounced site visits and request documentation to review compliance with program
requirements.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 30.

Minnesota Statutes 2018, section 256B.0625, subdivision 30, is amended to read:


Subd. 30.

Other clinic services.

(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.

(b) A federally qualified health center new text begin(FQHC) new text endthat is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. deleted text beginA federally qualified health centerdeleted text endnew text begin An FQHCnew text end that
is already in operation shall submit an initial report using actual costs and visits for the
initial reporting period. Within 90 days of the end of its reporting period, deleted text begina federally qualified
health center
deleted text endnew text begin an FQHCnew text end shall submit, in the form and detail required by the commissioner,
a report of its operations, including allowable costs actually incurred for the period and the
actual number of visits for services furnished during the period, and other information
required by the commissioner. deleted text beginFederally qualified health centersdeleted text endnew text begin FQHCsnew text end that file Medicare
cost reports shall provide the commissioner with a copy of the most recent Medicare cost
report filed with the Medicare program intermediary for the reporting year which support
the costs claimed on their cost report to the state.

(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), deleted text begina federally qualified health centerdeleted text endnew text begin an FQHCnew text end or rural
health clinic must apply for designation as an essential community provider within six
months of final adoption of rules by the Department of Health according to section 62Q.19,
subdivision 7
. For those deleted text beginfederally qualified health centersdeleted text endnew text begin FQHCsnew text end and rural health clinics
that have applied for essential community provider status within the six-month time
prescribed, medical assistance payments will continue to be made according to paragraphs
(a) and (b) for the first three years after application. For deleted text beginfederally qualified health centersdeleted text endnew text begin
FQHCs
new text end and rural health clinics that either do not apply within the time specified above or
who have had essential community provider status for three years, medical assistance
payments for health services provided by these entities shall be according to the same rates
and conditions applicable to the same service provided by health care providers that are not
deleted text begin federally qualified health centersdeleted text endnew text begin FQHCsnew text end or rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring deleted text begina federally qualified
health center
deleted text endnew text begin an FQHCnew text end or a rural health clinic to make application for an essential community
provider designation in order to have cost-based payments made according to paragraphs
(a) and (b) no longer apply.

(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.

(f) Effective January 1, 2001, new text beginthrough December 31, 2020, new text endeach deleted text beginfederally qualified
health center
deleted text endnew text begin FQHCnew text end and rural health clinic may elect to be paid either under the prospective
payment system established in United States Code, title 42, section 1396a(aa), or under an
alternative payment methodology consistent with the requirements of United States Code,
title 42, section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services.
The alternative payment methodology shall be 100 percent of cost as determined according
to Medicare cost principles.

(g)new text begin Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).
new text end

new text begin (h)new text end For purposes of this section, "nonprofit community clinic" is a clinic that:

(1) has nonprofit status as specified in chapter 317A;

(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);

(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;

(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;

(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and

(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.

deleted text begin (h)deleted text endnew text begin (i)new text end Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by deleted text beginfederally qualified health centersdeleted text endnew text begin FQHCsnew text end and rural health
clinics shall be paid by the commissioner. the commissioner shall determine the most feasible
method for paying claims from the following options:

(1) deleted text beginfederally qualified health centersdeleted text endnew text begin FQHCsnew text end and rural health clinics submit claims
directly to the commissioner for payment, and the commissioner provides claims information
for recipients enrolled in a managed care or county-based purchasing plan to the plan, on
a regular basis; or

(2) deleted text beginfederally qualified health centersdeleted text endnew text begin FQHCsnew text end and rural health clinics submit claims for
recipients enrolled in a managed care or county-based purchasing plan to the plan, and those
claims are submitted by the plan to the commissioner for payment to the clinic.

deleted text begin (i)deleted text endnew text begin (j)new text end For clinic services provided prior to January 1, 2015, the commissioner shall
calculate and pay monthly the proposed managed care supplemental payments to clinics,
and clinics shall conduct a timely review of the payment calculation data in order to finalize
all supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.

deleted text begin (j)deleted text endnew text begin (k)new text end The commissioner shall seek a federal waiver, authorized under section 1115 of
the Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.

new text begin (l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
new text end

new text begin (1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;
new text end

new text begin (2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;
new text end

new text begin (3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
new text end

new text begin (i) general social services and administrative costs;
new text end

new text begin (ii) retail pharmacy;
new text end

new text begin (iii) patient incentives, food, housing assistance, and utility assistance;
new text end

new text begin (iv) external lab and x-ray;
new text end

new text begin (v) navigation services;
new text end

new text begin (vi) health care taxes;
new text end

new text begin (vii) advertising, public relations, and marketing;
new text end

new text begin (viii) office entertainment costs, food, alcohol, and gifts;
new text end

new text begin (ix) contributions and donations;
new text end

new text begin (x) bad debts or losses on awards or contracts;
new text end

new text begin (xi) fines, penalties, damages, or other settlements;
new text end

new text begin (xii) fund-raising, investment management, and associated administrative costs;
new text end

new text begin (xiii) research and associated administrative costs;
new text end

new text begin (xiv) nonpaid workers;
new text end

new text begin (xv) lobbying;
new text end

new text begin (xvi) scholarships and student aid; and
new text end

new text begin (xvii) nonmedical assistance covered services;
new text end

new text begin (4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
new text end

new text begin (5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:
new text end

new text begin (i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;
new text end

new text begin (ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
new text end

new text begin (iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year;
new text end

new text begin (iv) must be inflated to the base year using the inflation factor described in clause (6);
and
new text end

new text begin (v) the commissioner must provide for a 60-day appeals process under section 14.57;
new text end

new text begin (6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;
new text end

new text begin (7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;
new text end

new text begin (8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;
new text end

new text begin (9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;
new text end

new text begin (10) For FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
new text end

new text begin (i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
new text end

new text begin (ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
new text end

new text begin (iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);
new text end

new text begin (11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
new text end

new text begin (12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rate;
new text end

new text begin (13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and
new text end

new text begin (14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.
new text end

Sec. 31.

Minnesota Statutes 2018, section 256B.0625, subdivision 57, is amended to read:


Subd. 57.

Payment for Part B Medicare crossover claims.

(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.

(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.

(c) Excluded from this limitation are payments to federally qualified health centersnew text begin,
Indian Health Services,
new text end and rural health clinics.

new text begin EFFECTIVE DATE. new text end

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

Sec. 32.

Minnesota Statutes 2018, section 256B.064, subdivision 1a, is amended to read:


Subd. 1a.

Grounds for sanctions against vendors.

new text begin(a) new text endThe commissioner may impose
sanctions against a vendor of medical care for any of the following: (1) fraud, theft, or abuse
in connection with the provision of medical care to recipients of public assistance; (2) a
pattern of presentment of false or duplicate claims or claims for services not medically
necessary; (3) a pattern of making false statements of material facts for the purpose of
obtaining greater compensation than that to which the vendor is legally entitled; (4)
suspension or termination as a Medicare vendor; (5) refusal to grant the state agency access
during regular business hours to examine all records necessary to disclose the extent of
services provided to program recipients and appropriateness of claims for payment; (6)
failure to repay an overpayment or a fine finally established under this section; (7) failure
to correct errors in the maintenance of health service or financial records for which a fine
was imposed or after issuance of a warning by the commissioner; and (8) any reason for
which a vendor could be excluded from participation in the Medicare program under section
1128, 1128A, or 1866(b)(2) of the Social Security Act.

new text begin (b) The commissioner may impose sanctions against a pharmacy provider for failure to
respond to a cost of dispensing survey under section 256B.0625, subdivision 13e, paragraph
(h).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 33.

Minnesota Statutes 2018, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for provider enrollment of personal care assistance provider
agencies.

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

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

(2) proof of surety bond coveragenew text begin for each business location providing servicesnew text end. Upon
new enrollment, or if the provider's Medicaid revenue in the previous calendar year is up
to and including $300,000, the provider agency must purchase a surety bond of $50,000. If
the Medicaid revenue in the previous year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;

(3) proof of fidelity bond coverage in the amount of $20,000new text begin for each business location
providing service
new text end;

(4) proof of workers' compensation insurance coveragenew text begin identifying the business location
where personal care assistance services are provided
new text end;

(5) proof of liability insurancenew text begin coverage identifying the business location where personal
care assistance services are provided and naming the department as a certificate holder
new text end;

deleted text begin (6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;
deleted text end

deleted text begin (7)deleted text endnew text begin (6)new text end a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;

deleted text begin (8)deleted text endnew text begin (7)new text end copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:

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

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

(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;

deleted text begin (9)deleted text endnew text begin (8)new text end a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

deleted text begin (10)deleted text endnew text begin (9)new text end documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;

deleted text begin (11)deleted text endnew text begin (10)new text end documentation of the agency's marketing practices;

deleted text begin (12)deleted text endnew text begin (11)new text end disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;

deleted text begin (13)deleted text endnew text begin (12)new text end documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and

deleted text begin (14)deleted text endnew text begin (13)new text end effective May 15, 2010, documentation that the agency does not burden
recipients' free exercise of their right to choose service providers by requiring personal care
assistants to sign an agreement not to work with any particular personal care assistance
recipient or for another personal care assistance provider agency after leaving the agency
and that the agency is not taking action on any such agreements or requirements regardless
of the date signed.

(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.

(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner beforenew text begin submitting an application fornew text end enrollment of the
agency as a provider.new text begin All personal care assistance provider agencies shall also require
qualified professionals to complete the training required by subdivision 13 before submitting
an application for enrollment of the agency as a provider.
new text end Employees in management and
supervisory positions and owners who are active in the day-to-day operations of an agency
who have completed the required training as an employee with a personal care assistance
provider agency do not need to repeat the required training if they are hired by another
agency, if they have completed the training within the past three years. By September 1,
2010, the required training must be available with meaningful access according to title VI
of the Civil Rights Act and federal regulations adopted under that law or any guidance from
the United States Health and Human Services Department. The required training must be
available online or by electronic remote connection. The required training must provide for
competency testing. Personal care assistance provider agency billing staff shall complete
training about personal care assistance program financial management. This training is
effective July 1, 2009. Any personal care assistance provider agency enrolled before that
date shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new owners or employees in management and supervisory positions involved
in the day-to-day operations are required to complete mandatory training as a requisite of
working for the agency. Personal care assistance provider agencies certified for participation
in Medicare as home health agencies are exempt from the training required in this
subdivision. When available, Medicare-certified home health agency owners, supervisors,
or managers must successfully complete the competency test.

new text begin (d) All surety bonds, fidelity bonds, workers compensation insurance, and liability
insurance required by this subdivision must be maintained continuously. After initial
enrollment, a provider must submit proof of bonds and required coverages at any time at
the request of the commissioner. Services provided while there are lapses in coverage are
not eligible for payment. Lapses in coverage may result in sanctions, including termination.
The commissioner shall send instructions and a due date to submit the requested information
to the personal care assistance provider agency.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 34.

Minnesota Statutes 2018, section 256B.69, subdivision 4, is amended to read:


Subd. 4.

Limitation of choice.

(a) The commissioner shall develop criteria to determine
when limitation of choice may be implemented in the experimental counties. The criteria
shall ensure that all eligible individuals in the county have continuing access to the full
range of medical assistance services as specified in subdivision 6.

(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:

(1) persons eligible for medical assistance according to section 256B.055, subdivision
1
;

(2) persons eligible for medical assistance due to blindness or disability as determined
by the Social Security Administration or the state medical review team, unless:

(i) they are 65 years of age or older; or

(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;

(3) recipients who currently have private coverage through a health maintenance
organization;

(4) recipients who are eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense;

(5) recipients who receive benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);

(6) children who are both determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625, subdivision 20, except children
who are eligible for and who decline enrollment in an approved preferred integrated network
under section 245.4682;

(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;

(8) persons eligible for medical assistance according to section 256B.057, subdivision
10
; deleted text beginand
deleted text end

(9) persons with access to cost-effective employer-sponsored private health insurance
or persons enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15new text begin; and
new text end

new text begin (10) persons who are absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota, identified in accordance with section 256B.056, subdivision
1, paragraph (b)
new text end.

Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective
basis. The commissioner may enroll recipients in the prepaid medical assistance program
for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending
down excess income.

(c) The commissioner may allow persons with a one-month spenddown who are otherwise
eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.

(d) The commissioner may require those individuals to enroll in the prepaid medical
assistance program who otherwise would have been excluded under paragraph (b), clauses
(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.

(e) Before limitation of choice is implemented, eligible individuals shall be notified and
after notification, shall be allowed to choose only among demonstration providers. The
commissioner may assign an individual with private coverage through a health maintenance
organization, to the same health maintenance organization for medical assistance coverage,
if the health maintenance organization is under contract for medical assistance in the
individual's county of residence. After initially choosing a provider, the recipient is allowed
to change that choice only at specified times as allowed by the commissioner. If a
demonstration provider ends participation in the project for any reason, a recipient enrolled
with that provider must select a new provider but may change providers without cause once
more within the first 60 days after enrollment with the second provider.

(f) An infant born to a woman who is eligible for and receiving medical assistance and
who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to
the month of birth in the same managed care plan as the mother once the child is enrolled
in medical assistance unless the child is determined to be excluded from enrollment in a
prepaid plan under this section.

Sec. 35.

Minnesota Statutes 2018, section 256B.69, is amended by adding a subdivision
to read:


new text begin Subd. 31a. new text end

new text begin Trend limit; calculation. new text end

new text begin (a) Beginning January 1, 2020, and ending June
30, 2024, the commissioner of human services may, to the extent practicable, limit the year
over year increase in rates paid to managed care plans and county-based purchasing plans
under this section and section 256B.692 by an amount equal to the value of a 0.8 percent
reduction in rates in medical assistance across all products. Managed care rates must meet
actuarial soundness and rate development requirements under Code of Federal Regulations,
title 42, part 438, subpart A. Forecast expenditure growth assumptions cannot be part of the
rate-setting process.
new text end

new text begin (b) In the November 2019 forecast, the commissioner of human services, in consultation
with the commissioner of management and budget, shall determine the extent to which the
year over year change in managed care and county-based purchasing plan rates are forecasted
to reduce medical assistance expenditures in fiscal years 2020 through 2024, relative to
projected expenditures from the end of the 2019 legislative session that establish a budget
for the Department of Human Services. To the extent the total value of the reduction is less
than $145,150,000, the commissioner of management and budget shall transfer the difference
from the premium security account established in section 62E.25, subdivision 1, to the
general fund.
new text end

Sec. 36.

new text begin [256B.758] REIMBURSEMENT FOR DOULA SERVICES.
new text end

new text begin Effective for services provided on or after July 1, 2019, payments for doula services
provided by a certified doula shall be $47 per prenatal or postpartum visit and $488 for
attending and providing doula services at a birth.
new text end

Sec. 37.

Minnesota Statutes 2018, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for basic care
services, shall be reduced by three percent, except that for the period July 1, 2009, through
June 30, 2011, total payments shall be reduced by 4.5 percent for the medical assistance
and general assistance medical care programs, prior to third-party liability and spenddown
calculation. Effective July 1, 2010, the commissioner shall classify physical therapy services,
occupational therapy services, and speech-language pathology and related services as basic
care services. The reduction in this paragraph shall apply to physical therapy services,
occupational therapy services, and speech-language pathology and related services provided
on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall be
reduced for services provided on or after October 1, 2009, to reflect the reduction effective
July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010,
to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for outpatient hospital facility fees shall be reduced by five percent from the
rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for ambulatory surgery centers facility fees, medical supplies and durable
medical equipment not subject to a volume purchase contract, prosthetics and orthotics,
renal dialysis services, laboratory services, public health nursing services, physical therapy
services, occupational therapy services, speech therapy services, eyeglasses not subject to
a volume purchase contract, hearing aids not subject to a volume purchase contract, and
anesthesia services shall be reduced by three percent from the rates in effect on August 31,
2011.

(e) Effective for services provided on or after September 1, 2014, payments for
ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory
services, public health nursing services, eyeglasses not subject to a volume purchase contract,
and hearing aids not subject to a volume purchase contract shall be increased by three percent
and payments for outpatient hospital facility fees shall be increased by three percent.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a volume
purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through
June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable
medical equipment not subject to a volume purchase contract, and prosthetics and orthotics,
provided on or after July 1, 2015, shall be increased by three percent from the rates as
determined under paragraphs (i) and (j).

(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
from the rates in effect on June 30, 2015. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.

(h) This section does not apply to physician and professional services, inpatient hospital
services, family planning services, mental health services, dental services, prescription
drugs, medical transportation, federally qualified health centers, rural health centers, Indian
health services, and Medicare cost-sharing.

(i) Effective for services provided on or after July 1, 2015, the following categories of
medical supplies and durable medical equipment shall be individually priced items: enteral
nutrition and supplies, customized and other specialized tracheostomy tubes and supplies,
electric patient lifts, and durable medical equipment repair and service. This paragraph does
not apply to medical supplies and durable medical equipment subject to a volume purchase
contract, products subject to the preferred diabetic testing supply program, and items provided
to dually eligible recipients when Medicare is the primary payer for the item. The
commissioner shall not apply any medical assistance rate reductions to durable medical
equipment as a result of Medicare competitive bidding.

(j) Effective for services provided on or after July 1, 2015, medical assistance payment
rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased
as follows:

(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and

(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).

This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.

(k) Effective for nonpressure support ventilators provided on or after January 1, 2016,
the rate shall be the lower of the submitted charge or the Medicare fee schedule rate. Effective
for pressure support ventilators provided on or after January 1, 2016, the rate shall be the
lower of the submitted charge or 47 percent above the Medicare fee schedule rate. For
payments made in accordance with this paragraph, if, and to the extent that, the commissioner
identifies that the state has received federal financial participation for ventilators in excess
of the amount allowed effective January 1, 2018, under United States Code, title 42, section
1396b(i)(27), the state shall repay the excess amount to the Centers for Medicare and
Medicaid Services with state funds and maintain the full payment rate under this paragraph.

new text begin (l) Payment rates for durable medical equipment, prosthetics, orthotics or supplies, that
are subject to the upper payment limit in accordance with section 1903(i)(27) of the Social
Security Act, shall be paid the Medicare rate. Rate increases provided in this chapter shall
not be applied to the items listed in this paragraph.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019, subject to federal approval.
The commissioner shall notify the revisor of statutes when federal approval has been
obtained.
new text end

Sec. 38.

Minnesota Statutes 2018, section 256B.79, subdivision 2, is amended to read:


Subd. 2.

deleted text beginPilotdeleted text endnew text begin Grantnew text end program established.

The commissioner shall implement a deleted text beginpilotdeleted text endnew text begin
grant
new text end program to improve birth outcomes and strengthen early parental resilience for pregnant
women who are medical assistance enrollees, are at significantly elevated risk for adverse
outcomes of pregnancy, and are in targeted populations. The program must promote the
provision of integrated care and enhanced services to these pregnant women, including
postpartum coordination to ensure ongoing continuity of care, by qualified integrated
perinatal care collaboratives.

Sec. 39.

Minnesota Statutes 2018, section 256B.79, subdivision 3, is amended to read:


Subd. 3.

Grant awards.

The commissioner shall award grants to qualifying applicants
to support interdisciplinary, integrated perinatal care. deleted text beginGrants must be awarded beginning
July 1, 2016.
deleted text end Grant funds must be distributed through a request for proposals process to a
designated lead agency within an entity that has been determined to be a qualified integrated
perinatal care collaborative or within an entity in the process of meeting the qualifications
to become a qualified integrated perinatal care collaborativenew text begin, and priority shall be given to
qualified integrated perinatal care collaboratives that received grants under this section prior
to January 1, 2019
new text end. Grant awards must be used to support interdisciplinary, team-based
needs assessments, planning, and implementation of integrated care and enhanced services
for targeted populations. In determining grant award amounts, the commissioner shall
consider the identified health and social risks linked to adverse outcomes and attributed to
enrollees within the identified targeted population.

Sec. 40.

Minnesota Statutes 2018, section 256B.79, subdivision 4, is amended to read:


Subd. 4.

Eligibility for grants.

To be eligible for a grant under this section, an entity
must deleted text beginshow that the entity meets or is in the process of meetingdeleted text end new text beginmeet new text endqualifications established
by the commissioner to be a qualified integrated perinatal care collaborative. These
qualifications must include evidence that the entity has deleted text beginor is in the process of developingdeleted text end
policies, services, and partnerships to support interdisciplinary, integrated care. The policies,
services, and partnerships must meet specific criteria and be approved by the commissioner.
The commissioner shall deleted text beginestablish a process todeleted text end review the collaborative's capacity for
interdisciplinary, integrated care, to be reviewed at the commissioner's discretion. In
determining whether the entity meets the qualifications for a qualified integrated perinatal
care collaborative, the commissioner shall verify and review whether the entity's policies,
services, and partnerships:

(1) optimize early identification of drug and alcohol dependency and abuse during
pregnancy, effectively coordinate referrals and follow-up of identified patients to
evidence-based or evidence-informed treatment, and integrate perinatal care services with
behavioral health and substance abuse services;

(2) enhance access to, and effective use of, needed health care or tribal health care
services, public health or tribal public health services, social services, mental health services,
chemical dependency services, or services provided by community-based providers by
bridging cultural gaps within systems of care and by integrating community-based
paraprofessionals such as doulas and community health workers as routinely available
service components;

(3) encourage patient education about prenatal care, birthing, and postpartum care, and
document how patient education is provided. Patient education may include information
on nutrition, reproductive life planning, breastfeeding, and parenting;

(4) integrate child welfare case planning with substance abuse treatment planning and
monitoring, as appropriate;

(5) effectively systematize screening, collaborative care planning, referrals, and follow
up for behavioral and social risks known to be associated with adverse outcomes and known
to be prevalent within the targeted populations;

(6) facilitate ongoing continuity of care to include postpartum coordination and referrals
for interconception care, continued treatment for substance abuse, identification and referrals
for maternal depression and other chronic mental health conditions, continued medication
management for chronic diseases, and appropriate referrals to tribal or county-based social
services agencies and tribal or county-based public health nursing services; and

(7) implement ongoing quality improvement activities as determined by the commissioner,
including collection and use of data from qualified providers on metrics of quality such as
health outcomes and processes of care, and the use of other data that has been collected by
the commissioner.

Sec. 41.

Minnesota Statutes 2018, section 256B.79, subdivision 5, is amended to read:


Subd. 5.

Gaps in communication, support, and care.

A collaborative receiving a grant
under this section must deleted text begindevelop means of identifying and reportingdeleted text end new text beginidentify and report new text endgaps
in the collaborative's communication, administrative support, and direct carenew text begin, if any,new text end that
must be remedied for the collaborative to new text begincontinue to new text endeffectively provide integrated care
and enhanced services to targeted populations.

Sec. 42.

Minnesota Statutes 2018, section 256B.79, subdivision 6, is amended to read:


Subd. 6.

Report.

By January 31, deleted text begin2019deleted text endnew text begin 2021, and every two years thereafternew text end, the
commissioner shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance on the
status and deleted text beginprogressdeleted text endnew text begin outcomesnew text end of the deleted text beginpilotdeleted text endnew text begin grantnew text end program. The report must:

(1) describe the capacity of collaboratives receiving grants under this section;

(2) contain aggregate information about enrollees served within targeted populations;

(3) describe the utilization of enhanced prenatal services;

(4) for enrollees identified with maternal substance use disorders, describe the utilization
of substance use treatment and dispositions of any child protection cases;

(5) contain data on outcomes within targeted populations and compare these outcomes
to outcomes statewide, using standard categories of race and ethnicity; and

(6) include recommendations for continuing the program or sustaining improvements
through other means deleted text beginbeyond June 30, 2019deleted text end.

Sec. 43.

Minnesota Statutes 2018, section 256L.11, subdivision 2, is amended to read:


Subd. 2.

Payment of certain providers.

Services provided by federally qualified health
centers, rural health clinics, deleted text beginanddeleted text end facilities of the Indian health servicenew text begin, and certified
community behavioral health clinics
new text end shall be paid for according to the same rates and
conditions applicable to the same service provided by providers that are not federally
qualified health centers, rural health clinics, deleted text beginordeleted text end facilities of the Indian health servicenew text begin, or
certified community behavioral health clinics
new text end.new text begin The alternative payment methodology
described under section 256B.0625, subdivision 30, paragraph (l), shall not apply to services
delivered under this chapter by federally qualified health centers, rural health clinics, and
facilities of the Indian Health Services. The prospective payment system for certified
behavioral health clinics under section 256B.0625, subdivision 5m, shall not apply to services
delivered under this chapter.
new text end

Sec. 44. new text beginSTUDY OF CLINIC COSTS.
new text end

new text begin The commissioner of human services shall conduct a five-year comparative analysis of
the actual change in aggregate federally qualified health center (FQHC) and rural health
clinic costs versus the CMS FQHC Market Basket inflator using 2017 through 2022 finalized
Medicare Cost Reports, CMS 2224-14, and report the findings to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance, by July 1, 2025.
new text end

Sec. 45. new text beginCORRECTIVE PLAN TO ELIMINATE DUPLICATE PERSONAL
IDENTIFICATION NUMBERS.
new text end

new text begin (a) The commissioner of human services shall design and implement a corrective plan
to address the issue of medical assistance enrollees being assigned more than one personal
identification number. Any corrections or fixes that are necessary to address this issue are
required to be completed by June 30, 2021.
new text end

new text begin (b) By February 15, 2020, the commissioner shall submit a report to the chairs and
ranking minority members of the legislative committees with jurisdiction over health and
human services policy and finance on the progress of the corrective plan required in paragraph
(a), including an update on meeting the June 30, 2021, deadline. The report must also include
information on:
new text end

new text begin (1) the number of medical assistance enrollees who have been assigned two or more
personal identification numbers;
new text end

new text begin (2) any possible financial effect of enrollees having duplicate personal identification
numbers on health care providers and managed care organizations, including the effect on
reimbursement rates, meeting withhold requirements, and capitated payments; and
new text end

new text begin (3) any effect on federal payments received by the state.
new text end

Sec. 46. new text beginBLUE RIBBON COMMISSION ON HEALTH AND HUMAN SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioners of health and human services shall
convene a Blue Ribbon Commission to advise and assist the legislature and governor in
transforming the health and human services system to build greater efficiencies, savings,
and better outcomes for Minnesotans.
new text end

new text begin Subd. 2. new text end

new text begin Membership; appointment. new text end

new text begin (a) The Blue Ribbon Commission consists of 17
members as follows:
new text end

new text begin (1) two members of the house of representatives appointed by the speaker of the house;
new text end

new text begin (2) two members of the senate appointed by the senate majority leader;
new text end

new text begin (3) the commissioner of human services or designee;
new text end

new text begin (4) the commissioner of health or designee;
new text end

new text begin (5) four members appointed by the governor who have demonstrated expertise and
leadership in health care, long-term care, or social service organization, health and human
services technology, or other collaborative health and human services system improvement
activities with a history of providing guidance to state and local governments;
new text end

new text begin (6) two members appointed by the governor who have demonstrated leadership in
employer and group purchaser activities in which the group purchaser is not a health plan
company; one of the members appointed must be from a labor organization; and
new text end

new text begin (7) five members appointed by the governor who have demonstrated public or private
leadership, cultural responsiveness, and innovation in the area of health and human services.
new text end

new text begin (b) The governor is exempt from the requirements of the open appointments process for
purposes of appointing commission members.
new text end

new text begin Subd. 3. new text end

new text begin Cochairs. new text end

new text begin The commissioners of health and human services shall serve as
cochairs of the commission. The commissioner of human services shall convene the first
meeting.
new text end

new text begin Subd. 4. new text end

new text begin Compensation; expenses; reimbursement. new text end

new text begin Public members shall be
compensated and reimbursed for expenses as provided in Minnesota Statutes, section
15.0575, subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Administrative support. new text end

new text begin The commissioners of health and human services
shall provide meeting space and administrative support to the commission.
new text end

new text begin Subd. 6. new text end

new text begin Gifts. new text end

new text begin The commission may accept gifts and grants on behalf of the state for
the purpose of supporting the commission. Any such gifts or grants shall constitute donations
to the state. Funds received under this subdivision are appropriated to the commissioner of
human services to support the commission in performing its duties.
new text end

new text begin Subd. 7. new text end

new text begin Public and stakeholder engagement. new text end

new text begin The commissioners of health and human
services shall review available research to determine Minnesotans' values, preferences,
opinions, and perceptions related to human services and health care benefits and other issues
that may be before the commission and shall present the findings to the commission.
new text end

new text begin Subd. 8. new text end

new text begin Duties. new text end

new text begin (a) By October 1, 2020, the commission shall develop and present to
the legislature and the governor an action plan for transforming the health and human
services system to improve program efficiencies, produce savings, and promote better
outcomes for Minnesotans. The action plan must include, but is not limited to, the following:
new text end

new text begin (1) strategies to increase administrative efficiencies and improve program simplification
within health and human services public programs, including examining the roles and
experience of counties and tribes in delivering services and identifying any conflicting and
duplicative roles and responsibilities among health and human services agencies, counties,
and tribes;
new text end

new text begin (2) approaches to reducing health and human services expenditures, including identifying
evidence-based strategies for addressing the significant cost drivers of state spending on
health and human services, including the medical assistance program;
new text end

new text begin (3) opportunities for reducing fraud and improving program integrity in health and human
services; and
new text end

new text begin (4) statewide strategies for improving access to health and human services with a focus
on addressing geographic, racial, and ethnic disparities.
new text end

new text begin (b) The commission may contract with a private entity or consultant as necessary to
complete its duties under this section, and shall be exempt from state procurement process
requirements under Minnesota Statutes, chapter 16C.
new text end

new text begin Subd. 9. new text end

new text begin Limitations. new text end

new text begin (a) In developing the action plan, the commission shall take into
consideration the impact of its recommendations on:
new text end

new text begin (1) the existing capacity of state agencies, including staffing needs, technology resources,
and existing agency responsibilities; and
new text end

new text begin (2) the capacity of county and tribal partners.
new text end

new text begin (b) The commission shall not include in the action plan recommendations that may result
in loss of benefits for the individuals eligible for state health and human services public
programs or exacerbate health disparities and inequities in access to health care and human
services.
new text end

new text begin Subd. 10. new text end

new text begin Expiration. new text end

new text begin The Blue Ribbon Commission expires October 2, 2020, or the
day after submitting the action plan required under subdivision 8, whichever is earlier.
new text end

Sec. 47. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 256B.0625, subdivision 63; 256B.0659, subdivision
22; and 256L.11, subdivision 2a,
new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 256B.0625, subdivision 31c; and 256B.79,
subdivision 7,
new text end new text begin are repealed effective the day following final enactment.
new text end

ARTICLE 8

HEALTH COVERAGE

Section 1.

Minnesota Statutes 2018, section 62A.30, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Mammograms. new text end

new text begin (a) For purposes of subdivision 2, coverage for a preventive
mammogram screening (1) includes digital breast tomosynthesis for enrollees at risk for
breast cancer, and (2) is covered as a preventive item or service, as described under section
62Q.46.
new text end

new text begin (b) For purposes of this subdivision, "digital breast tomosynthesis" means a radiologic
procedure that involves the acquisition of projection images over the stationary breast to
produce cross-sectional digital three-dimensional images of the breast. "At risk for breast
cancer" means:
new text end

new text begin (1) having a family history with one or more first- or second-degree relatives with breast
cancer;
new text end

new text begin (2) testing positive for BRCA1 or BRCA2 mutations;
new text end

new text begin (3) having heterogeneously dense breasts or extremely dense breasts based on the Breast
Imaging Reporting and Data System established by the American College of Radiology; or
new text end

new text begin (4) having a previous diagnosis of breast cancer.
new text end

new text begin (c) This subdivision does not apply to coverage provided through a public health care
program under chapter 256B or 256L.
new text end

new text begin (d) Nothing in this subdivision limits the coverage of digital breast tomosynthesis in a
policy, plan, certificate, or contract referred to in subdivision 1 that is in effect prior to
January 1, 2020.
new text end

new text begin (e) Nothing in this subdivision prohibits a policy, plan, certificate, or contract referred
to in subdivision 1 from covering digital breast tomosynthesis for an enrollee who is not at
risk for breast cancer.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to health
plans issued, sold, or renewed on or after that date.
new text end

Sec. 2.

new text begin [62A.3097] PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC
DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS (PANDAS)
AND PEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME (PANS)
TREATMENT; COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Pediatric acute-onset neuropsychiatric syndrome" means a class of acute-onset
obsessive compulsive or tic disorders or other behavioral changes presenting in children
and adolescents that are not otherwise explained by another known neurologic or medical
disorder.
new text end

new text begin (c) "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections" means a condition in which a streptococcal infection in a child or adolescent
causes the abrupt onset of clinically significant obsessions, compulsions, tics, or other
neuropsychiatric symptoms or behavioral changes, or a relapsing and remitting course of
symptom severity.
new text end

new text begin Subd. 2. new text end

new text begin Scope of coverage. new text end

new text begin This section applies to all health plans that provide coverage
to Minnesota residents.
new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin Every health plan included in subdivision 2 must provide
coverage for treatment for pediatric autoimmune neuropsychiatric disorders associated with
streptococcal infections (PANDAS) and for treatment for pediatric acute-onset
neuropsychiatric syndrome (PANS). Treatments that must be covered under this section
must be recommended by the insured's licensed health care professional and include but
are not limited to antibiotics, medication and behavioral therapies to manage neuropsychiatric
symptoms, plasma exchange, and immunoglobulin.
new text end

new text begin Subd. 4. new text end

new text begin Reimbursement. new text end

new text begin The commissioner of commerce shall reimburse health carriers
for coverage under this section. Reimbursement is available only for coverage that would
not have been provided by the health carrier without the requirements of this section. Each
fiscal year an amount necessary to make payments to health carriers to defray the cost of
providing coverage under this section is appropriated to the commissioner of commerce.
Health carriers shall report to the commissioner quantified costs attributable to the additional
benefit under this section in a format developed by the commissioner. The commissioner
shall evaluate submissions and make payments to health carriers as provided in Code of
Federal Regulations, title 45, section 155.170.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62D.12, is amended by adding a subdivision to
read:


new text begin Subd. 8a. new text end

new text begin Net earnings. new text end

new text begin All net earnings of a nonprofit health maintenance organization
must be devoted to the nonprofit purposes of the health maintenance organization in providing
comprehensive health care. A nonprofit health maintenance organization must not provide
for the payment, whether directly or indirectly, of any part of its net earnings to any person
for a purpose other than providing comprehensive health care, except that the health
maintenance organization may make payments to providers or other persons based on the
efficient provision of services or as incentives to provide quality care. The commissioner
of health shall, pursuant to this chapter, revoke the certificate of authority of any nonprofit
health maintenance organization in violation of this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2018, section 62D.124, subdivision 3, is amended to read:


Subd. 3.

deleted text beginExceptiondeleted text endnew text begin Waivernew text end.

deleted text begin The commissioner shall grant an exception to the
requirements of this section according to Minnesota Rules, part 4685.1010, subpart 4, if the
health maintenance organization can demonstrate with specific data that the requirement
of subdivision 1 or 2 is not feasible in a particular service area or part of a service area.
deleted text end new text begin (a)
A health maintenance organization may apply to the commissioner of health for a waiver
of the requirements in subdivision 1 or 2 if it is unable to meet those requirements. A waiver
application must be submitted on a form provided by the commissioner, must be accompanied
by an application fee of $500 per county per year, for each application to waive the
requirements in subdivision 1 or 2 for one or more provider types in that county, and must:
new text end

new text begin (1) demonstrate with specific data that the requirements of subdivision 1 or 2 are not
feasible in a particular service area or part of a service area; and
new text end

new text begin (2) include specific information as to the steps that were and will be taken to address
network inadequacy, and for steps that will be taken prospectively to address network
inadequacy, the time frame within which those steps will be taken.
new text end

new text begin (b) Using the guidelines and standards established under section 62K.10, subdivision 5,
paragraph (b), the commissioner shall review each waiver request and shall approve a waiver
only if:
new text end

new text begin (1) the standards for approval established by the commissioner are satisfied; and
new text end

new text begin (2) the steps that were and will be taken to address the network inadequacy and the time
frame for implementing these steps satisfy the standards established by the commissioner.
new text end

new text begin (c) If, in its waiver application, a health maintenance organization demonstrates to the
commissioner that there are no providers of a specific type or specialty in a county, the
commissioner may approve a waiver in which the health maintenance organization is allowed
to address network inadequacy in that county by providing for patient access to providers
of that type or specialty via telemedicine, as defined in section 62A.671, subdivision 9.
new text end

new text begin (d) A waiver shall automatically expire after three years. Upon or prior to expiration of
a waiver, a health maintenance organization unable to meet the requirements in subdivision
1 or 2 must submit a new waiver application under paragraph (a) and must also submit
evidence of steps the organization took to address the network inadequacy. When the
commissioner reviews a waiver application for a network adequacy requirement which has
been waived for the organization for the most recent three-year period, the commissioner
shall also examine the steps the organization took during that three-year period to address
network inadequacy, and shall only approve a subsequent waiver application if it satisfies
the requirements in paragraph (b), demonstrates that the organization took the steps it
proposed to address network inadequacy, and explains why the organization continues to
be unable to satisfy the requirements in subdivision 1 or 2.
new text end

new text begin (e) Application fees collected under this subdivision shall be deposited in the state
government special revenue fund in the state treasury.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, for health plans sold,
issued, or renewed on or after January 1, 2021.
new text end

Sec. 5.

Minnesota Statutes 2018, section 62D.124, is amended by adding a subdivision to
read:


new text begin Subd. 7. new text end

new text begin Provider network notifications. new text end

new text begin A health maintenance organization must
provide on the organization's website the provider network for each product offered by the
organization, and must update the organization's website at least once a month with any
changes to the organization's provider network, including provider changes from in-network
status to out-of-network status. A health maintenance organization must also provide on
the organization's website, for each product offered by the organization, a list of the current
waivers of the requirements in subdivision 1 or 2, in a format that is easily accessed and
searchable by enrollees and prospective enrollees.
new text end

Sec. 6.

Minnesota Statutes 2018, section 62E.23, subdivision 3, is amended to read:


Subd. 3.

Operation.

(a) The board shall propose to the commissioner the payment
parameters for the next benefit year by January 15 of the year before the applicable benefit
year. The commissioner shall approve or reject the payment parameters no later than 14
days following the board's proposal. If the commissioner fails to approve or reject the
payment parameters within 14 days following the board's proposal, the proposed payment
parameters are final and effective.

(b) If the amount in the premium security plan account in section 62E.25, subdivision
1, is not anticipated to be adequate to fully fund the approved payment parameters as of
July 1 of the year before the applicable benefit year, the board, in consultation with the
commissioner and the commissioner of management and budget, shall propose payment
parameters within the available appropriations. The commissioner must permit an eligible
health carrier to revise an applicable rate filing based on the final payment parameters for
the next benefit year.

new text begin (c) Notwithstanding paragraph (a), the payment parameters for benefit year 2020 are:
new text end

new text begin (1) an attachment point of $50,000;
new text end

new text begin (2) a coinsurance rate of 80 percent; and
new text end

new text begin (3) a reinsurance cap of $250,000.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

Minnesota Statutes 2018, section 62E.24, subdivision 2, is amended to read:


Subd. 2.

Reports.

new text begin(a) new text endThe board must submit to the commissioner new text beginand to the chairs and
ranking minority members of the legislative committees with jurisdiction over commerce
and health
new text endand make available to the public deleted text beginadeleted text endnew text begin quarterly reports on plan operations and an
annual
new text end report summarizing the plan operations for each benefit year deleted text beginbydeleted text endnew text begin. All reports must
be made public by
new text end posting the deleted text beginsummarydeleted text endnew text begin reportnew text end on the Minnesota Comprehensive Health
Association website deleted text beginand making thedeleted text endnew text begin. The annualnew text end summary deleted text beginotherwisedeleted text endnew text begin must be madenew text end available
by November 1 of the year following the applicable benefit year or 60 calendar days
following the final disbursement of reinsurance payments for the applicable benefit year,
whichever is later.

new text begin (b) The reports must include information about:
new text end

new text begin (1) the reinsurance parameters used;
new text end

new text begin (2) the metal levels affected;
new text end

new text begin (3) the number of claims payments estimated and submitted for payment per products
offered on-exchange and off-exchange and per eligible health carrier;
new text end

new text begin (4) the estimated reinsurance payments by plan type based on carrier submitted templates;
new text end

new text begin (5) funds appropriated for reinsurance payments and administrative and operational
expenses for each year, including the federal and state contributions received, investment
income, and any other revenue or funds received;
new text end

new text begin (6) the total amount of reinsurance payments made to each eligible health carrier; and
new text end

new text begin (7) administrative and operational expenses incurred for the plan, including the total
amount incurred and as a percentage of the plan's operational budget.
new text end

Sec. 8.

Minnesota Statutes 2018, section 62K.07, is amended to read:


62K.07 INFORMATION DISCLOSURES.

new text begin Subdivision 1. new text end

new text begin In general. new text end

(a) A health carrier offering individual or small group health
plans must submit the following information in a format determined by the commissioner
of commerce:

(1) claims payment policies and practices;

(2) periodic financial disclosures;

(3) data on enrollment;

(4) data on disenrollment;

(5) data on the number of claims that are denied;

(6) data on rating practices;

(7) information on cost-sharing and payments with respect to out-of-network coverage;
and

(8) other information required by the secretary of the United States Department of Health
and Human Services under the Affordable Care Act.

(b) A health carrier offering an individual or small group health plan must comply with
all information disclosure requirements of all applicable state and federal law, including
the Affordable Care Act.

(c) Except for qualified health plans sold on MNsure, information reported under
paragraph (a), clauses (3) and (4), is nonpublic data as defined under section 13.02,
subdivision 9
. Information reported under paragraph (a), clauses (1) through (8), must be
reported by MNsure for qualified health plans sold through MNsure.

new text begin Subd. 2. new text end

new text begin Prescription drug costs. new text end

new text begin (a) Each health carrier that offers a prescription drug
benefit in its individual health plans or small group health plans shall include in the applicable
rate filing required under section 62A.02 the following information about covered prescription
drugs:
new text end

new text begin (1) the 25 most frequently prescribed drugs in the previous plan year;
new text end

new text begin (2) the 25 most costly prescription drugs as a portion of the individual health plan's or
small group health plan's total annual expenditures in the previous plan year;
new text end

new text begin (3) the 25 prescription drugs that have caused the greatest increase in total individual
health plan or small group health plan spending in the previous plan year;
new text end

new text begin (4) the projected impact of the cost of prescription drugs on premium rates;
new text end

new text begin (5) if any health plan offered by the health carrier requires enrollees to pay cost-sharing
on any covered prescription drugs including deductibles, co-payments, or coinsurance in
an amount that is greater than the amount the enrollee's health plan would pay for the drug
absent the applicable enrollee cost-sharing and after accounting for any rebate amount; and
new text end

new text begin (6) if the health carrier prohibits third-party payments including manufacturer drug
discounts or coupons that cover all or a portion of an enrollee's cost-sharing requirements
including deductibles, co-payments, or coinsurance from applying toward the enrollee's
cost-sharing obligations under the enrollee's health plan.
new text end

new text begin (b) The commissioner of commerce, in consultation with the commissioner of health,
shall release a summary of the information reported in paragraph (a) at the same time as
the information required under section 62A.02, subdivision 2, paragraph (c).
new text end

new text begin Subd. 3. new text end

new text begin Enforcement. new text end

deleted text begin(d)deleted text end The commissioner of commerce shall enforce this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for individual health plans and small
group health plans offered, issued, sold, or renewed on or after January 1, 2021.
new text end

Sec. 9.

Minnesota Statutes 2018, section 62K.075, is amended to read:


62K.075 PROVIDER NETWORK NOTIFICATIONS.

(a) A health carrier must new text begin provide on the carrier's website the provider network for each
product offered by the carrier, and must
new text endupdate the carrier's website at least once a month
with any changes to the carrier's provider network, including provider changes from
in-network status to out-of-network status.new text begin A health carrier must also provide on the carrier's
website, for each product offered by the carrier, a list of the current waivers of the
requirements in section 62K.10, subdivision 2 or 3, in a format that is easily accessed and
searchable by enrollees and prospective enrollees.
new text end

(b) Upon notification from an enrollee, a health carrier must reprocess any claim for
services provided by a provider whose status has changed from in-network to out-of-network
as an in-network claim if the service was provided after the network change went into effect
but before the change was posted as required under paragraph (a) unless the health carrier
notified the enrollee of the network change prior to the service being provided. This paragraph
does not apply if the health carrier is able to verify that the health carrier's website displayed
the correct provider network status on the health carrier's website at the time the service
was provided.

(c) The limitations of section 62Q.56, subdivision 2a, shall apply to payments required
by paragraph (b).

Sec. 10.

Minnesota Statutes 2018, section 62K.10, subdivision 5, is amended to read:


Subd. 5.

Waiver.

new text begin(a) new text endA health carrier deleted text beginor preferred provider organizationdeleted text end may apply to
the commissioner of health for a waiver of the requirements in subdivision 2 or 3 if it is
unable to meet the statutory requirements. A waiver application must be submitted on a
form provided by the commissionernew text begin, must be accompanied by an application fee of $500
for each application to waive the requirements in subdivision 2 or 3 for one or more provider
types per county,
new text end and must:

(1) demonstrate with specific data that the requirement of subdivision 2 or 3 is not
feasible in a particular service area or part of a service area; and

(2) include new text beginspecific new text endinformation as to the steps that were and will be taken to address
the network inadequacynew text begin, and for steps that will be taken prospectively to address network
inadequacy, the time frame within which those steps will be taken
new text end.

new text begin (b) The commissioner shall establish guidelines for evaluating waiver applications,
standards governing approval or denial of a waiver application, and standards for steps that
health carriers must take to address the network inadequacy and allow the health carrier to
meet network adequacy requirements within a reasonable time period. The commissioner
shall review each waiver application using these guidelines and standards and shall approve
a waiver application only if:
new text end

new text begin (1) the standards for approval established by the commissioner are satisfied; and
new text end

new text begin (2) the steps that were and will be taken to address the network inadequacy and the time
frame for taking these steps satisfy the standards established by the commissioner.
new text end

new text begin (c) If, in its waiver application, a health carrier demonstrates to the commissioner that
there are no providers of a specific type or specialty in a county, the commissioner may
approve a waiver in which the health carrier is allowed to address network inadequacy in
that county by providing for patient access to providers of that type or specialty via
telemedicine, as defined in section 62A.671, subdivision 9.
new text end

new text begin (d) new text endThe waiver shall automatically expire after deleted text beginfour years. If a renewal of the waiver is
sought, the commissioner of health shall take into consideration steps that have been taken
to address network adequacy.
deleted text endnew text begin one year.new text endnew text begin Upon or prior to expiration of a waiver, a health
carrier unable to meet the requirements in subdivision 2 or 3 must submit a new waiver
application under paragraph (a) and must also submit evidence of steps the carrier took to
address the network inadequacy. When the commissioner reviews a waiver application for
a network adequacy requirement which has been waived for the carrier for the most recent
one-year period, the commissioner shall also examine the steps the carrier took during that
one-year period to address network inadequacy, and shall only approve a subsequent waiver
application that satisfies the requirements in paragraph (b), demonstrates that the carrier
took the steps it proposed to address network inadequacy, and explains why the carrier
continues to be unable to satisfy the requirements in subdivision 2 or 3.
new text end

new text begin (e) Application fees collected under this subdivision shall be deposited in the state
government special revenue fund in the state treasury.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, for health plans sold,
issued, or renewed on or after January 1, 2021.
new text end

Sec. 11.

new text begin [62K.105] NETWORK ADEQUACY COMPLAINTS.
new text end

new text begin The commissioner of health shall establish a clear, easily accessible process for accepting
complaints from enrollees regarding health carrier compliance with section 62K.10,
subdivision 2, 3, or 4. Using this process, an enrollee may file a complaint with the
commissioner that a health carrier is not in compliance with the requirements of section
62K.10, subdivision 2, 3, or 4. The commissioner of health shall investigate all complaints
received under this section.
new text end

Sec. 12.

Minnesota Statutes 2018, section 62Q.01, is amended by adding a subdivision to
read:


new text begin Subd. 6b. new text end

new text begin Nonquantitative treatment limitations or NQTLs. new text end

new text begin "Nonquantitative treatment
limitations" or "NQTLs" means processes, strategies, or evidentiary standards, or other
factors that are not expressed numerically, but otherwise limit the scope or duration of
benefits for treatment. NQTLs include but are not limited to:
new text end

new text begin (1) medical management standards limiting or excluding benefits based on (i) medical
necessity or medical appropriateness, or (ii) whether the treatment is experimental or
investigative;
new text end

new text begin (2) formulary design for prescription drugs;
new text end

new text begin (3) health plans with multiple network tiers;
new text end

new text begin (4) criteria and parameters for provider inclusion in provider networks, including
credentialing standards and reimbursement rates;
new text end

new text begin (5) health plan methods for determining usual, customary, and reasonable charges;
new text end

new text begin (6) fail-first or step therapy protocols;
new text end

new text begin (7) exclusions based on failure to complete a course of treatment;
new text end

new text begin (8) restrictions based on geographic location, facility type, provider specialty, and other
criteria that limit the scope or duration of benefits for services provided under the health
plan;
new text end

new text begin (9) in- and out-of-network geographic limitations;
new text end

new text begin (10) standards for providing access to out-of-network providers;
new text end

new text begin (11) limitations on inpatient services for situations where the enrollee is a threat to self
or others;
new text end

new text begin (12) exclusions for court-ordered and involuntary holds;
new text end

new text begin (13) experimental treatment limitations;
new text end

new text begin (14) service coding;
new text end

new text begin (15) exclusions for services provided by clinical social workers; and
new text end

new text begin (16) provider reimbursement rates, including rates of reimbursement for mental health
and substance use disorder services in primary care.
new text end

Sec. 13.

new text begin [62Q.1841] PROHIBITION ON USE OF STEP THERAPY FOR
METASTATIC CANCER.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
apply.
new text end

new text begin (b) "Health plan" has the meaning given in section 62Q.01, subdivision 3. Health plan
includes health coverage provided by a county-based purchasing plan participating in a
public program under chapter 256B or 256L or an integrated health partnership under section
256B.0755.
new text end

new text begin (c) "Stage four advanced metastatic cancer" means cancer that has spread from the
primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the
body.
new text end

new text begin (d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.
new text end

new text begin Subd. 2. new text end

new text begin Prohibition on use of step therapy protocols. new text end

new text begin A health plan that provides
coverage for the treatment of stage four advanced metastatic cancer or associated conditions
must not limit or exclude coverage for a drug approved by the United States Food and Drug
Administration that is on the health plan's prescription drug formulary by mandating that
an enrollee with stage four advanced metastatic cancer or associated conditions follow a
step therapy protocol if the use of the approved drug is consistent with:
new text end

new text begin (1) a United States Food and Drug Administration-approved indication; and
new text end

new text begin (2) a clinical practice guideline published by the National Comprehensive Care Network.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 14.

Minnesota Statutes 2018, section 62Q.47, is amended to read:


62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY
SERVICES.

(a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism,
mental health, or chemical dependency services, must comply with the requirements of this
section.

(b) Cost-sharing requirements and benefit or service limitations for outpatient mental
health and outpatient chemical dependency and alcoholism services, except for persons
placed in chemical dependency services under Minnesota Rules, parts 9530.6600 to
9530.6655, must not place a greater financial burden on the insured or enrollee, or be more
restrictive than those requirements and limitations for outpatient medical services.

(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital
mental health and inpatient hospital and residential chemical dependency and alcoholism
services, except for persons placed in chemical dependency services under Minnesota Rules,
parts 9530.6600 to 9530.6655, must not place a greater financial burden on the insured or
enrollee, or be more restrictive than those requirements and limitations for inpatient hospital
medical services.

new text begin (d) A health plan company must not impose an NQTL with respect to mental health and
substance use disorders in any classification of benefits unless, under the terms of the health
plan as written and in operation, any processes, strategies, evidentiary standards, or other
factors used in applying the NQTL to mental health and substance use disorders in the
classification are comparable to, and are applied no more stringently than, the processes,
strategies, evidentiary standards, or other factors used in applying the NQTL with respect
to medical and surgical benefits in the same classification.
new text end

deleted text begin (d)deleted text endnew text begin (e)new text end All health plans must meet the requirements of the federal Mental Health Parity
Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity
and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and
federal guidance or regulations issued under, those acts.

new text begin (f) The commissioner may require information from health plan companies to confirm
that mental health parity is being implemented by the health plan company. Information
required may include comparisons between mental health and substance use disorder
treatment and other medical conditions, including a comparison of prior authorization
requirements, drug formulary design, claim denials, rehabilitation services, and other
information the commissioner deems appropriate.
new text end

new text begin (g) Regardless of the health care provider's professional license, if the service provided
is consistent with the provider's scope of practice and the health plan company's credentialing
and contracting provisions, mental health therapy visits and medication maintenance visits
shall be considered primary care visits for the purpose of applying any enrollee cost-sharing
requirements imposed under the enrollee's health plan.
new text end

new text begin (h) By June 1 of each year, beginning June 1, 2021, the commissioner of commerce, in
consultation with the commissioner of health, shall submit a report on compliance and
oversight to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and commerce. The report must:
new text end

new text begin (1) describe the commissioner's process for reviewing health plan company compliance
with United States Code, title 42, section 18031(j), any federal regulations or guidance
relating to compliance and oversight, and compliance with this section and section 62Q.53;
new text end

new text begin (2) identify any enforcement actions taken by either commissioner during the preceding
12-month period regarding compliance with parity for mental health and substance use
disorders benefits under state and federal law, summarizing the results of any market conduct
examinations. The summary must include: (i) the number of formal enforcement actions
taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the
subject matter of each enforcement action, including quantitative and nonquantitative
treatment limitations;
new text end

new text begin (3) detail any corrective action taken by either commissioner to ensure health plan
company compliance with this section and section 62Q.53, and United States Code, title
42, section 18031(j); and
new text end

new text begin (4) describe the information provided by either commissioner to the public about
alcoholism, mental health, or chemical dependency parity protections under state and federal
law.
new text end

new text begin The report must be written in nontechnical, readily understandable language and must be
made available to the public by, among other means as the commissioners find appropriate,
posting the report on department websites. Individually identifiable information must be
excluded from the report, consistent with state and federal privacy protections.
new text end

Sec. 15.

new text begin [62Q.48] COST-SHARING IN PRESCRIPTION INSULIN DRUGS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin This section applies to all health plans issued or
renewed to a Minnesota resident.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in this
subdivision have the meanings given them.
new text end

new text begin (b) "Cost-sharing" means a deductible payment, co-payment, or coinsurance amount
imposed on an enrollee for a covered prescription drug in accordance with the terms and
conditions of the enrollee's health plan.
new text end

new text begin (c) "Legend drug" has the same meaning as in section 151.01, subdivision 17.
new text end

new text begin (d) "Prescription insulin drug" means a legend drug that contains insulin and is used to
treat diabetes.
new text end

new text begin (e) "Net price" means the health plan company's cost for a prescription insulin drug,
including any rebates or discounts received by or accrued directly or indirectly to the health
plan company from a drug manufacturer or pharmacy benefit manager.
new text end

new text begin Subd. 3. new text end

new text begin Cost-sharing limits. new text end

new text begin (a) A health plan that imposes a cost-sharing requirement
on the coverage of a prescription insulin drug shall limit the total amount of cost-sharing
that an enrollee is required to pay at point of sale, including deductible payments and the
cost-sharing amounts charged once the deductible is met at an amount that does not exceed
the net price of the prescription insulin drug.
new text end

new text begin (b) Nothing in this section shall prevent a health plan company from imposing a
cost-sharing requirement that is less than the amount specified in paragraph (a).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans issued or renewed on or
after January 1, 2020.
new text end

Sec. 16.

Minnesota Statutes 2018, section 62U.04, subdivision 4, is amended to read:


Subd. 4.

Encounter data.

(a) Beginning July 1, 2009, and every six months thereafter,
all health plan companies and third-party administrators shall submit encounter data to a
private entity designated by the commissioner of health. The data shall be submitted in a
form and manner specified by the commissioner subject to the following requirements:

(1) the data must be de-identified data as described under the Code of Federal Regulations,
title 45, section 164.514;

(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care homenew text begin and, for claims incurred on or after
January 1, 2019, data deemed necessary by the commissioner to uniquely identify claims
in the individual health insurance market
new text end; and

(3) except for the identifier described in clause (2), the data must not include information
that is not included in a health care claim or equivalent encounter information transaction
that is required under section 62J.536.

(b) The commissioner or the commissioner's designee shall only use the data submitted
under paragraph (a) to carry out the commissioner's responsibilities in this section, including
supplying the data to providers so they can verify their results of the peer grouping process
consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
and adopted by the commissioner and, if necessary, submit comments to the commissioner
or initiate an appeal.

(c) Data on providers collected under this subdivision are private data on individuals or
nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary data
in section 13.02, subdivision 19, summary data prepared under this subdivision may be
derived from nonpublic data. The commissioner or the commissioner's designee shall
establish procedures and safeguards to protect the integrity and confidentiality of any data
that it maintains.

(d) The commissioner or the commissioner's designee shall not publish analyses or
reports that identify, or could potentially identify, individual patients.

(e) The commissioner shall compile summary information on the data submitted under
this subdivision. The commissioner shall work with its vendors to assess the data submitted
in terms of compliance with the data submission requirements and the completeness of the
data submitted by comparing the data with summary information compiled by the
commissioner and with established and emerging data quality standards to ensure data
quality.

Sec. 17.

Minnesota Statutes 2018, section 256B.0625, subdivision 13f, is amended to read:


Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.

(d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.

(e) The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2
.

(f) Notwithstanding this subdivision, the commissioner may automatically require prior
authorization, for a period not to exceed 180 days, for any drug that is approved by the
United States Food and Drug Administration on or after July 1, 2005. The 180-day period
begins no later than the first day that a drug is available for shipment to pharmacies within
the state. The Formulary Committee shall recommend to the commissioner general criteria
to be used for the prior authorization of the drugs, but the committee is not required to
review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.

new text begin (g) Any step therapy protocol requirements established by the commissioner must comply
with section 62Q.1841.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 18.

Minnesota Statutes 2018, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 66. new text end

new text begin Coverage for treatment of pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset
neuropsychiatric syndrome (PANS).
new text end

new text begin Medical assistance covers treatment of pediatric
autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
and pediatric acute-onset neuropsychiatric syndrome (PANS). Coverage shall be developed
in collaboration with the Health Services Policy Committee established under subdivision
3c.
new text end

Sec. 19.

Laws 2017, chapter 13, article 1, section 15, as amended by Laws 2017, First
Special Session chapter 6, article 5, section 10, is amended to read:


Sec. 15. MINNESOTA PREMIUM SECURITY PLAN FUNDING.

(a) The Minnesota Comprehensive Health Association shall fund the operational and
administrative costs and reinsurance payments of the Minnesota security plan and association
using the following amounts deposited in the premium security plan account in Minnesota
Statutes, section 62E.25, subdivision 1, in the following order:

(1) any federal funding available;

(2) funds deposited under article 1, sections 12 and 13;

(3) any state funds from the health care access fund; and

(4) any state funds from the general fund.

(b) The association shall transfer from the premium security plan account any new text beginremainingnew text end
state funds not used for the Minnesota premium security plan by June 30, deleted text begin2021deleted text endnew text begin 2023new text end, to the
commissioner of commerce. Any amount transferred to the commissioner of commerce
shall be deposited in the health care access fund in Minnesota Statutes, section 16A.724.

(c) The Minnesota Comprehensive Health Association may not spend more than
$271,000,000 for benefit year 2018 and not more than $271,000,000 for benefit year 2019
for the operational and administrative costs of, and reinsurance payments under, the
Minnesota premium security plan.

Sec. 20.

Laws 2017, First Special Session chapter 6, article 5, section 11, is amended to
read:


Sec. 11. MORATORIUM ON CONVERSION TRANSACTIONS.

(a) Notwithstanding Laws 2017, chapter 2, article 2, a nonprofit health service plan
corporation operating under Minnesota Statutes, chapter 62C, or new text begina nonprofit new text endhealth
maintenance organization operating under Minnesota Statutes, chapter 62D, as of January
1, 2017, may only merge or consolidate with; deleted text beginordeleted text end convertdeleted text begin,deleted text endnew text begin;new text end or transfernew text begin, as part of a single
transaction or a series of transactions within a 24-month period,
new text end all or a deleted text beginsubstantial portiondeleted text endnew text begin
material amount
new text end of its assets to an entity that is a corporation organized under Minnesota
Statutes, chapter 317Anew text begin; or to a Minnesota nonprofit hospital within the same integrated
health system as the health maintenance organization
new text end.new text begin For purposes of this section, "material
amount" means the lesser of ten percent of such an entity's total admitted net assets as of
December 31 of the previous year, or $50,000,000.
new text end

(b) Paragraph (a) does not apply if the new text beginnonprofit new text endservice plan corporation or new text beginnonprofit
new text end health maintenance organization files an intent to dissolve due to insolvency of the
corporation in accordance with Minnesota Statutes, chapter 317A, or insolvency proceedings
are commenced under Minnesota Statutes, chapter 60B.

(c) Nothing in this section shall be construed to authorize a new text beginnonprofit new text endhealth maintenance
organization or a nonprofit deleted text beginhealthdeleted text end service plan corporation to engage in any transaction or
activities not otherwise permitted under state law.

(d) This section expires July 1, deleted text begin2019deleted text endnew text begin 2023new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 21. new text beginCOVERAGE FOR PANDAS OR PANS.
new text end

new text begin A health plan's coverage as of January 1, 2019, must be used by the health carrier as the
basis for determining whether coverage would not have been provided by the health carrier
pursuant to Minnesota Statutes, section 62A.3097, subdivision 4. Treatments and services
covered by the health plan as of January 1, 2019, are not eligible for payment as provided
under Minnesota Statutes, section 62A.3097, subdivision 4, by the commissioner of
commerce.
new text end

Sec. 22. new text beginMINNESOTA PREMIUM SECURITY PLAN ADMINISTERED THROUGH
THE 2021 BENEFIT YEAR.
new text end

new text begin The Minnesota Comprehensive Health Association must administer the Minnesota
premium security plan through the 2021 benefit year.
new text end

ARTICLE 9

PRESCRIPTION DRUGS

Section 1.

Minnesota Statutes 2018, section 62J.23, subdivision 2, is amended to read:


Subd. 2.

Restrictions.

(a) From July 1, 1992, until rules are adopted by the commissioner
under this section, the restrictions in the federal Medicare antikickback statutes in section
1128B(b) of the Social Security Act, United States Code, title 42, section 1320a-7b(b), and
rules adopted under the federal statutes, apply to all persons in the state, regardless of whether
the person participates in any state health care program.

(b) Nothing in paragraph (a) shall be construed to prohibit an individual from receiving
a discount or other reduction in price or a limited-time free supply or samples of a prescription
drug, medical supply, or medical equipment offered by a pharmaceutical manufacturer,
medical supply or device manufacturer, health plan company, or pharmacy benefit manager,
so long as:

(1) the discount or reduction in price is provided to the individual in connection with
the purchase of a prescription drug, medical supply, or medical equipment prescribed for
that individual;

(2) it otherwise complies with the requirements of state and federal law applicable to
enrollees of state and federal public health care programs;

(3) the discount or reduction in price does not exceed the amount paid directly by the
individual for the prescription drug, medical supply, or medical equipment; and

(4) the limited-time free supply or samples are provided by a physician or pharmacist,
as provided by the federal Prescription Drug Marketing Act.

new text begin For purposes of this paragraph, "prescription drug" includes prescription drugs that are
administered through infusion, and related services and supplies.
new text end

(c) No benefit, reward, remuneration, or incentive for continued product use may be
provided to an individual or an individual's family by a pharmaceutical manufacturer,
medical supply or device manufacturer, or pharmacy benefit manager, except that this
prohibition does not apply to:

(1) activities permitted under paragraph (b);

(2) a pharmaceutical manufacturer, medical supply or device manufacturer, health plan
company, or pharmacy benefit manager providing to a patient, at a discount or reduced
price or free of charge, ancillary products necessary for treatment of the medical condition
for which the prescription drug, medical supply, or medical equipment was prescribed or
provided; and

(3) a pharmaceutical manufacturer, medical supply or device manufacturer, health plan
company, or pharmacy benefit manager providing to a patient a trinket or memento of
insignificant value.

(d) Nothing in this subdivision shall be construed to prohibit a health plan company
from offering a tiered formulary with different co-payment or cost-sharing amounts for
different drugs.

Sec. 2.

new text begin [62Q.528] DRUG COVERAGE IN EMERGENCY SITUATIONS.
new text end

new text begin A health plan that provides prescription drug coverage must provide coverage for a
prescription drug dispensed by a pharmacist under section 151.211, subdivision 3, under
the terms of coverage that would apply had the prescription drug been dispensed according
to a prescription.
new text end

Sec. 3.

Minnesota Statutes 2018, section 151.01, subdivision 23, is amended to read:


Subd. 23.

Practitioner.

"Practitioner" means a licensed doctor of medicine, licensed
doctor of osteopathic medicine duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, licensed veterinarian, or licensed
advanced practice registered nurse. For purposes of sections 151.15, subdivision 4;new text begin 151.211,
subdivision 3;
new text end 151.252, subdivision 3; 151.37, subdivision 2, paragraphs (b), (e), and (f);
and 151.461, "practitioner" also means a physician assistant authorized to prescribe, dispense,
and administer under chapter 147A. For purposes of sections 151.15, subdivision 4;new text begin 151.211,
subdivision 3;
new text end 151.252, subdivision 3; 151.37, subdivision 2, paragraph (b); and 151.461,
"practitioner" also means a dental therapist authorized to dispense and administer under
chapter 150A.

Sec. 4.

Minnesota Statutes 2018, section 151.06, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Information provision; sources of lower cost prescription drugs. new text end

new text begin (a) The
board shall publish a page on its website that provides regularly updated information
concerning:
new text end

new text begin (1) patient assistance programs offered by drug manufacturers, including information
on how to access the programs;
new text end

new text begin (2) the prescription drug assistance program established by the Minnesota Board of
Aging under section 256.975, subdivision 9;
new text end

new text begin (3) the websites through which individuals can access information concerning eligibility
for and enrollment in Medicare, medical assistance, MinnesotaCare, and other
government-funded programs that help pay for the cost of health care;
new text end

new text begin (4) availability of providers that are authorized to participate under section 340b of the
federal Public Health Services Act, United States Code, title 42, section 256b;
new text end

new text begin (5) having a discussion with the pharmacist or the consumer's health care provider about
alternatives to a prescribed drug, including a lower cost or generic drug if the drug prescribed
is too costly for the consumer; and
new text end

new text begin (6) any other resource that the board deems useful to individuals who are attempting to
purchase prescription drugs at lower costs.
new text end

new text begin (b) The board must prepare educational materials, including brochures and posters, based
on the information it provides on its website under paragraph (a). The materials must be in
a form that can be downloaded from the board's website and used for patient education by
pharmacists and by health care practitioners who are licensed to prescribe. The board is not
required to provide printed copies of these materials.
new text end

new text begin (c) The board shall require pharmacists and pharmacies to make available to patients
information on sources of lower cost prescription drugs, including information on the
availability of the website established under paragraph (a).
new text end

Sec. 5.

Minnesota Statutes 2018, section 151.211, subdivision 2, is amended to read:


Subd. 2.

Refill requirements.

new text beginExcept as provided in subdivision 3, new text enda prescription drug
order may be refilled only with the written, electronic, or verbal consent of the prescriber
and in accordance with the requirements of this chapter, the rules of the board, and where
applicable, section 152.11. The date of such refill must be recorded and initialed upon the
original prescription drug order, or within the electronically maintained record of the original
prescription drug order, by the pharmacist, pharmacist intern, or practitioner who refills the
prescription.

Sec. 6.

Minnesota Statutes 2018, section 151.211, is amended by adding a subdivision to
read:


new text begin Subd. 3. new text end

new text begin Emergency prescription refills. new text end

new text begin (a) A pharmacist may, using sound professional
judgment and in accordance with accepted standards of practice, dispense a legend drug
without a current prescription drug order from a licensed practitioner if all of the following
conditions are met:
new text end

new text begin (1) the patient has been compliant with taking the medication and has consistently had
the drug filled or refilled as demonstrated by records maintained by the pharmacy;
new text end

new text begin (2) the pharmacy from which the legend drug is dispensed has record of a prescription
drug order for the drug in the name of the patient who is requesting it, but the prescription
drug order does not provide for a refill, or the time during which the refills were valid has
elapsed;
new text end

new text begin (3) the pharmacist has tried but is unable to contact the practitioner who issued the
prescription drug order, or another practitioner responsible for the patient's care, to obtain
authorization to refill the prescription;
new text end

new text begin (4) the drug is essential to sustain the life of the patient or to continue therapy for a
chronic condition;
new text end

new text begin (5) failure to dispense the drug to the patient would result in harm to the health of the
patient; and
new text end

new text begin (6) the drug is not a controlled substance listed in section 152.02, subdivisions 3 to 6,
except for a controlled substance that has been specifically prescribed to treat a seizure
disorder, in which case the pharmacist may dispense up to a 72-hour supply.
new text end

new text begin (b) If the conditions in paragraph (a) are met, the amount of the drug dispensed by the
pharmacist to the patient must not exceed a 30-day supply, or the quantity originally
prescribed, whichever is less, except as provided for controlled substances in paragraph (a),
clause (6). If the standard unit of dispensing for the drug exceeds a 30-day supply, the
amount of the drug dispensed or sold must not exceed the standard unit of dispensing.
new text end

new text begin (c) A pharmacist shall not dispense or sell the same drug to the same patient, as provided
in this section, more than one time in any 12-month period.
new text end

new text begin (d) A pharmacist must notify the practitioner who issued the prescription drug order not
later than 72 hours after the drug is sold or dispensed. The pharmacist must request and
receive authorization before any additional refills may be dispensed. If the practitioner
declines to provide authorization for additional refills, the pharmacist must inform the patient
of that fact.
new text end

new text begin (e) The record of a drug sold or dispensed under this section shall be maintained in the
same manner required for prescription drug orders under this section.
new text end

Sec. 7.

new text begin [151.555] PRESCRIPTION DRUG REPOSITORY PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
new text end

new text begin (c) "Distribute" means to deliver, other than by administering or dispensing.
new text end

new text begin (d) "Donor" means:
new text end

new text begin (1) a health care facility as defined in this subdivision;
new text end

new text begin (2) a skilled nursing facility licensed under chapter 144A;
new text end

new text begin (3) an assisted living facility registered under chapter 144D where there is centralized
storage of drugs and 24-hour on-site licensed nursing coverage provided seven days a week;
new text end

new text begin (4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
new text end

new text begin (5) a drug wholesaler licensed under section 151.47;
new text end

new text begin (6) a drug manufacturer licensed under section 151.252; or
new text end

new text begin (7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
new text end

new text begin (e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donation. This definition includes cancer
drugs and antirejection drugs, but does not include controlled substances, as defined in
section 152.01, subdivision 4, or a prescription drug that can only be dispensed to a patient
registered with the drug's manufacturer in accordance with federal Food and Drug
Administration requirements.
new text end

new text begin (f) "Health care facility" means:
new text end

new text begin (1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
new text end

new text begin (2) a hospital licensed under section 144.50;
new text end

new text begin (3) a pharmacy licensed under section 151.19 and located in Minnesota; or
new text end

new text begin (4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
new text end

new text begin (g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
new text end

new text begin (h) "Medical supplies" or "supplies" means any prescription and nonprescription medical
supply needed to administer a prescription drug.
new text end

new text begin (i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
new text end

new text begin (j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
new text end

new text begin Subd. 2. new text end

new text begin Establishment. new text end

new text begin By January 1, 2020, the Board of Pharmacy shall establish a
drug repository program, through which donors may donate a drug or medical supply for
use by an individual who meets the eligibility criteria specified under subdivision 5. The
board shall contract with a central repository that meets the requirements of subdivision 3
to implement and administer the prescription drug repository program.
new text end

new text begin Subd. 3. new text end

new text begin Central repository requirements. new text end

new text begin (a) The board shall publish a request for
proposal for participants who meet the requirements of this subdivision and are interested
in acting as the central repository for the drug repository program. The board shall follow
all applicable state procurement procedures in the selection process.
new text end

new text begin (b) To be eligible to act as the central repository, the participant must be a wholesale
drug distributor located in Minnesota, licensed pursuant to section 151.47, and in compliance
with all applicable federal and state statutes, rules, and regulations.
new text end

new text begin (c) The central repository shall be subject to inspection by the board pursuant to section
151.06, subdivision 1.
new text end

new text begin (d) The central repository shall comply with all applicable federal and state laws, rules,
and regulations pertaining to the drug repository program, drug storage, and dispensing.
The facility must maintain in good standing any state license or registration that applies to
the facility.
new text end

new text begin Subd. 4. new text end

new text begin Local repository requirements. new text end

new text begin (a) To be eligible for participation in the drug
repository program, a health care facility must agree to comply with all applicable federal
and state laws, rules, and regulations pertaining to the drug repository program, drug storage,
and dispensing. The facility must also agree to maintain in good standing any required state
license or registration that may apply to the facility.
new text end

new text begin (b) A local repository may elect to participate in the program by submitting the following
information to the central repository on a form developed by the board and made available
on the board's website:
new text end

new text begin (1) the name, street address, and telephone number of the health care facility and any
state-issued license or registration number issued to the facility, including the issuing state
agency;
new text end

new text begin (2) the name and telephone number of a responsible pharmacist or practitioner who is
employed by or under contract with the health care facility; and
new text end

new text begin (3) a statement signed and dated by the responsible pharmacist or practitioner indicating
that the health care facility meets the eligibility requirements under this section and agrees
to comply with this section.
new text end

new text begin (c) Participation in the drug repository program is voluntary. A local repository may
withdraw from participation in the drug repository program at any time by providing written
notice to the central repository on a form developed by the board and made available on
the board's website. The central repository shall provide the board with a copy of the
withdrawal notice within ten business days from the date of receipt of the withdrawal notice.
new text end

new text begin Subd. 5. new text end

new text begin Individual eligibility and application requirements. new text end

new text begin (a) To be eligible for
the drug repository program, an individual must submit to a local repository an intake
application form that is signed by the individual and attests that the individual:
new text end

new text begin (1) is a resident of Minnesota;
new text end

new text begin (2) is uninsured and is not enrolled in the medical assistance program under chapter
256B or the MinnesotaCare program under chapter 256L, has no prescription drug coverage,
or is underinsured;
new text end

new text begin (3) acknowledges that the drugs or medical supplies to be received through the program
may have been donated; and
new text end

new text begin (4) consents to a waiver of the child-resistant packaging requirements of the federal
Poison Prevention Packaging Act.
new text end

new text begin (b) Upon determining that an individual is eligible for the program, the local repository
shall furnish the individual with an identification card. The card shall be valid for one year
from the date of issuance and may be used at any local repository. A new identification card
may be issued upon expiration once the individual submits a new application form.
new text end

new text begin (c) The local repository shall send a copy of the intake application form to the central
repository by regular mail, facsimile, or secured e-mail within ten days from the date the
application is approved by the local repository.
new text end

new text begin (d) The board shall develop and make available on the board's website an application
form and the format for the identification card.
new text end

new text begin Subd. 6. new text end

new text begin Standards and procedures for accepting donations of drugs and supplies. new text end

new text begin (a)
A donor may donate prescription drugs or medical supplies to the central repository or a
local repository if the drug or supply meets the requirements of this section as determined
by a pharmacist or practitioner who is employed by or under contract with the central
repository or a local repository.
new text end

new text begin (b) A prescription drug is eligible for donation under the drug repository program if the
following requirements are met:
new text end

new text begin (1) the donation is accompanied by a drug repository donor form described under
paragraph (d) that is signed by an individual who is authorized by the donor to attest to the
donor's knowledge in accordance with paragraph (d);
new text end

new text begin (2) the drug's expiration date is at least six months after the date the drug was donated.
If a donated drug bears an expiration date that is less than six months from the donation
date, the drug may be accepted and distributed if the drug is in high demand and can be
dispensed for use by a patient before the drug's expiration date;
new text end

new text begin (3) the drug is in its original, sealed, unopened, tamper-evident packaging that includes
the expiration date. Single-unit-dose drugs may be accepted if the single-unit-dose packaging
is unopened;
new text end

new text begin (4) the drug or the packaging does not have any physical signs of tampering, misbranding,
deterioration, compromised integrity, or adulteration;
new text end

new text begin (5) the drug does not require storage temperatures other than normal room temperature
as specified by the manufacturer or United States Pharmacopoeia, unless the drug is being
donated directly by its manufacturer, a wholesale drug distributor, or a pharmacy located
in Minnesota; and
new text end

new text begin (6) the prescription drug is not a controlled substance.
new text end

new text begin (c) A medical supply is eligible for donation under the drug repository program if the
following requirements are met:
new text end

new text begin (1) the supply has no physical signs of tampering, misbranding, or alteration and there
is no reason to believe it has been adulterated, tampered with, or misbranded;
new text end

new text begin (2) the supply is in its original, unopened, sealed packaging;
new text end

new text begin (3) the donation is accompanied by a drug repository donor form described under
paragraph (d) that is signed by an individual who is authorized by the donor to attest to the
donor's knowledge in accordance with paragraph (d); and
new text end

new text begin (4) if the supply bears an expiration date, the date is at least six months later than the
date the supply was donated. If the donated supply bears an expiration date that is less than
six months from the date the supply was donated, the supply may be accepted and distributed
if the supply is in high demand and can be dispensed for use by a patient before the supply's
expiration date.
new text end

new text begin (d) The board shall develop the drug repository donor form and make it available on the
board's website. The form must state that to the best of the donor's knowledge the donated
drug or supply has been properly stored under appropriate temperature and humidity
conditions, and that the drug or supply has never been opened, used, tampered with,
adulterated, or misbranded.
new text end

new text begin (e) Donated drugs and supplies may be shipped or delivered to the premises of the central
repository or a local repository, and shall be inspected by a pharmacist or an authorized
practitioner who is employed by or under contract with the repository and who has been
designated by the repository to accept donations. A drop box must not be used to deliver
or accept donations.
new text end

new text begin (f) The central repository and local repository shall inventory all drugs and supplies
donated to the repository. For each drug, the inventory must include the drug's name, strength,
quantity, manufacturer, expiration date, and the date the drug was donated. For each medical
supply, the inventory must include a description of the supply, its manufacturer, the date
the supply was donated, and, if applicable, the supply's brand name and expiration date.
new text end

new text begin Subd. 7. new text end

new text begin Standards and procedures for inspecting and storing donated prescription
drugs and supplies.
new text end

new text begin (a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
prescription drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
new text end

new text begin (b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory. If
donated drugs or supplies are not inspected immediately upon receipt, a repository must
quarantine the donated drugs or supplies separately from all dispensing stock until the
donated drugs or supplies have been inspected and (1) approved for dispensing under the
program; (2) disposed of pursuant to paragraph (c); or (3) returned to the donor pursuant to
paragraph (d).
new text end

new text begin (c) The central repository and local repositories shall dispose of all prescription drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
new text end

new text begin (d) In the event that controlled substances or prescription drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
new text end

new text begin (e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
new text end

new text begin (f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least five years. For each drug or supply
destroyed, the record shall include the following information:
new text end

new text begin (1) the date of destruction;
new text end

new text begin (2) the name, strength, and quantity of the drug destroyed; and
new text end

new text begin (3) the name of the person or firm that destroyed the drug.
new text end

new text begin Subd. 8. new text end

new text begin Dispensing requirements. new text end

new text begin (a) Donated drugs and supplies may be dispensed
if the drugs or supplies are prescribed by a practitioner for use by an eligible individual and
are dispensed by a pharmacist or practitioner. A repository shall dispense drugs and supplies
to eligible individuals in the following priority order: (1) individuals who are uninsured;
(2) individuals with no prescription drug coverage; and (3) individuals who are underinsured.
A repository shall dispense donated prescription drugs in compliance with applicable federal
and state laws and regulations for dispensing prescription drugs, including all requirements
relating to packaging, labeling, record keeping, drug utilization review, and patient
counseling.
new text end

new text begin (b) Before dispensing or administering a drug or supply, the pharmacist or practitioner
shall visually inspect the drug or supply for adulteration, misbranding, tampering, and date
of expiration. Drugs or supplies that have expired or appear upon visual inspection to be
adulterated, misbranded, or tampered with in any way must not be dispensed or administered.
new text end

new text begin (c) Before a drug or supply is dispensed or administered to an individual, the individual
must sign a drug repository recipient form acknowledging that the individual understands
the information stated on the form. The board shall develop the form and make it available
on the board's website. The form must include the following information:
new text end

new text begin (1) that the drug or supply being dispensed or administered has been donated and may
have been previously dispensed;
new text end

new text begin (2) that a visual inspection has been conducted by the pharmacist or practitioner to ensure
that the drug or supply has not expired, has not been adulterated or misbranded, and is in
its original, unopened packaging; and
new text end

new text begin (3) that the dispensing pharmacist, the dispensing or administering practitioner, the
central repository or local repository, the Board of Pharmacy, and any other participant of
the drug repository program cannot guarantee the safety of the drug or medical supply being
dispensed or administered and that the pharmacist or practitioner has determined that the
drug or supply is safe to dispense or administer based on the accuracy of the donor's form
submitted with the donated drug or medical supply and the visual inspection required to be
performed by the pharmacist or practitioner before dispensing or administering.
new text end

new text begin Subd. 9. new text end

new text begin Handling fees. new text end

new text begin (a) The central or local repository may charge the individual
receiving a drug or supply a handling fee of no more than 250 percent of the medical
assistance program dispensing fee for each drug or medical supply dispensed or administered
by that repository.
new text end

new text begin (b) A repository that dispenses or administers a drug or medical supply through the drug
repository program shall not receive reimbursement under the medical assistance program
or the MinnesotaCare program for that dispensed or administered drug or supply.
new text end

new text begin Subd. 10. new text end

new text begin Distribution of donated drugs and supplies. new text end

new text begin (a) The central repository and
local repositories may distribute drugs and supplies donated under the drug repository
program to other participating repositories for use pursuant to this program.
new text end

new text begin (b) A local repository that elects not to dispense donated drugs or supplies must transfer
all donated drugs and supplies to the central repository. A copy of the donor form that was
completed by the original donor under subdivision 6 must be provided to the central
repository at the time of transfer.
new text end

new text begin Subd. 11. new text end

new text begin Forms and record-keeping requirements. new text end

new text begin (a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
new text end

new text begin (1) intake application form described under subdivision 5;
new text end

new text begin (2) local repository participation form described under subdivision 4;
new text end

new text begin (3) local repository withdrawal form described under subdivision 4;
new text end

new text begin (4) drug repository donor form described under subdivision 6;
new text end

new text begin (5) record of destruction form described under subdivision 7; and
new text end

new text begin (6) drug repository recipient form described under subdivision 8.
new text end

new text begin (b) All records, including drug inventory, inspection, and disposal of donated prescription
drugs and medical supplies must be maintained by a repository for a minimum of five years.
Records required as part of this program must be maintained pursuant to all applicable
practice acts.
new text end

new text begin (c) Data collected by the drug repository program from all local repositories shall be
submitted quarterly or upon request to the central repository. Data collected may consist of
the information, records, and forms required to be collected under this section.
new text end

new text begin (d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
new text end

new text begin Subd. 12. new text end

new text begin Liability. new text end

new text begin (a) The manufacturer of a drug or supply is not subject to criminal
or civil liability for injury, death, or loss to a person or to property for causes of action
described in clauses (1) and (2). A manufacturer is not liable for:
new text end

new text begin (1) the intentional or unintentional alteration of the drug or supply by a party not under
the control of the manufacturer; or
new text end

new text begin (2) the failure of a party not under the control of the manufacturer to transfer or
communicate product or consumer information or the expiration date of the donated drug
or supply.
new text end

new text begin (b) A health care facility participating in the program, a pharmacist dispensing a drug
or supply pursuant to the program, a practitioner dispensing or administering a drug or
supply pursuant to the program, or a donor of a drug or medical supply is immune from
civil liability for an act or omission that causes injury to or the death of an individual to
whom the drug or supply is dispensed and no disciplinary action by a health-related licensing
board shall be taken against a pharmacist or practitioner so long as the drug or supply is
donated, accepted, distributed, and dispensed according to the requirements of this section.
This immunity does not apply if the act or omission involves reckless, wanton, or intentional
misconduct, or malpractice unrelated to the quality of the drug or medical supply.
new text end

new text begin Subd. 13. new text end

new text begin Drug returned for credit. new text end

new text begin Nothing in this section allows a long-term care
facility to donate a drug to a central or local repository when federal or state law requires
the drug to be returned to the pharmacy that initially dispensed it, so that the pharmacy can
credit the payer for the amount of the drug returned.
new text end

Sec. 8.

new text begin [214.122] INFORMATION PROVISION; PHARMACEUTICAL
ASSISTANCE PROGRAMS.
new text end

new text begin (a) The Board of Medical Practice and the Board of Nursing shall at least annually inform
licensees who are authorized to prescribe prescription drugs of the availability of the Board
of Pharmacy's website that contains information on resources and programs to assist patients
with the cost of prescription drugs. The boards shall provide licensees with the website
address established by the Board of Pharmacy under section 151.06, subdivision 6, and the
materials described under section 151.06, subdivision 6, paragraph (b).
new text end

new text begin (b) Licensees must make available to patients information on sources of lower cost
prescription drugs, including information on the availability of the website established by
the Board of Pharmacy under section 151.06, subdivision 6.
new text end

ARTICLE 10

HEALTH-RELATED LICENSING BOARDS

Section 1.

new text begin [144A.291] FEES.
new text end

new text begin Subdivision 1. new text end

new text begin Nonrefundable fees. new text end

new text begin All fees are nonrefundable.
new text end

new text begin Subd. 2. new text end

new text begin Amounts. new text end

new text begin (a) Fees may not exceed the following amounts but may be adjusted
lower by board direction and are for the exclusive use of the board as required to sustain
board operations. The maximum amounts of fees are:
new text end

new text begin (1) application for licensure, $200;
new text end

new text begin (2) for a prospective applicant for a review of education and experience advisory to the
license application, $100, to be applied to the fee for application for licensure if the latter
is submitted within one year of the request for review of education and experience;
new text end

new text begin (3) state examination, $125;
new text end

new text begin (4) initial license, $250 if issued between July 1 and December 31, $100 if issued between
January 1 and June 30;
new text end

new text begin (5) acting administrator permit, $400;
new text end

new text begin (6) renewal license, $250;
new text end

new text begin (7) duplicate license, $50;
new text end

new text begin (8) reinstatement fee, $250;
new text end

new text begin (9) health services executive initial license, $200;
new text end

new text begin (10) health services executive renewal license, $200;
new text end

new text begin (11) reciprocity verification fee, $50;
new text end

new text begin (12) second shared administrator assignment, $250;
new text end

new text begin (13) continuing education fees:
new text end

new text begin (i) greater than 6 hours, $50; and
new text end

new text begin (ii) 7 hours or more, $75;
new text end

new text begin (14) education review, $100;
new text end

new text begin (15) fee to a sponsor for review of individual continuing education seminars, institutes,
workshops, or home study courses:
new text end

new text begin (i) for less than seven clock hours, $30; and
new text end

new text begin (ii) for seven or more clock hours, $50;
new text end

new text begin (16) fee to a licensee for review of continuing education seminars, institutes, workshops,
or home study courses not previously approved for a sponsor and submitted with an
application for license renewal:
new text end

new text begin (i) for less than seven clock hours total, $30; and
new text end

new text begin (ii) for seven or more clock hours total, $50;
new text end

new text begin (17) late renewal fee, $75;
new text end

new text begin (18) fee to a licensee for verification of licensure status and examination scores, $30;
new text end

new text begin (19) registration as a registered continuing education sponsor, $1,000; and
new text end

new text begin (20) mail labels, $75.
new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
new text end

Sec. 2.

Minnesota Statutes 2018, section 147.037, subdivision 1, is amended to read:


Subdivision 1.

Requirements.

The board shall issue a license to practice medicine to
any person who satisfies the requirements in paragraphs (a) to (g).

(a) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1
, paragraphs (a), (e), (f), (g), and (h).

(b) The applicant shall present evidence satisfactory to the board that the applicant is a
graduate of a medical or osteopathic school approved by the board as equivalent to accredited
United States or Canadian schools based upon its faculty, curriculum, facilities, accreditation,
or other relevant data. If the applicant is a graduate of a medical or osteopathic program
that is not accredited by the Liaison Committee for Medical Education or the American
Osteopathic Association, the applicant may use the Federation of State Medical Boards'
Federation Credentials Verification Service (FCVS) or its successor. If the applicant uses
this service as allowed under this paragraph, the physician application fee may be less than
$200 but must not exceed the cost of administering this paragraph.

(c) The applicant shall present evidence satisfactory to the board that the applicant has
been awarded a certificate by the Educational Council for Foreign Medical Graduates, and
the applicant has a working ability in the English language sufficient to communicate with
patients and physicians and to engage in the practice of medicine.

(d) The applicant shall present evidence satisfactory to the board of the completion of
deleted text begin two yearsdeleted text endnew text begin one yearnew text end of graduate, clinical medical training in a program deleted text beginlocated in the United
States, its territories, or Canada and accredited by a national accrediting organization
approved by the board
deleted text endnew text begin accredited by a national accrediting organization approved by the
board or other graduate training approved in advance by the board as meeting standards
similar to those of a national accrediting organization
new text end. This requirement does not apply:

(1) to an applicant who is admitted as a permanent immigrant to the United States on or
before October 1, 1991, as a person of exceptional ability in the sciences according to Code
of Federal Regulations, title 20, section 656.22(d);new text begin or
new text end

(2) to an applicant holding a valid license to practice medicine in another country and
issued a permanent immigrant visa after October 1, 1991, as a person of extraordinary ability
in the field of science or as an outstanding professor or researcher according to Code of
Federal Regulations, title 8, section 204.5(h) and (i), or a temporary nonimmigrant visa as
a person of extraordinary ability in the field of science according to Code of Federal
Regulations, title 8, section 214.2(o),

provided that a person under clause (1) or (2) is admitted pursuant to rules of the United
States Department of Labordeleted text begin; or
deleted text end

deleted text begin (3) to an applicant who is licensed in another state, has practiced five years without
disciplinary action in the United States, its territories, or Canada, has completed one year
of the graduate, clinical medical training required by this paragraph, and has passed the
Special Purpose Examination of the Federation of State Medical Boards within three attempts
in the 24 months before licensing
deleted text end.

(e) The applicant must:

(1) have passed an examination prepared and graded by the Federation of State Medical
Boards, the United States Medical Licensing Examination program in accordance with
section 147.02, subdivision 1, paragraph (c), clause (2), or the Medical Council of Canada;
and

(2) deleted text beginhave a current license from the equivalent licensing agency in another state or country
and,
deleted text end if the examination in clause (1) was passed more than ten years ago, either:

(i) pass the Special Purpose Examination of the Federation of State Medical Boards with
a score of 75 or better within three attempts; or

(ii) have a current certification by a specialty board of the American Board of Medical
Specialties, of the American Osteopathic Association, of the Royal College of Physicians
and Surgeons of Canada, or of the College of Family Physicians of Canada; or

(3) if the applicant fails to meet the requirement established in section 147.02, subdivision
1, paragraph (c), clause (2), because the applicant failed to pass each of steps one, two, and
three of the USMLE within the required three attempts, the applicant may be granted a
license provided the applicant:

(i) has passed each of steps one, two, and three with passing scores as recommended by
the USMLE program within no more than four attempts for any of the three steps;

(ii) is currently licensed in another state; and

(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or the College of Family Physicians of Canada.

(f) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.

(g) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (f). If an applicant does not satisfy the requirements stated in this paragraph, the
board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions or limitations the board considers appropriate.

Sec. 3.

Minnesota Statutes 2018, section 147.0375, subdivision 1, is amended to read:


Subdivision 1.

Requirements.

The board shall issue a license to practice medicine to
any person who satisfies the requirements in paragraphs (a) to (d).

(a) The applicant must satisfy all the requirements established in section 147.02,
subdivision 1
, paragraphs (a), (e), (f), (g), and (h).

(b) The applicant must present evidence satisfactory to the board that the applicant is a
graduate of a medical or osteopathic school approved by the board as equivalent to accredited
United States or Canadian schools based upon its faculty, curriculum, facilities, accreditation,
or other relevant data. If the applicant is a graduate of a medical or osteopathic program
that is not accredited by the Liaison Committee for Medical Education or the American
Osteopathic Association, the applicant may use the Federation of State Medical Boards'
Federation Credentials Verification Service (FCVS) or its successor. If the applicant uses
this service as allowed under this paragraph, the physician application fee may be less than
$200 but must not exceed the cost of administering this paragraph.

(c) The applicant must present evidence satisfactory to the board of the completion of
deleted text begin two yearsdeleted text endnew text begin one yearnew text end of graduate, clinical medical training in a program deleted text beginlocated in the United
States, its territories, or Canada and accredited by a national accrediting organization
approved by the board
deleted text endnew text begin accredited by a national accrediting organization approved by the
board or other graduate training approved in advance by the board as meeting standards
similar to those of a national accrediting organization
new text end. This requirement does not apply:

(1) to an applicant who is admitted as a permanent immigrant to the United States on or
before October 1, 1991, as a person of exceptional ability in the sciences according to Code
of Federal Regulations, title 20, section 656.22 (d);new text begin or
new text end

(2) to an applicant holding a valid license to practice medicine in another state or country
and issued a permanent immigrant visa after October 1, 1991, as a person of extraordinary
ability in the field of science or as an outstanding professor or researcher according to Code
of Federal Regulations, title 8, section 204.5(h) and (i), or a temporary nonimmigrant visa
or status as a person of extraordinary ability in the field of science according to Code of
Federal Regulations, title 8, section 214.2(o)deleted text begin; or
deleted text end

deleted text begin (3) to an applicant who is licensed in another state, has practiced five years without
disciplinary action in the United States, its territories, or Canada, has completed one year
of the graduate, clinical medical training required by this paragraph, and has passed the
Special Purpose Examination of the Federation of State Medical Boards within three attempts
in the 24 months before licensing
deleted text end.

(d) The applicant must present evidence satisfactory to the board that the applicant has
been appointed to serve as a faculty member of a medical school accredited by the Liaison
Committee of Medical Education or an osteopathic medical school accredited by the
American Osteopathic Association.

Sec. 4.

Minnesota Statutes 2018, section 147D.27, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Additional fees. new text end

new text begin (a) The following fees also apply:
new text end

new text begin (1) traditional midwifery annual registration fee, $100;
new text end

new text begin (2) traditional midwifery application fee, $100;
new text end

new text begin (3) traditional midwifery late fee, $75;
new text end

new text begin (4) traditional midwifery inactive status, $50;
new text end

new text begin (5) traditional midwifery temporary permit, $75;
new text end

new text begin (6) traditional midwifery certification fee, $25;
new text end

new text begin (7) duplicate license or registration fee, $20;
new text end

new text begin (8) certification letter, $25;
new text end

new text begin (9) education or training program approval fee, $100; and
new text end

new text begin (10) report creation and generation, $60 per hour billed in quarter-hour increments with
a quarter-hour minimum.
new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

Minnesota Statutes 2018, section 147E.40, subdivision 1, as amended by Laws
2019, chapter 8, article 7, section 8, is amended to read:


Subdivision 1.

Fees.

new text begin(a) new text endFees are as follows:

(1) registration application fee, $200;

(2) renewal fee, $150;

(3) late fee, $75;

(4) inactive status fee, $50;

(5) temporary permit fee, $25;

new text begin (6) naturopathic doctor certification fee, $25;
new text end

new text begin (7) naturopathic doctor duplicate license fee, $20;
new text end

deleted text begin (6)deleted text end new text begin(8) naturopathic doctor new text endemeritus registration fee, $50;

new text begin (9) naturopathic doctor certification fee, $25;
new text end

deleted text begin (7)deleted text endnew text begin (10)new text end duplicate license new text beginor registration new text endfee, $20;

deleted text begin (8)deleted text endnew text begin (11)new text end certification letter fee, $25;

deleted text begin (9)deleted text endnew text begin (12)new text end verification fee, $25;

deleted text begin (10)deleted text endnew text begin (13)new text end education or training program approval fee, $100; and

deleted text begin (11)deleted text end new text begin(14) new text endreport creation and generation fee, $60 per hournew text begin billed in quarter-hour
increments with a quarter-hour minimum
new text end.

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

Minnesota Statutes 2018, section 147F.17, subdivision 1, as amended by Laws
2019, chapter 8, article 7, section 9, is amended to read:


Subdivision 1.

Fees.

new text begin(a) new text endFees are as follows:

(1) license application fee, $200;

(2) initial licensure and annual renewal, $150;

(3) late fee, $75;

new text begin (4) genetic counselor certification fee, $25;
new text end

deleted text begin (4)deleted text endnew text begin (5)new text end temporary license fee, $60;

deleted text begin (5)deleted text endnew text begin (6)new text end duplicate license fee, $20;

deleted text begin (6)deleted text endnew text begin (7)new text end certification letter fee, $25;

deleted text begin (7)deleted text endnew text begin (8)new text end education or training program approval fee, $100;

deleted text begin (8)deleted text endnew text begin (9)new text end report creation and generation fee, $60 per hournew text begin billed in quarter-hour increments
with a quarter-hour minimum
new text end; and

deleted text begin (9)deleted text endnew text begin (10)new text end criminal background check fee, $32.

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

Minnesota Statutes 2018, section 148.59, is amended to read:


148.59 LICENSE RENEWAL; LICENSE AND REGISTRATION FEES.

A licensed optometrist shall pay to the state Board of Optometry a fee as set by the board
in order to renew a license as provided by board rule. No fees shall be refunded. Fees may
not exceed the following amounts but may be adjusted lower by board direction and are for
the exclusive use of the board:

(1) optometry licensure application, $160;

(2) optometry annual licensure renewal, deleted text begin$135deleted text endnew text begin $200new text end;

(3) optometry late penalty fee, $75;

(4) annual license renewal card, $10;

(5) continuing education provider application, $45;

(6) emeritus registration, $10;

(7) endorsement/reciprocity application, $160;

(8) replacement of initial license, $12; deleted text beginand
deleted text end

(9) license verification, $50deleted text begin.deleted text endnew text begin;
new text end

new text begin (10) state jurisprudence examination, $75;
new text end

new text begin (11) optometric education continuing education data bank registration, $25; and
new text end

new text begin (12) miscellaneous labels and data retrieval, $50.
new text end

Sec. 8.

Minnesota Statutes 2018, section 148.6445, subdivision 1, is amended to read:


Subdivision 1.

Initial licensure fee.

The initial licensure fee for occupational therapists
is deleted text begin$145deleted text endnew text begin $185new text end. The initial licensure fee for occupational therapy assistants is deleted text begin$80deleted text endnew text begin $105new text end. deleted text beginThe
board shall prorate fees based on the number of quarters remaining in the biennial licensure
period.
deleted text end

Sec. 9.

Minnesota Statutes 2018, section 148.6445, subdivision 2, is amended to read:


Subd. 2.

Licensure renewal fee.

The biennial licensure renewal fee for occupational
therapists is deleted text begin$145deleted text endnew text begin $185new text end. The biennial licensure renewal fee for occupational therapy assistants
is deleted text begin$80deleted text endnew text begin $105new text end.

Sec. 10.

Minnesota Statutes 2018, section 148.6445, subdivision 2a, is amended to read:


Subd. 2a.

Duplicate license fee.

The fee for a duplicate license is deleted text begin$25deleted text endnew text begin $30new text end.

Sec. 11.

Minnesota Statutes 2018, section 148.6445, subdivision 3, is amended to read:


Subd. 3.

Late fee.

The fee for late submission of a renewal application is deleted text begin$25deleted text endnew text begin $50new text end.

Sec. 12.

Minnesota Statutes 2018, section 148.6445, subdivision 4, is amended to read:


Subd. 4.

Temporary licensure fee.

The fee for temporary licensure is deleted text begin$50deleted text endnew text begin $75new text end.

Sec. 13.

Minnesota Statutes 2018, section 148.6445, subdivision 5, is amended to read:


Subd. 5.

Limited licensure fee.

The fee for limited licensure is deleted text begin$96deleted text endnew text begin $100new text end.

Sec. 14.

Minnesota Statutes 2018, section 148.6445, subdivision 6, is amended to read:


Subd. 6.

Fee for course approval after lapse of licensure.

The fee for course approval
after lapse of licensure is deleted text begin$96deleted text endnew text begin $100new text end.

Sec. 15.

Minnesota Statutes 2018, section 148.6445, subdivision 10, is amended to read:


Subd. 10.

Use of fees.

new text begin(a) new text endAll fees are nonrefundable. The board shall only use fees
collected under this section for the purposes of administering this chapter. The legislature
must not transfer money generated by these fees from the state government special revenue
fund to the general fund.

new text begin (b) Licensure fees are for the exclusive use of the board and shall be established by the
board not to exceed the nonrefundable amounts in this section.
new text end

Sec. 16.

Minnesota Statutes 2018, section 148.7815, subdivision 1, as amended by Laws
2019, chapter 8, article 7, section 10, is amended to read:


Subdivision 1.

Fees.

new text begin(a) new text endThe board shall establish fees as follows:

(1) application fee, $50;

(2) annual license fee, $100;

new text begin (3) athletic trainer certification fee, $25;
new text end

new text begin (4) athletic trainer duplicate license fee, $20;
new text end

deleted text begin (3)deleted text endnew text begin (5)new text end late fee, $15;

deleted text begin (4)deleted text endnew text begin (6)new text end duplicate license new text beginor registration new text endfee, $20;

deleted text begin (5)deleted text endnew text begin (7)new text end certification letter fee, $25;

deleted text begin (6)deleted text endnew text begin (8)new text end verification fee, $25;

deleted text begin (7)deleted text endnew text begin (9)new text end education or training program approval fee, $100; deleted text beginand
deleted text end

deleted text begin (8)deleted text endnew text begin (10)new text end report creation and generation fee, $60 per hourdeleted text begin.deleted text endnew text begin billed in quarter-hour increments
with a quarter-hour minimum; and
new text end

new text begin (11) examination administrative fee:
new text end

new text begin (i) half day, $50; and
new text end

new text begin (ii) full day, $80.
new text end

new text begin (b) The revenue generated from the fees must be deposited in an account in the state
government special revenue fund.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 17.

new text begin [148.981] FEES.
new text end

new text begin Subdivision 1. new text end

new text begin Licensing fees. new text end

new text begin The nonrefundable fees for licensure shall be established
by the board, not to exceed the following amounts:
new text end

new text begin (1) application for admission to national standardized examination, $150;
new text end

new text begin (2) application for professional responsibility examination, $150;
new text end

new text begin (3) application for licensure as a licensed psychologist, $500;
new text end

new text begin (4) renewal of license for a licensed psychologist, $500;
new text end

new text begin (5) late renewal of license for a licensed psychologist, $250;
new text end

new text begin (6) application for converting from master's to doctoral level licensure, $150;
new text end

new text begin (7) application for guest licensure, $150;
new text end

new text begin (8) certificate replacement fee, $25;
new text end

new text begin (9) mailing and duplication fee, $5;
new text end

new text begin (10) statute and rule book fee, $10;
new text end

new text begin (11) verification fee, $20; and
new text end

new text begin (12) fee for optional preapproval of postdoctoral supervision, $50.
new text end

new text begin Subd. 2. new text end

new text begin Continuing education sponsor fee. new text end

new text begin A sponsor applying for approval of a
continuing education activity pursuant to Minnesota Rules, part 7200.3830, subpart 2, shall
submit with the application a fee to be established by the board, not to exceed $80 for each
activity.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 18.

Minnesota Statutes 2018, section 148E.180, is amended to read:


148E.180 FEE AMOUNTS.

Subdivision 1.

Application fees.

new text beginNonrefundable new text endapplication fees for licensure deleted text beginare as
follows
deleted text endnew text begin may not exceed the following amounts but may be adjusted lower by board actionnew text end:

(1) for a licensed social worker, deleted text begin$45deleted text endnew text begin $75new text end;

(2) for a licensed graduate social worker, deleted text begin$45deleted text endnew text begin $75new text end;

(3) for a licensed independent social worker, deleted text begin$45deleted text endnew text begin $75new text end;

(4) for a licensed independent clinical social worker, deleted text begin$45deleted text endnew text begin $75new text end;

(5) for a temporary license, $50; and

(6) for a deleted text beginlicensuredeleted text endnew text begin licensenew text end by endorsement, deleted text begin$85deleted text endnew text begin $115new text end.

The fee for criminal background checks is the fee charged by the Bureau of Criminal
Apprehension. The criminal background check fee must be included with the application
fee as required according to section 148E.055.

Subd. 2.

License fees.

new text beginNonrefundable new text endlicense fees deleted text beginare as followsdeleted text endnew text begin may not exceed the
following amounts but may be adjusted lower by board action
new text end:

(1) for a licensed social worker, deleted text begin$81deleted text endnew text begin $115new text end;

(2) for a licensed graduate social worker, deleted text begin$144deleted text endnew text begin $210new text end;

(3) for a licensed independent social worker, deleted text begin$216deleted text endnew text begin $305new text end;

(4) for a licensed independent clinical social worker, deleted text begin$238.50deleted text endnew text begin $335new text end;

(5) for an emeritus inactive license, deleted text begin$43.20deleted text endnew text begin $65new text end;

(6) for an emeritus active license, one-half of the renewal fee specified in subdivision
3; and

(7) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.

If the licensee's initial license term is less or more than 24 months, the required license
fees must be prorated proportionately.

Subd. 3.

Renewal fees.

new text beginNonrefundable new text endrenewal fees for licensure deleted text beginare as followsdeleted text endnew text begin may
not exceed the following amounts but may be adjusted lower by board action
new text end:

(1) for a licensed social worker, deleted text begin$81deleted text endnew text begin $115new text end;

(2) for a licensed graduate social worker, deleted text begin$144deleted text endnew text begin $210new text end;

(3) for a licensed independent social worker, deleted text begin$216deleted text endnew text begin $305new text end; and

(4) for a licensed independent clinical social worker, deleted text begin$238.50deleted text endnew text begin $335new text end.

Subd. 4.

Continuing education provider fees.

Continuing education provider fees are
deleted text begin as followsdeleted text endnew text begin the following nonrefundable amountsnew text end:

(1) for a provider who offers programs totaling one to eight clock hours in a one-year
period according to section 148E.145, $50;

(2) for a provider who offers programs totaling nine to 16 clock hours in a one-year
period according to section 148E.145, $100;

(3) for a provider who offers programs totaling 17 to 32 clock hours in a one-year period
according to section 148E.145, $200;

(4) for a provider who offers programs totaling 33 to 48 clock hours in a one-year period
according to section 148E.145, $400; and

(5) for a provider who offers programs totaling 49 or more clock hours in a one-year
period according to section 148E.145, $600.

Subd. 5.

Late fees.

Late fees are deleted text beginas followsdeleted text endnew text begin the following nonrefundable amountsnew text end:

(1) renewal late fee, one-fourth of the renewal fee specified in subdivision 3;

(2) supervision plan late fee, $40; and

(3) license late fee, $100 plus the prorated share of the license fee specified in subdivision
2 for the number of months during which the individual practiced social work without a
license.

Subd. 6.

License cards and wall certificates.

(a) The new text beginnonrefundable new text endfee for a license
card as specified in section 148E.095 is $10.

(b) The new text beginnonrefundable new text endfee for a license wall certificate as specified in section 148E.095
is $30.

Subd. 7.

Reactivation fees.

Reactivation fees are deleted text beginas followsdeleted text endnew text begin the following nonrefundable
amounts
new text end:

(1) reactivation from a temporary leave or emeritus status, the prorated share of the
renewal fee specified in subdivision 3; and

(2) reactivation of an expired license, 1-1/2 times the renewal fees specified in subdivision
3.

Sec. 19.

Minnesota Statutes 2018, section 150A.06, subdivision 3, is amended to read:


Subd. 3.

Waiver of examination.

(a) All or any part of the examination for dentists,
dental therapists, dental hygienists, or dental assistants, except that pertaining to the law of
Minnesota relating to dentistry and the rules of the board, may, at the discretion of the board,
be waived for an applicant who presents a certificate of having passed all components of
the National Board Dental Examinations or evidence of having maintained an adequate
scholastic standing as determined by the board.

(b) The board shall waive the clinical examination required for licensure for any dentist
applicant who is a graduate of a dental school accredited by the Commission on Dental
Accreditation, who has passed all components of the National Board Dental Examinations,
and who has satisfactorily completed a deleted text beginMinnesota-baseddeleted text end postdoctoral general dentistry
residency program (GPR) or an advanced education in general dentistry (AEGD) program
after January 1, 2004. The postdoctoral program must be accredited by the Commission on
Dental Accreditation, be of at least one year's duration, and include an outcome assessment
evaluation assessing the resident's competence to practice dentistry. The board may require
the applicant to submit any information deemed necessary by the board to determine whether
the waiver is applicable.

Sec. 20.

Minnesota Statutes 2018, section 150A.06, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Emeritus inactive license. new text end

new text begin A person licensed to practice dentistry, dental
therapy, dental hygiene, or dental assisting pursuant to section 150A.05 or Minnesota Rules,
part 3100.8500, who retires from active practice in the state may apply to the board for
emeritus inactive licensure. An application for emeritus inactive licensure may be made on
the biennial licensing form or by petitioning the board, and the applicant must pay a onetime
application fee pursuant to section 150A.091, subdivision 19. In order to receive emeritus
inactive licensure, the applicant must be in compliance with board requirements and cannot
be the subject of current disciplinary action resulting in suspension, revocation,
disqualification, condition, or restriction of the licensee to practice dentistry, dental therapy,
dental hygiene, or dental assisting. An emeritus inactive license is not a license to practice,
but is a formal recognition of completion of a person's dental career in good standing.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 21.

Minnesota Statutes 2018, section 150A.06, is amended by adding a subdivision
to read:


new text begin Subd. 11. new text end

new text begin Emeritus active licensure. new text end

new text begin (a) A person licensed to practice dentistry, dental
therapy, dental hygiene, or dental assisting may apply for an emeritus active license if the
person is retired from active practice, is in compliance with board requirements, and is not
the subject of current disciplinary action resulting in suspension, revocation, disqualification,
condition, or restriction of the license to practice dentistry, dental therapy, dental hygiene,
or dental assisting.
new text end

new text begin (b) An emeritus active licensee may engage only in the following types of practice:
new text end

new text begin (1) pro bono or volunteer dental practice;
new text end

new text begin (2) paid practice not to exceed 500 hours per calendar year for the exclusive purpose of
providing licensing supervision to meet the board's requirements; or
new text end

new text begin (3) paid consulting services not to exceed 500 hours per calendar year.
new text end

new text begin (c) An emeritus active licensee shall not hold out as a full licensee and may only hold
out as authorized to practice as described in this subdivision. The board may take disciplinary
or corrective action against an emeritus active licensee based on violations of applicable
law or board requirements.
new text end

new text begin (d) A person may apply for an emeritus active license by completing an application form
specified by the board and must pay the application fee pursuant to section 150A.091,
subdivision 20.
new text end

new text begin (e) If an emeritus active license is not renewed every two years, the license expires. The
renewal date is the same as the licensee's renewal date when the licensee was in active
practice. In order to renew an emeritus active license, the licensee must:
new text end

new text begin (1) complete an application form as specified by the board;
new text end

new text begin (2) pay the required renewal fee pursuant to section 150A.091, subdivision 20; and
new text end

new text begin (3) report at least 25 continuing education hours completed since the last renewal, which
must include:
new text end

new text begin (i) at least one hour in two different required CORE areas;
new text end

new text begin (ii) at least one hour of mandatory infection control;
new text end

new text begin (iii) for dentists and dental therapists, at least 15 hours of fundamental credits for dentists
and dental therapists, and for dental hygienists and dental assistants, at least seven hours of
fundamental credits; and
new text end

new text begin (iv) for dentists and dental therapists, no more than ten elective credits, and for dental
hygienists and dental assistants, no more than six elective credits.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 22.

Minnesota Statutes 2018, section 150A.091, is amended by adding a subdivision
to read:


new text begin Subd. 19. new text end

new text begin Emeritus inactive license. new text end

new text begin An individual applying for emeritus inactive
licensure under section 150A.06, subdivision 10, must pay a onetime fee of $50. There is
no renewal fee for an emeritus inactive license.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 23.

Minnesota Statutes 2018, section 150A.091, is amended by adding a subdivision
to read:


new text begin Subd. 20. new text end

new text begin Emeritus active license. new text end

new text begin An individual applying for emeritus active licensure
under section 150A.06, subdivision 11, must pay a fee upon application and upon renewal
every two years. The fees for emeritus active license application and renewal are as follows:
dentist, $212; dental therapist, $100; dental hygienist, $75; and dental assistant, $55.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end

Sec. 24.

Minnesota Statutes 2018, section 151.01, subdivision 31, is amended to read:


Subd. 31.

Central service pharmacy.

"Central service pharmacy" means a pharmacy
that deleted text beginmay providedeleted text end new text beginperforms those activities involved in the new text enddispensing deleted text beginfunctions,deleted text end new text beginof a new text enddrug
deleted text begin utilization review, packaging, labeling, or delivery of a prescription product todeleted text end new text beginfor new text endanother
pharmacy deleted text beginfor the purpose of filling a prescriptiondeleted text endnew text begin, pursuant to the requirements of this
chapter and the rules of the board
new text end.

Sec. 25.

Minnesota Statutes 2018, section 151.01, subdivision 35, is amended to read:


Subd. 35.

Compounding.

"Compounding" means preparing, mixing, assembling,
packaging, and labeling a drug for an identified individual patient as a result of a practitioner's
prescription drug order. Compounding also includes anticipatory compounding, as defined
in this section, and the preparation of drugs in which all bulk drug substances and components
are nonprescription substances. Compounding does not include mixing or reconstituting a
drug according to the product's labeling or to the manufacturer's directionsnew text begin, provided that
such labeling has been approved by the United States Food and Drug Administration (FDA)
or the manufacturer is licensed under section 151.252
new text end. Compounding does not include the
preparation of a drug for the purpose of, or incident to, research, teaching, or chemical
analysis, provided that the drug is not prepared for dispensing or administration to patients.
All compounding, regardless of the type of product, must be done pursuant to a prescription
drug order unless otherwise permitted in this chapter or by the rules of the board.
Compounding does not include a minor deviation from such directions with regard to
radioactivity, volume, or stability, which is made by or under the supervision of a licensed
nuclear pharmacist or a physician, and which is necessary in order to accommodate
circumstances not contemplated in the manufacturer's instructions, such as the rate of
radioactive decay or geographical distance from the patient.

Sec. 26.

Minnesota Statutes 2018, section 151.065, subdivision 1, is amended to read:


Subdivision 1.

Application fees.

Application fees for licensure and registration are as
follows:

(1) pharmacist licensed by examination, deleted text begin$145deleted text endnew text begin $175new text end;

(2) pharmacist licensed by reciprocity, deleted text begin$240deleted text endnew text begin $275new text end;

(3) pharmacy intern, deleted text begin$37.50deleted text endnew text begin $50new text end;

(4) pharmacy technician, deleted text begin$37.50deleted text endnew text begin $50new text end;

(5) pharmacy, deleted text begin$225deleted text endnew text begin $260new text end;

(6) drug wholesaler, legend drugs only, deleted text begin$235deleted text endnew text begin $260new text end;

(7) drug wholesaler, legend and nonlegend drugs, deleted text begin$235deleted text endnew text begin $260new text end;

(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin$210deleted text endnew text begin $260new text end;

(9) drug wholesaler, medical gases, deleted text begin$175deleted text endnew text begin $260new text end;

(10) deleted text begindrug wholesaler, also licensed as a pharmacy in Minnesota, $150deleted text endnew text begin third-party logistics
provider, $260
new text end;

(11) drug manufacturer, legend drugs only, deleted text begin$235deleted text endnew text begin $260new text end;

(12) drug manufacturer, legend and nonlegend drugs, deleted text begin$235deleted text endnew text begin $260new text end;

(13) drug manufacturer, nonlegend or veterinary legend drugs, deleted text begin$210deleted text endnew text begin $260new text end;

(14) drug manufacturer, medical gases, deleted text begin$185deleted text endnew text begin $260new text end;

(15) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin$150deleted text endnew text begin $260new text end;

(16) medical gas distributor, deleted text begin$110deleted text endnew text begin $260new text end;

(17) controlled substance researcher, $75; and

(18) pharmacy professional corporation, deleted text begin$125deleted text endnew text begin $150new text end.

Sec. 27.

Minnesota Statutes 2018, section 151.065, subdivision 2, is amended to read:


Subd. 2.

Original license fee.

The pharmacist original licensure fee, deleted text begin$145deleted text endnew text begin $175new text end.

Sec. 28.

Minnesota Statutes 2018, section 151.065, subdivision 3, is amended to read:


Subd. 3.

Annual renewal fees.

Annual licensure and registration renewal fees are as
follows:

(1) pharmacist, deleted text begin$145deleted text endnew text begin $175new text end;

(2) pharmacy technician, deleted text begin$37.50deleted text endnew text begin $50new text end;

(3) pharmacy, deleted text begin$225deleted text endnew text begin $260new text end;

(4) drug wholesaler, legend drugs only, deleted text begin$235deleted text endnew text begin $260new text end;

(5) drug wholesaler, legend and nonlegend drugs, deleted text begin$235deleted text endnew text begin $260new text end;

(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin$210deleted text endnew text begin $260new text end;

(7) drug wholesaler, medical gases, deleted text begin$185deleted text endnew text begin $260new text end;

(8) deleted text begindrug wholesaler, also licensed as a pharmacy in Minnesota, $150deleted text endnew text begin third-party logistics
provider, $260
new text end;

(9) drug manufacturer, legend drugs only, deleted text begin$235deleted text endnew text begin $260new text end;

(10) drug manufacturer, legend and nonlegend drugs, deleted text begin$235deleted text endnew text begin $260new text end;

(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, deleted text begin$210deleted text endnew text begin $260new text end;

(12) drug manufacturer, medical gases, deleted text begin$185deleted text endnew text begin $260new text end;

(13) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin$150deleted text endnew text begin $260new text end;

(14) medical gas distributor, deleted text begin$110deleted text endnew text begin $260new text end;

(15) controlled substance researcher, $75; and

(16) pharmacy professional corporation, deleted text begin$75deleted text endnew text begin $100new text end.

Sec. 29.

Minnesota Statutes 2018, section 151.065, subdivision 6, is amended to read:


Subd. 6.

Reinstatement fees.

(a) A pharmacist who has allowed the pharmacist's license
to lapse may reinstate the license with board approval and upon payment of any fees and
late fees in arrears, up to a maximum of $1,000.

(b) A pharmacy technician who has allowed the technician's registration to lapse may
reinstate the registration with board approval and upon payment of any fees and late fees
in arrears, up to a maximum of $90.

(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer,new text begin third-party logistics
provider,
new text end or a medical gas distributor who has allowed the license of the establishment to
lapse may reinstate the license with board approval and upon payment of any fees and late
fees in arrears.

(d) A controlled substance researcher who has allowed the researcher's registration to
lapse may reinstate the registration with board approval and upon payment of any fees and
late fees in arrears.

(e) A pharmacist owner of a professional corporation who has allowed the corporation's
registration to lapse may reinstate the registration with board approval and upon payment
of any fees and late fees in arrears.

Sec. 30.

Minnesota Statutes 2018, section 151.071, subdivision 2, is amended to read:


Subd. 2.

Grounds for disciplinary action.

The following conduct is prohibited and is
grounds for disciplinary action:

(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;

(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;

(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;

(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;

(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;

(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:

(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and

(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;

(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;

(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;

(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;

(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;

(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;

(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;

(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;

(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, deleted text begindrunkenness,deleted text end use of new text beginalcohol, new text enddrugs, narcotics, chemicals, or
any other type of material or as a result of any mental or physical condition, including
deterioration through the aging process or loss of motor skills. In the case of registered
pharmacy technicians, pharmacist interns, or controlled substance researchers, the inability
to carry out duties allowed under this chapter or the rules of the board with reasonable skill
and safety to patients by reason of illness, deleted text begindrunkenness,deleted text end use of new text beginalcohol, new text enddrugs, narcotics,
chemicals, or any other type of material or as a result of any mental or physical condition,
including deterioration through the aging process or loss of motor skills;

(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
distributor, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;

(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;

(17) fee splitting, including without limitation:

(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
deleted text begin and
deleted text end

(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;new text begin
and
new text end

new text begin (iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
new text end

(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;

(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;

(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;

(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;

(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:

(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;

(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;

(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or

(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board shall investigate any complaint of a violation of section 609.215, subdivision 1
or 2;

(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; and

(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the program.

Sec. 31.

Minnesota Statutes 2018, section 151.15, subdivision 1, is amended to read:


Subdivision 1.

Location.

It shall be unlawful for any person to compounddeleted text begin,deleted text end new text beginor new text enddispensedeleted text begin,
vend, or sell
deleted text end drugsdeleted text begin, medicines, chemicals, or poisonsdeleted text end in any place other than a pharmacy,
except as provided in this chapternew text begin; except that a licensed pharmacist or pharmacist intern
working within a licensed hospital may receive a prescription drug order and access the
hospital's pharmacy prescription processing system through secure and encrypted electronic
means in order to process the prescription drug order
new text end.

Sec. 32.

Minnesota Statutes 2018, section 151.15, is amended by adding a subdivision to
read:


new text begin Subd. 5. new text end

new text begin Receipt of emergency prescription orders. new text end

new text begin A pharmacist, when that pharmacist
is not present within a licensed pharmacy, may accept a written, verbal, or electronic
prescription drug order from a practitioner only if:
new text end

new text begin (1) the prescription drug order is for an emergency situation where waiting for the
pharmacist to travel to a licensed pharmacy to accept the prescription drug order would
likely cause the patient to experience significant physical harm or discomfort;
new text end

new text begin (2) the pharmacy from which the prescription drug order will be dispensed is closed for
business;
new text end

new text begin (3) the pharmacist has been designated to be on call for the licensed pharmacy that will
fill the prescription drug order;
new text end

new text begin (4) electronic prescription drug orders are received through secure and encrypted
electronic means;
new text end

new text begin (5) the pharmacist takes reasonable precautions to ensure that the prescription drug order
will be handled in a manner consistent with federal and state statutes regarding the handling
of protected health information; and
new text end

new text begin (6) the pharmacy from which the prescription drug order will be dispensed has relevant
and appropriate policies and procedures in place and makes them available to the board
upon request.
new text end

Sec. 33.

Minnesota Statutes 2018, section 151.15, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Processing of emergency prescription orders. new text end

new text begin A pharmacist, when that
pharmacist is not present within a licensed pharmacy, may access a pharmacy prescription
processing system through secure and encrypted electronic means in order to process an
emergency prescription accepted pursuant to subdivision 5 only if:
new text end

new text begin (1) the pharmacy from which the prescription drug order will be dispensed is closed for
business;
new text end

new text begin (2) the pharmacist has been designated to be on call for the licensed pharmacy that will
fill the prescription drug order;
new text end

new text begin (3) the prescription drug order is for a patient of a long-term care facility or a county
correctional facility;
new text end

new text begin (4) the prescription drug order is not being processed pursuant to section 151.58;
new text end

new text begin (5) the prescription drug order is processed pursuant to this chapter and the rules
promulgated thereunder; and
new text end

new text begin (6) the pharmacy from which the prescription drug order will be dispensed has relevant
and appropriate policies and procedures in place and makes them available to the board
upon request.
new text end

Sec. 34.

Minnesota Statutes 2018, section 151.19, subdivision 1, is amended to read:


Subdivision 1.

Pharmacy licensure requirements.

(a) No person shall operate a
pharmacy without first obtaining a license from the board and paying any applicable fee
specified in section 151.065. The license shall be displayed in a conspicuous place in the
pharmacy for which it is issued and expires on June 30 following the date of issue. It is
unlawful for any person to operate a pharmacy unless the license has been issued to the
person by the board.

(b) Application for a pharmacy license under this section shall be made in a manner
specified by the board.

(c) No license shall be issued or renewed for a pharmacy located within the state unless
the applicant agrees to operate the pharmacy in a manner prescribed by federal and state
law and according to rules adopted by the board. No license shall be issued for a pharmacy
located outside of the state unless the applicant agrees to operate the pharmacy in a manner
prescribed by federal law and, when dispensing medications for residents of this state, the
laws of this state, and Minnesota Rules.

(d) No license shall be issued or renewed for a pharmacy that is required to be licensed
or registered by the state in which it is physically located unless the applicant supplies the
board with proof of such licensure or registration.

(e) The board shall require a separate license for each pharmacy located within the state
and for each pharmacy located outside of the state at which any portion of the dispensing
process occurs for drugs dispensed to residents of this state.

(f) deleted text beginThe board shall not issuedeleted text end new text beginPrior to the issuance of new text endan initial or renewed license for a
pharmacy deleted text beginunlessdeleted text endnew text begin, the board may requirenew text end the pharmacy deleted text beginpassesdeleted text end new text beginto pass new text endan inspection conducted
by an authorized representative of the board. In the case of a pharmacy located outside of
the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.

(g) The board shall not issue an initial or renewed license for a pharmacy located outside
of the state unless the applicant discloses and certifies:

(1) the location, names, and titles of all principal corporate officers and all pharmacists
who are involved in dispensing drugs to residents of this state;

(2) that it maintains its records of drugs dispensed to residents of this state so that the
records are readily retrievable from the records of other drugs dispensed;

(3) that it agrees to cooperate with, and provide information to, the board concerning
matters related to dispensing drugs to residents of this state;

(4) that, during its regular hours of operation, but no less than six days per week, for a
minimum of 40 hours per week, a toll-free telephone service is provided to facilitate
communication between patients in this state and a pharmacist at the pharmacy who has
access to the patients' records; the toll-free number must be disclosed on the label affixed
to each container of drugs dispensed to residents of this state; and

(5) that, upon request of a resident of a long-term care facility located in this state, the
resident's authorized representative, or a contract pharmacy or licensed health care facility
acting on behalf of the resident, the pharmacy will dispense medications prescribed for the
resident in unit-dose packaging or, alternatively, comply with section 151.415, subdivision
5
.

new text begin (h) This subdivision does not apply to a manufacturer licensed under section 151.252,
subdivision 1, a wholesale drug distributor licensed under section 151.47, or a third-party
logistics provider, to the extent the manufacturer, wholesale drug distributor, or third-party
logistics provider is engaged in the distribution of dialysate or devices necessary to perform
home peritoneal dialysis on patients with end-stage renal disease, if:
new text end

new text begin (1) the manufacturer or its agent leases or owns the licensed manufacturing or wholesaling
facility from which the dialysate or devices will be delivered;
new text end

new text begin (2) the dialysate is comprised of dextrose or icodextrin and has been approved by the
United States Food and Drug Administration;
new text end

new text begin (3) the dialysate is stored and delivered in its original, sealed, and unopened
manufacturer's packaging;
new text end

new text begin (4) the dialysate or devices are delivered only upon:
new text end

new text begin (i) receipt of a physician's order by a Minnesota licensed pharmacy; and
new text end

new text begin (ii) the review and processing of the prescription by a pharmacist licensed by the state
in which the pharmacy is located, who is employed by or under contract to the pharmacy;
new text end

new text begin (5) prescriptions, policies, procedures, and records of delivery are maintained by the
manufacturer for a minimum of three years and are made available to the board upon request;
and
new text end

new text begin (6) the manufacturer or the manufacturer's agent delivers the dialysate or devices directly
to:
new text end

new text begin (i) a patient with end-stage renal disease for whom the prescription was written or the
patient's designee, for the patient's self-administration of the dialysis therapy; or
new text end

new text begin (ii) a health care provider or institution, for administration or delivery of the dialysis
therapy to a patient with end-stage renal disease for whom the prescription was written.
new text end

Sec. 35.

Minnesota Statutes 2018, section 151.19, subdivision 3, is amended to read:


Subd. 3.

Sale of federally restricted medical gases.

(a) A person or establishment not
licensed as a pharmacy or a practitioner shall not engage in the retail sale or distribution of
federally restricted medical gases without first obtaining a registration from the board and
paying the applicable fee specified in section 151.065. The registration shall be displayed
in a conspicuous place in the business for which it is issued and expires on the date set by
the board. It is unlawful for a person to sell or distribute federally restricted medical gases
unless a certificate has been issued to that person by the board.

(b) Application for a medical gas distributor registration under this section shall be made
in a manner specified by the board.

(c) No registration shall be issued or renewed for a medical gas distributor located within
the state unless the applicant agrees to operate in a manner prescribed by federal and state
law and according to the rules adopted by the board. No license shall be issued for a medical
gas distributor located outside of the state unless the applicant agrees to operate in a manner
prescribed by federal law and, when distributing medical gases for residents of this state,
the laws of this state and Minnesota Rules.

(d) No registration shall be issued or renewed for a medical gas distributor that is required
to be licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of the licensure or registration. The board may, by rule,
establish standards for the registration of a medical gas distributor that is not required to be
licensed or registered by the state in which it is physically located.

(e) The board shall require a separate registration for each medical gas distributor located
within the state and for each facility located outside of the state from which medical gases
are distributed to residents of this state.

(f) deleted text beginThe board shall not issuedeleted text endnew text begin Prior to the issuance ofnew text end an initial or renewed registration
for a medical gas distributor deleted text beginunlessdeleted text endnew text begin, the board may requirenew text end the medical gas distributor deleted text beginpassesdeleted text end
new text begin to pass new text endan inspection conducted by an authorized representative of the board. In the case of
a medical gas distributor located outside of the state, the board may require the applicant
to pay the cost of the inspection, in addition to the license fee in section 151.065, unless the
applicant furnishes the board with a report, issued by the appropriate regulatory agency of
the state in which the facility is located, of an inspection that has occurred within the 24
months immediately preceding receipt of the license application by the board. The board
may deny licensure unless the applicant submits documentation satisfactory to the board
that any deficiencies noted in an inspection report have been corrected.

Sec. 36.

Minnesota Statutes 2018, section 151.252, subdivision 1, is amended to read:


Subdivision 1.

Requirements.

(a) No person shall act as a drug manufacturer without
first obtaining a license from the board and paying any applicable fee specified in section
151.065.

(b) Application for a drug manufacturer license under this section shall be made in a
manner specified by the board.

(c) No license shall be issued or renewed for a drug manufacturer unless the applicant
agrees to operate in a manner prescribed by federal and state law and according to Minnesota
Rules.

(d) No license shall be issued or renewed for a drug manufacturer that is required to be
registered pursuant to United States Code, title 21, section 360, unless the applicant supplies
the board with proof of registration. The board may establish by rule the standards for
licensure of drug manufacturers that are not required to be registered under United States
Code, title 21, section 360.

(e) No license shall be issued or renewed for a drug manufacturer that is required to be
licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of licensure or registration. The board may establish, by rule,
standards for the licensure of a drug manufacturer that is not required to be licensed or
registered by the state in which it is physically located.

(f) The board shall require a separate license for each facility located within the state at
which drug manufacturing occurs and for each facility located outside of the state at which
drugs that are shipped into the state are manufactured.

(g) deleted text beginThe board shall not issuedeleted text end new text beginPrior to the issuance of new text endan initial or renewed license for a
drug manufacturing facility deleted text beginunlessdeleted text endnew text begin, the board may requirenew text end the facility deleted text beginpasses andeleted text end new text beginto pass a
current good manufacturing practices
new text endinspection conducted by an authorized representative
of the board. In the case of a drug manufacturing facility located outside of the state, the
board may require the applicant to pay the cost of the inspection, in addition to the license
fee in section 151.065, unless the applicant furnishes the board with a report, issued by the
appropriate regulatory agency of the state in which the facility is located or by the United
States Food and Drug Administration, of an inspection that has occurred within the 24
months immediately preceding receipt of the license application by the board. The board
may deny licensure unless the applicant submits documentation satisfactory to the board
that any deficiencies noted in an inspection report have been corrected.

Sec. 37.

Minnesota Statutes 2018, section 151.252, subdivision 1a, is amended to read:


Subd. 1a.

Outsourcing facility.

(a) No person shall act as an outsourcing facility without
first obtaining a license from the board and paying any applicable manufacturer licensing
fee specified in section 151.065.

(b) Application for an outsourcing facility license under this section shall be made in a
manner specified by the board and may differ from the application required of other drug
manufacturers.

(c) No license shall be issued or renewed for an outsourcing facility unless the applicant
agrees to operate in a manner prescribed for outsourcing facilities by federal and state law
and according to Minnesota Rules.

(d) No license shall be issued or renewed for an outsourcing facility unless the applicant
supplies the board with proof of such registration by the United States Food and Drug
Administration as required by United States Code, title 21, section 353b.

(e) No license shall be issued or renewed for an outsourcing facility that is required to
be licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of such licensure or registration. The board may establish, by
rule, standards for the licensure of an outsourcing facility that is not required to be licensed
or registered by the state in which it is physically located.

(f) The board shall require a separate license for each outsourcing facility located within
the state and for each outsourcing facility located outside of the state at which drugs that
are shipped into the state are prepared.

(g) The board shall not issue an initial or renewed license for an outsourcing facility
unless the facility passes deleted text beginandeleted text end new text begina current good manufacturing practices new text endinspection conducted
by an authorized representative of the board. In the case of an outsourcing facility located
outside of the state, the board may require the applicant to pay the cost of the inspection,
in addition to the license fee in section 151.065, unless the applicant furnishes the board
with a report, issued by the appropriate regulatory agency of the state in which the facility
is located or by the United States Food and Drug Administration, of deleted text beginandeleted text end new text begina current good
manufacturing practices
new text endinspection that has occurred within the 24 months immediately
preceding receipt of the license application by the board. The board may deny licensure
unless the applicant submits documentation satisfactory to the board that any deficiencies
noted in an inspection report have been corrected.

Sec. 38.

Minnesota Statutes 2018, section 151.252, subdivision 3, is amended to read:


Subd. 3.

Payment to practitioner; reporting.

Unless prohibited by United States Code,
title 42, section 1320a-7h, a drug manufacturer new text beginor outsourcing facility new text endshall file with the
board an annual report, in a form and on the date prescribed by the board, identifying all
payments, honoraria, reimbursement, or other compensation authorized under section
151.461, clauses (4) and (5), paid to practitioners in Minnesota during the preceding calendar
year. The report shall identify the nature and value of any payments totaling $100 or more
to a particular practitioner during the year, and shall identify the practitioner. Reports filed
under this subdivision are public data.

Sec. 39.

Minnesota Statutes 2018, section 151.253, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Emergency veterinary compounding. new text end

new text begin A pharmacist working within a pharmacy
licensed by the board in the veterinary pharmacy license category may compound and
provide a drug product to a veterinarian without first receiving a patient-specific prescription
only when:
new text end

new text begin (1) the compounded drug product is needed to treat animals in urgent or emergency
situations, meaning where the health of an animal is threatened, or where suffering or death
of an animal is likely to result from failure to immediately treat;
new text end

new text begin (2) timely access to a compounding pharmacy is not available, as determined by the
prescribing veterinarian;
new text end

new text begin (3) there is no commercially manufactured drug, approved by the United States Food
and Drug Administration, that is suitable for treating the animal, or there is a documented
shortage of such drug;
new text end

new text begin (4) the compounded drug is to be administered by a veterinarian or a bona fide employee
of the veterinarian, or dispensed to a client of a veterinarian in an amount not to exceed
what is necessary to treat an animal for a period of ten days;
new text end

new text begin (5) the pharmacy has selected the sterile or nonsterile compounding license category,
in addition to the veterinary pharmacy licensing category; and
new text end

new text begin (6) the pharmacy is appropriately registered by the United States Drug Enforcement
Administration when providing compounded products that contain controlled substances.
new text end

Sec. 40.

Minnesota Statutes 2018, section 151.32, is amended to read:


151.32 CITATION.

The title of sections 151.01 to deleted text begin151.40deleted text end new text begin151.58 new text endshall be the Pharmacy Practice new text beginand
Wholesale Distribution
new text endAct.

Sec. 41.

Minnesota Statutes 2018, section 151.40, subdivision 1, is amended to read:


Subdivision 1.

Generally.

deleted text beginExcept as otherwise provided in subdivision 2,deleted text end It is unlawful
for any person to possess, control, manufacture, sell, furnish, dispense, or otherwise dispose
of hypodermic syringes or needles or any instrument or implement which can be adapted
for subcutaneous injections, except deleted text beginbydeleted text end new text beginfor:
new text end

new text begin (1) new text endThe following persons when acting in the course of their practice or employment:

new text begin (i) new text endlicensed practitionersdeleted text begin, registereddeleted text end new text beginand their employees, agents, or delegates;
new text end

new text begin (ii) licensed new text endpharmacies and their employees or agentsdeleted text begin,deleted text endnew text begin;
new text end

new text begin (iii) new text endlicensed pharmacistsdeleted text begin, licensed doctors of veterinary medicine or their assistants,deleted text endnew text begin;
new text end

new text begin (iv) new text endregistered nursesdeleted text begin,deleted text end new text beginand licensed practical nurses;
new text end

new text begin (v) new text endregistered medical technologistsdeleted text begin,deleted text endnew text begin;
new text end

new text begin (vi) new text endmedical internsdeleted text begin,deleted text end new text beginand residents;
new text end

new text begin (vii) new text endlicensed drug wholesalersdeleted text begin,deleted text end new text beginand new text endtheir employees or agentsdeleted text begin,deleted text endnew text begin;
new text end

new text begin (viii) new text endlicensed hospitalsdeleted text begin,deleted text endnew text begin;
new text end

new text begin (ix) bona fide hospitals in which animals are treated;
new text end

new text begin (x) new text endlicensed nursing homesdeleted text begin, bona fide hospitals where animals are treated,deleted text endnew text begin;
new text end

new text begin (xi) new text endlicensed morticiansdeleted text begin,deleted text endnew text begin;
new text end

new text begin (xii) new text endsyringe and needle manufacturersdeleted text begin,deleted text endnew text begin andnew text end their dealers and agentsdeleted text begin,deleted text endnew text begin;
new text end

new text begin (xiii) new text endpersons engaged in animal husbandrydeleted text begin,deleted text endnew text begin;
new text end

new text begin (xiv) new text endclinical laboratoriesnew text begin and their employeesnew text enddeleted text begin,deleted text endnew text begin;
new text end

new text begin (xv) new text endpersons engaged in bona fide research or education or industrial use of hypodermic
syringes and needles provided such persons cannot use hypodermic syringes and needles
for the administration of drugs to human beings unless such drugs are prescribed, dispensed,
and administered by a person lawfully authorized to do sodeleted text begin,deleted text endnew text begin; and
new text end

new text begin (xvi) new text endpersons who administer drugs pursuant to an order or direction of a licensed deleted text begindoctor
of medicine or of a licensed doctor of osteopathic medicine duly licensed to practice
medicine.
deleted text endnew text begin practitioner;
new text end

new text begin (2) a person who self-administers drugs pursuant to either the prescription or the direction
of a practitioner, or a family member, caregiver, or other individual who is designated by
such person to assist the person in obtaining and using needles and syringes for the
administration of such drugs;
new text end

new text begin (3) a person who is disposing of hypodermic syringes and needles through an activity
or program developed under section 325F.785; or
new text end

new text begin (4) a person who sells, possesses, or handles hypodermic syringes and needles pursuant
to subdivision 2.
new text end

Sec. 42.

Minnesota Statutes 2018, section 151.40, subdivision 2, is amended to read:


Subd. 2.

Sales of limited quantities of clean needles and syringes.

(a) A registered
pharmacy deleted text beginor its agentdeleted text end or a licensed pharmacist may sell, without deleted text beginadeleted text end new text beginthe new text endprescriptionnew text begin or
direction of a practitioner
new text end, unused hypodermic needles and syringes in quantities of ten or
fewer, provided the pharmacy or pharmacist complies with all of the requirements of this
subdivision.

(b) At any location where hypodermic needles and syringes are kept for retail sale under
this subdivision, the needles and syringes shall be stored in a manner that makes them
available only to authorized personnel and not openly available to customers.

deleted text begin (c) No registered pharmacy or licensed pharmacist may advertise to the public the
availability for retail sale, without a prescription, of hypodermic needles or syringes in
quantities of ten or fewer.
deleted text end

deleted text begin (d)deleted text endnew text begin (c)new text end A registered pharmacy or licensed pharmacist that sells hypodermic needles or
syringes under this subdivision may give the purchaser the materials developed by the
commissioner of health under section 325F.785.

deleted text begin (e)deleted text end new text begin(d) new text endA registered pharmacy or licensed pharmacist that sells hypodermic needles or
syringes new text beginunder this subdivision new text endmust certify to the commissioner of health participation in
an activity, including but not limited to those developed under section 325F.785, that supports
proper disposal of used hypodermic needles or syringes.

Sec. 43.

Minnesota Statutes 2018, section 151.43, is amended to read:


151.43 SCOPE.

Sections deleted text begin151.42deleted text end new text begin151.43 new text endto 151.51 apply to any persondeleted text begin, partnership, corporation, or
business firm
deleted text end engaging in the wholesale distribution of deleted text beginprescriptiondeleted text end drugs within the statenew text begin,
and to persons operating as third-party logistics providers
new text end.

Sec. 44.

new text begin [151.441] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin As used in sections 151.43 to 151.51, the following terms have
the meanings given in this section.
new text end

new text begin Subd. 2. new text end

new text begin Dispenser. new text end

new text begin "Dispenser" means a retail pharmacy, hospital pharmacy, a group
of chain pharmacies under common ownership and control that do not act as a wholesale
distributor, or any other person authorized by law to dispense or administer prescription
drugs, and the affiliated warehouses or distribution centers of such entities under common
ownership and control that do not act as a wholesale distributor, but does not include a
person who dispenses only products to be used in animals in accordance with United States
Code, title 21, section 360b(a)(5).
new text end

new text begin Subd. 3. new text end

new text begin Disposition. new text end

new text begin "Disposition," with respect to a product within the possession or
control of an entity, means the removal of such product from the pharmaceutical distribution
supply chain, which may include disposal or return of the product for disposal or other
appropriate handling and other actions, such as retaining a sample of the product for further
additional physical examination or laboratory analysis of the product by a manufacturer or
regulatory or law enforcement agency.
new text end

new text begin Subd. 4. new text end

new text begin Distribute or distribution. new text end

new text begin "Distribute" or "distribution" means the sale,
purchase, trade, delivery, handling, storage, or receipt of a product, and does not include
the dispensing of a product pursuant to a prescription executed in accordance with United
States Code, title 21, section 353(b)(1), or the dispensing of a product approved under United
States Code, title 21, section 360b(b).
new text end

new text begin Subd. 5. new text end

new text begin Manufacturer. new text end

new text begin "Manufacturer" means, with respect to a product:
new text end

new text begin (1) a person who holds an application approved under United States Code, title 21,
section 355, or a license issued under United States Code, title 42, section 262, for such
product, or if such product is not the subject of an approved application or license, the person
who manufactured the product;
new text end

new text begin (2) a co-licensed partner of the person described in clause (1) that obtains the product
directly from a person described in this subdivision; or
new text end

new text begin (3) an affiliate of a person described in clause (1) or (2) that receives the product directly
from a person described in this subdivision.
new text end

new text begin Subd. 6. new text end

new text begin Medical convenience kit. new text end

new text begin "Medical convenience kit" means a collection of
finished medical devices, which may include a product or biological product, assembled in
kit form strictly for the convenience of the purchaser or user.
new text end

new text begin Subd. 7. new text end

new text begin Package. new text end

new text begin "Package" means the smallest individual salable unit of product for
distribution by a manufacturer or repackager that is intended by the manufacturer for ultimate
sale to the dispenser of such product. For purposes of this subdivision, an "individual salable
unit" is the smallest container of product introduced into commerce by the manufacturer or
repackager that is intended by the manufacturer or repackager for individual sale to a
dispenser.
new text end

new text begin Subd. 8. new text end

new text begin Prescription drug. new text end

new text begin "Prescription drug" means a drug for human use subject
to United States Code, title 21, section 353(b)(1).
new text end

new text begin Subd. 9. new text end

new text begin Product. new text end

new text begin "Product" means a prescription drug in a finished dosage form for
administration to a patient without substantial further manufacturing, but does not include
blood or blood components intended for transfusion; radioactive drugs or radioactive
biological products as defined in Code of Federal Regulations, title 21, section 600.3(ee),
that are regulated by the Nuclear Regulatory Commission or by a state pursuant to an
agreement with such commission under United States Code, title 42, section 2021; imaging
drugs; an intravenous product described in subdivision 12, paragraph (b), clauses (14) to
(16); any medical gas defined in United States Code, title 21, section 360ddd; homeopathic
drugs marketed in accordance with applicable federal law; or a drug compounded in
compliance with United States Code, title 21, section 353a or 353b.
new text end

new text begin Subd. 10. new text end

new text begin Repackager. new text end

new text begin "Repackager" means a person who owns or operates an
establishment that repacks and relabels a product or package for further sale or for distribution
without a further transaction.
new text end

new text begin Subd. 11. new text end

new text begin Third-party logistics provider. new text end

new text begin "Third-party logistics provider" means an
entity that provides or coordinates warehousing or other logistics services of a product in
interstate commerce on behalf of a manufacturer, wholesale distributor, or dispenser of a
product, but does not take ownership of the product nor have responsibility to direct the
sale or disposition of the product.
new text end

new text begin Subd. 12. new text end

new text begin Transaction. new text end

new text begin (a) "Transaction" means the transfer of product between persons
in which a change of ownership occurs.
new text end

new text begin (b) The term "transaction" does not include:
new text end

new text begin (1) intracompany distribution of any product between members of an affiliate or within
a manufacturer;
new text end

new text begin (2) the distribution of a product among hospitals or other health care entities that are
under common control;
new text end

new text begin (3) the distribution of a drug or an offer to distribute a drug for emergency medical
reasons, including:
new text end

new text begin (i) a public health emergency declaration pursuant to United States Code, title 42, section
247d;
new text end

new text begin (ii) a national security or peacetime emergency declared by the governor pursuant to
section 12.31; or
new text end

new text begin (iii) a situation involving an action taken by the commissioner of health pursuant to
section 144.4197, 144.4198 or 151.37, subdivisions 2, paragraph (b), and 10, except that,
for purposes of this paragraph, a drug shortage not caused by a public health emergency
shall not constitute an emergency medical reason;
new text end

new text begin (4) the dispensing of a drug pursuant to a valid prescription issued by a licensed
practitioner;
new text end

new text begin (5) the distribution of product samples by a manufacturer or a licensed wholesale
distributor in accordance with United States Code, title 21, section 353(d);
new text end

new text begin (6) the distribution of blood or blood components intended for transfusion;
new text end

new text begin (7) the distribution of minimal quantities of product by a licensed retail pharmacy to a
licensed practitioner for office use;
new text end

new text begin (8) the sale, purchase, or trade of a drug or an offer to sell, purchase, or trade a drug by
a charitable organization described in United States Code, title 26, section 501(c)(3), to a
nonprofit affiliate of the organization to the extent otherwise permitted by law;
new text end

new text begin (9) the distribution of a product pursuant to the sale or merger of a pharmacy or
pharmacies or a wholesale distributor or wholesale distributors, except that any records
required to be maintained for the product shall be transferred to the new owner of the
pharmacy or pharmacies or wholesale distributor or wholesale distributors;
new text end

new text begin (10) the dispensing of a product approved under United States Code, title 21, section
360b(c);
new text end

new text begin (11) transfer of products to or from any facility that is licensed by the Nuclear Regulatory
Commission or by a state pursuant to an agreement with such commission under United
States Code, title 42, section 2021;
new text end

new text begin (12) transfer of a combination product that is not subject to approval under United States
Code, title 21, section 355, or licensure under United States Code, title 42, section 262, and
that is:
new text end

new text begin (i) a product comprised of a device and one or more other regulated components (such
as a drug/device, biologic/device, or drug/device/biologic) that are physically, chemically,
or otherwise combined or mixed and produced as a single entity;
new text end

new text begin (ii) two or more separate products packaged together in a single package or as a unit
and comprised of a drug and device or device and biological product; or
new text end

new text begin (iii) two or more finished medical devices plus one or more drug or biological products
that are packaged together in a medical convenience kit;
new text end

new text begin (13) the distribution of a medical convenience kit if:
new text end

new text begin (i) the medical convenience kit is assembled in an establishment that is registered with
the Food and Drug Administration as a device manufacturer in accordance with United
States Code, title 21, section 360(b)(2);
new text end

new text begin (ii) the medical convenience kit does not contain a controlled substance that appears in
a schedule contained in the Comprehensive Drug Abuse Prevention and Control Act of
1970, United States Code, title 21, section 801, et seq.;
new text end

new text begin (iii) in the case of a medical convenience kit that includes a product, the person who
manufactures the kit:
new text end

new text begin (A) purchased the product directly from the pharmaceutical manufacturer or from a
wholesale distributor that purchased the product directly from the pharmaceutical
manufacturer; and
new text end

new text begin (B) does not alter the primary container or label of the product as purchased from the
manufacturer or wholesale distributor; and
new text end

new text begin (iv) in the case of a medical convenience kit that includes a product, the product is:
new text end

new text begin (A) an intravenous solution intended for the replenishment of fluids and electrolytes;
new text end

new text begin (B) a product intended to maintain the equilibrium of water and minerals in the body;
new text end

new text begin (C) a product intended for irrigation or reconstitution;
new text end

new text begin (D) an anesthetic;
new text end

new text begin (E) an anticoagulant;
new text end

new text begin (F) a vasopressor; or
new text end

new text begin (G) a sympathomimetic;
new text end

new text begin (14) the distribution of an intravenous product that, by its formulation, is intended for
the replenishment of fluids and electrolytes, such as sodium, chloride, and potassium; or
calories, such as dextrose and amino acids;
new text end

new text begin (15) the distribution of an intravenous product used to maintain the equilibrium of water
and minerals in the body, such as dialysis solutions;
new text end

new text begin (16) the distribution of a product that is intended for irrigation, or sterile water, whether
intended for such purposes or for injection;
new text end

new text begin (17) the distribution of a medical gas as defined in United States Code, title 21, section
360ddd; or
new text end

new text begin (18) the distribution or sale of any licensed product under United States Code, title 42,
section 262, that meets the definition of a device under United States Code, title 21, section
321(h).
new text end

new text begin Subd. 13. new text end

new text begin Wholesale distribution. new text end

new text begin "Wholesale distribution" means the distribution of
a drug to a person other than a consumer or patient, or receipt of a drug by a person other
than the consumer or patient, but does not include:
new text end

new text begin (1) intracompany distribution of any drug between members of an affiliate or within a
manufacturer;
new text end

new text begin (2) the distribution of a drug or an offer to distribute a drug among hospitals or other
health care entities that are under common control;
new text end

new text begin (3) the distribution of a drug or an offer to distribute a drug for emergency medical
reasons, including:
new text end

new text begin (i) a public health emergency declaration pursuant to United States Code, title 42, section
247d;
new text end

new text begin (ii) a national security or peacetime emergency declared by the governor pursuant to
section 12.31; or
new text end

new text begin (iii) a situation involving an action taken by the commissioner of health pursuant to
sections 144.4197, 144.4198 or 151.37, subdivisions 2, paragraph (b), and 10, except that,
for purposes of this paragraph, a drug shortage not caused by a public health emergency
shall not constitute an emergency medical reason;
new text end

new text begin (4) the dispensing of a drug pursuant to a valid prescription issued by a licensed
practitioner;
new text end

new text begin (5) the distribution of minimal quantities of a drug by a licensed retail pharmacy to a
licensed practitioner for office use;
new text end

new text begin (6) the distribution of a drug or an offer to distribute a drug by a charitable organization
to a nonprofit affiliate of the organization to the extent otherwise permitted by law;
new text end

new text begin (7) the purchase or other acquisition by a dispenser, hospital, or other health care entity
of a drug for use by such dispenser, hospital, or other health care entity;
new text end

new text begin (8) the distribution of a drug by the manufacturer of such drug;
new text end

new text begin (9) the receipt or transfer of a drug by an authorized third-party logistics provider provided
that such third-party logistics provider does not take ownership of the drug;
new text end

new text begin (10) a common carrier that transports a drug, provided that the common carrier does not
take ownership of the drug;
new text end

new text begin (11) the distribution of a drug or an offer to distribute a drug by an authorized repackager
that has taken ownership or possession of the drug and repacks it in accordance with United
States Code, title 21, section 360eee-1(e);
new text end

new text begin (12) salable drug returns when conducted by a dispenser;
new text end

new text begin (13) the distribution of a collection of finished medical devices, which may include a
product or biological product, assembled in kit form strictly for the convenience of the
purchaser or user, referred to in this section as a medical convenience kit, if:
new text end

new text begin (i) the medical convenience kit is assembled in an establishment that is registered with
the Food and Drug Administration as a device manufacturer in accordance with United
States Code, title 21, section 360(b)(2);
new text end

new text begin (ii) the medical convenience kit does not contain a controlled substance that appears in
a schedule contained in the Comprehensive Drug Abuse Prevention and Control Act of
1970, United States Code, title 21, section 801, et seq.;
new text end

new text begin (iii) in the case of a medical convenience kit that includes a product, the person that
manufactures the kit:
new text end

new text begin (A) purchased such product directly from the pharmaceutical manufacturer or from a
wholesale distributor that purchased the product directly from the pharmaceutical
manufacturer; and
new text end

new text begin (B) does not alter the primary container or label of the product as purchased from the
manufacturer or wholesale distributor; and
new text end

new text begin (iv) in the case of a medical convenience kit that includes a product, the product is:
new text end

new text begin (A) an intravenous solution intended for the replenishment of fluids and electrolytes;
new text end

new text begin (B) a product intended to maintain the equilibrium of water and minerals in the body;
new text end

new text begin (C) a product intended for irrigation or reconstitution;
new text end

new text begin (D) an anesthetic;
new text end

new text begin (E) an anticoagulant;
new text end

new text begin (F) a vasopressor; or
new text end

new text begin (G) a sympathomimetic;
new text end

new text begin (14) the distribution of an intravenous drug that, by its formulation, is intended for the
replenishment of fluids and electrolytes, such as sodium, chloride, and potassium; or calories,
such as dextrose and amino acids;
new text end

new text begin (15) the distribution of an intravenous drug used to maintain the equilibrium of water
and minerals in the body, such as dialysis solutions;
new text end

new text begin (16) the distribution of a drug that is intended for irrigation, or sterile water, whether
intended for such purposes or for injection;
new text end

new text begin (17) the distribution of medical gas, as defined in United States Code, title 21, section
360ddd;
new text end

new text begin (18) facilitating the distribution of a product by providing solely administrative services,
including processing of orders and payments; or
new text end

new text begin (19) the transfer of a product by a hospital or other health care entity, or by a wholesale
distributor or manufacturer operating at the direction of the hospital or other health care
entity, to a repackager described in United States Code, title 21, section 360eee(16)(B), and
registered under United States Code, title 21, section 360, for the purpose of repackaging
the drug for use by that hospital, or other health care entity and other health care entities
that are under common control, if ownership of the drug remains with the hospital or other
health care entity at all times.
new text end

new text begin Subd. 14. new text end

new text begin Wholesale distributor. new text end

new text begin "Wholesale distributor" means a person engaged in
wholesale distribution but does not include a manufacturer, a manufacturer's co-licensed
partner, a third-party logistics provider, or a repackager.
new text end

Sec. 45.

Minnesota Statutes 2018, section 151.46, is amended to read:


151.46 PROHIBITED DRUG PURCHASES OR RECEIPT.

It is unlawful for any person to knowingly purchase or receive a prescription drug from
a source other than a person or entity licensed under the laws of the state, except where
otherwise provided. Licensed wholesale drug distributors deleted text beginother than pharmaciesdeleted text end new text beginand licensed
third-party logistics providers
new text endshall not dispense or distribute deleted text beginprescriptiondeleted text end drugs directly to
patients. A person violating the provisions of this section is guilty of a misdemeanor.

Sec. 46.

Minnesota Statutes 2018, section 151.47, subdivision 1, is amended to read:


Subdivision 1.

deleted text beginRequirementsdeleted text endnew text begin Generallynew text end.

deleted text begin (a) All wholesale drug distributors are subject
to the requirements of this subdivision.
deleted text end new text begin Each manufacturer, repackager, wholesale distributor,
and dispenser shall comply with the requirements set forth in United States Code, title 21,
section 360eee-1, with respect to the role of such manufacturer, repackager, wholesale
distributor, or dispenser in a transaction involving a product. If an entity meets the definition
of more than one of the entities listed in the preceding sentence, such entity shall comply
with all applicable requirements in United States Code, title 21, section 360eee-1, but shall
not be required to duplicate requirements.
new text end

deleted text begin (b) No person or distribution outlet shall act as a wholesale drug distributor without first
obtaining a license from the board and paying any applicable fee specified in section 151.065.
deleted text end

deleted text begin (c) Application for a wholesale drug distributor license under this section shall be made
in a manner specified by the board.
deleted text end

deleted text begin (d) No license shall be issued or renewed for a wholesale drug distributor to operate
unless the applicant agrees to operate in a manner prescribed by federal and state law and
according to the rules adopted by the board.
deleted text end

deleted text begin (e) No license may be issued or renewed for a drug wholesale distributor that is required
to be licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of licensure or registration. The board may establish, by rule,
standards for the licensure of a drug wholesale distributor that is not required to be licensed
or registered by the state in which it is physically located.
deleted text end

deleted text begin (f) The board shall require a separate license for each drug wholesale distributor facility
located within the state and for each drug wholesale distributor facility located outside of
the state from which drugs are shipped into the state or to which drugs are reverse distributed.
deleted text end

deleted text begin (g) The board shall not issue an initial or renewed license for a drug wholesale distributor
facility unless the facility passes an inspection conducted by an authorized representative
of the board, or is accredited by an accreditation program approved by the board. In the
case of a drug wholesale distributor facility located outside of the state, the board may
require the applicant to pay the cost of the inspection, in addition to the license fee in section
151.065, unless the applicant furnishes the board with a report, issued by the appropriate
regulatory agency of the state in which the facility is located, of an inspection that has
occurred within the 24 months immediately preceding receipt of the license application by
the board, or furnishes the board with proof of current accreditation. The board may deny
licensure unless the applicant submits documentation satisfactory to the board that any
deficiencies noted in an inspection report have been corrected.
deleted text end

deleted text begin (h) As a condition for receiving and retaining a wholesale drug distributor license issued
under sections 151.42 to 151.51, an applicant shall satisfy the board that it has and will
continuously maintain:
deleted text end

deleted text begin (1) adequate storage conditions and facilities;
deleted text end

deleted text begin (2) minimum liability and other insurance as may be required under any applicable
federal or state law;
deleted text end

deleted text begin (3) a viable security system that includes an after hours central alarm, or comparable
entry detection capability; restricted access to the premises; comprehensive employment
applicant screening; and safeguards against all forms of employee theft;
deleted text end

deleted text begin (4) a system of records describing all wholesale drug distributor activities set forth in
section 151.44 for at least the most recent two-year period, which shall be reasonably
accessible as defined by board regulations in any inspection authorized by the board;
deleted text end

deleted text begin (5) principals and persons, including officers, directors, primary shareholders, and key
management executives, who must at all times demonstrate and maintain their capability
of conducting business in conformity with sound financial practices as well as state and
federal law;
deleted text end

deleted text begin (6) complete, updated information, to be provided to the board as a condition for obtaining
and retaining a license, about each wholesale drug distributor to be licensed, including all
pertinent corporate licensee information, if applicable, or other ownership, principal, key
personnel, and facilities information found to be necessary by the board;
deleted text end

deleted text begin (7) written policies and procedures that assure reasonable wholesale drug distributor
preparation for, protection against, and handling of any facility security or operation
problems, including, but not limited to, those caused by natural disaster or government
emergency, inventory inaccuracies or product shipping and receiving, outdated product or
other unauthorized product control, appropriate disposition of returned goods, and product
recalls;
deleted text end

deleted text begin (8) sufficient inspection procedures for all incoming and outgoing product shipments;
and
deleted text end

deleted text begin (9) operations in compliance with all federal requirements applicable to wholesale drug
distribution.
deleted text end

deleted text begin (i) An agent or employee of any licensed wholesale drug distributor need not seek
licensure under this section.
deleted text end

Sec. 47.

Minnesota Statutes 2018, section 151.47, is amended by adding a subdivision to
read:


new text begin Subd. 1a. new text end

new text begin Licensing. new text end

new text begin (a) The board shall license wholesale distributors in a manner that
is consistent with United States Code, title 21, section 360eee-2, and the regulations
promulgated thereunder. In the event that the provisions of this section, or of the rules of
the board, conflict with the provisions of United States Code, title 21, section 360eee-2, or
the rules promulgated thereunder, the federal provisions shall prevail. The board shall not
license a person as a wholesale distributor unless the person is engaged in wholesale
distribution.
new text end

new text begin (b) No person shall act as a wholesale distributor without first obtaining a license from
the board and paying any applicable fee specified in section 151.065.
new text end

new text begin (c) Application for a wholesale distributor license under this section shall be made in a
manner specified by the board.
new text end

new text begin (d) No license shall be issued or renewed for a wholesale distributor unless the applicant
agrees to operate in a manner prescribed by federal and state law and according to the rules
adopted by the board.
new text end

new text begin (e) No license may be issued or renewed for a wholesale distributor facility that is located
in another state unless the applicant supplies the board with proof of licensure or registration
by the state in which the wholesale distributor is physically located or by the United States
Food and Drug Administration.
new text end

new text begin (f) The board shall require a separate license for each drug wholesale distributor facility
located within the state and for each drug wholesale distributor facility located outside of
the state from which drugs are shipped into the state or to which drugs are reverse distributed.
new text end

new text begin (g) The board shall not issue an initial or renewed license for a drug wholesale distributor
facility unless the facility passes an inspection conducted by an authorized representative
of the board or is inspected and accredited by an accreditation program approved by the
board. In the case of a drug wholesale distributor facility located outside of the state, the
board may require the applicant to pay the cost of the inspection, in addition to the license
fee in section 151.065, unless the applicant furnishes the board with a report, issued by the
appropriate regulatory agency of the state in which the facility is located, of an inspection
that has occurred within the 24 months immediately preceding receipt of the license
application by the board, or furnishes the board with proof of current accreditation. The
board may deny licensure unless the applicant submits documentation satisfactory to the
board that any deficiencies noted in an inspection report have been corrected.
new text end

new text begin (h) As a condition for receiving and retaining a wholesale drug distributor license issued
under this section, an applicant shall satisfy the board that it:
new text end

new text begin (1) has adequate storage conditions and facilities to allow for the safe receipt, storage,
handling, and sale of drugs;
new text end

new text begin (2) has minimum liability and other insurance as may be required under any applicable
federal or state law;
new text end

new text begin (3) has a functioning security system that includes an after-hours central alarm or
comparable entry detection capability, and security policies and procedures that include
provisions for restricted access to the premises, comprehensive employee applicant screening,
and safeguards against all forms of employee theft;
new text end

new text begin (4) will maintain appropriate records of the distribution of drugs, which shall be kept
for a minimum of two years and be made available to the board upon request;
new text end

new text begin (5) employs principals and other persons, including officers, directors, primary
shareholders, and key management executives, who will at all times demonstrate and maintain
their capability of conducting business in conformity with state and federal law, at least one
of whom will serve as the primary designated representative for each licensed facility and
who will be responsible for ensuring that the facility operates in a manner consistent with
state and federal law;
new text end

new text begin (6) will ensure that all personnel have sufficient education, training, and experience, in
any combination, so that they may perform assigned duties in a manner that maintains the
quality, safety, and security of drugs;
new text end

new text begin (7) will provide the board with updated information about each wholesale distributor
facility to be licensed, as requested by the board;
new text end

new text begin (8) will develop and, as necessary, update written policies and procedures that assure
reasonable wholesale drug distributor preparation for, protection against, and handling of
any facility security or operation problems, including but not limited to those caused by
natural disaster or government emergency, inventory inaccuracies or drug shipping and
receiving, outdated drugs, appropriate handling of returned goods, and drug recalls;
new text end

new text begin (9) will have sufficient policies and procedures in place for the inspection of all incoming
and outgoing drug shipments;
new text end

new text begin (10) will operate in compliance with all state and federal requirements applicable to
wholesale drug distribution; and
new text end

new text begin (11) will meet the requirements for inspections found in this subdivision.
new text end

new text begin (i) An agent or employee of any licensed wholesale drug distributor need not seek
licensure under this section. Paragraphs (i) to (p) apply to wholesaler personnel.
new text end

new text begin (j) The board is authorized to and shall require fingerprint-based criminal background
checks of facility managers or designated representatives, as required under United States
Code, title 21, section 360eee-2. The criminal background checks shall be conducted as
provided in section 214.075. The board shall use the criminal background check data received
to evaluate the qualifications of persons for ownership of or employment by a licensed
wholesaler and shall not disseminate this data except as allowed by law.
new text end

new text begin (k) A licensed wholesaler shall not be owned by, or employ, a person who has:
new text end

new text begin (1) been convicted of any felony for conduct relating to wholesale distribution, any
felony violation of United States Code, title 21, section 331, subsections (i) or (k), or any
felony violation of United States Code, title 18, section 1365, relating to product tampering;
or
new text end

new text begin (2) engaged in a pattern of violating the requirements of United States Code, title 21,
section 360eee-2, or the regulations promulgated thereunder, or state requirements for
licensure, that presents a threat of serious adverse health consequences or death to humans.
new text end

new text begin (l) An applicant for the issuance or renewal of a wholesale distributor license shall
execute and file with the board a surety bond.
new text end

new text begin (m) Prior to issuing or renewing a wholesale distributor license, the board shall require
an applicant that is not a government owned and operated wholesale distributor to submit
a surety bond of $100,000, except that if the annual gross receipts of the applicant for the
previous tax year is $10,000,000 or less, a surety bond of $25,000 shall be required.
new text end

new text begin (n) If a wholesale distributor can provide evidence satisfactory to the board that it
possesses the required bond in another state, the requirement for a bond shall be waived.
new text end

new text begin (o) The purpose of the surety bond required under this subdivision is to secure payment
of any civil penalty imposed by the board pursuant to section 151.071, subdivision 1. The
board may make a claim against the bond if the licensee fails to pay a civil penalty within
30 days after the order imposing the fine or costs become final.
new text end

new text begin (p) A single surety bond shall satisfy the requirement for the submission of a bond for
all licensed wholesale distributor facilities under common ownership.
new text end

Sec. 48.

new text begin [151.471] THIRD-PARTY LOGISTICS PROVIDER REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Generally. new text end

new text begin Each third-party logistics provider shall comply with the
requirements set forth in United States Code, title 21, section 360eee to 360eee-4, that are
applicable to third-party logistics providers.
new text end

new text begin Subd. 2. new text end

new text begin Licensing. new text end

new text begin (a) The board shall license third-party logistics providers in a manner
that is consistent with United States Code, title 21, section 360eee-3, and the regulations
promulgated thereunder. In the event that the provisions of this section or of the rules of
the board conflict with the provisions of United States Code, title 21, section 360eee-3, or
the rules promulgated thereunder, the federal provisions shall prevail. The board shall not
license a person as a third-party logistics provider unless the person is operating as such.
new text end

new text begin (b) No person shall act as a third-party logistics provider without first obtaining a license
from the board and paying any applicable fee specified in section 151.065.
new text end

new text begin (c) Application for a third-party logistics provider license under this section shall be
made in a manner specified by the board.
new text end

new text begin (d) No license shall be issued or renewed for a third-party logistics provider unless the
applicant agrees to operate in a manner prescribed by federal and state law and according
to the rules adopted by the board.
new text end

new text begin (e) No license may be issued or renewed for a third-party logistics provider facility that
is located in another state unless the applicant supplies the board with proof of licensure or
registration by the state in which the third-party logistics provider facility is physically
located or by the United States Food and Drug Administration.
new text end

new text begin (f) The board shall require a separate license for each third-party logistics provider
facility located within the state and for each third-party logistics provider facility located
outside of the state from which drugs are shipped into the state or to which drugs are reverse
distributed.
new text end

new text begin (g) The board shall not issue an initial or renewed license for a third-party logistics
provider facility unless the facility passes an inspection conducted by an authorized
representative of the board or is inspected and accredited by an accreditation program
approved by the board. In the case of a third-party logistics provider facility located outside
of the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board, or furnishes the board with proof of current accreditation.
The board may deny licensure unless the applicant submits documentation satisfactory to
the board that any deficiencies noted in an inspection report have been corrected.
new text end

new text begin (h) As a condition for receiving and retaining a third-party logistics provider facility
license issued under this section, an applicant shall satisfy the board that it:
new text end

new text begin (1) has adequate storage conditions and facilities to allow for the safe receipt, storage,
handling, and transfer of drugs;
new text end

new text begin (2) has minimum liability and other insurance as may be required under any applicable
federal or state law;
new text end

new text begin (3) has a functioning security system that includes an after-hours central alarm or
comparable entry detection capability, and security policies and procedures that include
provisions for restricted access to the premises, comprehensive employee applicant screening,
and safeguards against all forms of employee theft;
new text end

new text begin (4) will maintain appropriate records of the handling of drugs, which shall be kept for
a minimum of two years and be made available to the board upon request;
new text end

new text begin (5) employs principals and other persons, including officers, directors, primary
shareholders, and key management executives, who will at all times demonstrate and maintain
their capability of conducting business in conformity with state and federal law, at least one
of whom will serve as the primary designated representative for each licensed facility and
who will be responsible for ensuring that the facility operates in a manner consistent with
state and federal law;
new text end

new text begin (6) will ensure that all personnel have sufficient education, training, and experience, in
any combination, so that they may perform assigned duties in a manner that maintains the
quality, safety, and security of drugs;
new text end

new text begin (7) will provide the board with updated information about each third-party logistics
provider facility to be licensed by the board;
new text end

new text begin (8) will develop and, as necessary, update written policies and procedures that ensure
reasonable preparation for, protection against, and handling of any facility security or
operation problems, including, but not limited to, those caused by natural disaster or
government emergency, inventory inaccuracies or drug shipping and receiving, outdated
drug, appropriate handling of returned goods, and drug recalls;
new text end

new text begin (9) will have sufficient policies and procedures in place for the inspection of all incoming
and outgoing drug shipments;
new text end

new text begin (10) will operate in compliance with all state and federal requirements applicable to
third-party logistics providers; and
new text end

new text begin (11) will meet the requirements for inspections found in this subdivision.
new text end

new text begin (i) An agent or employee of any licensed third-party logistics provider need not seek
licensure under this section. Paragraphs (j) and (k) apply to third-party logistics provider
personnel.
new text end

new text begin (j) The board is authorized to and shall require fingerprint-based criminal background
checks of facility managers or designated representatives. The criminal background checks
shall be conducted as provided in section 214.075. The board shall use the criminal
background check data received to evaluate the qualifications of persons for ownership of
or employment by a licensed third-party logistics provider and shall not disseminate this
data except as allowed by law.
new text end

new text begin (k) A licensed third-party logistics provider shall not have as a facility manager or
designated representative any person who has been convicted of any felony for conduct
relating to wholesale distribution, any felony violation of United States Code, title 21, section
331, subsection (i) or (k), or any felony violation of United States Code, title 18, section
1365, relating to product tampering.
new text end

Sec. 49.

Minnesota Statutes 2018, section 152.126, subdivision 6, is amended to read:


Subd. 6.

Access to reporting system data.

(a) Except as indicated in this subdivision,
the data submitted to the board under subdivision 4 is private data on individuals as defined
in section 13.02, subdivision 12, and not subject to public disclosure.

(b) Except as specified in subdivision 5, the following persons shall be considered
permissible users and may access the data submitted under subdivision 4 in the same or
similar manner, and for the same or similar purposes, as those persons who are authorized
to access similar private data on individuals under federal and state law:

(1) a prescriber or an agent or employee of the prescriber to whom the prescriber has
delegated the task of accessing the data, to the extent the information relates specifically to
a current patient, to whom the prescriber is:

(i) prescribing or considering prescribing any controlled substance;

(ii) providing emergency medical treatment for which access to the data may be necessary;

(iii) providing care, and the prescriber has reason to believe, based on clinically valid
indications, that the patient is potentially abusing a controlled substance; or

(iv) providing other medical treatment for which access to the data may be necessary
for a clinically valid purpose and the patient has consented to access to the submitted data,
and with the provision that the prescriber remains responsible for the use or misuse of data
accessed by a delegated agent or employee;

(2) a dispenser or an agent or employee of the dispenser to whom the dispenser has
delegated the task of accessing the data, to the extent the information relates specifically to
a current patient to whom that dispenser is dispensing or considering dispensing any
controlled substance and with the provision that the dispenser remains responsible for the
use or misuse of data accessed by a delegated agent or employee;

(3) a licensed pharmacist who is providing pharmaceutical care for which access to the
data may be necessary to the extent that the information relates specifically to a current
patient for whom the pharmacist is providing pharmaceutical care: (i) if the patient has
consented to access to the submitted data; or (ii) if the pharmacist is consulted by a prescriber
who is requesting data in accordance with clause (1);

(4) an individual who is the recipient of a controlled substance prescription for which
data was submitted under subdivision 4, or a guardian of the individual, parent or guardian
of a minor, or health care agent of the individual acting under a health care directive under
chapter 145C;

(5) personnel or designees of a health-related licensing board listed in section 214.01,
subdivision 2
, or of the Emergency Medical Services Regulatory Board, assigned to conduct
a bona fide investigation of a complaint received by that board that alleges that a specific
licensee is impaired by use of a drug for which data is collected under subdivision 4, has
engaged in activity that would constitute a crime as defined in section 152.025, or has
engaged in the behavior specified in subdivision 5, paragraph (a);

(6) personnel of the board engaged in the collection, review, and analysis of controlled
substance prescription information as part of the assigned duties and responsibilities under
this section;

(7) authorized personnel of a vendor under contract with the state of Minnesota who are
engaged in the design, implementation, operation, and maintenance of the prescription
monitoring program as part of the assigned duties and responsibilities of their employment,
provided that access to data is limited to the minimum amount necessary to carry out such
duties and responsibilities, and subject to the requirement of de-identification and time limit
on retention of data specified in subdivision 5, paragraphs (d) and (e);

(8) federal, state, and local law enforcement authorities acting pursuant to a valid search
warrant;

(9) personnel of the Minnesota health care programs assigned to use the data collected
under this section to identify and manage recipients whose usage of controlled substances
may warrant restriction to a single primary care provider, a single outpatient pharmacy, and
a single hospital;

(10) personnel of the Department of Human Services assigned to access the data pursuant
to paragraph (i);

(11) personnel of the health professionals services program established under section
214.31, to the extent that the information relates specifically to an individual who is currently
enrolled in and being monitored by the program, and the individual consents to access to
that information. The health professionals services program personnel shall not provide this
data to a health-related licensing board or the Emergency Medical Services Regulatory
Board, except as permitted under section 214.33, subdivision 3.

For purposes of clause (4), access by an individual includes persons in the definition of
an individual under section 13.02; and

(12) personnel or designees of a health-related licensing board listed in section 214.01,
subdivision 2
, assigned to conduct a bona fide investigation of a complaint received by that
board that alleges that a specific licensee is inappropriately prescribing controlled substances
as defined in this section.

(c) By July 1, 2017, every prescriber licensed by a health-related licensing board listed
in section 214.01, subdivision 2, practicing within this state who is authorized to prescribe
controlled substances for humans and who holds a current registration issued by the federal
Drug Enforcement Administration, and every pharmacist licensed by the board and practicing
within the state, shall register and maintain a user account with the prescription monitoring
program. Data submitted by a prescriber, pharmacist, or their delegate during the registration
application process, other than their name, license number, and license type, is classified
as private pursuant to section 13.02, subdivision 12.

(d) Only permissible users identified in paragraph (b), clauses (1), (2), (3), (6), (7), (9),
and (10), may directly access the data electronically. No other permissible users may directly
access the data electronically. If the data is directly accessed electronically, the permissible
user shall implement and maintain a comprehensive information security program that
contains administrative, technical, and physical safeguards that are appropriate to the user's
size and complexity, and the sensitivity of the personal information obtained. The permissible
user shall identify reasonably foreseeable internal and external risks to the security,
confidentiality, and integrity of personal information that could result in the unauthorized
disclosure, misuse, or other compromise of the information and assess the sufficiency of
any safeguards in place to control the risks.

(e) The board shall not release data submitted under subdivision 4 unless it is provided
with evidence, satisfactory to the board, that the person requesting the information is entitled
to receive the data.

(f) The board shall maintain a log of all persons who access the data for a period of at
least three years and shall ensure that any permissible user complies with paragraph deleted text begin(c)deleted text endnew text begin (d)new text end
prior to attaining direct access to the data.

(g) Section 13.05, subdivision 6, shall apply to any contract the board enters into pursuant
to subdivision 2. A vendor shall not use data collected under this section for any purpose
not specified in this section.

(h) The board may participate in an interstate prescription monitoring program data
exchange system provided that permissible users in other states have access to the data only
as allowed under this section, and that section 13.05, subdivision 6, applies to any contract
or memorandum of understanding that the board enters into under this paragraph.

(i) With available appropriations, the commissioner of human services shall establish
and implement a system through which the Department of Human Services shall routinely
access the data for the purpose of determining whether any client enrolled in an opioid
treatment program licensed according to chapter 245A has been prescribed or dispensed a
controlled substance in addition to that administered or dispensed by the opioid treatment
program. When the commissioner determines there have been multiple prescribers or multiple
prescriptions of controlled substances, the commissioner shall:

(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and

(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.

If determined necessary, the commissioner of human services shall seek a federal waiver
of, or exception to, any applicable provision of Code of Federal Regulations, title 42, section
2.34, paragraph (c), prior to implementing this paragraph.

(j) The board shall review the data submitted under subdivision 4 on at least a quarterly
basis and shall establish criteria, in consultation with the advisory task force, for referring
information about a patient to prescribers and dispensers who prescribed or dispensed the
prescriptions in question if the criteria are met.

new text begin (k) The board shall conduct random audits, on at least a quarterly basis, of electronic
access by permissible users, as identified in paragraph (b), clauses (1), (2), (3), (6), (7), (9),
and (10), to the data in subdivision 4, to ensure compliance with permissible use as defined
in this section. A permissible user whose account has been selected for a random audit shall
respond to an inquiry by the board, no later than 30 days after receipt of notice that an audit
is being conducted. Failure to respond may result in deactivation of access to the electronic
system and referral to the appropriate health licensing board, or the commissioner of human
services, for further action. The board shall report the results of random audits to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finance and government data practices.
new text end

new text begin (l) A permissible user who has delegated the task of accessing the data in subdivision 4
to an agent or employee shall audit the use of the electronic system by delegated agents or
employees on at least a quarterly basis to ensure compliance with permissible use as defined
in this section. When a delegated agent or employee has been identified as inappropriately
accessing data, the permissible user must immediately remove access for that individual
and notify the board within seven days. The board shall notify all permissible users associated
with the delegated agent or employee of the alleged violation.
new text end

new text begin (m) A permissible user who delegates access to the data submitted under subdivision 4
to an agent or employee shall terminate that individual's access to the data within three
business days of the agent or employee leaving employment with the permissible user. The
board may conduct random audits to determine compliance with this requirement.
new text end

Sec. 50.

Minnesota Statutes 2018, section 152.126, subdivision 7, is amended to read:


Subd. 7.

Disciplinary action.

(a) A dispenser who knowingly fails to submit data to the
board as required under this section is subject to disciplinary action by the appropriate
health-related licensing board.

(b) A prescriber or dispenser authorized to access the data who knowingly discloses the
data in violation of state or federal laws relating to the privacy of health care data shall be
subject to disciplinary action by the appropriate health-related licensing board, and
appropriate civil penalties.

new text begin (c) A prescriber or dispenser authorized to access the data who fails to comply with
subdivision 6, paragraph (l) or (m), shall be subject to disciplinary action by the appropriate
health-related licensing board.
new text end

Sec. 51.

Minnesota Statutes 2018, section 152.126, is amended by adding a subdivision
to read:


new text begin Subd. 10a. new text end

new text begin Patient information on record access. new text end

new text begin A patient who has been prescribed
a controlled substance may access the prescription monitoring program database in order
to obtain information on access by permissible users to the patient's data record, including
the name and organizational affiliation of the permissible user and the date of access. In
order to obtain this information, the patient must complete, notarize, and submit a request
form developed by the board. The board shall make this form available to the public on the
board's website.
new text end

Sec. 52. new text beginREVISOR INSTRUCTION.
new text end

new text begin The fee increases in Minnesota Statutes, section 151.065, subdivisions 1 and 3, in this
article are in addition to any other fee increases in Minnesota Statutes, section 151.065,
subdivisions 1 and 3, enacted in 2019 regular or special sessions. If multiple fees are enacted,
the revisor of statutes shall add the fees together for publication in the 2019 Minnesota
Statutes Supplement to effectuate the intent of the legislature.
new text end

Sec. 53. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 151.42; 151.44; 151.49; 151.50; 151.51; and
151.55,
new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Rules, parts 6400.6970; 7200.6100; and 7200.6105, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 11

HEALTH DEPARTMENT

Section 1.

Minnesota Statutes 2018, section 18K.03, is amended to read:


18K.03 AGRICULTURAL CROP; POSSESSION AUTHORIZED.

new text begin Subdivision 1. new text end

new text begin Industrial hemp. new text end

Industrial hemp is an agricultural crop in this state. A
person may possess, transport, process, sell, or buy industrial hemp that is grown pursuant
to this chapter.

new text begin Subd. 2. new text end

new text begin Sale to medical cannabis manufacturers. new text end

new text begin A licensee under this chapter may
sell hemp products derived from industrial hemp grown in this state to medical cannabis
manufacturers as authorized under sections 152.22 to 152.37.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62J.495, subdivision 1, is amended to read:


Subdivision 1.

Implementation.

deleted text beginBy January 1, 2015, all hospitals and health care
providers, as defined in section 62J.03, subdivision 8, must have in place an interoperable
electronic health records system within their hospital system or clinical practice setting.
deleted text end
The commissioner of health, in consultation with the e-Health Advisory Committee, shall
develop deleted text begina statewide plan to meet this goal, includingdeleted text end uniform standards to be used for the
interoperable new text beginelectronic health records new text endsystem for sharing and synchronizing patient data
across systems. The standards must be compatible with federal efforts. The uniform standards
must be developed by January 1, 2009, and updated on an ongoing basis. The commissioner
shall include an update on standards development as part of an annual report to the legislature.
Individual health care providers in private practice with no other providers and health care
providers that do not accept reimbursement from a group purchaser, as defined in section
62J.03, subdivision 6, are excluded from the requirements of this section.

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

Minnesota Statutes 2018, section 62J.495, subdivision 3, is amended to read:


Subd. 3.

Interoperable electronic health record requirements.

(a) deleted text beginTo meet the
requirements of subdivision 1,
deleted text end Hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.

(b) The electronic health record must be a qualified electronic health record.

(c) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and health
care providers if a certified electronic health record product for the provider's particular
practice setting is available. This criterion shall be considered met if a hospital or health
care provider is using an electronic health records system that has been certified within the
last three years, even if a more current version of the system has been certified within the
three-year period.

(d) The electronic health record must meet the standards established according to section
3004 of the HITECH Act as applicable.

(e) The electronic health record must have the ability to generate information on clinical
quality measures and other measures reported under sections 4101, 4102, and 4201 of the
HITECH Act.

(f) The electronic health record system must be connected to a state-certified health
information organization either directly or through a connection facilitated by a state-certified
health data intermediary as defined in section 62J.498.

(g) A health care provider who is a prescriber or dispenser of legend drugs must have
an electronic health record system that meets the requirements of section 62J.497.

new text begin EFFECTIVE DATE. new text end

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

Sec. 4.

Minnesota Statutes 2018, section 103I.005, subdivision 2, is amended to read:


Subd. 2.

Boring.

"Boring" means a hole or excavation that deleted text beginis not used to extract water
and
deleted text end includes exploratory borings, bored geothermal heat exchangers, new text begintemporary borings,
new text end and elevator borings.

Sec. 5.

Minnesota Statutes 2018, section 103I.005, subdivision 8a, is amended to read:


Subd. 8a.

Environmental well.

"Environmental well" means an excavation 15 or more
feet in depth that is drilled, cored, bored, washed, driven, dug, jetted, or otherwise constructed
to:

(1) conduct physical, chemical, or biological testing of groundwater, and includes a
groundwater quality monitoring or sampling well;

(2) lower a groundwater level to control or remove contamination in groundwater, and
includes a remedial well and excludes horizontal trenches; or

(3) monitor or measure physical, chemical, radiological, or biological parameters of the
earth and earth fluids, or for vapor recovery or venting systems. An environmental well
includes an excavation used to:

(i) measure groundwater levels, including a piezometer;

(ii) determine groundwater flow direction or velocity;

(iii) measure earth properties such as hydraulic conductivity, bearing capacity, or
resistance;

(iv) obtain samples of geologic materials for testing or classification; or

(v) remove or remediate pollution or contamination from groundwater or soil through
the use of a vent, vapor recovery system, or sparge point.

new text begin An environmental well does not include an exploratory boring.
new text end

Sec. 6.

Minnesota Statutes 2018, section 103I.005, subdivision 17a, is amended to read:


Subd. 17a.

Temporary deleted text beginenvironmental welldeleted text endnew text begin boringnew text end.

deleted text begin "Temporary environmental well"
means an environmental well as defined in section 103I.005, subdivision 8a, that is sealed
within 72 hours of the time construction on the well begins.
deleted text end new text begin "Temporary boring" means an
excavation that is 15 feet or more in depth, is sealed within 72 hours of the time of
construction, and is drilled, cored, washed, driven, dug, jetted, or otherwise constructed to:
new text end

new text begin (1) conduct physical, chemical, or biological testing of groundwater, including
groundwater quality monitoring;
new text end

new text begin (2) monitor or measure physical, chemical, radiological, or biological parameters of
earth materials or earth fluids, including hydraulic conductivity, bearing capacity, or
resistance;
new text end

new text begin (3) measure groundwater levels, including use of a piezometer; and
new text end

new text begin (4) determine groundwater flow direction or velocity.
new text end

Sec. 7.

Minnesota Statutes 2018, section 103I.205, subdivision 1, is amended to read:


Subdivision 1.

Notification required.

(a) Except as provided in paragraph (d), a person
may not construct a water-supply, dewatering, or environmental well until a notification of
the proposed well on a form prescribed by the commissioner is filed with the commissioner
with the filing fee in section 103I.208, and, when applicable, the person has met the
requirements of paragraph (e). If after filing the well notification an attempt to construct a
well is unsuccessful, a new notification is not required unless the information relating to
the successful well has substantially changed. A notification is not required prior to
construction of a temporary deleted text beginenvironmental welldeleted text endnew text begin boringnew text end.

(b) The property owner, the property owner's agent, or the licensed contractor where a
well is to be located must file the well notification with the commissioner.

(c) The well notification under this subdivision preempts local permits and notifications,
and counties or home rule charter or statutory cities may not require a permit or notification
for wells unless the commissioner has delegated the permitting or notification authority
under section 103I.111.

(d) A person who is an individual that constructs a drive point water-supply well on
property owned or leased by the individual for farming or agricultural purposes or as the
individual's place of abode must notify the commissioner of the installation and location of
the well. The person must complete the notification form prescribed by the commissioner
and mail it to the commissioner by ten days after the well is completed. A fee may not be
charged for the notification. A person who sells drive point wells at retail must provide
buyers with notification forms and informational materials including requirements regarding
wells, their location, construction, and disclosure. The commissioner must provide the
notification forms and informational materials to the sellers.

(e) When the operation of a well will require an appropriation permit from the
commissioner of natural resources, a person may not begin construction of the well until
the person submits the following information to the commissioner of natural resources:

(1) the location of the well;

(2) the formation or aquifer that will serve as the water source;

(3) the maximum daily, seasonal, and annual pumpage rates and volumes that will be
requested in the appropriation permit; and

(4) other information requested by the commissioner of natural resources that is necessary
to conduct the preliminary assessment required under section 103G.287, subdivision 1,
paragraph (c).

The person may begin construction after receiving preliminary approval from the
commissioner of natural resources.

Sec. 8.

Minnesota Statutes 2018, section 103I.205, subdivision 4, is amended to read:


Subd. 4.

License required.

(a) Except as provided in paragraph (b), (c), (d), or (e),
section 103I.401, subdivision 2, or 103I.601, subdivision 2, a person may not drill, construct,
repair, or seal a well or boring unless the person has a well contractor's license in possession.

(b) A person may construct, repair, and seal an environmental well new text beginor temporary boring
new text end if the person:

(1) is a professional engineer licensed under sections 326.02 to 326.15 in the branches
of civil or geological engineering;

(2) is a hydrologist or hydrogeologist certified by the American Institute of Hydrology;

(3) is a professional geoscientist licensed under sections 326.02 to 326.15;

(4) is a geologist certified by the American Institute of Professional Geologists; or

(5) meets the qualifications established by the commissioner in rule.

A person must be licensed by the commissioner as an environmental well contractor on
forms provided by the commissioner.

(c) A person may do the following work with a limited well/boring contractor's license
in possession. A separate license is required for each of the four activities:

(1) installing, repairing, and modifying well screens, pitless units and pitless adaptors,
well pumps and pumping equipment, and well casings from the pitless adaptor or pitless
unit to the upper termination of the well casing;

(2) sealing wells and borings;

(3) constructing, repairing, and sealing dewatering wells; or

(4) constructing, repairing, and sealing bored geothermal heat exchangers.

(d) A person may construct, repair, and seal an elevator boring with an elevator boring
contractor's license.

(e) Notwithstanding other provisions of this chapter requiring a license, a license is not
required for a person who complies with the other provisions of this chapter if the person
is:

(1) an individual who constructs a water-supply well on land that is owned or leased by
the individual and is used by the individual for farming or agricultural purposes or as the
individual's place of abode;new text begin or
new text end

(2) an individual who performs labor or services for a contractor licensed under the
provisions of this chapter in connection with the construction, sealing, or repair of a well
or boring at the direction and under the personal supervision of a contractor licensed under
the provisions of this chapterdeleted text begin; ordeleted text endnew text begin.
new text end

deleted text begin (3) a licensed plumber who is repairing submersible pumps or water pipes associated
deleted text end deleted text begin with well water systems if: (i) the repair location is within an area where there is no licensed
deleted text end deleted text begin well contractor within 50 miles, and (ii) the licensed plumber complies with all relevant
deleted text end deleted text begin sections of the plumbing code.
deleted text end

Sec. 9.

Minnesota Statutes 2018, section 103I.205, subdivision 9, is amended to read:


Subd. 9.

Report of work.

Within deleted text begin30deleted text endnew text begin 60new text end days after completion or sealing of a well or
boring, the person doing the work must submit a verified report to the commissioner
containing the information specified by rules adopted under this chapter.

Within 30 days after receiving the report, the commissioner shall send or otherwise
provide access to a copy of the report to the commissioner of natural resources, to the local
soil and water conservation district where the well is located, and to the director of the
Minnesota Geological Survey.

Sec. 10.

Minnesota Statutes 2018, section 103I.208, subdivision 1, is amended to read:


Subdivision 1.

Well notification fee.

The well notification fee to be paid by a property
owner is:

(1) for construction of a water supply well, $275, which includes the state core function
fee;

(2) for a well sealing, $75 for each wellnew text begin or temporary boringnew text end, which includes the state
core function fee, except thatnew text begin: (i)new text end a single new text beginnotification and new text endfee of $75 is required for all
temporary deleted text beginenvironmental wells recorded on the sealing notification fordeleted text end new text beginborings on new text enda single
propertydeleted text begin, having depths within a 25 foot range,deleted text end and sealed within 72 hours of start of
constructionnew text begin; and (ii) temporary borings less than 25 feet in depth are exempt from the
notification and fee requirements in this chapter
new text end;

(3) for construction of a dewatering well, $275, which includes the state core function
fee, for each dewatering well except a dewatering project comprising five or more dewatering
wells shall be assessed a single fee of $1,375 for the dewatering wells recorded on the
notification; and

(4) for construction of an environmental well, $275, which includes the state core function
fee, except that a single fee of $275 is required for all environmental wells recorded on the
notification that are located on a single property, and except that no fee is required for
construction of a temporary deleted text beginenvironmental welldeleted text endnew text begin boringnew text end.

Sec. 11.

Minnesota Statutes 2018, section 103I.235, subdivision 3, is amended to read:


Subd. 3.

Temporary deleted text beginenvironmental welldeleted text endnew text begin boringnew text end and unsuccessful well exemption.

This
section does not apply to temporary deleted text beginenvironmental wellsdeleted text endnew text begin boringsnew text end or unsuccessful wells that
have been sealed by a licensed contractor in compliance with this chapter.

Sec. 12.

Minnesota Statutes 2018, section 103I.301, is amended by adding a subdivision
to read:


new text begin Subd. 3a. new text end

new text begin Temporary boring. new text end

new text begin (a) The owner of the property where a temporary boring
is located must have the temporary boring sealed within 72 hours after the start of
construction of the temporary boring.
new text end

new text begin (b) The owner must have a well contractor, a limited well/boring sealing contractor, or
an environmental well contractor seal the temporary boring.
new text end

Sec. 13.

Minnesota Statutes 2018, section 103I.301, subdivision 6, is amended to read:


Subd. 6.

Notification required.

A person may not seal a well new text beginor temporary boring new text enduntil
a notification of the proposed sealing is filed as prescribed by the commissioner.new text begin A single
notification is required for all temporary borings sealed on a single property. Temporary
borings less than 25 feet in depth are exempt from the notification requirements in this
chapter.
new text end

Sec. 14.

Minnesota Statutes 2018, section 103I.601, subdivision 4, is amended to read:


Subd. 4.

Notification and map of borings.

(a) By ten days before beginning exploratory
boring, an explorer must submit to the commissioner of health a notification of the proposed
boring deleted text beginon a form prescribed by the commissioner,deleted text endnew text begin mapnew text end and a fee of $275 deleted text beginfor each exploratory
boring
deleted text end.

(b) By ten days before beginning exploratory boring, an explorer must submit to the
commissioners of health and natural resources a county road map new text beginon a single sheet of paper
that is 8-1/2 by 11 inches in size and
new text end having a scale of one-half inch equal to one mile, as
prepared by the Department of Transportation, or a 7.5 minute series topographic map
(1:24,000 scale), as prepared by the United States Geological Survey, showing the location
of each proposed exploratory boring to the nearest estimated 40 acre parcel. Exploratory
boring that is proposed on the map may not be commenced later than 180 days after
submission of the map, unless a new map is submitted.

Sec. 15.

Minnesota Statutes 2018, section 144.121, subdivision 1a, is amended to read:


Subd. 1a.

Fees for ionizing radiation-producing equipment.

(a) A facility with ionizing
radiation-producing equipment must pay an annual initial or annual renewal registration
fee consisting of a base facility fee of $100 and an additional fee for each radiation source,
as follows:

(1)
medical or veterinary equipment
$
100
(2)
dental x-ray equipment
$
40
(3)
x-ray equipment not used on
humans or animals
$
100
(4)
devices with sources of ionizing
radiation not used on humans or
animals
$
100
new text begin (5)
new text end
new text begin security screening system
new text end
new text begin $
new text end
new text begin 100
new text end

(b) A facility with radiation therapy and accelerator equipment must pay an annual
registration fee of $500. A facility with an industrial accelerator must pay an annual
registration fee of $150.

(c) Electron microscopy equipment is exempt from the registration fee requirements of
this section.

new text begin (d) For purposes of this section, a security screening system means radiation-producing
equipment designed and used for security screening of humans who are in the custody of a
correctional or detention facility, and used by the facility to image and identify contraband
items concealed within or on all sides of a human body. For purposes of this section, a
correctional or detention facility is a facility licensed under section 241.021 and operated
by a state agency or political subdivision charged with detection, enforcement, or
incarceration in respect to state criminal and traffic laws.
new text end

Sec. 16.

Minnesota Statutes 2018, section 144.121, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Exemption from examination requirements; operators of security screening
systems.
new text end

new text begin (a) An employee of a correctional or detention facility who operates a security
screening system and the facility in which the system is being operated are exempt from
the requirements of subdivisions 5 and 6.
new text end

new text begin (b) An employee of a correctional or detention facility who operates a security screening
system and the facility in which the system is being operated must meet the requirements
of a variance to Minnesota Rules, parts 4732.0305 and 4732.0565, issued under Minnesota
Rules, parts 4717.7000 to 4717.7050. This paragraph expires on December 31 of the year
that the permanent rules adopted by the commissioner governing security screening systems
are published in the State Register.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 17.

Minnesota Statutes 2018, section 144.1506, subdivision 2, is amended to read:


Subd. 2.

Expansion grant program.

(a) The commissioner of health shall award primary
care residency expansion grants to eligible primary care residency programs to plan and
implement new residency slots. A planning grant shall not exceed $75,000, and a training
grant shall not exceed $150,000 per new residency slot for the first year, $100,000 for the
second year, and $50,000 for the third year of the new residency slot.new text begin For eligible residency
programs longer than three years, training grants may be awarded for the duration of the
residency, not exceeding an average of $100,000 per residency slot per year.
new text end

(b) Funds may be spent to cover the costs of:

(1) planning related to establishing an accredited primary care residency program;

(2) obtaining accreditation by the Accreditation Council for Graduate Medical Education
or another national body that accredits residency programs;

(3) establishing new residency programs or new resident training slots;

(4) recruitment, training, and retention of new residents and faculty;

(5) travel and lodging for new residents;

(6) faculty, new resident, and preceptor salaries related to new residency slots;

(7) training site improvements, fees, equipment, and supplies required for new primary
care resident training slots; and

(8) supporting clinical education in which trainees are part of a primary care team model.

Sec. 18.

Minnesota Statutes 2018, section 144.225, subdivision 2, is amended to read:


Subd. 2.

Data about births.

(a) Except as otherwise provided in this subdivision, data
pertaining to the birth of a child to a woman who was not married to the child's father when
the child was conceived nor when the child was born, including the original record of birth
and the certified vital record, are confidential data. At the time of the birth of a child to a
woman who was not married to the child's father when the child was conceived nor when
the child was born, the mother may designate demographic data pertaining to the birth as
public. Notwithstanding the designation of the data as confidential, it may be disclosed:

(1) to a parent or guardian of the child;

(2) to the child when the child is 16 years of age or older;

(3) under paragraph (b) deleted text beginordeleted text endnew text begin,new text end (e)new text begin, or (f)new text end; or

(4) pursuant to a court order. For purposes of this section, a subpoena does not constitute
a court order.

(b) Unless the child is adopted, data pertaining to the birth of a child that are not accessible
to the public become public data if 100 years have elapsed since the birth of the child who
is the subject of the data, or as provided under section 13.10, whichever occurs first.

(c) If a child is adopted, data pertaining to the child's birth are governed by the provisions
relating to adoption records, including sections 13.10, subdivision 5; 144.218, subdivision
1
; 144.2252; and 259.89.

(d) The name and address of a mother under paragraph (a) and the child's date of birth
may be disclosed to the county social servicesnew text begin, tribal health department,new text end or public health
member of a family services collaborative for purposes of providing services under section
124D.23.

(e) The commissioner of human services shall have access to birth records for:

(1) the purposes of administering medical assistance and the MinnesotaCare program;

(2) child support enforcement purposes; and

(3) other public health purposes as determined by the commissioner of health.

new text begin (f) Tribal child support programs shall have access to birth records for child support
enforcement purposes.
new text end

Sec. 19.

Minnesota Statutes 2018, section 144.225, subdivision 2a, is amended to read:


Subd. 2a.

Health data associated with birth registration.

Information from which an
identification of risk for disease, disability, or developmental delay in a mother or child can
be made, that is collected in conjunction with birth registration or fetal death reporting, is
private data as defined in section 13.02, subdivision 12. The commissioner may disclose to
a new text begintribal health department or new text endcommunity health board, as defined in section 145A.02,
subdivision 5
, health data associated with birth registration which identifies a mother or
child at high risk for serious disease, disability, or developmental delay in order to assure
access to appropriate health, social, or educational services. Notwithstanding the designation
of the private data, the commissioner of human services shall have access to health data
associated with birth registration for:

(1) purposes of administering medical assistance and the MinnesotaCare program; and

(2) for other public health purposes as determined by the commissioner of health.

Sec. 20.

Minnesota Statutes 2018, section 144.225, subdivision 7, is amended to read:


Subd. 7.

Certified birth or death record.

(a) The state registrar or local issuance office
shall issue a certified birth or death record or a statement of no vital record found to an
individual upon the individual's proper completion of an attestation provided by the
commissioner and payment of the required fee:

(1) to a person who has a tangible interest in the requested vital record. A person who
has a tangible interest is:

(i) the subject of the vital record;

(ii) a child of the subject;

(iii) the spouse of the subject;

(iv) a parent of the subject;

(v) the grandparent or grandchild of the subject;

(vi) if the requested record is a death record, a sibling of the subject;

(vii) the party responsible for filing the vital record;

(viii) the legal custodian, guardian or conservator, or health care agent of the subject;

(ix) a personal representative, by sworn affidavit of the fact that the certified copy is
required for administration of the estate;

(x) a successor of the subject, as defined in section 524.1-201, if the subject is deceased,
by sworn affidavit of the fact that the certified copy is required for administration of the
estate;

(xi) if the requested record is a death record, a trustee of a trust by sworn affidavit of
the fact that the certified copy is needed for the proper administration of the trust;

(xii) a person or entity who demonstrates that a certified vital record is necessary for the
determination or protection of a personal or property right, pursuant to rules adopted by the
commissioner; or

(xiii) an adoption agency in order to complete confidential postadoption searches as
required by section 259.83;

(2) to any local, state, new text begintribal, new text endor federal governmental agency upon request if the certified
vital record is necessary for the governmental agency to perform its authorized duties;

(3) to an attorney upon evidence of the attorney's license;

(4) pursuant to a court order issued by a court of competent jurisdiction. For purposes
of this section, a subpoena does not constitute a court order; or

(5) to a representative authorized by a person under clauses (1) to (4).

(b) The state registrar or local issuance office shall also issue a certified death record to
an individual described in paragraph (a), clause (1), items (ii) to (viii), if, on behalf of the
individual, a licensed mortician furnishes the registrar with a properly completed attestation
in the form provided by the commissioner within 180 days of the time of death of the subject
of the death record. This paragraph is not subject to the requirements specified in Minnesota
Rules, part 4601.2600, subpart 5, item B.

Sec. 21.

Minnesota Statutes 2018, section 144.3831, subdivision 1, is amended to read:


Subdivision 1.

Fee setting.

The commissioner of health may assess an annual fee of
deleted text begin $6.36deleted text endnew text begin $9.72new text end for every service connection to a public water supply that is owned or operated
by a home rule charter city, a statutory city, a city of the first class, or a town. The
commissioner of health may also assess an annual fee for every service connection served
by a water user district defined in section 110A.02.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end

Sec. 22.

new text begin [144.397] STATEWIDE TOBACCO CESSATION SERVICES.
new text end

new text begin (a) The commissioner of health shall administer, or contract for the administration of,
statewide tobacco cessation services to assist Minnesotans who are seeking advice or services
to help them quit using tobacco products. The commissioner shall establish statewide public
awareness activities to inform the public of the availability of the services and encourage
the public to utilize the services because of the dangers and harm of tobacco use and
dependence.
new text end

new text begin (b) Services to be provided may include but are not limited to:
new text end

new text begin (1) telephone-based coaching and counseling;
new text end

new text begin (2) referrals;
new text end

new text begin (3) written materials mailed upon request;
new text end

new text begin (4) web-based texting or e-mail services; and
new text end

new text begin (5) free Food and Drug Administration-approved tobacco cessation medications.
new text end

new text begin (c) Services provided must be consistent with evidence-based best practices in tobacco
cessation services. Services provided must be coordinated with health plan company tobacco
prevention and cessation services that may be available to individuals depending on their
health coverage.
new text end

Sec. 23.

Minnesota Statutes 2018, section 144.412, is amended to read:


144.412 PUBLIC POLICY.

The purpose of sections 144.411 to 144.417 is to protect employees and the general
public from the hazards of secondhand smokenew text begin and involuntary exposure to aerosol or vapor
from electronic delivery devices
new text end by eliminating smoking in public places, places of
employment, public transportation, and at public meetings.

Sec. 24.

Minnesota Statutes 2018, section 144.413, subdivision 1, is amended to read:


Subdivision 1.

Scope.

As used in sections 144.411 to deleted text begin144.416deleted text endnew text begin 144.417new text end, the terms defined
in this section have the meanings given them.

Sec. 25.

Minnesota Statutes 2018, section 144.413, subdivision 4, is amended to read:


Subd. 4.

Smoking.

"Smoking" means inhaling deleted text beginordeleted text endnew text begin,new text end exhaling deleted text beginsmoke fromdeleted text endnew text begin, burning, or
carrying
new text end any lighted new text beginor heated new text endcigar, cigarette, pipe, or any other lighted deleted text begintobacco or plantdeleted text end
new text begin or heated new text endproductnew text begin containing, made, or derived from nicotine, tobacco, marijuana, or other
plant, whether natural or synthetic, that is intended for inhalation
new text end. Smoking deleted text beginalsodeleted text end includes
deleted text begin carrying a lighted cigar, cigarette, pipe, or any other lighted tobacco or plant product intended
for inhalation
deleted text endnew text begin carrying or using an activated electronic delivery device, as defined in section
609.685
new text end.

Sec. 26.

Minnesota Statutes 2018, section 144.414, subdivision 2, is amended to read:


Subd. 2.

Day care premises.

deleted text begin(a)deleted text end Smoking is prohibited in a day care center licensed
under Minnesota Rules, parts 9503.0005 to 9503.0170, or in a family home or in a group
family day care provider home licensed under Minnesota Rules, parts 9502.0300 to
9502.0445, during its hours of operation. The proprietor of a family home or group family
day care provider must disclose to parents or guardians of children cared for on the premises
if the proprietor permits smoking outside of its hours of operation. Disclosure must include
posting on the premises a conspicuous written notice and orally informing parents or
guardians.

deleted text begin (b) For purposes of this subdivision, the definition of smoking includes the use of
electronic cigarettes, including the inhaling and exhaling of vapor from any electronic
delivery device as defined in section 609.685, subdivision 1.
deleted text end

Sec. 27.

Minnesota Statutes 2018, section 144.414, subdivision 3, is amended to read:


Subd. 3.

Health care facilities and clinics.

(a) Smoking is prohibited in any area of a
hospital, health care clinic, doctor's office, licensed residential facility for children, or other
health care-related facility, except that a patient or resident in a nursing home, boarding
care facility, or licensed residential facility for adults may smoke in a designated separate,
enclosed room maintained in accordance with applicable state and federal laws.

(b) Except as provided in section 246.0141, smoking by patients in a locked psychiatric
unit may be allowed in a separated well-ventilated area in the unit under a policy established
by the administrator of the program that allows the treating physician to approve smoking
if, in the opinion of the treating physician, the benefits to be gained in obtaining patient
cooperation with treatment outweigh the negative impacts of smoking.

deleted text begin (c) For purposes of this subdivision, the definition of smoking includes the use of
electronic cigarettes, including the inhaling and exhaling of vapor from any electronic
delivery device as defined in section 609.685, subdivision 1.
deleted text end

Sec. 28.

Minnesota Statutes 2018, section 144.416, is amended to read:


144.416 RESPONSIBILITIES OF PROPRIETORS.

(a) The proprietor or other person, firm, limited liability company, corporation, or other
entity that owns, leases, manages, operates, or otherwise controls the use of a public place,
public transportation, place of employment, or public meeting shall make reasonable efforts
to prevent smoking in the public place, public transportation, place of employment, or public
meeting by:

(1) posting appropriate signs or by any other means which may be appropriate; and

(2) asking any person who smokes in an area where smoking is prohibited to refrain
from smoking and, if the person does not refrain from smoking after being asked to do so,
asking the person to leave. If the person refuses to leave, the proprietor, person, or entity
in charge shall handle the situation consistent with lawful methods for handling other persons
acting in a disorderly manner or as a trespasser.

(b) The proprietor or other person or entity in charge of a public place, public meeting,
public transportation, or place of employment must not provide smoking equipment, including
ashtrays or matches, in areas where smoking is prohibited. Nothing in this section prohibits
the proprietor or other person or entity in charge from taking more stringent measures than
those under sections 144.414 to 144.417 to protect individuals from secondhand smokenew text begin or
from involuntary exposure to aerosol or vapor from electronic delivery devices
new text end. The
proprietor or other person or entity in charge of a restaurant or bar may not serve an individual
who is in violation of sections 144.411 to 144.417.

Sec. 29.

Minnesota Statutes 2018, section 144.4165, is amended to read:


144.4165 TOBACCO PRODUCTS PROHIBITED IN PUBLIC SCHOOLS.

No person shall at any time smoke, chew, or otherwise ingest tobacco or a tobacco
product, or deleted text begininhale or exhale vapor fromdeleted text endnew text begin carry or usenew text end an new text beginactivated new text endelectronic delivery device
as defined in section 609.685, subdivision 1, in a public school, as defined in section 120A.05,
subdivisions 9, 11, and 13
,new text begin or in a charter school governed by chapter 124E,new text end and no person
under the age of 18 shall possess any of these items. This prohibition extends to all facilities,
whether owned, rented, or leased, and all vehicles that a school district owns, leases, rents,
contracts for, or controls. Nothing in this section shall prohibit the lighting of tobacco by
an adult as a part of a traditional Indian spiritual or cultural ceremony. For purposes of this
section, an Indian is a person who is a member of an Indian tribe as defined in section
260.755 subdivision 12.

Sec. 30.

Minnesota Statutes 2018, section 144.4167, subdivision 4, is amended to read:


Subd. 4.

Tobacco products shop.

Sections 144.414 to 144.417 do not prohibit the
lightingnew text begin, heating, or activationnew text end of tobacco in a tobacco products shop by a customer or
potential customer for the specific purpose of sampling tobacco products. For the purposes
of this subdivision, a tobacco products shop is a retail establishment deleted text beginwithdeleted text endnew text begin that hasnew text end an entrance
door opening directly to the outsidenew text begin and new text endthat derives more than 90 percent of its gross revenue
from the sale of deleted text beginloosedeleted text end tobacco, deleted text beginplants, or herbs and cigars, cigarettes, pipes, and other
smoking devices for burning tobacco and related smoking accessories
deleted text endnew text begin tobacco-related
devices, and electronic delivery devices, as defined in section 609.685,
new text end and in which the
sale of other products is merely incidental. "Tobacco products shop" does not include a
tobacco department or section of any individual business establishment with any type of
liquor, food, or restaurant license.

Sec. 31.

Minnesota Statutes 2018, section 144.417, subdivision 4, is amended to read:


Subd. 4.

Local government ordinances.

(a) Nothing in sections 144.414 to 144.417
prohibits a statutory or home rule charter city or county from enacting and enforcing more
stringent measures to protect individuals from secondhand smokenew text begin or from involuntary
exposure to aerosol or vapor from electronic delivery devices
new text end.

(b) Except as provided in sections 144.411 to 144.417, smoking is permitted outside of
restaurants, bars, and bingo halls unless limited or prohibited by restrictions adopted in
accordance with paragraph (a).

Sec. 32.

Minnesota Statutes 2018, section 144.552, is amended to read:


144.552 PUBLIC INTEREST REVIEW.

(a) The following entities must submit a plan to the commissioner:

(1) a hospital seeking to increase its number of licensed beds; or

(2) an organization seeking to obtain a hospital license and notified by the commissioner
under section 144.553, subdivision 1, paragraph (c), that it is subject to this section.

The plan must include information that includes an explanation of how the expansion will
meet the public's interest. When submitting a plan to the commissioner, an applicant shall
pay the commissioner for the commissioner's cost of reviewing and monitoring the plan,
as determined by the commissioner and notwithstanding section 16A.1283. Money received
by the commissioner under this section is appropriated to the commissioner for the purpose
of administering this section. new text beginIf the commissioner does not issue a finding within the time
limit specified in paragraph (c), the commissioner must return to the applicant the entire
amount the applicant paid to the commissioner.
new text endFor a hospital that is seeking an exception
to the moratorium under section 144.551, the plan must be submitted to the commissioner
no later than August 1 of the calendar year prior to the year when the exception will be
considered by the legislature.

(b) Plans submitted under this section shall include detailed information necessary for
the commissioner to review the plan and reach a finding. The commissioner may request
additional information from the hospital submitting a plan under this section and from others
affected by the plan that the commissioner deems necessary to review the plan and make a
finding. If the commissioner determines that additional information is required from the
hospital submitting a plan under this section, the commissioner shall notify the hospital of
the additional information required no more than 30 days after the initial submission of the
plan.new text begin A hospital submitting a plan from whom the commissioner has requested additional
information shall submit the requested additional information within 14 calendar days of
the commissioner's request.
new text end

(c) The commissioner shall review the plan and, within deleted text begin90deleted text endnew text begin 150 calendarnew text end daysdeleted text begin, but no
more than six months if extenuating circumstances apply
deleted text endnew text begin of the date when the commissioner
sends the applicant organization a notice of complete application letter
new text end, issue a finding on
whether the plan is in the public interest.new text begin The commissioner shall provide a copy of the
notice of complete application letter to the chairs and ranking minority members of the
house of representatives and senate committees with jurisdiction over health and human
services policy and finance.
new text end In making the recommendation, the commissioner shall consider
issues including but not limited to:

(1) whether the new hospital or hospital beds are needed to provide timely access to care
or access to new or improved servicesnew text begin given the number of available beds. For the purposes
of this clause, "available beds" means the number of licensed acute care beds that are
immediately available for use or could be brought online within 48 hours without significant
facility modifications
new text end;

(2) the financial impact of the new hospital or hospital beds on existing acute-care
hospitals that have emergency departments in the region;

(3) how the new hospital or hospital beds will affect the ability of existing hospitals in
the region to maintain existing staff;

(4) the extent to which the new hospital or hospital beds will provide services to
nonpaying or low-income patients relative to the level of services provided to these groups
by existing hospitals in the region; and

(5) the views of affected parties.

(d) If the plan is being submitted by an existing hospital seeking authority to construct
a new hospital, the commissioner shall also consider:

(1) the ability of the applicant to maintain the applicant's current level of community
benefit as defined in section 144.699, subdivision 5, at the existing facility; and

(2) the impact on the workforce at the existing facility including the applicant's plan for:

(i) transitioning current workers to the new facility;

(ii) retraining and employment security for current workers; and

(iii) addressing the impact of layoffs at the existing facility on affected workers.

new text begin (e) If the commissioner receives multiple plan submissions under this section within the
same review period, the commissioner shall review the plans in the order they were received.
Time periods under this section shall begin for each review once the commissioner has sent
the applicant organization a notice of complete application letter. The commissioner shall
provide to the chairs and ranking minority members of the house of representatives and
senate committees having jurisdiction over health and human services policy and finance
updates every 30 days on the progress of the review of any plan submitted under this section.
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end Prior to making a recommendation, the commissioner shall conduct a public
hearing in the affected hospital service area to take testimony from interested persons.

deleted text begin (f)deleted text endnew text begin (g)new text end Upon making a recommendation under paragraph (c), the commissioner shall
provide a copy of the recommendation to the chairs of the house of representatives and
senate committees having jurisdiction over health and human services policy and finance.

deleted text begin (g)deleted text endnew text begin (h)new text end If an exception to the moratorium is approved under section 144.551 after a
review under this section, the commissioner shall monitor the implementation of the
exception up to completion of the construction project. Thirty days after completion of the
construction project, the hospital shall submit to the commissioner a report on how the
construction has met the provisions of the plan originally submitted under the public interest
review process or a plan submitted pursuant to section 144.551, subdivision 1, paragraph
(b), clause (20).

Sec. 33.

Minnesota Statutes 2018, section 144.562, subdivision 2, is amended to read:


Subd. 2.

Eligibility for license condition.

(a) A hospital is not eligible to receive a
license condition for swing beds unless (1) it either has a licensed bed capacity of less than
50 beds defined in the federal Medicare regulations, Code of Federal Regulations, title 42,
section 482.66, or it has a licensed bed capacity of 50 beds or more and has swing beds that
were approved for Medicare reimbursement before May 1, 1985, or it has a licensed bed
capacity of less than 65 beds and the available nursing homes within 50 miles have had, in
the aggregate, an average occupancy rate of 96 percent or higher in the most recent two
years as documented on the statistical reports to the Department of Health; and (2) it is
located in a rural area as defined in the federal Medicare regulations, Code of Federal
Regulations, title 42, section 482.66.

(b) Except for those critical access hospitals established under section 144.1483, clause
(9), and section 1820 of the federal Social Security Act, United States Code, title 42, section
1395i-4, that have an attached nursing home or that owned a nursing home located in the
same municipality as of May 1, 2005, eligible hospitals are allowed a total new text beginnumbernew text end of deleted text begin2,000deleted text end
days of swing bed use per yearnew text begin as provided in paragraph (c)new text end. Critical access hospitals that
have an attached nursing home or that owned a nursing home located in the same municipality
as of May 1, 2005, are allowed swing bed use as provided in federal law.

new text begin (c) An eligible hospital is allowed a total of 3,000 days of swing bed use in calendar
year 2020. Beginning in calendar year 2021, and for each subsequent calendar year until
calendar year 2027, the total number of days of swing bed use per year is increased by 200
swing bed use days. Beginning in calendar year 2028, an eligible hospital is allowed a total
of 4,500 days of swing bed use per year.
new text end

new text begin (d) Days of swing bed use for medical care that an eligible hospital has determined are
charity care shall not count toward the applicable limit in paragraph (b) or (c). For purposes
of this paragraph, "charity care" means care that an eligible hospital provided for free or at
a discount to persons who cannot afford to pay and for which the eligible hospital did not
expect payment.
new text end

new text begin (e) Days of swing bed use for care of a person who has been denied admission to every
Medicare-certified skilled nursing facility within 25 miles of the eligible hospital shall not
count toward the applicable limit in paragraphs (b) and (c). Eligible hospitals must maintain
documentation that they have contacted each skilled nursing facility within 25 miles to
determine if any skilled nursing facility beds are available and if the skilled nursing facilities
are willing to admit the patient. Skilled nursing facilities that are contacted must admit the
patient or deny admission within 24 hours of being contacted by the eligible hospital. Failure
to respond within 24 hours is deemed a denial of admission.
new text end

deleted text begin (c)deleted text end new text begin(f) new text endExcept for critical access hospitals that have an attached nursing home or that
owned a nursing home located in the same municipality as of May 1, 2005, the commissioner
of health may approve swing bed use beyond 2,000 days as long as there are no Medicare
certified skilled nursing facility beds available within 25 miles of that hospital that are
willing to admit the patient and the patient agrees to the referral being sent to the skilled
nursing facility. Critical access hospitals exceeding 2,000 swing bed days must maintain
documentation that they have contacted skilled nursing facilities within 25 miles to determine
if any skilled nursing facility beds are available that are willing to admit the patient and the
patient agrees to the referral being sent to the skilled nursing facility.new text begin This paragraph expires
January 1, 2020.
new text end

deleted text begin (d)deleted text end new text begin(g) new text endAfter reaching 2,000 days of swing bed use in a year, an eligible hospital to which
this limit applies may admit six additional patients to swing beds each year without seeking
approval from the commissioner or being in violation of this subdivision. These six swing
bed admissions are exempt from the limit of 2,000 annual swing bed days for hospitals
subject to this limit.new text begin This paragraph expires January 1, 2020.
new text end

deleted text begin (e)deleted text end new text begin(h) new text endA health care system that is in full compliance with this subdivision may allocate
its total limit of swing bed days among the hospitals within the system, provided that no
hospital in the system without an attached nursing home may exceed 2,000 swing bed days
per year.new text begin This paragraph expires January 1, 2020.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, except that new
paragraphs (d) and (e) are effective the day following final enactment.
new text end

Sec. 34.

Minnesota Statutes 2018, section 144.586, is amended by adding a subdivision
to read:


new text begin Subd. 3. new text end

new text begin Care coordination implementation. new text end

new text begin (a) This subdivision applies to hospital
discharges involving a child with a high-cost medical or chronic condition who needs
post-hospital continuing aftercare, including but not limited to home health care services,
post-hospital extended care services, or outpatient services for follow-up or ancillary care,
or is at risk of recurrent hospitalization or emergency room services due to a medical or
chronic condition.
new text end

new text begin (b) In addition to complying with the discharge planning requirements in subdivision
2, the hospital must ensure that the following conditions are met and arrangements made
before discharging any patient described in paragraph (a):
new text end

new text begin (1) the patient's primary care provider and either the health carrier or, if the patient is
enrolled in medical assistance, the managed care organization are notified of the patient's
date of anticipated discharge and provided a description of the patient's aftercare needs and
a copy of the patient's discharge plan, including any necessary medical information release
forms;
new text end

new text begin (2) the appropriate arrangements for home health care or post-hospital extended care
services are made and the initial services as indicated on the discharge plan are scheduled;
and
new text end

new text begin (3) if the patient is eligible for care coordination services through a health plan or health
certified medical home, the appropriate care coordinator has connected with the patient's
family.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2019.
new text end

Sec. 35.

new text begin [144.591] DISCLOSURE OF HOSPITAL CHARGES.
new text end

new text begin (a) Each hospital, including hospitals designated as critical access hospitals, shall provide
to each discharged patient within 30 calendar days of discharge an itemized description of
billed charges for medical services and goods the patient received during the hospital stay.
The itemized description of billed charges may include technical terms to describe the
medical services and goods if the technical terms are defined on the itemized description
with limited medical nomenclature. The itemized description of billed charges must not
describe a billed charge using only a medical billing code, "miscellaneous charges," or
"supply charges."
new text end

new text begin (b) A hospital may not bill or otherwise charge a patient for the itemized description of
billed charges.
new text end

new text begin (c) A hospital must provide an itemized description by secure e-mail, via a secure online
portal, or, upon request, by mail.
new text end

new text begin (d) This section does not apply to patients enrolled in Medicare, medical assistance, the
MinnesotaCare program, or who receive health care coverage through an employer
self-insured health plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2020.
new text end

Sec. 36.

Minnesota Statutes 2018, section 144.966, subdivision 2, is amended to read:


Subd. 2.

Newborn Hearing Screening Advisory Committee.

(a) The commissioner
of health shall establish a Newborn Hearing Screening Advisory Committee to advise and
assist the Department of Health and the Department of Education in:

(1) developing protocols and timelines for screening, rescreening, and diagnostic
audiological assessment and early medical, audiological, and educational intervention
services for children who are deaf or hard-of-hearing;

(2) designing protocols for tracking children from birth through age three that may have
passed newborn screening but are at risk for delayed or late onset of permanent hearing
loss;

(3) designing a technical assistance program to support facilities implementing the
screening program and facilities conducting rescreening and diagnostic audiological
assessment;

(4) designing implementation and evaluation of a system of follow-up and tracking; and

(5) evaluating program outcomes to increase effectiveness and efficiency and ensure
culturally appropriate services for children with a confirmed hearing loss and their families.

(b) The commissioner of health shall appoint at least one member from each of the
following groups with no less than two of the members being deaf or hard-of-hearing:

(1) a representative from a consumer organization representing culturally deaf persons;

(2) a parent with a child with hearing loss representing a parent organization;

(3) a consumer from an organization representing oral communication options;

(4) a consumer from an organization representing cued speech communication options;

(5) an audiologist who has experience in evaluation and intervention of infants and
young children;

(6) a speech-language pathologist who has experience in evaluation and intervention of
infants and young children;

(7) two primary care providers who have experience in the care of infants and young
children, one of which shall be a pediatrician;

(8) a representative from the early hearing detection intervention teams;

(9) a representative from the Department of Education resource center for the deaf and
hard-of-hearing or the representative's designee;

(10) a representative of the Commission of the Deaf, DeafBlind and Hard of Hearing;

(11) a representative from the Department of Human Services Deaf and Hard-of-Hearing
Services Division;

(12) one or more of the Part C coordinators from the Department of Education, the
Department of Health, or the Department of Human Services or the department's designees;

(13) the Department of Health early hearing detection and intervention coordinators;

(14) two birth hospital representatives from one rural and one urban hospital;

(15) a pediatric geneticist;

(16) an otolaryngologist;

(17) a representative from the Newborn Screening Advisory Committee under this
subdivision; deleted text beginand
deleted text end

(18) a representative of the Department of Education regional low-incidence facilitatorsdeleted text begin.deleted text endnew text begin;
new text end

new text begin (19) a representative from the deaf mentor program; and
new text end

new text begin (20) a representative of the Minnesota State Academy for the Deaf from the Minnesota
State Academies staff.
new text end

The commissioner must complete the new text begininitialnew text end appointments required under this subdivision
by September 1, 2007new text begin, and the initial appointments under clauses (19) and (20) by September
1, 2019
new text end.

(c) The Department of Health member shall chair the first meeting of the committee. At
the first meeting, the committee shall elect a chair from its membership. The committee
shall meet at the call of the chair, at least four times a year. The committee shall adopt
written bylaws to govern its activities. The Department of Health shall provide technical
and administrative support services as required by the committee. These services shall
include technical support from individuals qualified to administer infant hearing screening,
rescreening, and diagnostic audiological assessments.

Members of the committee shall receive no compensation for their service, but shall be
reimbursed as provided in section 15.059 for expenses incurred as a result of their duties
as members of the committee.

(d) By February 15, 2015, and by February 15 of the odd-numbered years after that date,
the commissioner shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and data privacy on the activities of the committee
that have occurred during the past two years.

(e) This subdivision expires June 30, deleted text begin2019deleted text endnew text begin 2025new text end.

new text begin EFFECTIVE DATE. new text end

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

Sec. 37.

Minnesota Statutes 2018, section 144.99, subdivision 1, is amended to read:


Subdivision 1.

Remedies available.

The provisions of chapters 103I and 157 and sections
115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), (12), (13), (14),
and (15)
; 144.1201 to 144.1204; 144.121; 144.1215; 144.1222; 144.35; 144.381 to 144.385;
144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9512; 144.97 to 144.98;
144.992; new text begin152.22 to 152.37; new text end326.70 to 326.785; 327.10 to 327.131; and 327.14 to 327.28
and all rules, orders, stipulation agreements, settlements, compliance agreements, licenses,
registrations, certificates, and permits adopted or issued by the department or under any
other law now in force or later enacted for the preservation of public health may, in addition
to provisions in other statutes, be enforced under this section.

Sec. 38.

Minnesota Statutes 2018, section 144A.43, subdivision 11, is amended to read:


Subd. 11.

Medication administration.

"Medication administration" means performing
a set of tasks deleted text beginto ensure a client takes medications, and includesdeleted text endnew text begin that includenew text end the following:

(1) checking the client's medication record;

(2) preparing the medication as necessary;

(3) administering the medication to the client;

(4) documenting the administration or reason for not administering the medication; and

(5) reporting to a new text beginregistered new text endnurse new text beginor appropriate licensed health professional new text endany concerns
about the medication, the client, or the client's refusal to take the medication.

Sec. 39.

Minnesota Statutes 2018, section 144A.43, is amended by adding a subdivision
to read:


new text begin Subd. 12a. new text end

new text begin Medication reconciliation. new text end

new text begin "Medication reconciliation" means the process
of identifying the most accurate list of all medications the client is taking, including the
name, dosage, frequency, and route by comparing the client record to an external list of
medications obtained from the client, hospital, prescriber, or other provider.
new text end

Sec. 40.

Minnesota Statutes 2018, section 144A.43, subdivision 30, is amended to read:


Subd. 30.

Standby assistance.

"Standby assistance" means the presence of another
person deleted text beginwithin arm's reach to minimize the risk of injury while performing daily activities
through physical intervention or cuing
deleted text endnew text begin to assist a client with an assistive task by providing
cues, oversight, and minimal physical assistance
new text end.

Sec. 41.

Minnesota Statutes 2018, section 144A.472, subdivision 5, is amended to read:


Subd. 5.

deleted text beginTransfers prohibited;deleted text end Changes in ownership.

deleted text beginAnydeleted text end new text begin(a) A new text endhome care license
issued by the commissioner may not be transferred to another party. Before acquiring
ownership of new text beginor a controlling interest in new text enda home care provider business, a prospective
deleted text begin applicantdeleted text endnew text begin ownernew text end must apply for a new deleted text begintemporarydeleted text end license. A change of ownership is a transfer
of operational control deleted text beginto a different business entitydeleted text end new text beginof the home care provider business new text endand
includes:

(1) transfer of the business to a different or new corporation;

(2) in the case of a partnership, the dissolution or termination of the partnership under
chapter 323A, with the business continuing by a successor partnership or other entity;

(3) relinquishment of control of the provider to another party, including to a contract
management firm that is not under the control of the owner of the business' assets;

(4) transfer of the business by a sole proprietor to another party or entity; or

(5) deleted text beginin the case of a privately held corporation, the change indeleted text endnew text begin transfer ofnew text end ownership or
control of 50 percent or more of the deleted text beginoutstanding voting stockdeleted text endnew text begin controlling interest of a home
care provider business not covered by clauses (1) to (4)
new text end.

new text begin (b) An employee who was employed by the previous owner of the home care provider
business prior to the effective date of a change in ownership under paragraph (a), and who
will be employed by the new owner in the same or a similar capacity, shall be treated as if
no change in employer occurred, with respect to orientation, training, tuberculosis testing,
background studies, and competency testing and training on the policies identified in
subdivision 1, clause (14), and subdivision 2, if applicable.
new text end

new text begin (c) Notwithstanding paragraph (b), a new owner of a home care provider business must
ensure that employees of the provider receive and complete training and testing on any
provisions of policies that differ from those of the previous owner within 90 days after the
date of the change in ownership.
new text end

Sec. 42.

Minnesota Statutes 2018, section 144A.472, subdivision 7, is amended to read:


Subd. 7.

Fees; application, change of ownership, deleted text beginanddeleted text end renewalnew text begin, and failure to
notify
new text end.

(a) An initial applicant seeking temporary home care licensure must submit the
following application fee to the commissioner along with a completed application:

(1) for a basic home care provider, $2,100; or

(2) for a comprehensive home care provider, $4,200.

(b) A home care provider who is filing a change of ownership as required under
subdivision 5 must submit the following application fee to the commissioner, along with
the documentation required for the change of ownership:

(1) for a basic home care provider, $2,100; or

(2) for a comprehensive home care provider, $4,200.

(c) For the period ending June 30, 2018, a home care provider who is seeking to renew
the provider's license shall pay a fee to the commissioner based on revenues derived from
the provision of home care services during the calendar year prior to the year in which the
application is submitted, according to the following schedule:

License Renewal Fee

Provider Annual Revenue
Fee
greater than $1,500,000
$6,625
greater than $1,275,000 and no more than
$1,500,000
$5,797
greater than $1,100,000 and no more than
$1,275,000
$4,969
greater than $950,000 and no more than
$1,100,000
$4,141
greater than $850,000 and no more than $950,000
$3,727
greater than $750,000 and no more than $850,000
$3,313
greater than $650,000 and no more than $750,000
$2,898
greater than $550,000 and no more than $650,000
$2,485
greater than $450,000 and no more than $550,000
$2,070
greater than $350,000 and no more than $450,000
$1,656
greater than $250,000 and no more than $350,000
$1,242
greater than $100,000 and no more than $250,000
$828
greater than $50,000 and no more than $100,000
$500
greater than $25,000 and no more than $50,000
$400
no more than $25,000
$200

(d) For the period between July 1, 2018, and June 30, 2020, a home care provider who
is seeking to renew the provider's license shall pay a fee to the commissioner in an amount
that is ten percent higher than the applicable fee in paragraph (c). A home care provider's
fee shall be based on revenues derived from the provision of home care services during the
calendar year prior to the year in which the application is submitted.

(e) Beginning July 1, 2020, a home care provider who is seeking to renew the provider's
license shall pay a fee to the commissioner based on revenues derived from the provision
of home care services during the calendar year prior to the year in which the application is
submitted, according to the following schedule:

License Renewal Fee

Provider Annual Revenue
Fee
greater than $1,500,000
$7,651
greater than $1,275,000 and no more than
$1,500,000
$6,695
greater than $1,100,000 and no more than
$1,275,000
$5,739
greater than $950,000 and no more than
$1,100,000
$4,783
greater than $850,000 and no more than $950,000
$4,304
greater than $750,000 and no more than $850,000
$3,826
greater than $650,000 and no more than $750,000
$3,347
greater than $550,000 and no more than $650,000
$2,870
greater than $450,000 and no more than $550,000
$2,391
greater than $350,000 and no more than $450,000
$1,913
greater than $250,000 and no more than $350,000
$1,434
greater than $100,000 and no more than $250,000
$957
greater than $50,000 and no more than $100,000
$577
greater than $25,000 and no more than $50,000
$462
no more than $25,000
$231

(f) If requested, the home care provider shall provide the commissioner information to
verify the provider's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.

(g) At each annual renewal, a home care provider may elect to pay the highest renewal
fee for its license category, and not provide annual revenue information to the commissioner.

(h) A temporary license or license applicant, or temporary licensee or licensee that
knowingly provides the commissioner incorrect revenue amounts for the purpose of paying
a lower license fee, shall be subject to a civil penalty in the amount of double the fee the
provider should have paid.

(i)new text begin The fine for failure to comply with the notification requirements of section 144A.473,
subdivision 2, paragraph (c), is $1,000.
new text end

new text begin (j)new text end Fees and penalties collected under this section shall be deposited in the state treasury
and credited to the state government special revenue fund. All fees are nonrefundable. Fees
collected under paragraphs (c), (d), and (e) are nonrefundable even if received before July
1, 2017, for temporary licenses or licenses being issued effective July 1, 2017, or later.

new text begin EFFECTIVE DATE. new text end

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

Sec. 43.

Minnesota Statutes 2018, section 144A.473, is amended to read:


144A.473 ISSUANCE OF TEMPORARY LICENSE AND LICENSE RENEWAL.

Subdivision 1.

Temporary license and renewal of license.

(a) The department shall
review each application to determine the applicant's knowledge of and compliance with
Minnesota home care regulations. Before granting a temporary license or renewing a license,
the commissioner may further evaluate the applicant or licensee by requesting additional
information or documentation or by conducting an on-site survey of the applicant to
determine compliance with sections 144A.43 to 144A.482.

(b) Within 14 calendar days after receiving an application for a license, the commissioner
shall acknowledge receipt of the application in writing. The acknowledgment must indicate
whether the application appears to be complete or whether additional information is required
before the application will be considered complete.

(c) Within 90 days after receiving a complete application, the commissioner shall issue
a temporary license, renew the license, or deny the license.

(d) The commissioner shall issue a license that contains the home care provider's name,
address, license level, expiration date of the license, and unique license number. All licensesnew text begin,
except for temporary licenses issued under subdivision 2,
new text end are valid for new text beginup to new text endone year from
the date of issuance.

Subd. 2.

Temporary license.

(a) For new license applicants, the commissioner shall
issue a temporary license for either the basic or comprehensive home care level. A temporary
license is effective for up to one year from the date of issuancenew text begin, except that a temporary
license may be extended according to subdivision 3
new text end. Temporary licensees must comply with
sections 144A.43 to 144A.482.

(b) During the temporary license deleted text beginyeardeleted text endnew text begin periodnew text end, the commissioner shall survey the temporary
licensee new text beginwithin 90 calendar daysnew text end after the commissioner is notified or has evidence that the
temporary licensee is providing home care services.

(c) Within five days of beginning the provision of services, the temporary licensee must
notify the commissioner that it is serving clients. The notification to the commissioner may
be mailed or e-mailed to the commissioner at the address provided by the commissioner. If
the temporary licensee does not provide home care services during the temporary license
deleted text begin yeardeleted text endnew text begin periodnew text end, then the temporary license expires at the end of the deleted text beginyeardeleted text endnew text begin periodnew text end and the applicant
must reapply for a temporary home care license.

(d) A temporary licensee may request a change in the level of licensure prior to being
surveyed and granted a license by notifying the commissioner in writing and providing
additional documentation or materials required to update or complete the changed temporary
license application. The applicant must pay the difference between the application fees
when changing from the basic level to the comprehensive level of licensure. No refund will
be made if the provider chooses to change the license application to the basic level.

(e) If the temporary licensee notifies the commissioner that the licensee has clients within
45 days prior to the temporary license expiration, the commissioner may extend the temporary
license for up to 60 days in order to allow the commissioner to complete the on-site survey
required under this section and follow-up survey visits.

Subd. 3.

Temporary licensee survey.

(a) If the temporary licensee is in substantial
compliance with the survey, the commissioner shall issue either a basic or comprehensive
home care license. If the temporary licensee is not in substantial compliance with the survey,
the commissioner shall new text begineither: (1) new text endnot issue a deleted text beginbasic or comprehensivedeleted text end license and deleted text beginthere will
be no contested hearing right under chapter 14.
deleted text endnew text begin terminate the temporary license; or (2)
extend the temporary license for a period not to exceed 90 days and apply conditions, as
permitted under section 144A.475, subdivision 2, to the extension of a temporary license.
If the temporary licensee is not in substantial compliance with the survey within the time
period of the extension, or if the temporary licensee does not satisfy the license conditions,
the commissioner may deny the license.
new text end

(b) If the temporary licensee whose basic or comprehensive license has been denied new text beginor
extended with conditions
new text enddisagrees with the conclusions of the commissioner, then the
new text begin temporary new text endlicensee may request a reconsideration by the commissioner or commissioner's
designee. The reconsideration request process must be conducted internally by the
commissioner or commissioner's designee, and chapter 14 does not apply.

(c) The temporary licensee requesting reconsideration must make the request in writing
and must list and describe the reasons why the new text begintemporary new text endlicensee disagrees with the decision
to deny the basic or comprehensive home care licensenew text begin or the decision to extend the temporary
license with conditions
new text end.

(d)new text begin The reconsideration request and supporting documentation must be received by the
commissioner within 15 calendar days after the date the temporary licensee receives the
correction order.
new text end

new text begin (e) A temporary licensee whose license is denied, is permitted to continue operating as
a home care provider during the period of time when:
new text end

new text begin (1) a reconsideration request is in process;
new text end

new text begin (2) an extension of a temporary license is being negotiated;
new text end

new text begin (3) the placement of conditions on a temporary license is being negotiated; or
new text end

new text begin (4) a transfer of home care clients from the temporary licensee to a new home care
provider is in process.
new text end

new text begin (f)new text end A temporary licensee whose license is denied must comply with the requirements
for notification and transfer of clients in section 144A.475, subdivision 5.

Sec. 44.

Minnesota Statutes 2018, section 144A.474, subdivision 2, is amended to read:


Subd. 2.

Types of home care surveys.

(a) "Initial full survey" means the survey of a
new temporary licensee conducted after the department is notified or has evidence that the
temporary licensee is providing home care services to determine if the provider is in
compliance with home care requirements. Initial full surveys must be completed within 14
months after the department's issuance of a temporary basic or comprehensive license.

(b)new text begin "Change in ownership survey" means a full survey of a new licensee due to a change
in ownership. Change in ownership surveys must be completed within six months after the
department's issuance of a new license due to a change in ownership.
new text end

new text begin (c)new text end "Core survey" means periodic inspection of home care providers to determine ongoing
compliance with the home care requirements, focusing on the essential health and safety
requirements. Core surveys are available to licensed home care providers who have been
licensed for three years and surveyed at least once in the past three years with the latest
survey having no widespread violations beyond Level 1 as provided in subdivision 11.
Providers must also not have had any substantiated licensing complaints, substantiated
complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
Act, or an enforcement action as authorized in section 144A.475 in the past three years.

(1) The core survey for basic home care providers must review compliance in the
following areas:

(i) reporting of maltreatment;

(ii) orientation to and implementation of the home care bill of rights;

(iii) statement of home care services;

(iv) initial evaluation of clients and initiation of services;

(v) client review and monitoring;

(vi) service plan implementation and changes to the service plan;

(vii) client complaint and investigative process;

(viii) competency of unlicensed personnel; and

(ix) infection control.

(2) For comprehensive home care providers, the core survey must include everything
in the basic core survey plus these areas:

(i) delegation to unlicensed personnel;

(ii) assessment, monitoring, and reassessment of clients; and

(iii) medication, treatment, and therapy management.

deleted text begin (c)deleted text endnew text begin (d)new text end "Full survey" means the periodic inspection of home care providers to determine
ongoing compliance with the home care requirements that cover the core survey areas and
all the legal requirements for home care providers. A full survey is conducted for all
temporary licensees deleted text beginanddeleted text endnew text begin, for licensees that receive licenses due to an approved change in
ownership,
new text end for providers who do not meet the requirements needed for a core survey, and
when a surveyor identifies unacceptable client health or safety risks during a core survey.
A full survey must include all the tasks identified as part of the core survey and any additional
review deemed necessary by the department, including additional observation, interviewing,
or records review of additional clients and staff.

deleted text begin (d)deleted text endnew text begin (e)new text end "Follow-up surveys" means surveys conducted to determine if a home care
provider has corrected deficient issues and systems identified during a core survey, full
survey, or complaint investigation. Follow-up surveys may be conducted via phone, e-mail,
fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
concluded with an exit conference and written information provided on the process for
requesting a reconsideration of the survey results.

deleted text begin (e)deleted text endnew text begin (f)new text end Upon receiving information alleging that a home care provider has violated or is
currently violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
investigate the complaint according to sections 144A.51 to 144A.54.

Sec. 45.

Minnesota Statutes 2018, section 144A.475, subdivision 1, is amended to read:


Subdivision 1.

Conditions.

(a) The commissioner may refuse to grant a temporary
license, new text beginrefuse to grant a license as a result of a change in ownership, refuse to new text endrenew a
license, suspend or revoke a license, or impose a conditional license if the home care provider
or owner or managerial official of the home care provider:

(1) is in violation of, or during the term of the license has violated, any of the requirements
in sections 144A.471 to 144A.482;

(2) permits, aids, or abets the commission of any illegal act in the provision of home
care;

(3) performs any act detrimental to the health, safety, and welfare of a client;

(4) obtains the license by fraud or misrepresentation;

(5) knowingly made or makes a false statement of a material fact in the application for
a license or in any other record or report required by this chapter;

(6) denies representatives of the department access to any part of the home care provider's
books, records, files, or employees;

(7) interferes with or impedes a representative of the department in contacting the home
care provider's clients;

(8) interferes with or impedes a representative of the department in the enforcement of
this chapter or has failed to fully cooperate with an inspection, survey, or investigation by
the department;

(9) destroys or makes unavailable any records or other evidence relating to the home
care provider's compliance with this chapter;

(10) refuses to initiate a background study under section 144.057 or 245A.04;

(11) fails to timely pay any fines assessed by the department;

(12) violates any local, city, or township ordinance relating to home care services;

(13) has repeated incidents of personnel performing services beyond their competency
level; or

(14) has operated beyond the scope of the home care provider's license level.

(b) A violation by a contractor providing the home care services of the home care provider
is a violation by the home care provider.

Sec. 46.

Minnesota Statutes 2018, section 144A.475, subdivision 2, is amended to read:


Subd. 2.

Terms to suspension or conditional license.

new text begin(a) new text endA suspension or conditional
license designation may include terms that must be completed or met before a suspension
or conditional license designation is lifted. A conditional license designation may include
restrictions or conditions that are imposed on the provider. Terms for a suspension or
conditional license may include one or more of the following and the scope of each will be
determined by the commissioner:

(1) requiring a consultant to review, evaluate, and make recommended changes to the
home care provider's practices and submit reports to the commissioner at the cost of the
home care provider;

(2) requiring supervision of the home care provider or staff practices at the cost of the
home care provider by an unrelated person who has sufficient knowledge and qualifications
to oversee the practices and who will submit reports to the commissioner;

(3) requiring the home care provider or employees to obtain training at the cost of the
home care provider;

(4) requiring the home care provider to submit reports to the commissioner;

(5) prohibiting the home care provider from taking any new clients for a period of time;
or

(6) any other action reasonably required to accomplish the purpose of this subdivision
and section 144A.45, subdivision 2.

new text begin (b) A home care provider subject to this subdivision may continue operating during the
period of time home care clients are being transferred to other providers.
new text end

Sec. 47.

Minnesota Statutes 2018, section 144A.475, subdivision 5, is amended to read:


Subd. 5.

Plan required.

(a) The process of suspending or revoking a license must include
a plan for transferring affected clients to other providers by the home care provider, which
will be monitored by the commissioner. Within three business days of being notified of the
final revocation or suspension action, the home care provider shall provide the commissioner,
the lead agencies as defined in section 256B.0911, and the ombudsman for long-term care
with the following information:

(1) a list of all clients, including full names and all contact information on file;

(2) a list of each client's representative or emergency contact person, including full names
and all contact information on file;

(3) the location or current residence of each client;

(4) the payor sources for each client, including payor source identification numbers; and

(5) for each client, a copy of the client's service plan, and a list of the types of services
being provided.

(b) The revocation or suspension notification requirement is satisfied by mailing the
notice to the address in the license record. The home care provider shall cooperate with the
commissioner and the lead agencies during the process of transferring care of clients to
qualified providers. Within three business days of being notified of the final revocation or
suspension action, the home care provider must notify and disclose to each of the home
care provider's clients, or the client's representative or emergency contact persons, that the
commissioner is taking action against the home care provider's license by providing a copy
of the revocation or suspension notice issued by the commissioner.

new text begin (c) A home care provider subject to this subdivision may continue operating during the
period of time home care clients are being transferred to other providers.
new text end

Sec. 48.

Minnesota Statutes 2018, section 144A.476, subdivision 1, is amended to read:


Subdivision 1.

Prior criminal convictions; owner and managerial officials.

(a) Before
the commissioner issues a temporary licensenew text begin, issues a license new text endnew text beginas a result of an approved
change in ownership,
new text end or renews a license, an owner or managerial official is required to
complete a background study under section 144.057. No person may be involved in the
management, operation, or control of a home care provider if the person has been disqualified
under chapter 245C. If an individual is disqualified under section 144.057 or chapter 245C,
the individual may request reconsideration of the disqualification. If the individual requests
reconsideration and the commissioner sets aside or rescinds the disqualification, the individual
is eligible to be involved in the management, operation, or control of the provider. If an
individual has a disqualification under section 245C.15, subdivision 1, and the disqualification
is affirmed, the individual's disqualification is barred from a set aside, and the individual
must not be involved in the management, operation, or control of the provider.

(b) For purposes of this section, owners of a home care provider subject to the background
check requirement are those individuals whose ownership interest provides sufficient
authority or control to affect or change decisions related to the operation of the home care
provider. An owner includes a sole proprietor, a general partner, or any other individual
whose individual ownership interest can affect the management and direction of the policies
of the home care provider.

(c) For the purposes of this section, managerial officials subject to the background check
requirement are individuals who provide direct contact as defined in section 245C.02,
subdivision 11
, or individuals who have the responsibility for the ongoing management or
direction of the policies, services, or employees of the home care provider. Data collected
under this subdivision shall be classified as private data on individuals under section 13.02,
subdivision 12
.

(d) The department shall not issue any license if the applicant or owner or managerial
official has been unsuccessful in having a background study disqualification set aside under
section 144.057 and chapter 245C; if the owner or managerial official, as an owner or
managerial official of another home care provider, was substantially responsible for the
other home care provider's failure to substantially comply with sections 144A.43 to
144A.482; or if an owner that has ceased doing business, either individually or as an owner
of a home care provider, was issued a correction order for failing to assist clients in violation
of this chapter.

Sec. 49.

Minnesota Statutes 2018, section 144A.479, subdivision 7, is amended to read:


Subd. 7.

Employee records.

The home care provider must maintain current records of
each paid employee, regularly scheduled volunteers providing home care services, and of
each individual contractor providing home care services. The records must include the
following information:

(1) evidence of current professional licensure, registration, or certification, if licensure,
registration, or certification is required by this statute or other rules;

(2) records of orientation, required annual training and infection control training, and
competency evaluations;

(3) current job description, including qualifications, responsibilities, and identification
of staff providing supervision;

(4) documentation of annual performance reviews which identify areas of improvement
needed and training needs;

(5) for individuals providing home care services, verification that deleted text beginrequireddeleted text endnew text begin anynew text end health
screenings new text beginrequired by infection control programs established new text endunder section 144A.4798
have taken place and the dates of those screenings; and

(6) documentation of the background study as required under section 144.057.

Each employee record must be retained for at least three years after a paid employee, home
care volunteer, or contractor ceases to be employed by or under contract with the home care
provider. If a home care provider ceases operation, employee records must be maintained
for three years.

Sec. 50.

Minnesota Statutes 2018, section 144A.479, is amended by adding a subdivision
to read:


new text begin Subd. 8. new text end

new text begin Labor market reporting. new text end

new text begin A home care provider shall comply with the labor
market reporting requirements described in section 256B.4912, subdivision 1a.
new text end

Sec. 51.

Minnesota Statutes 2018, section 144A.4791, subdivision 1, is amended to read:


Subdivision 1.

Home care bill of rights; notification to client.

(a) The home care
provider shall provide the client or the client's representative a written notice of the rights
under section 144A.44 before the deleted text begininitiation ofdeleted text endnew text begin date thatnew text end services new text beginare first provided new text endto that
client. The provider shall make all reasonable efforts to provide notice of the rights to the
client or the client's representative in a language the client or client's representative can
understand.

(b) In addition to the text of the home care bill of rights in section 144A.44, subdivision
1, the notice shall also contain the following statement describing how to file a complaint
with these offices.

"If you have a complaint about the provider or the person providing your home care
services, you may call, write, or visit the Office of Health Facility Complaints, Minnesota
Department of Health. You may also contact the Office of Ombudsman for Long-Term
Care or the Office of Ombudsman for Mental Health and Developmental Disabilities."

The statement should include the telephone number, website address, e-mail address,
mailing address, and street address of the Office of Health Facility Complaints at the
Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care, and
the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
statement should also include the home care provider's name, address, e-mail, telephone
number, and name or title of the person at the provider to whom problems or complaints
may be directed. It must also include a statement that the home care provider will not retaliate
because of a complaint.

(c) The home care provider shall obtain written acknowledgment of the client's receipt
of the home care bill of rights or shall document why an acknowledgment cannot be obtained.
The acknowledgment may be obtained from the client or the client's representative.
Acknowledgment of receipt shall be retained in the client's record.

Sec. 52.

Minnesota Statutes 2018, section 144A.4791, subdivision 3, is amended to read:


Subd. 3.

Statement of home care services.

Prior to the deleted text begininitiation ofdeleted text endnew text begin date thatnew text end servicesnew text begin
are first provided to the client
new text end, a home care provider must provide to the client or the client's
representative a written statement which identifies if the provider has a basic or
comprehensive home care license, the services the provider is authorized to provide, and
which services the provider cannot provide under the scope of the provider's license. The
home care provider shall obtain written acknowledgment from the clients that the provider
has provided the statement or must document why the provider could not obtain the
acknowledgment.

Sec. 53.

Minnesota Statutes 2018, section 144A.4791, subdivision 6, is amended to read:


Subd. 6.

Initiation of services.

When a provider deleted text begininitiatesdeleted text endnew text begin provides home carenew text end services
deleted text begin anddeleted text endnew text begin to a client beforenew text end the individualized review or assessment new text beginby a licensed health
professional or registered nurse as
new text endrequired in subdivisions 7 and 8 deleted text beginhas not beendeleted text endnew text begin isnew text end completed,
the deleted text beginproviderdeleted text endnew text begin licensed health professional or registered nursenew text end must complete a temporary
plan deleted text beginand agreementdeleted text end with the client deleted text beginfor servicesdeleted text endnew text begin and orient staff assigned to deliver services
as identified in the
new text endnew text begintemporary plannew text end.

Sec. 54.

Minnesota Statutes 2018, section 144A.4791, subdivision 7, is amended to read:


Subd. 7.

Basic individualized client review and monitoring.

(a) When services being
provided are basic home care services, an individualized initial review of the client's needs
and preferences must be conducted at the client's residence with the client or client's
representative. This initial review must be completed within 30 days after the deleted text begininitiation of
the
deleted text endnew text begin date thatnew text end home care servicesnew text begin are first providednew text end.

(b) Client monitoring and review must be conducted as needed based on changes in the
needs of the client and cannot exceed 90 days from the date of the last review. The monitoring
and review may be conducted at the client's residence or through the utilization of
telecommunication methods based on practice standards that meet the individual client's
needs.

Sec. 55.

Minnesota Statutes 2018, section 144A.4791, subdivision 8, is amended to read:


Subd. 8.

Comprehensive assessment, monitoring, and reassessment.

(a) When the
services being provided are comprehensive home care services, an individualized initial
assessment must be conducted in person by a registered nurse. When the services are provided
by other licensed health professionals, the assessment must be conducted by the appropriate
health professional. This initial assessment must be completed within five days after deleted text begininitiation
of
deleted text endnew text begin the date thatnew text end home care servicesnew text begin are first providednew text end.

(b) Client monitoring and reassessment must be conducted in the client's home no more
than 14 days after deleted text begininitiation ofdeleted text endnew text begin the date that home carenew text end servicesnew text begin are first providednew text end.

(c) Ongoing client monitoring and reassessment must be conducted as needed based on
changes in the needs of the client and cannot exceed 90 days from the last date of the
assessment. The monitoring and reassessment may be conducted at the client's residence
or through the utilization of telecommunication methods based on practice standards that
meet the individual client's needs.

Sec. 56.

Minnesota Statutes 2018, section 144A.4791, subdivision 9, is amended to read:


Subd. 9.

Service plan, implementation, and revisions to service plan.

(a) No later
than 14 days after the deleted text begininitiation ofdeleted text endnew text begin date that home carenew text end servicesnew text begin are first providednew text end, a home
care provider shall finalize a current written service plan.

(b) The service plan and any revisions must include a signature or other authentication
by the home care provider and by the client or the client's representative documenting
agreement on the services to be provided. The service plan must be revised, if needed, based
on client review or reassessment under subdivisions 7 and 8. The provider must provide
information to the client about changes to the provider's fee for services and how to contact
the Office of the Ombudsman for Long-Term Care.

(c) The home care provider must implement and provide all services required by the
current service plan.

(d) The service plan and revised service plan must be entered into the client's record,
including notice of a change in a client's fees when applicable.

(e) Staff providing home care services must be informed of the current written service
plan.

(f) The service plan must include:

(1) a description of the home care services to be provided, the fees for services, and the
frequency of each service, according to the client's current review or assessment and client
preferences;

(2) the identification of the staff or categories of staff who will provide the services;

(3) the schedule and methods of monitoring reviews or assessments of the client;

(4) deleted text beginthe frequency of sessions of supervision of staff and type of personnel who will
deleted text enddeleted text begin supervise staffdeleted text enddeleted text begin; anddeleted text endnew text begin the schedule and methods of monitoring staff providing home care
services; and
new text end

(5) a contingency plan that includes:

(i) the action to be taken by the home care provider and by the client or client's
representative if the scheduled service cannot be provided;

(ii) information and a method for a client or client's representative to contact the home
care provider;

(iii) names and contact information of persons the client wishes to have notified in an
emergency or if there is a significant adverse change in the client's conditiondeleted text begin, including
identification of and information as to who has authority to sign for the client in an
emergency
deleted text end; and

(iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the client under those
chapters.

Sec. 57.

Minnesota Statutes 2018, section 144A.4792, subdivision 1, is amended to read:


Subdivision 1.

Medication management services; comprehensive home care
license.

(a) This subdivision applies only to home care providers with a comprehensive
home care license that provide medication management services to clients. Medication
management services may not be provided by a home care provider who has a basic home
care license.

(b) A comprehensive home care provider who provides medication management services
must develop, implement, and maintain current written medication management policies
and procedures. The policies and procedures must be developed under the supervision and
direction of a registered nurse, licensed health professional, or pharmacist consistent with
current practice standards and guidelines.

(c) The written policies and procedures must address requesting and receiving
prescriptions for medications; preparing and giving medications; verifying that prescription
drugs are administered as prescribed; documenting medication management activities;
controlling and storing medications; monitoring and evaluating medication use; resolving
medication errors; communicating with the prescriber, pharmacist, and client and client
representative, if any; disposing of unused medications; and educating clients and client
representatives about medications. When controlled substances are being managed, new text beginstored,
and secured by the comprehensive home care provider,
new text endthe policies and procedures must
also identify how the provider will ensure security and accountability for the overall
management, control, and disposition of those substances in compliance with state and
federal regulations and with subdivision 22.

Sec. 58.

Minnesota Statutes 2018, section 144A.4792, subdivision 2, is amended to read:


Subd. 2.

Provision of medication management services.

(a) For each client who
requests medication management services, the comprehensive home care provider shall,
prior to providing medication management services, have a registered nurse, licensed health
professional, or authorized prescriber under section 151.37 conduct an assessment to
determine what medication management services will be provided and how the services
will be provided. This assessment must be conducted face-to-face with the client. The
assessment must include an identification and review of all medications the client is known
to be taking. The review and identification must include indications for medications, side
effects, contraindications, allergic or adverse reactions, and actions to address these issues.

(b) The assessment mustnew text begin:
new text end

new text begin (1)new text end identify interventions needed in management of medications to prevent diversion of
medication by the client or others who may have access to the medicationsdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (2) provide instructions to the client or client's representative on interventions to manage
the client's medications and prevent diversion of medications.
new text end

"Diversion of medications" means the misuse, theft, or illegal or improper disposition of
medications.

Sec. 59.

Minnesota Statutes 2018, section 144A.4792, subdivision 5, is amended to read:


Subd. 5.

Individualized medication management plan.

(a) For each client receiving
medication management services, the comprehensive home care provider must prepare and
include in the service plan a written statement of the medication management services that
will be provided to the client. The provider must develop and maintain a current
individualized medication management record for each client based on the client's assessment
that must contain the following:

(1) a statement describing the medication management services that will be provided;

(2) a description of storage of medications based on the client's needs and preferences,
risk of diversion, and consistent with the manufacturer's directions;

(3) documentation of specific client instructions relating to the administration of
medications;

(4) identification of persons responsible for monitoring medication supplies and ensuring
that medication refills are ordered on a timely basis;

(5) identification of medication management tasks that may be delegated to unlicensed
personnel;

(6) procedures for staff notifying a registered nurse or appropriate licensed health
professional when a problem arises with medication management services; and

(7) any client-specific requirements relating to documenting medication administration,
verifications that all medications are administered as prescribed, and monitoring of
medication use to prevent possible complications or adverse reactions.

(b) The medication management record must be current and updated when there are any
changes.

new text begin (c) Medication reconciliation must be completed when a licensed nurse, licensed health
professional, or authorized prescriber is providing medication management.
new text end

Sec. 60.

Minnesota Statutes 2018, section 144A.4792, subdivision 10, is amended to read:


Subd. 10.

Medication management for clients who will be away from home.

(a) A
home care provider who is providing medication management services to the client and
controls the client's access to the medications must develop and implement policies and
procedures for giving accurate and current medications to clients for planned or unplanned
times away from home according to the client's individualized medication management
plan. The policy and procedures must state that:

(1) for planned time away, the medications must be obtained from the pharmacy or set
up by deleted text beginthe registereddeleted text endnew text begin a licensednew text end nurse according to appropriate state and federal laws and
nursing standards of practice;

(2) for unplanned time away, when the pharmacy is not able to provide the medications,
a licensed nurse or unlicensed personnel shall give the client or client's representative
medications in amounts and dosages needed for the length of the anticipated absence, not
to exceed deleted text begin120 hoursdeleted text endnew text begin seven calendar daysnew text end;

(3) the client or client's representative must be provided written information on
medications, including any special instructions for administering or handling the medications,
including controlled substances;

(4) the medications must be placed in a medication container or containers appropriate
to the provider's medication system and must be labeled with the client's name and the dates
and times that the medications are scheduled; and

(5) the client or client's representative must be provided in writing the home care
provider's name and information on how to contact the home care provider.

(b) For unplanned time away when the licensed nurse is not available, the registered
nurse may delegate this task to unlicensed personnel if:

(1) the registered nurse has trained the unlicensed staff and determined the unlicensed
staff is competent to follow the procedures for giving medications to clients; and

(2) the registered nurse has developed written procedures for the unlicensed personnel,
including any special instructions or procedures regarding controlled substances that are
prescribed for the client. The procedures must address:

(i) the type of container or containers to be used for the medications appropriate to the
provider's medication system;

(ii) how the container or containers must be labeled;

(iii) the written information about the medications to be given to the client or client's
representative;

(iv) how the unlicensed staff must document in the client's record that medications have
been given to the client or the client's representative, including documenting the date the
medications were given to the client or the client's representative and who received the
medications, the person who gave the medications to the client, the number of medications
that were given to the client, and other required information;

(v) how the registered nurse shall be notified that medications have been given to the
client or client's representative and whether the registered nurse needs to be contacted before
the medications are given to the client or the client's representative; deleted text beginand
deleted text end

(vi) a review by the registered nurse of the completion of this task to verify that this task
was completed accurately by the unlicensed personneldeleted text begin.deleted text endnew text begin; and
new text end

new text begin (vii) how the unlicensed staff must document in the client's record any unused medications
that are returned to the provider, including the name of each medication and the doses of
each returned medication.
new text end

Sec. 61.

Minnesota Statutes 2018, section 144A.4793, subdivision 6, is amended to read:


Subd. 6.

new text beginTreatment and therapy new text endorders deleted text beginor prescriptionsdeleted text end.

There must be an up-to-date
written or electronically recorded order deleted text beginor prescriptiondeleted text endnew text begin from an authorized prescribernew text end for
all treatments and therapies. The order must contain the name of the client, a description of
the treatment or therapy to be provided, and the frequencynew text begin, duration,new text end and other information
needed to administer the treatment or therapy.new text begin Treatment and therapy orders must be renewed
at least every 12 months.
new text end

Sec. 62.

Minnesota Statutes 2018, section 144A.4796, subdivision 2, is amended to read:


Subd. 2.

Content.

(a) The orientation must contain the following topics:

(1) an overview of sections 144A.43 to 144A.4798;

(2) introduction and review of all the provider's policies and procedures related to the
provision of home care servicesnew text begin by the individual staff personnew text end;

(3) handling of emergencies and use of emergency services;

(4) compliance with and reporting of the maltreatment of minors or vulnerable adults
under sections 626.556 and 626.557;

(5) home care bill of rights under section 144A.44;

(6) handling of clients' complaints, reporting of complaints, and where to report
complaints including information on the Office of Health Facility Complaints and the
Common Entry Point;

(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
Ombudsman at the Department of Human Services, county managed care advocates, or
other relevant advocacy services; and

(8) review of the types of home care services the employee will be providing and the
provider's scope of licensure.

(b) In addition to the topics listed in paragraph (a), orientation may also contain training
on providing services to clients with hearing loss. Any training on hearing loss provided
under this subdivision must be high quality and research-based, may include online training,
and must include training on one or more of the following topics:

(1) an explanation of age-related hearing loss and how it manifests itself, its prevalence,
and challenges it poses to communication;

(2) health impacts related to untreated age-related hearing loss, such as increased
incidence of dementia, falls, hospitalizations, isolation, and depression; or

(3) information about strategies and technology that may enhance communication and
involvement, including communication strategies, assistive listening devices, hearing aids,
visual and tactile alerting devices, communication access in real time, and closed captions.

Sec. 63.

Minnesota Statutes 2018, section 144A.4797, subdivision 3, is amended to read:


Subd. 3.

Supervision of staff providing delegated nursing or therapy home care
tasks.

(a) Staff who perform delegated nursing or therapy home care tasks must be supervised
by an appropriate licensed health professional or a registered nurse periodically where the
services are being provided to verify that the work is being performed competently and to
identify problems and solutions related to the staff person's ability to perform the tasks.
Supervision of staff performing medication or treatment administration shall be provided
by a registered nurse or appropriate licensed health professional and must include observation
of the staff administering the medication or treatment and the interaction with the client.

(b) The direct supervision of staff performing delegated tasks must be provided within
30 days after the new text begindate on which the new text endindividual begins working for the home care providernew text begin
and first performs delegated tasks for clients
new text end and thereafter as needed based on performance.
This requirement also applies to staff who have not performed delegated tasks for one year
or longer.

Sec. 64.

Minnesota Statutes 2018, section 144A.4798, is amended to read:


144A.4798 deleted text beginEMPLOYEE HEALTH STATUSdeleted text endnew text begin DISEASE PREVENTION AND
INFECTION CONTROL
new text end.

Subdivision 1.

Tuberculosis (TB) deleted text beginprevention anddeleted text endnew text begin infectionnew text end control.

new text begin(a) new text endA home care
provider must establish and maintain a deleted text beginTB prevention anddeleted text end new text begincomprehensive tuberculosis
infection
new text endcontrol program deleted text beginbased ondeleted text endnew text begin according tonew text end the most current new text begintuberculosis infection
control
new text endguidelines issued by the new text beginUnited States new text endCenters for Disease Control and Prevention
(CDC)new text begin, Division of Tuberculosis Elimination, as published in the CDC's Morbidity and
Mortality Weekly Report
new text end. deleted text beginComponents of a TB prevention and control program include
screening all staff providing home care services, both paid and unpaid, at the time of hire
for active TB disease and latent TB infection, and developing and implementing a written
TB infection control plan. The commissioner shall make the most recent CDC standards
available to home care providers on the department's website.
deleted text endnew text begin This program must include
a tuberculosis infection control plan that covers all paid and unpaid employees, contractors,
students, and volunteers. The commissioner shall provide technical assistance regarding
implementation of the guidelines.
new text end

new text begin (b) The home care provider must maintain written evidence of compliance with this
subdivision.
new text end

Subd. 2.

Communicable diseases.

A home care provider must follow current deleted text beginfederal
or state guidelines
deleted text endnew text begin state requirementsnew text end for prevention, control, and reporting of deleted text beginhuman
immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
deleted text end
communicable diseases as defined in Minnesota Rules, deleted text beginpartdeleted text endnew text begin partsnew text end 4605.7040new text begin, 4605.7044,
4605.7050, 4605.7075, 4605.7080, and 4605.7090
new text end.

new text begin Subd. 3. new text end

new text begin Infection control program. new text end

new text begin A home care provider must establish and maintain
an effective infection control program that complies with accepted health care, medical,
and nursing standards for infection control.
new text end

Sec. 65.

Minnesota Statutes 2018, section 144A.4799, subdivision 1, is amended to read:


Subdivision 1.

Membership.

The commissioner of health shall appoint eight persons
to a home care and assisted living program advisory council consisting of the following:

(1) three public members as defined in section 214.02 who shall be deleted text begineitherdeleted text end persons who
are currently receiving home care services deleted text beginordeleted text endnew text begin, persons who have received home care services
within five years of the application date,
new text endnew text beginpersons whonew text end have family members receiving home
care services, or persons who have family members who have received home care services
within five years of the application date;

(2) three Minnesota home care licensees representing basic and comprehensive levels
of licensure who may be a managerial official, an administrator, a supervising registered
nurse, or an unlicensed personnel performing home care tasks;

(3) one member representing the Minnesota Board of Nursing; and

(4) one member representing the new text beginOffice of new text endOmbudsman for Long-Term Care.

Sec. 66.

Minnesota Statutes 2018, section 144A.4799, subdivision 3, is amended to read:


Subd. 3.

Duties.

(a) At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed home care providers in this
chapter, including advice on the following:

(1) community standards for home care practices;

(2) enforcement of licensing standards and whether certain disciplinary actions are
appropriate;

(3) ways of distributing information to licensees and consumers of home care;

(4) training standards;

(5) identifying emerging issues and opportunities in deleted text beginthedeleted text end home care deleted text beginfield, includingdeleted text endnew text begin and
assisted living;
new text end

new text begin (6) identifyingnew text end the use of technology in home and telehealth capabilities;

deleted text begin (6)deleted text endnew text begin (7)new text end allowable home care licensing modifications and exemptions, including a method
for an integrated license with an existing license for rural licensed nursing homes to provide
limited home care services in an adjacent independent living apartment building owned by
the licensed nursing home; and

deleted text begin (7)deleted text endnew text begin (8)new text end recommendations for studies using the data in section 62U.04, subdivision 4,
including but not limited to studies concerning costs related to dementia and chronic disease
among an elderly population over 60 and additional long-term care costs, as described in
section 62U.10, subdivision 6.

(b) The advisory council shall perform other duties as directed by the commissioner.

(c) The advisory council shall annually review the balance of the account in the state
government special revenue fund described in section 144A.474, subdivision 11, paragraph
(i), and make annual recommendations by January 15 directly to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services regarding appropriations to the commissioner for the purposes in section 144A.474,
subdivision 11, paragraph (i).

Sec. 67.

Minnesota Statutes 2018, section 144A.484, subdivision 1, is amended to read:


Subdivision 1.

Integrated licensing established.

deleted text begin (a) From January 1, 2014, to June 30,
2015, the commissioner of health shall enforce the home and community-based services
standards under chapter 245D for those providers who also have a home care license pursuant
to this chapter as required under Laws 2013, chapter 108, article 8, section 60, and article
11, section 31. During this period, the commissioner shall provide technical assistance to
achieve and maintain compliance with applicable law or rules governing the provision of
home and community-based services, including complying with the service recipient rights
notice in subdivision 4, clause (4). If during the survey, the commissioner finds that the
licensee has failed to achieve compliance with an applicable law or rule under chapter 245D
and this failure does not imminently endanger the health, safety, or rights of the persons
served by the program, the commissioner may issue a licensing survey report with
recommendations for achieving and maintaining compliance.
deleted text end

deleted text begin (b) Beginning July 1, 2015,deleted text end A home care provider applicant or license holder may apply
to the commissioner of health for a home and community-based services designation for
the provision of basic support services identified under section 245D.03, subdivision 1,
paragraph (b). The designation allows the license holder to provide basic support services
that would otherwise require licensure under chapter 245D, under the license holder's home
care license governed by sections 144A.43 to deleted text begin144A.481deleted text endnew text begin 144A.4799new text end.

Sec. 68.

Minnesota Statutes 2018, section 145.908, subdivision 1, is amended to read:


Subdivision 1.

Grant program established.

Within the limits of deleted text beginfederal fundsdeleted text end available
deleted text begin specificallydeleted text end new text beginappropriations new text endfor this purpose, the commissioner of health shall establish a
grant program to provide culturally competent programs to screen and treat pregnant women
and women who have given birth in the preceding 12 months for pre- and postpartum mood
and anxiety disorders. Organizations may use grant funds to establish new screening or
treatment programs, or expand or maintain existing screening or treatment programs. In
establishing the grant program, the commissioner shall prioritize expanding or enhancing
screening for pre- and postpartum mood and anxiety disorders in primary care settings. The
commissioner shall determine the types of organizations eligible for grants.

Sec. 69.

Minnesota Statutes 2018, section 145.928, subdivision 1, is amended to read:


Subdivision 1.

Goal; establishment.

It is the goal of the statedeleted text begin, by 2010,deleted text end to decrease deleted text beginby
50 percent
deleted text end the disparities in infant mortality rates and adult and child immunization rates
for American Indians and populations of color, as compared with rates for whites. To do
so and to achieve other measurable outcomes, the commissioner of health shall establish a
program to close the gap in the health status of American Indians and populations of color
as compared with whites in the following priority areas: infant mortality, new text beginaccess to and
utilization of high-quality prenatal care,
new text endbreast and cervical cancer screening, HIV/AIDS
and sexually transmitted infections, adult and child immunizations, cardiovascular disease,
diabetes, and accidental injuries and violence.

Sec. 70.

Minnesota Statutes 2018, section 145.928, subdivision 7, is amended to read:


Subd. 7.

Community grant program; immunization ratesnew text begin, prenatal care access and
utilization,
new text end and infant mortality rates.

(a) The commissioner shall award grants to eligible
applicants for local or regional projects and initiatives directed at reducing health disparities
in one or deleted text beginbothdeleted text endnew text begin morenew text end of the following priority areas:

(1) decreasing racial and ethnic disparities in infant mortality rates; deleted text beginor
deleted text end

new text begin (2) decreasing racial and ethnic disparities in access to and utilization of high-quality
prenatal care; or
new text end

deleted text begin (2)deleted text endnew text begin (3)new text end increasing adult and child immunization rates in nonwhite racial and ethnic
populations.

(b) The commissioner may award up to 20 percent of the funds available as planning
grants. Planning grants must be used to address such areas as community assessment,
coordination activities, and development of community supported strategies.

(c) Eligible applicants may include, but are not limited to, faith-based organizations,
social service organizations, community nonprofit organizations, community health boards,
tribal governments, and community clinics. Applicants must submit proposals to the
commissioner. A proposal must specify the strategies to be implemented to address one or
deleted text begin bothdeleted text endnew text begin morenew text end of the priority areas listed in paragraph (a) and must be targeted to achieve the
outcomes established according to subdivision 3.

(d) The commissioner shall give priority to applicants who demonstrate that their
proposed project or initiative:

(1) is supported by the community the applicant will serve;

(2) is research-based or based on promising strategies;

(3) is designed to complement other related community activities;

(4) utilizes strategies that positively impact deleted text beginbothdeleted text endnew text begin two or morenew text end priority areas;

(5) reflects racially and ethnically appropriate approaches; and

(6) will be implemented through or with community-based organizations that reflect the
race or ethnicity of the population to be reached.

Sec. 71.

Minnesota Statutes 2018, section 145.986, subdivision 1, is amended to read:


Subdivision 1.

Purpose.

The purpose of the statewide health improvement program is
to:

(1) address the deleted text begintop threedeleted text end leading preventable causes of illness and deathdeleted text begin: tobacco use
and exposure, poor diet, and lack of regular physical activity
deleted text endnew text begin such as tobacco use or exposure,
poor diet, and lack of regular physical activity, and other issues as determined by the
commissioner through the statewide health assessment
new text end;

(2) promote the development, availability, and use of evidence-based, community level,
comprehensive strategies to create healthy communities; and

(3) measure the impact of the evidence-based, community health improvement practices
which over time work to contain health care costs and reduce chronic diseases.

Sec. 72.

Minnesota Statutes 2018, section 145.986, subdivision 1a, is amended to read:


Subd. 1a.

Grants to local communities.

(a) deleted text beginBeginning July 1, 2009,deleted text end The commissioner
of health shall award competitive grants to community health boards and tribal governments
to convene, coordinate, and implement deleted text beginevidence-baseddeleted text endnew text begin proven-effectivenew text end strategies deleted text begintargeted
at reducing the percentage of Minnesotans who are obese or overweight and to reduce the
use of tobacco
deleted text endnew text begin, promising practice strategies, or theory-based strategies that can be evaluated
using experimental or quasi-experimental design
new text end. Grants shall be awarded to all community
health boards and tribal governments whose proposals demonstrate the ability to implement
programs designed to achieve the purposes in subdivision 1 and other requirements of this
section.new text begin In each grant cycle, the commissioner may award up to 100 percent of tribal grants
and up to 25 percent of the grants awarded to community health boards to theory-based
strategies that are culturally or ethnically focused.
new text end

(b) Grantee activities shall:

(1) be based on scientific evidence;

(2) be based on community input;

(3) address behavior change at the individual, community, and systems levels;

(4) occur in community, school, work site, and health care settings;

(5) be focused on policy, systems, and environmental changes that support healthy
behaviors; and

(6) address the health disparities and inequities that exist in the grantee's community.

(c) To receive a grant under this section, community health boards and tribal governments
must submit proposals to the commissioner. A local match of ten percent of the total funding
allocation is required. This local match may include funds donated by community partners.

(d) In order to receive a grant, community health boards and tribal governments must
submit a health improvement plan to the commissioner of health for approval. The
commissioner may require the plan to identify a community leadership team, community
partners, and a community action plan that includes an assessment of area strengths and
needs, proposed action strategies, technical assistance needs, and a staffing plan.

(e) The grant recipient must implement the health improvement plan, evaluate the
effectiveness of the strategies, and modify or discontinue strategies found to be ineffective.

(f) Grant recipients shall report their activities and their progress toward the outcomes
established under subdivision 2 to the commissioner in a format and at a time specified by
the commissioner.

(g) All grant recipients shall be held accountable for making progress toward the
measurable outcomes established in subdivision 2. The commissioner shall require a
corrective action plan and may reduce the funding level of grant recipients that do not make
adequate progress toward the measurable outcomes.

(h)deleted text begin Beginning November 1, 2015, the commissioner shall offer grant recipients the
option of using a grant awarded under this subdivision to implement health improvement
strategies that improve the health status, delay the expression of dementia, or slow the
progression of dementia, for a targeted population at risk for dementia and shall award at
least two of the grants awarded on November 1, 2015, for these purposes. The grants must
meet all other requirements of this section. The commissioner shall coordinate grant planning
activities with the commissioner of human services, the Minnesota Board on Aging, and
community-based organizations with a focus on dementia. Each grant must include selected
outcomes and evaluation measures related to the incidence or progression of dementia
among the targeted population using the procedure described in subdivision 2.
deleted text endnew text begin For purposes
of this subdivision, "proven-effective" means a strategy or practice that offers a high level
of research on effectiveness for at least one outcome of interest; "promising practice" means
a practice or activity that is supported by research demonstrating effectiveness for at least
one outcome of interest; and "theory-based" means a strategy or activity that has no research
on effectiveness but has a well-constructed logical model or theory of change.
new text end

deleted text begin (i) Beginning July 1, 2017, the commissioner shall offer grant recipients the option of
using a grant awarded under this subdivision to confront the opioid addiction and overdose
epidemic, and shall award at least two of the grants awarded on or after July 1, 2017, for
these purposes. The grants awarded under this paragraph must meet all other requirements
of this section. The commissioner shall coordinate grant planning activities with the
commissioner of human services. Each grant shall include selected outcomes and evaluation
measures related to addressing the opioid epidemic.
deleted text end

Sec. 73.

Minnesota Statutes 2018, section 145.986, subdivision 4, is amended to read:


Subd. 4.

Evaluation.

(a) Using the outcome measures established in subdivision 3, the
commissioner shall conduct a biennial evaluation of the statewide health improvement
program new text begingrants new text endfunded under this section. new text beginThe evaluation must use the most appropriate
experimental or quasi-experimental design suitable for the grant activity or project.
new text endGrant
recipients shall cooperate with the commissioner in the evaluation and provide the
commissioner with the information necessary to conduct the evaluation, including information
on any impact on the health indicators listed in section 62U.10, subdivision 6, within the
geographic area or among the population targeted.

(b) Grant recipients will collect, monitor, and submit to the Department of Health baseline
and annual data and provide information to improve the quality and impact of community
health improvement strategies.

(c) For the purposes of carrying out the grant program under this section, including for
administrative purposes, the commissioner shall award contracts to appropriate entities to
assist in designing and implementing evaluation systems.new text begin The commissioner shall consult
with the commissioner of management and budget to ensure that the evaluation process is
using experimental or quasi-experimental design.
new text end

(d) Contracts awarded under paragraph (c) may be used to:

(1) develop grantee monitoring and reporting systems to track grantee progress, including
aggregated and disaggregated data;

(2) manage, analyze, and report program evaluation data results; and

(3) utilize innovative support tools to analyze and predict the impact of prevention
strategies on health outcomes and state health care costs over time.

new text begin (e) For purposes of this subdivision, "experimental design" means a method of evaluating
the impact of a strategy that uses random assignment to establish statistically similar groups,
so that any difference in outcomes found at the end of the evaluation can be attributed to
the strategy being evaluated; and "quasi-experimental design" means a method of evaluating
the impact of a strategy that uses an approach other than random assignment to establish
statistically similar groups, so that any difference in outcomes found at the end of the
evaluation can be attributed to the strategy being evaluated.
new text end

Sec. 74.

Minnesota Statutes 2018, section 145.986, subdivision 5, is amended to read:


Subd. 5.

Report.

The commissioner shall submit a biennial report to the legislature on
the statewide health improvement program funded under this section. The report must
include information on each grant recipient, including the activities that were conducted by
the grantee using grant funds, the grantee's progress toward achieving the measurable
outcomes established under subdivision 2, and the data provided to the commissioner by
the grantee to measure these outcomes for grant activities. The commissioner shall provide
information on grants in which a corrective action plan was required under subdivision 1a,
the types of plan action, and the progress that has been made toward meeting the measurable
outcomes. In addition, the commissioner shall provide recommendations on future areas of
focus for health improvement. These reports are due by January 15 of every other year,
beginning in 2010. deleted text beginIn the report due on January 15, 2014,deleted text end new text beginIn the reports due beginning
January 15, 2020,
new text endthe commissioner shall include a description of the contracts awarded
under subdivision 4, paragraph (c), and the monitoring and evaluation systems that were
designed and implemented under these contracts.

Sec. 75.

Minnesota Statutes 2018, section 145.986, subdivision 6, is amended to read:


Subd. 6.

Supplantation of existing funds.

Community health boards and tribal
governments must use funds received under this section to develop new programs, expand
current programs deleted text beginthat work to reduce the percentage of Minnesotans who are obese or
overweight or who use tobacco
deleted text end, or replace discontinued state or federal funds deleted text beginpreviously
used to reduce the percentage of Minnesotans who are obese or overweight or who use
tobacco
deleted text end. Funds must not be used to supplant current state or local funding to community
health boards or tribal governments deleted text beginused to reduce the percentage of Minnesotans who are
obese or overweight or to reduce tobacco use
deleted text end.

Sec. 76.

new text begin [151.72] SALE OF CERTAIN CANNABINOID PRODUCTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Hemp" has the meaning given to "industrial hemp" in section 18K.02, subdivision
3.
new text end

new text begin (c) "Labeling" means all labels and other written, printed, or graphic matter that are:
new text end

new text begin (1) affixed to the immediate container in which a product regulated under this section
is sold; or
new text end

new text begin (2) provided, in any manner, with the immediate container, including but not limited to
outer containers, wrappers, package inserts, brochures, or pamphlets.
new text end

new text begin Subd. 2. new text end

new text begin Scope. new text end

new text begin (a) This section applies to the sale of any product that contains
nonintoxicating cannabinoids extracted from hemp other than food that is intended for
human or animal consumption by any route of administration.
new text end

new text begin (b) This section does not apply to any product dispensed by a registered medical cannabis
manufacturer pursuant to sections 152.22 to 152.37.
new text end

new text begin Subd. 3. new text end

new text begin Sale of cannabinoids derived from hemp. new text end

new text begin Notwithstanding any other section
of this chapter, a product containing nonintoxicating cannabinoids may be sold for human
or animal consumption if all of the requirements of this section are met.
new text end

new text begin Subd. 4. new text end

new text begin Testing requirements. new text end

new text begin (a) A manufacturer of a product regulated under this
section must submit representative samples of the product to
new text end new text begin an independent, accredited
laboratory in order to certify that the product complies with the standards adopted by the
board. Testing must be consistent with generally accepted industry standards for herbal and
botanical substances, and at a minimum, the testing must confirm that the product:
new text end

new text begin (1) contains the amount or percentage of cannabinoids that is stated on the label of the
product;
new text end

new text begin (2) does not contain more than trace amounts of any pesticides, fertilizers, or heavy
metals; and
new text end

new text begin (3) does not contain a delta-9 tetrahydrocannabinol concentration that exceeds the
concentration permitted for industrial hemp as defined in section 18K.02, subdivision 3.
new text end

new text begin (b) Upon the request of the board, the manufacturer of the product must provide the
board with the results of the testing required in this section.
new text end

new text begin Subd. 5. new text end

new text begin Labeling requirements. new text end

new text begin (a) A product regulated under this section must bear
a label that contains, at a minimum:
new text end

new text begin (1) the name, location, contact phone number, and website of the manufacturer of the
product;
new text end

new text begin (2) the name and address of the independent, accredited laboratory used by the
manufacturer to test the product;
new text end

new text begin (3) an accurate statement of the amount or percentage of cannabinoids found in each
unit of the product meant to be consumed; and
new text end

new text begin (4) a statement stating that this product does not claim to diagnose, treat, cure, or prevent
any disease and has not been evaluated or approved by the United States Food and Drug
Administration (FDA) unless the product has been so approved.
new text end

new text begin (b) The information required to be on the label must be prominently and conspicuously
placed and in terms that can be easily read and understood by the consumer.
new text end

new text begin (c) The label must not contain any claim that the product may be used or is effective for
the prevention, treatment, or cure of a disease or that it may be used to alter the structure
or function of human or animal bodies, unless the claim has been approved by the FDA.
new text end

new text begin Subd. 6. new text end

new text begin Enforcement. new text end

new text begin (a) A product sold under this section shall be considered an
adulterated drug if:
new text end

new text begin (1) it consists, in whole or in part, of any filthy, putrid, or decomposed substance;
new text end

new text begin (2) it has been produced, prepared, packed, or held under unsanitary conditions where
it may have been rendered injurious to health, or where it may have been contaminated with
filth;
new text end

new text begin (3) its container is composed, in whole or in part, of any poisonous or deleterious
substance that may render the contents injurious to health;
new text end

new text begin (4) it contains any color additives or excipients that have been found by the FDA to be
unsafe for human or animal consumption; or
new text end

new text begin (5) it contains an amount or percentage of cannabinoids that is different than the amount
or percentage stated on the label.
new text end

new text begin (b) A product sold under this section shall be considered a misbranded drug if the
product's labeling is false or misleading in any manner or in violation of the requirements
of this section.
new text end

new text begin (c) The board's authority to issue cease and desist orders under section 151.06; to embargo
adulterated and misbranded drugs under section 151.38; and to seek injunctive relief under
section 214.11, extends to any violation of this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to any
product sold in Minnesota on or after that date.
new text end

Sec. 77.

Minnesota Statutes 2018, section 152.01, subdivision 9, is amended to read:


Subd. 9.

Marijuana.

"Marijuana" means all parts of the plant of any species of the genus
Cannabis, including all agronomical varieties, whether growing or not; the seeds thereof;
the resin extracted from any part of such plant; and every compound, manufacture, salt,
derivative, mixture, or preparation of such plant, its seeds or resin, but shall not include the
mature stalks of such plant, fiber from such stalks, oil or cake made from the seeds of such
plant, any other compound, manufacture, salt, derivative, mixture, or preparation of such
mature stalks, except the resin extracted therefrom, fiber, oil, or cake, or the sterilized seed
of such plant which is incapable of germination.new text begin Marijuana does not include hemp as defined
in section 152.22, subdivision 5a.
new text end

Sec. 78.

Minnesota Statutes 2018, section 152.22, is amended by adding a subdivision to
read:


new text begin Subd. 5a. new text end

new text begin Hemp. new text end

new text begin "Hemp" has the meaning given to industrial hemp in section 18K.02,
subdivision 3.
new text end

Sec. 79.

Minnesota Statutes 2018, section 152.22, is amended by adding a subdivision to
read:


new text begin Subd. 5b. new text end

new text begin Hemp grower. new text end

new text begin "Hemp grower" means a person licensed by the commissioner
of agriculture under chapter 18K to grow hemp for commercial purposes.
new text end

Sec. 80.

Minnesota Statutes 2018, section 152.22, subdivision 6, is amended to read:


Subd. 6.

Medical cannabis.

(a) "Medical cannabis" means any species of the genus
cannabis plant, or any mixture or preparation of them, including whole plant extracts and
resins, and is delivered in the form of:

(1) liquid, including, but not limited to, oil;

(2) pill;

(3) vaporized delivery method with use of liquid or oil but which does not require the
use of dried leaves or plant form; or

(4) any other method, excluding smoking, approved by the commissioner.

(b) This definition includes any part of the genus cannabis plant prior to being processed
into a form allowed under paragraph (a), that is possessed by a person while that person is
engaged in employment duties necessary to carry out a requirement under sections 152.22
to 152.37 for a registered manufacturer or a laboratory under contract with a registered
manufacturer.new text begin This definition also includes any hemp acquired by a manufacturer by a hemp
grower as permitted under section 152.29, subdivision 1, paragraph (b).
new text end

Sec. 81.

Minnesota Statutes 2018, section 152.22, subdivision 11, is amended to read:


Subd. 11.

Registered designated caregiver.

"Registered designated caregiver" means
a person who:

(1) is at least deleted text begin21deleted text endnew text begin 18new text end years old;

(2) does not have a conviction for a disqualifying felony offense;

(3) has been approved by the commissioner to assist a patient who has been identified
by a health care practitioner as developmentally or physically disabled and therefore deleted text beginunable
to self-administer medication
deleted text endnew text begin requires assistance in administering medical cannabisnew text end or
deleted text begin acquiredeleted text endnew text begin obtainingnew text end medical cannabis from a distribution facility due to the disability; and

(4) is authorized by the commissioner to assist the patient with the use of medical
cannabis.

Sec. 82.

Minnesota Statutes 2018, section 152.22, subdivision 13, is amended to read:


Subd. 13.

Registry verification.

"Registry verification" means the verification provided
by the commissioner that a patient is enrolled in the registry program and that includes the
patient's name, registry number, deleted text beginand qualifying medical conditiondeleted text end and, if applicable, the
name of the patient's registered designated caregiver or parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end.

Sec. 83.

Minnesota Statutes 2018, section 152.25, subdivision 1, is amended to read:


Subdivision 1.

Medical cannabis manufacturer registration.

(a) The commissioner
shall register two in-state manufacturers for the production of all medical cannabis within
the state. new text beginA registration agreement between the commissioner and a manufacturer is
nontransferable.
new text endThe commissioner shall register new manufacturers or reregister the existing
manufacturers by December 1 every two years, using the factors described in this subdivision.
The commissioner shall accept applications after December 1, 2014, if one of the
manufacturers registered before December 1, 2014, ceases to be registered as a manufacturer.
The commissioner's determination that no manufacturer exists to fulfill the duties under
sections 152.22 to 152.37 is subject to judicial review in Ramsey County District Court.
Data submitted during the application process are private data on individuals or nonpublic
data as defined in section 13.02 until the manufacturer is registered under this section. Data
on a manufacturer that is registered are public data, unless the data are trade secret or security
information under section 13.37.

(b) As a condition for registration, a manufacturer must agree to:

(1) begin supplying medical cannabis to patients by July 1, 2015; and

(2) comply with all requirements under sections 152.22 to 152.37.

(c) The commissioner shall consider the following factors when determining which
manufacturer to register:

(1) the technical expertise of the manufacturer in cultivating medical cannabis and
converting the medical cannabis into an acceptable delivery method under section 152.22,
subdivision 6;

(2) the qualifications of the manufacturer's employees;

(3) the long-term financial stability of the manufacturer;

(4) the ability to provide appropriate security measures on the premises of the
manufacturer;

(5) whether the manufacturer has demonstrated an ability to meet the medical cannabis
production needs required by sections 152.22 to 152.37; and

(6) the manufacturer's projection and ongoing assessment of fees on patients with a
qualifying medical condition.

(d) If an officer, director, or controlling person of the manufacturer pleads or is found
guilty of intentionally diverting medical cannabis to a person other than allowed by law
under section 152.33, subdivision 1, the commissioner may decide not to renew the
registration of the manufacturer, provided the violation occurred while the person was an
officer, director, or controlling person of the manufacturer.

(e) The commissioner shall require each medical cannabis manufacturer to contract with
an independent laboratory to test medical cannabis produced by the manufacturer. The
commissioner shall approve the laboratory chosen by each manufacturer and require that
the laboratory report testing results to the manufacturer in a manner determined by the
commissioner.

Sec. 84.

Minnesota Statutes 2018, section 152.25, subdivision 1a, is amended to read:


Subd. 1a.

Revocationdeleted text begin,deleted text endnew text begin ornew text end nonrenewaldeleted text begin, or denial of consent to transferdeleted text endnew text begin ofnew text end a medical
cannabis manufacturer registration.

If the commissioner intends to revokedeleted text begin,deleted text endnew text begin ornew text end not renewdeleted text begin,
or deny consent to transfer
deleted text end a registration issued under this section, the commissioner must
first notify in writing the manufacturer against whom the action is to be taken and provide
the manufacturer with an opportunity to request a hearing under the contested case provisions
of chapter 14. If the manufacturer does not request a hearing by notifying the commissioner
in writing within 20 days after receipt of the notice of proposed action, the commissioner
may proceed with the action without a hearing. For revocations, the registration of a
manufacturer is considered revoked on the date specified in the commissioner's written
notice of revocation.

Sec. 85.

Minnesota Statutes 2018, section 152.25, subdivision 1c, is amended to read:


Subd. 1c.

Notice to patients.

Upon the revocation or nonrenewal of a manufacturer's
registration under subdivision 1a or implementation of an enforcement action under
subdivision 1b that may affect the ability of a registered patient, registered designated
caregiver, or a registered patient's parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end to obtain medical
cannabis from the manufacturer subject to the enforcement action, the commissioner shall
notify in writing each registered patient and the patient's registered designated caregiver or
registered patient's parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end about the outcome of the proceeding
and information regarding alternative registered manufacturers. This notice must be provided
two or more business days prior to the effective date of the revocation, nonrenewal, or other
enforcement action.

Sec. 86.

Minnesota Statutes 2018, section 152.25, subdivision 4, is amended to read:


Subd. 4.

Reports.

(a) The commissioner shall provide regular updates to the task force
on medical cannabis therapeutic research and to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services, public safety,
judiciary, and civil law regardingnew text begin: (1)new text end any changes in federal law or regulatory restrictions
regarding the use of medical cannabisnew text begin or hemp; and (2) the market demand and supply in
this state for products made from hemp that can be used for medicinal purposes
new text end.

(b) The commissioner may submit medical research based on the data collected under
sections 152.22 to 152.37 to any federal agency with regulatory or enforcement authority
over medical cannabis to demonstrate the effectiveness of medical cannabis for treating a
qualifying medical condition.

Sec. 87.

Minnesota Statutes 2018, section 152.27, subdivision 2, is amended to read:


Subd. 2.

Commissioner duties.

(a) The commissioner shall:

(1) give notice of the program to health care practitioners in the state who are eligible
to serve as health care practitioners and explain the purposes and requirements of the
program;

(2) allow each health care practitioner who meets or agrees to meet the program's
requirements and who requests to participate, to be included in the registry program to
collect data for the patient registry;

(3) provide explanatory information and assistance to each health care practitioner in
understanding the nature of therapeutic use of medical cannabis within program requirements;

(4) create and provide a certification to be used by a health care practitioner for the
practitioner to certify whether a patient has been diagnosed with a qualifying medical
condition and include in the certification an option for the practitioner to certify whether
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability, the patient deleted text beginis unable to self-administer medicationdeleted text endnew text begin
requires assistance in administering medical cannabis
new text end or deleted text beginacquiredeleted text endnew text begin obtainingnew text end medical cannabis
from a distribution facility;

(5) supervise the participation of the health care practitioner in conducting patient
treatment and health records reporting in a manner that ensures stringent security and
record-keeping requirements and that prevents the unauthorized release of private data on
individuals as defined by section 13.02;

(6) develop safety criteria for patients with a qualifying medical condition as a
requirement of the patient's participation in the program, to prevent the patient from
undertaking any task under the influence of medical cannabis that would constitute negligence
or professional malpractice on the part of the patient; and

(7) conduct research and studies based on data from health records submitted to the
registry program and submit reports on intermediate or final research results to the legislature
and major scientific journals. The commissioner may contract with a third party to complete
the requirements of this clause. Any reports submitted must comply with section 152.28,
subdivision 2
.

(b)new text begin The commissioner may add a delivery method under section 152.22, subdivision 6,
or add or modify a qualifying medical condition under section 152.22, subdivision 14, upon
a petition from a member of the public or the task force on medical cannabis therapeutic
research or as directed by law. The commissioner shall evaluate all petitions to add a
qualifying medical condition or modify an existing qualifying medical condition submitted
by the task force on medical cannabis therapeutic research or as directed by law and shall
make the addition or modification if the commissioner determines the addition or
modification is warranted based on the best available evidence and research.
new text end If the
commissioner wishes to add a delivery method under section 152.22, subdivision 6, or a
qualifying medical condition under section 152.22, subdivision 14, the commissioner must
notify the chairs and ranking minority members of the legislative policy committees having
jurisdiction over health and public safety of the addition and the reasons for its addition,
including any written comments received by the commissioner from the public and any
guidance received from the task force on medical cannabis research, by January 15 of the
year in which the commissioner wishes to make the change. The change shall be effective
on August 1 of that year, unless the legislature by law provides otherwise.

Sec. 88.

Minnesota Statutes 2018, section 152.27, subdivision 3, is amended to read:


Subd. 3.

Patient application.

(a) The commissioner shall develop a patient application
for enrollment into the registry program. The application shall be available to the patient
and given to health care practitioners in the state who are eligible to serve as health care
practitioners. The application must include:

(1) the name, mailing address, and date of birth of the patient;

(2) the name, mailing address, and telephone number of the patient's health care
practitioner;

(3) the name, mailing address, and date of birth of the patient's designated caregiver, if
any, or the patient's parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end if the parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or
spouse
new text end will be acting as a caregiver;

(4) a copy of the certification from the patient's health care practitioner that is dated
within 90 days prior to submitting the application which certifies that the patient has been
diagnosed with a qualifying medical condition and, if applicable, that, in the health care
practitioner's medical opinion, the patient is developmentally or physically disabled and,
as a result of that disability, the patient deleted text beginis unable to self-administer medicationdeleted text endnew text begin requires
assistance in administering medical cannabis
new text end or deleted text beginacquiredeleted text endnew text begin obtainingnew text end medical cannabis from
a distribution facility; and

(5) all other signed affidavits and enrollment forms required by the commissioner under
sections 152.22 to 152.37, including, but not limited to, the disclosure form required under
paragraph (c).

(b) The commissioner shall require a patient to resubmit a copy of the certification from
the patient's health care practitioner on a yearly basis and shall require that the recertification
be dated within 90 days of submission.

(c) The commissioner shall develop a disclosure form and require, as a condition of
enrollment, all patients to sign a copy of the disclosure. The disclosure must include:

(1) a statement that, notwithstanding any law to the contrary, the commissioner, or an
employee of any state agency, may not be held civilly or criminally liable for any injury,
loss of property, personal injury, or death caused by any act or omission while acting within
the scope of office or employment under sections 152.22 to 152.37; and

(2) the patient's deleted text beginacknowledgementdeleted text endnew text begin acknowledgmentnew text end that enrollment in the patient registry
program is conditional on the patient's agreement to meet all of the requirements of sections
152.22 to 152.37.

Sec. 89.

Minnesota Statutes 2018, section 152.27, subdivision 4, is amended to read:


Subd. 4.

Registered designated caregiver.

(a) The commissioner shall register a
designated caregiver for a patient if the patient's health care practitioner has certified that
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability, the patient deleted text beginis unable to self-administer medication
or acquire
deleted text endnew text begin requires assistance in administering medical cannabis or obtainingnew text end medical
cannabis from a distribution facility and the caregiver has agreed, in writing, to be the
patient's designated caregiver. As a condition of registration as a designated caregiver, the
commissioner shall require the person to:

(1) be at least deleted text begin21deleted text endnew text begin 18new text end years of age;

(2) agree to only possess deleted text beginanydeleted text endnew text begin the patient'snew text end medical cannabis for purposes of assisting the
patient; and

(3) agree that if the application is approved, the person will not be a registered designated
caregiver for more than one patient, unless the patients reside in the same residence.

(b) The commissioner shall conduct a criminal background check on the designated
caregiver prior to registration to ensure that the person does not have a conviction for a
disqualifying felony offense. Any cost of the background check shall be paid by the person
seeking registration as a designated caregiver.new text begin A designated caregiver must have the criminal
background check renewed every two years.
new text end

new text begin (c) Nothing in sections 152.22 to 152.37 shall be construed to prevent a person registered
as a designated caregiver from also being enrolled in the registry program as a patient and
possessing and using medical cannabis as a patient.
new text end

Sec. 90.

Minnesota Statutes 2018, section 152.27, subdivision 5, is amended to read:


Subd. 5.

Parents deleted text beginordeleted text endnew text begin,new text end legal guardiansnew text begin, and spousesnew text end.

A parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or
spouse
new text end of a patient may act as the caregiver to the patient without having to register as a
designated caregiver. The parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end shall follow all of the
requirements of parents deleted text beginanddeleted text endnew text begin,new text end legal guardiansnew text begin, and spousesnew text end listed in sections 152.22 to 152.37.
Nothing in sections 152.22 to 152.37 limits any legal authority a parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin,
or spouse
new text end may have for the patient under any other law.

Sec. 91.

Minnesota Statutes 2018, section 152.27, subdivision 6, is amended to read:


Subd. 6.

Patient enrollment.

(a) After receipt of a patient's application, application fees,
and signed disclosure, the commissioner shall enroll the patient in the registry program and
issue the patient and patient's registered designated caregiver or parent deleted text beginordeleted text endnew text begin,new text end legal guardian,
new text begin or spouse, new text endif applicable, a registry verification. The commissioner shall approve or deny a
patient's application for participation in the registry program within 30 days after the
commissioner receives the patient's application and application fee. The commissioner may
approve applications up to 60 days after the receipt of a patient's application and application
fees until January 1, 2016. A patient's enrollment in the registry program shall only be
denied if the patient:

(1) does not have certification from a health care practitioner that the patient has been
diagnosed with a qualifying medical condition;

(2) has not signed and returned the disclosure form required under subdivision 3,
paragraph (c), to the commissioner;

(3) does not provide the information required;

(4) has previously been removed from the registry program for violations of section
152.30 or 152.33; or

(5) provides false information.

(b) The commissioner shall give written notice to a patient of the reason for denying
enrollment in the registry program.

(c) Denial of enrollment into the registry program is considered a final decision of the
commissioner and is subject to judicial review under the Administrative Procedure Act
pursuant to chapter 14.

(d) A patient's enrollment in the registry program may only be revoked upon the death
of the patient or if a patient violates a requirement under section 152.30 or 152.33.

(e) The commissioner shall develop a registry verification to provide to the patient, the
health care practitioner identified in the patient's application, and to the manufacturer. The
registry verification shall include:

(1) the patient's name and date of birth;

(2) the patient registry number assigned to the patient;new text begin and
new text end

deleted text begin (3) the patient's qualifying medical condition as provided by the patient's health care
practitioner in the certification; and
deleted text end

deleted text begin (4)deleted text endnew text begin (3)new text end the name and date of birth of the patient's registered designated caregiver, if any,
or the name of the patient's parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end if the parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin,
or spouse
new text end will be acting as a caregiver.

Sec. 92.

Minnesota Statutes 2018, section 152.28, subdivision 1, is amended to read:


Subdivision 1.

Health care practitioner duties.

(a) Prior to a patient's enrollment in
the registry program, a health care practitioner shall:

(1) determine, in the health care practitioner's medical judgment, whether a patient suffers
from a qualifying medical condition, and, if so determined, provide the patient with a
certification of that diagnosis;

(2) determine whether a patient is developmentally or physically disabled and, as a result
of that disability, the patient deleted text beginis unable to self-administer medication or acquiredeleted text end new text beginrequires
assistance in administering medical cannabis or obtaining
new text end medical cannabis from a
distribution facility, and, if so determined, include that determination on the patient's
certification of diagnosis;

(3) advise patients, registered designated caregivers, and parents deleted text beginordeleted text endnew text begin,new text end legal guardiansnew text begin, or
spouses
new text end who are acting as caregivers of the existence of any nonprofit patient support groups
or organizations;

(4) provide explanatory information from the commissioner to patients with qualifying
medical conditions, including disclosure to all patients about the experimental nature of
therapeutic use of medical cannabis; the possible risks, benefits, and side effects of the
proposed treatment; the application and other materials from the commissioner; and provide
patients with the Tennessen warning as required by section 13.04, subdivision 2; and

(5) agree to continue treatment of the patient's qualifying medical condition and report
medical findings to the commissioner.

(b) Upon notification from the commissioner of the patient's enrollment in the registry
program, the health care practitioner shall:

(1) participate in the patient registry reporting system under the guidance and supervision
of the commissioner;

(2) report health records of the patient throughout the ongoing treatment of the patient
to the commissioner in a manner determined by the commissioner and in accordance with
subdivision 2;

(3) determine, on a yearly basis, if the patient continues to suffer from a qualifying
medical condition and, if so, issue the patient a new certification of that diagnosis; and

(4) otherwise comply with all requirements developed by the commissioner.

new text begin (c) A health care practitioner may conduct a patient assessment to issue a recertification
as required under paragraph (b), clause (3), via telemedicine as defined under section
62A.671, subdivision 9.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end Nothing in this section requires a health care practitioner to participate in the
registry program.

Sec. 93.

Minnesota Statutes 2018, section 152.29, subdivision 1, is amended to read:


Subdivision 1.

Manufacturer; requirements.

(a) A manufacturer shall operate deleted text beginfourdeleted text endnew text begin
eight
new text end distribution facilities, which may include the manufacturer's single location for
cultivation, harvesting, manufacturing, packaging, and processing but is not required to
include that location. deleted text beginA manufacturer is required to begin distribution of medical cannabis
from at least one distribution facility by July 1, 2015. All distribution facilities must be
operational and begin distribution of medical cannabis by July 1, 2016. The distribution
facilities shall be located
deleted text endnew text begin The commissioner shall designate the geographical service areas
to be served by each manufacturer
new text endbased on geographical need throughout the state to
improve patient access. deleted text beginA manufacturer shall disclose the proposed locations for the
distribution facilities to the commissioner during the registration process.
deleted text end new text beginA manufacturer
shall not have more than two distribution facilities in each geographical service area assigned
to the manufacturer by the commissioner.
new text endA manufacturer shall operate only one location
where all cultivation, harvesting, manufacturing, packaging, and processingnew text begin of medical
cannabis
new text end shall be conducted. deleted text beginAnydeleted text endnew text begin This location may be one of the manufacturer's distribution
facility sites. The
new text end additional distribution facilities may dispense medical cannabis and
medical cannabis products but may not contain any medical cannabis in a form other than
those forms allowed under section 152.22, subdivision 6, and the manufacturer shall not
conduct any cultivation, harvesting, manufacturing, packaging, or processing at deleted text beginan additionaldeleted text endnew text begin
the other
new text end distribution facility deleted text beginsitedeleted text endnew text begin sitesnew text end. Any distribution facility operated by the manufacturer
is subject to all of the requirements applying to the manufacturer under sections 152.22 to
152.37, including, but not limited to, security and distribution requirements.

new text begin (b) A manufacturer may acquire hemp grown in this state from a hemp grower. A
manufacturer may manufacture or process hemp into an allowable form of medical cannabis
under section 152.22, subdivision 6. Hemp acquired by a manufacturer under this paragraph
is subject to the same quality control program, security and testing requirements, and other
requirements that apply to medical cannabis under sections 152.22 to 152.37 and Minnesota
Rules, chapter 4770.
new text end

deleted text begin (b)deleted text endnew text begin (c)new text end A medical cannabis manufacturer shall contract with a laboratory approved by
the commissioner, subject to any additional requirements set by the commissioner, for
purposes of testing medical cannabis manufactured new text beginor hemp acquired new text endby the medical cannabis
manufacturer as to content, contamination, and consistency to verify the medical cannabis
meets the requirements of section 152.22, subdivision 6. The cost of laboratory testing shall
be paid by the manufacturer.

deleted text begin (c)deleted text endnew text begin (d)new text end The operating documents of a manufacturer must include:

(1) procedures for the oversight of the manufacturer and procedures to ensure accurate
record keeping; deleted text beginand
deleted text end

(2) procedures for the implementation of appropriate security measures to deter and
prevent the theft of medical cannabis and unauthorized entrance into areas containing medical
cannabisdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (3) procedures for the delivery and transportation of hemp between hemp growers and
manufacturers.
new text end

deleted text begin (d)deleted text endnew text begin (e)new text end A manufacturer shall implement security requirements, including requirements
for new text beginthe delivery and transportation of hemp, new text endprotection of each location by a fully operational
security alarm system, facility access controls, perimeter intrusion detection systems, and
a personnel identification system.

deleted text begin (e)deleted text endnew text begin (f)new text end A manufacturer shall not share office space with, refer patients to a health care
practitioner, or have any financial relationship with a health care practitioner.

deleted text begin (f)deleted text endnew text begin (g)new text end A manufacturer shall not permit any person to consume medical cannabis on the
property of the manufacturer.

deleted text begin (g)deleted text endnew text begin (h)new text end A manufacturer is subject to reasonable inspection by the commissioner.

deleted text begin (h)deleted text endnew text begin (i)new text end For purposes of sections 152.22 to 152.37, a medical cannabis manufacturer is
not subject to the Board of Pharmacy licensure or regulatory requirements under chapter
151.

deleted text begin (i)deleted text endnew text begin (j)new text end A medical cannabis manufacturer may not employ any person who is under 21
years of age or who has been convicted of a disqualifying felony offense. An employee of
a medical cannabis manufacturer must submit a completed criminal history records check
consent form, a full set of classifiable fingerprints, and the required fees for submission to
the Bureau of Criminal Apprehension before an employee may begin working with the
manufacturer. The bureau must conduct a Minnesota criminal history records check and
the superintendent is authorized to exchange the fingerprints with the Federal Bureau of
Investigation to obtain the applicant's national criminal history record information. The
bureau shall return the results of the Minnesota and federal criminal history records checks
to the commissioner.

deleted text begin (j)deleted text endnew text begin (k)new text end A manufacturer may not operate in any location, whether for distribution or
cultivation, harvesting, manufacturing, packaging, or processing, within 1,000 feet of a
public or private school existing before the date of the manufacturer's registration with the
commissioner.

deleted text begin (k)deleted text endnew text begin (l)new text end A manufacturer shall comply with reasonable restrictions set by the commissioner
relating to signage, marketing, display, and advertising of medical cannabis.

new text begin (m) Before a manufacturer acquires hemp from a hemp grower, the manufacturer must
verify that the hemp grower has a valid license issued by the commissioner of agriculture
under chapter 18K.
new text end

Sec. 94.

Minnesota Statutes 2018, section 152.29, subdivision 2, is amended to read:


Subd. 2.

Manufacturer; production.

(a) A manufacturer of medical cannabis shall
provide a reliable and ongoing supply of all medical cannabis needed for the registry programnew text begin
through cultivation by the manufacturer and through the purchase of hemp from hemp
growers
new text end.

(b) All cultivation, harvesting, manufacturing, packaging, and processing of medical
cannabis must take place in an enclosed, locked facility at a physical address provided to
the commissioner during the registration process.

(c) A manufacturer must process and prepare any medical cannabis plant material new text beginor
hemp plant material
new text endinto a form allowable under section 152.22, subdivision 6, prior to
distribution of any medical cannabis.

Sec. 95.

Minnesota Statutes 2018, section 152.29, subdivision 3, is amended to read:


Subd. 3.

Manufacturer; distribution.

(a) A manufacturer shall require that employees
licensed as pharmacists pursuant to chapter 151 be the only employees to give final approval
for the distribution of medical cannabis to a patient.new text begin A manufacturer may transport medical
cannabis or medical cannabis products that have been cultivated, harvested, manufactured,
packaged, and processed by that manufacturer to another registered manufacturer for the
other manufacturer to distribute.
new text end

(b) A manufacturer may deleted text begindispensedeleted text endnew text begin distributenew text end medical cannabis products, whether or not
the products have been manufactured by deleted text beginthedeleted text endnew text begin thatnew text end manufacturerdeleted text begin, but is not required to dispense
medical cannabis products
deleted text end.

(c) Prior to distribution of any medical cannabis, the manufacturer shall:

(1) verify that the manufacturer has received the registry verification from the
commissioner for that individual patient;

(2) verify that the person requesting the distribution of medical cannabis is the patient,
the patient's registered designated caregiver, or the patient's parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or
spouse
new text end listed in the registry verification using the procedures described in section 152.11,
subdivision 2d
;

(3) assign a tracking number to any medical cannabis distributed from the manufacturer;

(4) ensure that any employee of the manufacturer licensed as a pharmacist pursuant to
chapter 151 has consulted with the patient to determine the proper dosage for the individual
patient after reviewing the ranges of chemical compositions of the medical cannabis and
the ranges of proper dosages reported by the commissioner. For purposes of this clause, a
consultation may be conducted remotely using a videoconference, so long as the employee
providing the consultation is able to confirm the identity of the patient, the consultation
occurs while the patient is at a distribution facility, and the consultation adheres to patient
privacy requirements that apply to health care services delivered through telemedicine;

(5) properly package medical cannabis in compliance with the United States Poison
Prevention Packing Act regarding child-resistant packaging and exemptions for packaging
for elderly patients, and label distributed medical cannabis with a list of all active ingredients
and individually identifying information, including:

(i) the patient's name and date of birth;

(ii) the name and date of birth of the patient's registered designated caregiver or, if listed
on the registry verification, the name of the patient's parent or legal guardian, if applicable;

(iii) the patient's registry identification number;

(iv) the chemical composition of the medical cannabis; and

(v) the dosage; and

(6) ensure that the medical cannabis distributed contains a maximum of a deleted text begin30-daydeleted text end new text begin90-daynew text end
supply of the dosage determined for that patient.

(d) A manufacturer shall require any employee of the manufacturer who is transporting
medical cannabis or medical cannabis products to a distribution facility new text beginor to another
registered manufacturer
new text endto carry identification showing that the person is an employee of
the manufacturer.

Sec. 96.

Minnesota Statutes 2018, section 152.29, subdivision 3a, is amended to read:


Subd. 3a.

Transportation of medical cannabis; staffing.

new text begin(a) new text endA medical cannabis
manufacturer may staff a transport motor vehicle with only one employee if the medical
cannabis manufacturer is transporting medical cannabis to either a certified laboratory for
the purpose of testing or a facility for the purpose of disposal. If the medical cannabis
manufacturer is transporting medical cannabis for any other purpose or destination, the
transport motor vehicle must be staffed with a minimum of two employees as required by
rules adopted by the commissioner.

new text begin (b) Notwithstanding paragraph (a), a medical cannabis manufacturer that is only
transporting hemp for any purpose may staff the transport motor vehicle with only one
employee.
new text end

Sec. 97.

Minnesota Statutes 2018, section 152.31, is amended to read:


152.31 DATA PRACTICES.

(a) Government data in patient files maintained by the commissioner and the health care
practitioner, and data submitted to or by a medical cannabis manufacturer, are private data
on individuals, as defined in section 13.02, subdivision 12, or nonpublic data, as defined in
section 13.02, subdivision 9, but may be used for purposes of complying with chapter 13
and complying with a request from the legislative auditor or the state auditor in the
performance of official duties. The provisions of section 13.05, subdivision 11, apply to a
registration agreement entered between the commissioner and a medical cannabis
manufacturer under section 152.25.

(b) Not public data maintained by the commissioner may not be used for any purpose
not provided for in sections 152.22 to 152.37, and may not be combined or linked in any
manner with any other list, dataset, or database.

new text begin (c) The commissioner may execute data sharing arrangements with the commissioner
of agriculture to verify licensing, inspection, and compliance information related to hemp
growers under chapter 18K.
new text end

Sec. 98.

Minnesota Statutes 2018, section 152.32, subdivision 2, is amended to read:


Subd. 2.

Criminal and civil protections.

(a) Subject to section 152.23, the following
are not violations under this chapter:

(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end of a patient if the parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end
is listed on the registry verification;

(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and

(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.

(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.

(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.

(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.

(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.

(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.

(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.

(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.

(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.

(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.

Sec. 99.

Minnesota Statutes 2018, section 152.33, subdivision 1, is amended to read:


Subdivision 1.

Intentional diversion; criminal penalty.

In addition to any other
applicable penalty in law, a manufacturer or an agent of a manufacturer who intentionally
transfers medical cannabis to a person other than new text beginanother registered manufacturer, new text enda patient,
a registered designated caregiver or, if listed on the registry verification, a parent deleted text beginordeleted text endnew text begin,new text end legal
guardiannew text begin, or spousenew text end of a patient is guilty of a felony punishable by imprisonment for not
more than two years or by payment of a fine of not more than $3,000, or both. A person
convicted under this subdivision may not continue to be affiliated with the manufacturer
and is disqualified from further participation under sections 152.22 to 152.37.

Sec. 100.

Minnesota Statutes 2018, section 152.33, subdivision 2, is amended to read:


Subd. 2.

Diversion by patient, registered designated caregiver, deleted text beginordeleted text end parentnew text begin, legal
guardian, or patient's spouse
new text end; criminal penalty.

In addition to any other applicable penalty
in law, a patient, registered designated caregiver or, if listed on the registry verification, a
parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end of a patient who intentionally sells or otherwise transfers
medical cannabis to a person other than a patient, designated registered caregiver or, if listed
on the registry verification, a parent deleted text beginordeleted text endnew text begin,new text end legal guardiannew text begin, or spousenew text end of a patient is guilty of a
felony punishable by imprisonment for not more than two years or by payment of a fine of
not more than $3,000, or both.

Sec. 101.

Minnesota Statutes 2018, section 152.34, is amended to read:


152.34 HEALTH CARE FACILITIES.

(a) Health care facilities licensed under chapter 144A, new text beginhospice providers licensed under
chapter 144A,
new text endboarding care homes new text beginor supervised living facilities new text endlicensed under section
144.50, assisted living facilities, deleted text beginanddeleted text end facilities owned, controlled, managed, or under common
control with hospitals licensed under chapter 144, new text beginand other health facilities licensed by the
commissioner of health,
new text endmay adopt reasonable restrictions on the use of medical cannabis
by a patient enrolled in the registry program who resides at or is actively receiving treatment
or care at the facility. The restrictions may include a provision that the facility will not store
or maintain the patient's supply of medical cannabis, that the facility is not responsible for
providing the medical cannabis for patients, and that medical cannabis be used only in a
place specified by the facility.

(b) Any employee or agent of a facility listed in this section or a person licensed under
chapter 144E is not subject to violations under this chapter for possession of medical cannabis
while carrying out employment duties, including providing or supervising care to a registered
patient, or distribution of medical cannabis to a registered patient who resides at or is actively
receiving treatment or care at the facility with which the employee or agent is affiliated.
Nothing in this section shall require the facilities to adopt such restrictions and no facility
shall unreasonably limit a patient's access to or use of medical cannabis to the extent that
use is authorized by the patient under sections 152.22 to 152.37.

Sec. 102.

Minnesota Statutes 2018, section 152.36, subdivision 2, is amended to read:


Subd. 2.

Impact assessment.

The task force shall hold hearings to evaluate the impact
of the use of medical cannabisnew text begin and hempnew text end and Minnesota's activities involving medical
cannabisnew text begin and hempnew text end, including, but not limited to:

(1) program design and implementation;

(2) the impact on the health care provider community;

(3) patient experiences;

(4) the impact on the incidence of substance abuse;

(5) access to and quality of medical cannabisnew text begin, hemp,new text end and medical cannabis products;

(6) the impact on law enforcement and prosecutions;

(7) public awareness and perception; and

(8) any unintended consequences.

Sec. 103.

Minnesota Statutes 2018, section 157.22, is amended to read:


157.22 EXEMPTIONS.

This chapter does not apply to:

(1) interstate carriers under the supervision of the United States Department of Health
and Human Services;

(2) weddings, fellowship meals, or funerals conducted by a faith-based organization
using any building constructed and primarily used for religious worship or education;

(3) any building owned, operated, and used by a college or university in accordance
with health regulations promulgated by the college or university under chapter 14;

(4) any person, firm, or corporation whose principal mode of business is licensed under
sections 28A.04 and 28A.05, is exempt at that premises from licensure as a food or beverage
establishment; provided that the holding of any license pursuant to sections 28A.04 and
28A.05 shall not exempt any person, firm, or corporation from the applicable provisions of
this chapter or the rules of the state commissioner of health relating to food and beverage
service establishments;

(5) family day care homes and group family day care homes governed by sections
245A.01 to 245A.16;

(6) nonprofit senior citizen centers for the sale of home-baked goods;

(7) fraternal, sportsman, or patriotic organizations that are tax exempt under section
501(c)(3), 501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue
Code of 1986, or organizations related to, affiliated with, or supported by such fraternal,
sportsman, or patriotic organizations for events held in the building or on the grounds of
the organization and at which home-prepared food is donated by organization members for
sale at the events, provided:

(i) the event is not a circus, carnival, or fair;

(ii) the organization controls the admission of persons to the event, the event agenda, or
both; and

(iii) the organization's licensed kitchen is not used in any manner for the event;

(8) food not prepared at an establishment and brought in by individuals attending a
potluck event for consumption at the potluck event. An organization sponsoring a potluck
event under this clause may advertise the potluck event to the public through any means.
Individuals who are not members of an organization sponsoring a potluck event under this
clause may attend the potluck event and consume the food at the event. Licensed food
establishments other than schools cannot be sponsors of potluck events. A school may
sponsor and hold potluck events in areas of the school other than the school's kitchen,
provided that the school's kitchen is not used in any manner for the potluck event. For
purposes of this clause, "school" means a public school as defined in section 120A.05,
subdivisions 9, 11, 13, and 17
, or a nonpublic school, church, or religious organization at
which a child is provided with instruction in compliance with sections 120A.22 and 120A.24.
Potluck event food shall not be brought into a licensed food establishment kitchen;

(9) a home school in which a child is provided instruction at home;

(10) school concession stands serving commercially prepared, nonpotentially hazardous
foods, as defined in Minnesota Rules, chapter 4626;

(11) group residential facilities of ten or fewer beds licensed by the commissioner of
human services under Minnesota Rules, chapter 2960, provided the facility employs or
contracts with a certified food manager under Minnesota Rules, part 4626.2015;

(12) food served at fund-raisers or community events conducted in the building or on
the grounds of a faith-based organization, provided that a certified food manager, or a
volunteer trained in a food safety course, trains the food preparation workers in safe food
handling practices. This exemption does not apply to faith-based organizations at the state
agricultural society or county fairs or to faith-based organizations that choose to apply for
a license;

(13) food service events conducted following a disaster for purposes of feeding disaster
relief staff and volunteers serving commercially prepared, nonpotentially hazardous foods,
as defined in Minnesota Rules, chapter 4626; deleted text beginand
deleted text end

(14) chili or soup served at a chili or soup cook-off fund-raiser conducted by a
community-based nonprofit organization, provided:

(i) the municipality where the event is located approves the event;

(ii) the sponsoring organization must develop food safety rules and ensure that participants
follow these rules; and

(iii) if the food is not prepared in a kitchen that is licensed or inspected, a visible sign
or placard must be posted that states: "These products are homemade and not subject to
state inspection."

Foods exempt under this clause must be labeled to accurately reflect the name and
address of the person preparing the foodsdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (15) a special event food stand or a seasonal temporary food stand provided:
new text end

new text begin (i) the stand is located on private property with the permission of the property owner;
new text end

new text begin (ii) the stand has gross receipts or contributions of $1,000 or less in a calendar year; and
new text end

new text begin (iii) the operator of the stand posts a sign or placard at the site that states "The products
sold at this stand are not subject to state inspection or regulation.", if the stand offers for
sale potentially hazardous food as defined in Minnesota Rules, part 4626.0020, subdivision
62.
new text end

Sec. 104.

Minnesota Statutes 2018, section 214.25, subdivision 2, is amended to read:


Subd. 2.

Commissioner of health data.

deleted text begin(a)deleted text end All data collected or maintained as part of
the commissioner of health's duties under new text beginMinnesota Statutes 2018, new text endsections 214.19, 214.23,
and 214.24new text begin,new text end shall be classified as investigative data under section 13.39, except that inactive
investigative data shall be classified as private data under section 13.02, subdivision 12, or
nonpublic data under section 13.02, subdivision 9, in the case of data not on individuals.

deleted text begin (b) Notwithstanding section 13.05, subdivision 9, data addressed in this subdivision
shall not be disclosed except as provided in this subdivision or section 13.04; except that
the commissioner may disclose to the boards under section 214.23.
deleted text end

deleted text begin (c) The commissioner may disclose data addressed under this subdivision as necessary:
to identify, establish, implement, and enforce a monitoring plan; to investigate a regulated
person; to alert persons who may be threatened by illness as evidenced by epidemiologic
data; to control or prevent the spread of HIV, HBV, or HCV disease; or to diminish an
imminent threat to the public health.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective on January 1, 2020, and no new cases
shall be investigated under this subdivision after June 1, 2019.
new text end

Sec. 105.

Laws 2019, chapter 60, article 3, section 1, subdivision 5, is amended to read:


Subd. 5.

Notice to facility; exceptions.

(a) Electronic monitoring may begin only after
the resident or resident representative who intends to place an electronic monitoring device
and any roommate or roommate's resident representative completes the notification and
consent form and submits the form to the facility.

(b) Notwithstanding paragraph (a), the resident or resident representative who intends
to place an electronic monitoring device may do so without submitting a notification and
consent form to the facility for up to 14 days:

(1) if the resident or the resident representative reasonably fears retaliation against the
resident by the facility, timely submits the completed notification and consent form to the
Office of Ombudsman for Long-Term Care, and timely submits a Minnesota Adult Abuse
Reporting Center report or police report, or both, upon evidence from the electronic
monitoring device that suspected maltreatment has occurred;

(2) if there has not been a timely written response from the facility to a written
communication from the resident or resident representative expressing a concern prompting
the desire for placement of an electronic monitoring device and if the resident or a resident
representative timely submits a completed notification and consent form to the Office of
Ombudsman for Long-Term Care; or

(3) if the resident or resident representative has already submitted a Minnesota Adult
Abuse Reporting Center report or police report regarding the resident's concerns prompting
the desire for placement and if the resident or a resident representative timely submits a
completed notification and consent form to the Office of Ombudsman for Long-Term Care.

(c) Upon receipt of any completed notification and consent form, the facility must place
the original form in the resident's file or file the original form with the resident's housing
with services contract. The facility must provide a copy to the resident and the resident's
roommate, if applicable.

(d) If a resident is conducting electronic monitoring according to paragraph (b) and
deleted text begin obtains a signed notification and consent form from a roommatedeleted text endnew text begin a new roommate moves
into the room or living unit
new text end, the resident or resident representative must submit the signed
notification and consent form to the facility. In the event that a resident or roommate, or
the resident representative or roommate's resident representative if the representative is
consenting on behalf of the resident or roommate, chooses to alter the conditions under
which consent to electronic monitoring is given or chooses to withdraw consent to electronic
monitoring, the facility must make available the original notification and consent form so
that it may be updated. Upon receipt of the updated form, the facility must place the updated
form in the resident's file or file the original form with the resident's signed housing with
services contract. The facility must provide a copy of the updated form to the resident and
the resident's roommate, if applicable.

(e) If a new roommate, or the new roommate's resident representative when consenting
on behalf of the new roommate, does not submit to the facility a completed notification and
consent form and the resident conducting the electronic monitoring does not remove or
disable the electronic monitoring device, the facility must remove the electronic monitoring
device.

(f) If a roommate, or the roommate's resident representative when withdrawing consent
on behalf of the roommate, submits an updated notification and consent form withdrawing
consent and the resident conducting electronic monitoring does not remove or disable the
electronic monitoring device, the facility must remove the electronic monitoring device.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to all
agreements in effect, entered into, or renewed on or after that date.
new text end

Sec. 106. new text beginPLAN FOR A WORKING GROUP ON LINKS BETWEEN HEALTH
DISPARITIES AND EDUCATIONAL ACHIEVEMENT FOR CHILDREN FROM
AMERICAN INDIAN COMMUNITIES AND COMMUNITIES OF COLOR.
new text end

new text begin (a) The commissioner of health, in consultation with the commissioner of education,
shall develop a plan to convene one or more working groups to:
new text end

new text begin (1) examine the links between health disparities and disparities in educational achievement
for children from American Indian communities and communities of color; and
new text end

new text begin (2) develop recommendations for programs, services, or funding to address health
disparities and decrease disparities in educational achievement for children from American
Indian communities and communities of color.
new text end

new text begin (b) The plan shall include the possible membership of the proposed working group and
the duties for the proposed working group.
new text end

new text begin (c) The commissioner shall submit the plan for the working group, including proposed
legislation establishing the working group, to the chairs and ranking minority members of
the legislative committees with jurisdiction over health and education by February 15, 2020.
new text end

Sec. 107. new text beginCOMMUNITY SOLUTIONS FOR HEALTHY CHILD DEVELOPMENT
GRANT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall establish the community
solutions for healthy child development grant program. The purposes of the program are
to:
new text end

new text begin (1) improve child development outcomes as related to the well-being of children of color
and American Indian children from prenatal to grade 3 and their families, including but not
limited to the goals outlined by the Department of Human Service's early childhood systems
reform effort: early learning; health and well-being; economic security; and safe, stable,
nurturing relationships and environments by funding community-based solutions for
challenges that are identified by the affected community;
new text end

new text begin (2) reduce racial disparities in children's health and development, from prenatal to grade
3; and
new text end

new text begin (3) promote racial and geographic equity.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin The commissioner of health shall:
new text end

new text begin (1) develop a request for proposals for the healthy child development grant program in
consultation with the Community Solutions Advisory Council;
new text end

new text begin (2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing service providers in order to better meet statewide needs,
particularly in greater Minnesota and areas where services to reduce health disparities have
not been established;
new text end

new text begin (3) review responses to requests for proposals, in consultation with the Community
Solutions Advisory Council, and award grants under this section;
new text end

new text begin (4) ensure communication with the ethnic councils, Minnesota Indian Affairs Council,
and the governor's early learning council on the request for proposal process;
new text end

new text begin (5) establish a transparent and objective accountability process, in consultation with the
Community Solutions Advisory Council, focused on outcomes that grantees agree to achieve;
new text end

new text begin (6) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions;
new text end

new text begin (7) maintain data on outcomes reported by grantees; and
new text end

new text begin (8) contract with an independent third-party entity to evaluate the success of the grant
program and to build the evidence base for effective community solutions in reducing health
disparities of children of color and American Indian children from prenatal to grade 3.
new text end

new text begin Subd. 3. new text end

new text begin Community Solutions Advisory Council; establishment; duties;
compensation.
new text end

new text begin (a) No later than October 1, 2019, the commissioner shall convene a
12-member Community Solutions Advisory Council as follows:
new text end

new text begin (1) two members representing the African Heritage community;
new text end

new text begin (2) two members representing the Latino community;
new text end

new text begin (3) two members representing the Asian-Pacific Islander community;
new text end

new text begin (4) two members representing the American Indian community;
new text end

new text begin (5) two parents of children of color or that are American Indian with children under nine
years of age;
new text end

new text begin (6) one member with research or academic expertise in racial equity and healthy child
development; and
new text end

new text begin (7) one member representing an organization that advocates on behalf of communities
of color or American Indians.
new text end

new text begin (b) At least three of the 12 members of the advisory council must come from outside
the seven-county metropolitan area.
new text end

new text begin (c) The Community Solutions Advisory Council shall:
new text end

new text begin (1) advise the commissioner on the development of the request for proposals for
community solutions healthy child development grants. In advising the commissioner, the
council must consider how to build on the capacity of communities to promote child and
family well-being and address social determinants of healthy child development;
new text end

new text begin (2) review responses to requests for proposals and advise the commissioner on the
selection of grantees and grant awards;
new text end

new text begin (3) advise the commissioner on the establishment of a transparent and objective
accountability process focused on outcomes the grantees agree to achieve;
new text end

new text begin (4) advise the commissioner on ongoing oversight and necessary support in the
implementation of the program; and
new text end

new text begin (5) support the commissioner on other racial equity and early childhood grant efforts.
new text end

new text begin (d) Each advisory council member shall be compensated in accordance with Minnesota
Statutes, section 15.059, subdivision 3.
new text end

new text begin Subd. 4. new text end

new text begin Eligible grantees. new text end

new text begin Organizations eligible to receive grant funding under this
section include:
new text end

new text begin (1) organizations or entities that work with communities of color and American Indian
communities;
new text end

new text begin (2) tribal nations and tribal organizations as defined in section 658P of the Child Care
and Development Block Grant Act of 1990; and
new text end

new text begin (3) organizations or entities focused on supporting healthy child development.
new text end

new text begin Subd. 5. new text end

new text begin Strategic consideration and priority of proposals; eligible populations;
grant awards.
new text end

new text begin (a) The commissioner, in consultation with the Community Solutions
Advisory Council, shall develop a request for proposals for healthy child development
grants. In developing the proposals and awarding the grants, the commissioner shall consider
building on the capacity of communities to promote child and family well-being and address
social determinants of healthy child development. Proposals must focus on increasing racial
equity and healthy child development and reducing health disparities experienced by children
of color and American Indian children from prenatal to grade 3 and their families.
new text end

new text begin (b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from:
new text end

new text begin (1) organizations or entities led by people of color and serving communities of color;
new text end

new text begin (2) organizations or entities led by American Indians and serving American Indians,
including tribal nations and tribal organizations;
new text end

new text begin (3) organizations or entities with proposals focused on healthy development from prenatal
to age three;
new text end

new text begin (4) organizations or entities with proposals focusing on multigenerational solutions;
new text end

new text begin (5) organizations or entities located in or with proposals to serve communities located
in counties that are moderate to high risk according to the Wilder Research Risk and Reach
Report; and
new text end

new text begin (6) community-based organizations that have historically served communities of color
and American Indians and have not traditionally had access to state grant funding.
new text end

new text begin The advisory council may recommend additional strategic considerations and priorities to
the commissioner.
new text end

new text begin (c) The first round of grants must be awarded no later than April 15, 2020.
new text end

new text begin Subd. 6. new text end

new text begin Geographic distribution of grants. new text end

new text begin The commissioner and the advisory council
shall ensure that grant funds are prioritized and awarded to organizations and entities that
are within counties that have a higher proportion of people of color and American Indians
than the state average, to the extent possible.
new text end

new text begin Subd. 7. new text end

new text begin Report. new text end

new text begin Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end

Sec. 108. new text beginDOMESTIC VIOLENCE AND SEXUAL ASSAULT PREVENTION
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Program establishment. new text end

new text begin The commissioner of health shall administer
the domestic violence and sexual assault prevention program as established under this
section.
new text end

new text begin Subd. 2. new text end

new text begin Grant criteria. new text end

new text begin (a) The commissioner shall award grants to nonprofit
organizations for the purpose of funding programs that incorporate community-driven and
culturally relevant practices to prevent domestic violence and sexual assault. Grants made
pursuant to this section may either (1) encourage the development and deployment of new
prevention efforts, or (2) enhance, sustain, or expand existing prevention efforts.
new text end

new text begin (b) The commissioner of health shall award grants to nonprofit organizations supporting
activities that:
new text end

new text begin (1) promote the general development of domestic violence and sexual assault prevention
programs and activities;
new text end

new text begin (2) implement prevention activities through community outreach that address the root
causes of domestic violence and sexual assault;
new text end

new text begin (3) identify risk and protective factors for developing domestic violence and sexual
assault prevention strategies and outreach activities;
new text end

new text begin (4) provide trauma-informed domestic violence and sexual assault prevention services;
new text end

new text begin (5) educate youth and adults about healthy relationships and changing social norms;
new text end

new text begin (6) develop culturally and linguistically appropriate domestic violence and sexual assault
prevention programs for historically underserved communities;
new text end

new text begin (7) work collaboratively with educational institutions, including school districts, to
implement domestic violence and sexual assault prevention strategies for students, teachers,
and administrators; or
new text end

new text begin (8) work collaboratively with other nonprofit organizations, for-profit organizations,
and other community-based organizations to implement domestic violence and sexual assault
prevention strategies within their communities.
new text end

new text begin Subd. 3. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "domestic violence and sexual assault"
includes, but is not limited to, the following:
new text end

new text begin (1) intimate partner violence, including emotional, psychological, and economic abuse;
new text end

new text begin (2) sex trafficking as defined in Minnesota Statutes, section 609.321, subdivision 7a;
new text end

new text begin (3) domestic abuse as defined in Minnesota Statutes, section 518B.01, subdivision 2;
new text end

new text begin (4) any criminal sexual conduct crime in Minnesota Statutes, sections 609.342 to
609.3453;
new text end

new text begin (5) abusive international marriage;
new text end

new text begin (6) forced marriage; and
new text end

new text begin (7) female genital mutilation, as defined in Minnesota Statutes, section 609.2245,
subdivision 1.
new text end

new text begin Subd. 4. new text end

new text begin Promotion; administration. new text end

new text begin The commissioner may spend up to 15 percent
of the total program funding for each fiscal year to promote and administer the program
authorized under this section and to provide technical assistance to program grantees.
new text end

new text begin Subd. 5. new text end

new text begin Nonstate sources. new text end

new text begin The commissioner may accept contributions from nonstate
sources to supplement state appropriations for the program authorized under this section.
Contributions received under this subdivision are appropriated to the commissioner for
purposes of this section.
new text end

new text begin Subd. 6. new text end

new text begin Program evaluation. new text end

new text begin (a) The commissioner of health shall report by February
28 of each even-numbered year to the legislative committees with jurisdiction over health
detailing the expenditures of funds authorized under this section. The commissioner shall
use the data to evaluate the effectiveness of the program. The commissioner must include
in the report:
new text end

new text begin (1) the number of organizations receiving grant money under this section;
new text end

new text begin (2) the number of individuals served by the grant program;
new text end

new text begin (3) a description and analysis of the practices implemented by program grantees; and
new text end

new text begin (4) best practices recommendations to prevent domestic violence and sexual assault,
including best practices recommendations that are culturally relevant to historically
underserved communities.
new text end

new text begin (b) Any organization receiving grant money under this section must collect and make
available to the commissioner of health aggregate data related to the activity funded by the
grant program under this section.
new text end

new text begin (c) The commissioner of health shall use the information and data from the program
evaluation under paragraph (a), including best practices and culturally specific responses,
to inform the administration of existing Department of Health programming and the
development of Department of Health policies, programs, and procedures.
new text end

Sec. 109. new text beginSKIN LIGHTENING PRODUCTS PUBLIC AWARENESS AND
EDUCATION GRANT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin The commissioner of health shall develop a
grant program for the purpose of increasing public awareness and education on the health
dangers associated with using skin lightening creams and products that contain mercury
that are manufactured in other countries and brought into this country and sold illegally
online or in stores.
new text end

new text begin Subd. 2. new text end

new text begin Grants authorized. new text end

new text begin The commissioner shall award grants through a request
for proposals process to community-based organizations serving ethnic communities, local
public health entities, and nonprofit organizations that focus on providing health care and
public health outreach to minorities. Priority shall be given to organizations that have
historically served ethnic communities at significant risk from these products, but have not
traditionally had access to state grant funding.
new text end

new text begin Subd. 3. new text end

new text begin Grant allocation. new text end

new text begin (a) Grantees must use the funds to conduct public awareness
and education activities that are culturally specific and community-based and focus on:
new text end

new text begin (1) the dangers of exposure to mercury through dermal absorption, inhalation,
hand-to-mouth contact, and through contact with individuals who have used these skin
lightening products;
new text end

new text begin (2) the signs and symptoms of mercury poisoning;
new text end

new text begin (3) the health effects of mercury poisoning, including the permanent effects on the central
nervous system and kidneys;
new text end

new text begin (4) the dangers of using these products or being exposed to these products during
pregnancy and breastfeeding to the mother and to the infant;
new text end

new text begin (5) knowing how to identify products that contain mercury; and
new text end

new text begin (6) proper disposal of the product if the product contains mercury.
new text end

new text begin (b) The grant application must include:
new text end

new text begin (1) a description of the purpose or project for which the grant funds will be used;
new text end

new text begin (2) a description of the objectives, a work plan, and a timeline for implementation; and
new text end

new text begin (3) the community or group the grant proposes to focus on.
new text end

new text begin (c) The commissioner shall award 50 percent of the grant funds to community-based
organizations and nonprofit organizations and 50 percent of the funds to local public health
entities.
new text end

Sec. 110. new text beginSALE OF CERTAIN CANNABINOID PRODUCTS WORKGROUP.
new text end

new text begin (a) The commissioner of health, in consultation with the commissioners of commerce,
agriculture, and public safety, and the executive director of the Board of Pharmacy, shall
convene a workgroup to advise the legislature on how to regulate products that contain
cannabinoids extracted from hemp. For purposes of this section, "hemp" has the meaning
given to "industrial hemp" in Minnesota Statutes, section 18K.02, subdivision 3.
new text end

new text begin (b) The commissioner shall assess the public health and consumer safety impact on the
sale of cannabinoids derived from hemp and shall develop a regulatory framework of what
the legislature would need to consider including, but not limited to:
new text end

new text begin (1) cultivation standards for industrial hemp if the hemp is used for any product intended
for human or animal consumption;
new text end

new text begin (2) labeling requirements for products containing cannabidiol extracted from hemp,
including the amount and percentage of cannabidiol in the product, the name of the
manufacturer of the product, and the ingredients contained in the product;
new text end

new text begin (3) possible restrictions of advertising and marketing of the cannabidiol product;
new text end

new text begin (4) restrictions of false, misleading, or unsubstantiated health claims;
new text end

new text begin (5) requirements for the independent testing of cannabidiol products, including quality
control and chemical identification;
new text end

new text begin (6) safety standards for edible products containing cannabinoids extracted from hemp,
including container and packaging requirements; and
new text end

new text begin (7) any other requirement or procedure the commissioner deems necessary.
new text end

new text begin (c) By January 15, 2020, the commissioner of health shall submit the results of the
workgroup to the chairs and ranking minority members of the legislative committees with
jurisdiction over public health, consumer protection, public safety, and agriculture.
new text end

Sec. 111. new text beginREVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes shall correct any internal cross-references to Minnesota Statutes,
sections 214.17 to 214.25, that occur as a result of the repealed language and may make
changes necessary to correct punctuation, grammar, or structure of the remaining text and
preserve its meaning.
new text end

Sec. 112. new text beginREPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2018, sections 144.414, subdivision 5; 144A.45, subdivision 6;
and 144A.481,
new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2018, sections 214.17; 214.18; 214.19; 214.20; 214.21; 214.22;
214.23; and 214.24,
new text end new text begin are repealed on January 1, 2020, and no new cases shall be investigated
under these sections after June 1, 2019.
new text end

ARTICLE 12

MISCELLANEOUS

Section 1.

new text begin [10.584] MATERNAL MENTAL HEALTH AWARENESS MONTH.
new text end

new text begin The month of May is designated as Maternal Mental Health Awareness Month in
recognition of the state's desire to recognize the prevalence of pregnancy and postpartum
mental health issues and educate the people of the state about identifying symptoms and
seeking treatment options. Up to one-third of mothers report having symptoms of pregnancy
and postpartum mood and anxiety disorders each year. Many more cases go unreported due
to misunderstanding. Pregnancy and postpartum mood disorders are widespread but treatable
illnesses. Left untreated, pregnancy and postpartum mood and anxiety disorders can lead
to negative effects on birth outcomes, infant development, and the well-being of mothers
and families. The state declares that in order to educate the public, the governor may promote
and encourage the observance of Maternal Mental Health Awareness Month.
new text end

ARTICLE 13

FORECAST ADJUSTMENT

Section 1. new text beginDEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
new text end

new text begin The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2017, First Special
Session chapter 6, article 18, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2019" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2019.
new text end

new text begin APPROPRIATIONS
new text end
new text begin Available for the Year
new text end
new text begin Ending June 30
new text end
new text begin 2019
new text end

Sec. 2. new text beginCOMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
new text end

new text begin $
new text end
new text begin (318,423,000)
new text end
new text begin Appropriations by Fund
new text end
new text begin 2019
new text end
new text begin General
new text end
new text begin (317,538,000)
new text end
new text begin Health Care Access
new text end
new text begin 8,410,000
new text end
new text begin Federal TANF
new text end
new text begin (9,295,000)
new text end

new text begin Subd. 2. new text end

new text begin Forecasted Programs
new text end

new text begin (a) Minnesota Family
Investment Program
(MFIP)/Diversionary Work
Program (DWP)
new text end
new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin (19,361,000)
new text end
new text begin Federal TANF
new text end
new text begin (8,893,000)
new text end
new text begin (b) MFIP Child Care Assistance
new text end
new text begin (16,789,000)
new text end
new text begin (c) General Assistance
new text end
new text begin (7,928,000)
new text end
new text begin (d) Minnesota Supplemental Aid
new text end
new text begin (549,000)
new text end
new text begin (e) Housing Support
new text end
new text begin (13,836,000)
new text end
new text begin (f) Northstar Care for Children
new text end
new text begin (19,027,000)
new text end
new text begin (g) MinnesotaCare
new text end
new text begin 8,410,000
new text end

new text begin This appropriation is from the health care
access fund.
new text end

new text begin (h) Medical Assistance
new text end
new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin (222,176,000)
new text end
new text begin Health Care Access
new text end
new text begin -0-
new text end
new text begin (i) Alternative Care
new text end
new text begin -0-
new text end
new text begin (j) Consolidated Chemical Dependency
Treatment Fund (CCDTF) Entitlement
new text end
new text begin (17,872,000)
new text end

new text begin Subd. 3. new text end

new text begin Technical Activities
new text end

new text begin (402,000)
new text end

new text begin This appropriation is from the federal TANF
fund.
new text end

Sec. 3. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following final enactment.
new text end

ARTICLE 14

APPROPRIATIONS

Section 1. new text beginHEALTH AND HUMAN SERVICES APPROPRIATIONS.
new text end

new text begin The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2020" and "2021" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2020, or June 30, 2021, respectively.
"The first year" is fiscal year 2020. "The second year" is fiscal year 2021. "The biennium"
is fiscal years 2020 and 2021.
new text end

new text begin APPROPRIATIONS
new text end
new text begin Available for the Year
new text end
new text begin Ending June 30
new text end
new text begin 2020
new text end
new text begin 2021
new text end

Sec. 2. new text beginCOMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
new text end

new text begin $
new text end
new text begin 8,148,863,000
new text end
new text begin $
new text end
new text begin 8,400,601,000
new text end
new text begin Appropriations by Fund
new text end
new text begin 2020
new text end
new text begin 2021
new text end
new text begin General
new text end
new text begin 7,221,990,000
new text end
new text begin 7,320,071,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 4,299,000
new text end
new text begin 4,299,000
new text end
new text begin Health Care Access
new text end
new text begin 661,393,000
new text end
new text begin 795,115,000
new text end
new text begin Federal TANF
new text end
new text begin 259,285,000
new text end
new text begin 279,220,000
new text end
new text begin Lottery Prize
new text end
new text begin 1,896,000
new text end
new text begin 1,896,000
new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end

new text begin TANF Maintenance of Effort
new text end

new text begin (a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
new text end

new text begin (1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end

new text begin (2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end

new text begin (3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end

new text begin (4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
new text end

new text begin (5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end

new text begin (6) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end

new text begin (7) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end

new text begin (b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (7), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end

new text begin (c) Certain Expenditures Required. The
commissioner shall ensure that the MOE used
by the commissioner of management and
budget for the February and November
forecasts required under Minnesota Statutes,
section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 16
percent of the total required under Code of
Federal Regulations, title 45, section 263.1.
new text end

new text begin (d) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
new text end

new text begin (1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end

new text begin (2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end

new text begin (3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).
new text end

new text begin (e) Supplemental Expenditures. For the
purposes of paragraph (d), the commissioner
may supplement the MOE claim with other
qualified expenditures to the extent such
expenditures are otherwise available after
considering the expenditures allowed in this
subdivision.
new text end

new text begin (f) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
new text end

new text begin (g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end

new text begin (h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
new text end

new text begin (i) Federal SNAP Education and Training
Grants.
Federal funds available during fiscal
years 2020 and 2021 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
new text end

new text begin Subd. 3. new text end

new text begin Central Office; Operations
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 152,240,000
new text end
new text begin 151,012,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 4,174,000
new text end
new text begin 4,174,000
new text end
new text begin Health Care Access
new text end
new text begin 20,709,000
new text end
new text begin 20,724,000
new text end
new text begin Federal TANF
new text end
new text begin 100,000
new text end
new text begin 100,000
new text end

new text begin (a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end

new text begin (1) the statewide data management system
authorized in Minnesota Statutes, section
125A.744, subdivision 3;
new text end

new text begin (2) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 245.495,
paragraph (b);
new text end

new text begin (3) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end

new text begin (4) targeted case management under
Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end

new text begin (5) residential services for children with severe
emotional disturbance under Minnesota
Statutes, section 256B.0945, subdivision 4,
paragraph (d); and
new text end

new text begin (6) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end

new text begin (b) Child Care Licensing Inspections.
$673,000 in fiscal year 2020 and $722,000 in
fiscal year 2021 are from the general fund to
add eight child care licensing staff for the
purpose of increasing the frequency of
inspections of child care centers to ensure the
health and safety of children in care, provide
technical assistance to newly licensed
programs, and monitor struggling programs
more closely to evaluate whether the program
should be referred to the Office of Inspector
General for a potential fraud investigation.
new text end

new text begin (c) Child Care Assistance Programs - Fraud
and Abuse Data Analysts.
$317,000 in fiscal
year 2020 and $339,000 in fiscal year 2021
are from the general fund to add two data
analysts to strengthen the commissioner's
ability to identify, detect, and prevent fraud
and abuse in the child care assistance programs
under Minnesota Statutes, chapter 119B.
new text end

new text begin (d) Office of Inspector General
Investigators.
$418,000 in fiscal year 2020
and $483,000 in fiscal year 2021 are from the
general fund to add four investigators to the
Office of Inspector General to detect, prevent,
and make recoveries from fraudulent activities
among providers in the medical assistance
program under Minnesota Statutes, chapter
256B.
new text end

new text begin (e) Office of Inspector General Tracking
System.
$355,000 in fiscal year 2020 and
$105,000 in fiscal year 2021 are from the
general fund to purchase a system to record,
track, and report on investigative activity for
the Office of Inspector General to strengthen
fraud prevention and investigation activities
for child care assistance programs under
Minnesota Statutes, chapter 119B.
new text end

new text begin (f) Fraud Prevention Investigation Grant
Program.
$425,000 in fiscal year 2020 and
$425,000 in fiscal year 2021 are from the
general fund for the fraud prevention
investigation grant program under Minnesota
Statutes, section 256.983.
new text end

new text begin (g) Child Care Assistance Programs - Law
Enforcement.
$350,000 in fiscal year 2020
and $350,000 in fiscal year 2021 are from the
general fund to add two additional law
enforcement officers under contract with the
Bureau of Criminal Apprehension to conduct
criminal investigations in child care assistance
program cases.
new text end

new text begin (h) Transfer; Long-Term Care Options
Account.
By June 30, 2020, the commissioner
shall transfer $3,242,000 from the long-term
care options account authorized in Minnesota
Statutes, section 256.01, subdivision 34, to the
general fund. This is a onetime transfer.
new text end

new text begin (i) Transfer to Office of Legislative Auditor.
$300,000 in fiscal year 2020 and $300,000 in
fiscal year 2021 are from the general fund for
transfer to the Office of the Legislative
Auditor for audit activities under Minnesota
Statutes, section 3.972, subdivision 2b.
new text end

new text begin (j) Transfer to Office of Legislative Auditor.
$400,000 in fiscal year 2020 and $400,000 in
fiscal year 2021 are from the general fund for
transfer to the Office of the Legislative
Auditor for audit activities under Minnesota
Statutes, section 3.972, subdivision 2a.
new text end

new text begin (k) Family Child Care Task Force. $121,000
in fiscal year 2020 is from the general fund
for the Family Child Care Task Force under
article 2, section 130. This is a onetime
appropriation.
new text end

new text begin (l) Base Level Adjustment. The general fund
base is $142,929,000 in fiscal year 2022 and
$145,377,000 in fiscal year 2023. The health
care access base is $20,712,000 in fiscal year
2022 and $20,712,000 in fiscal year 2023.
new text end

new text begin Subd. 4. new text end

new text begin Central Office; Children and Families
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 13,558,000
new text end
new text begin 14,424,000
new text end
new text begin Federal TANF
new text end
new text begin 2,582,000
new text end
new text begin 2,582,000
new text end

new text begin (a) Financial Institution Data Match and
Payment of Fees.
The commissioner is
authorized to allocate up to $310,000 in fiscal
year 2020 and $310,000 in fiscal year 2021
from the state systems account authorized in
Minnesota Statutes, section 256.014,
subdivision 2, to make payments to financial
institutions in exchange for performing data
matches between account information held by
financial institutions and the public authority's
database of child support obligors as
authorized by Minnesota Statutes, section
13B.06, subdivision 7.
new text end

new text begin (b) Child Welfare Training Academy.
$1,371,000 in fiscal year 2020 and $2,517,000
in fiscal year 2021 are from the general fund
for the Child Welfare Training Academy for
the provision of child protection worker
training under Minnesota Statutes, section
626.5591, subdivision 2. The base for this
appropriation is $2,754,000 in fiscal year 2022
and $3,007,000 in fiscal year 2023.
new text end

new text begin (c) Child Care Assistance Programs -
Improvements.
$105,000 in fiscal year 2020
and $120,000 in fiscal year 2021 are from the
general fund to add one temporary staff person
to plan for improvements to provider
registration and oversight for the child care
assistance programs under Minnesota Statutes,
chapter 119B. This is a onetime appropriation.
new text end

new text begin (d) Base Level Adjustment. The general fund
base is $14,540,000 in fiscal year 2022 and
$14,793,000 in fiscal year 2023.
new text end

new text begin Subd. 5. new text end

new text begin Central Office; Health Care
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 22,769,000
new text end
new text begin 23,678,000
new text end
new text begin Health Care Access
new text end
new text begin 25,063,000
new text end
new text begin 24,406,000
new text end

new text begin (a) Nonemergency Medical Transportation
Program Audits.
$557,000 in fiscal year 2020
and $1,119,000 in fiscal year 2021 are from
the general fund to conduct audits of the
nonemergency medical transportation
program. The base for this appropriation is
$1,123,000 in fiscal year 2022 and $1,123,000
in fiscal year 2023.
new text end

new text begin (b) Outpatient Pharmacy. $113,000 in fiscal
year 2020 and $50,000 in fiscal year 2021 are
from the general fund to contract for 340B
pharmacy data in order to perform the new
pricing calculations and conduct a cost of
dispensing survey. The base for this
appropriation is $50,000 in fiscal year 2022
and $163,000 in fiscal year 2023.
new text end

new text begin (c) new text beginBase Level Adjustment.new text end The general fund
base is $24,028,000 in fiscal year 2022 and
$23,697,000 in fiscal year 2023. The health
care access fund base is $24,422,000 in fiscal
year 2022 and $24,422,000 in fiscal year 2023.
new text end

new text begin Subd. 6. new text end

new text begin Central Office; Continuing Care for
Older Adults
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 14,670,000
new text end
new text begin 14,677,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 125,000
new text end
new text begin 125,000
new text end

new text begin Subd. 7. new text end

new text begin Central Office; Community Supports
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 35,722,000
new text end
new text begin 35,741,000
new text end
new text begin Lottery Prize
new text end
new text begin 163,000
new text end
new text begin 163,000
new text end

new text begin (a) Community Competency Restoration
Task Force.
$125,000 in fiscal year 2020 and
$75,000 in fiscal year 2021 are for the
Community Competency Restoration Task
Force under article 6, section 78. This is a
onetime appropriation and is available until
June 30, 2023.
new text end

new text begin (b) new text end new text begin new text beginBase Level Adjustment. new text endThe general fund
base is $35,680,000 in fiscal year 2022 and
$35,599,000 in fiscal year 2023.
new text end

new text begin Subd. 8. new text end

new text begin Forecasted Programs; MFIP/DWP
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 83,886,000
new text end
new text begin 90,149,000
new text end
new text begin Federal TANF
new text end
new text begin 84,267,000
new text end
new text begin 97,771,000
new text end

new text begin Subd. 9. new text end

new text begin Forecasted Programs; MFIP Child Care
Assistance
new text end

new text begin 102,061,000
new text end
new text begin 101,855,000
new text end

new text begin Subd. 10. new text end

new text begin Forecasted Programs; General
Assistance
new text end

new text begin 49,959,000
new text end
new text begin 50,586,000
new text end

new text begin (a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
new text end

new text begin (b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2020 and $6,729,812
in fiscal year 2021. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
new text end

new text begin Subd. 11. new text end

new text begin Forecasted Programs; Minnesota
Supplemental Aid
new text end

new text begin 42,348,000
new text end
new text begin 46,420,000
new text end

new text begin Subd. 12. new text end

new text begin Forecasted Programs; Housing
Support
new text end

new text begin 169,610,000
new text end
new text begin 170,218,000
new text end

new text begin Subd. 13. new text end

new text begin Forecasted Programs; Northstar Care
for Children
new text end

new text begin 86,497,000
new text end
new text begin 94,095,000
new text end

new text begin Subd. 14. new text end

new text begin Forecasted Programs; MinnesotaCare
new text end

new text begin 25,197,000
new text end
new text begin 143,937,000
new text end

new text begin This appropriation is from the health care
access fund.
new text end

new text begin Subd. 15. new text end

new text begin Forecasted Programs; Medical
Assistance
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 5,515,098,000
new text end
new text begin 5,565,150,000
new text end
new text begin Health Care Access
new text end
new text begin 586,959,000
new text end
new text begin 602,583,000
new text end

new text begin (a) Behavioral Health Services. $1,000,000
in fiscal year 2020 and $1,000,000 in fiscal
year 2021 are for behavioral health services
provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
new text end

new text begin (b) Base Level Adjustment. The health care
access fund base is $611,178,000 in fiscal year
2022 and $612,099,000 in fiscal year 2023.
new text end

new text begin Subd. 16. new text end

new text begin Forecasted Programs; Alternative
Care
new text end

new text begin 45,246,000
new text end
new text begin 45,276,000
new text end

new text begin new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end

new text begin Subd. 17. new text end

new text begin Forecasted Programs; Chemical
Dependency Treatment Fund
new text end

new text begin 124,719,000
new text end
new text begin 135,609,000
new text end

new text begin new text begin Transfer; Consolidated Chemical
Dependency Treatment Fund.
new text end
Any balance
remaining in the consolidated chemical
dependency treatment fund at the end of fiscal
year 2020, estimated to be $23,855,000, shall
be transferred to the general fund.
new text end

new text begin Subd. 18. new text end

new text begin Grant Programs; Support Services
Grants
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 8,715,000
new text end
new text begin 8,715,000
new text end
new text begin Federal TANF
new text end
new text begin 96,312,000
new text end
new text begin 96,311,000
new text end

new text begin Subd. 19. new text end

new text begin Grant Programs; Basic Sliding Fee
Child Care Assistance Grants
new text end

new text begin 44,655,000
new text end
new text begin 53,616,000
new text end

new text begin Subd. 20. new text end

new text begin Grant Programs; Child Care
Development Grants
new text end

new text begin 1,737,000
new text end
new text begin 1,737,000
new text end

new text begin Subd. 21. new text end

new text begin Grant Programs; Child Support
Enforcement Grants
new text end

new text begin 50,000
new text end
new text begin 50,000
new text end

new text begin Subd. 22. new text end

new text begin Grant Programs; Children's Services
Grants
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 44,207,000
new text end
new text begin 48,785,000
new text end
new text begin Federal TANF
new text end
new text begin 140,000
new text end
new text begin 140,000
new text end

new text begin (a) new text beginTitle IV-E Adoption Assistance.new text end The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
new text end

new text begin Additional federal reimbursement to the state
as a result of the Fostering Connections to
Success and Increasing Adoptions Act's
expanded eligibility for title IV-E adoption
assistance is for postadoption, foster care,
adoption, and kinship services, including a
parent-to-parent support network.
new text end

new text begin (b) Parent Support for Better Outcomes
Grants.
$150,000 in fiscal year 2020 and
$150,000 in fiscal year 2021 are from the
general fund for grants to Minnesota One-Stop
for Communities to provide mentoring,
guidance, and support services to parents
navigating the child welfare system in
Minnesota in order to promote the
development of safe, stable, and healthy
families. Grant funds may be used for parent
mentoring, peer-to-peer support groups,
housing support services, training, staffing,
and administrative costs. This is a onetime
appropriation.
new text end

new text begin (c) Safe Harbor for Sexually Exploited
Youth.
$500,000 in fiscal year 2020 and
$500,000 in fiscal year 2021 are from the
general fund for activities under the safe
harbor program.
new text end

new text begin (d) Base Level Adjustment. The general fund
base is $51,483,000 in fiscal year 2022 and
$51,198,000 in fiscal year 2023.
new text end

new text begin Subd. 23. new text end

new text begin Grant Programs; Children and
Community Service Grants
new text end

new text begin 58,201,000
new text end
new text begin 58,201,000
new text end

new text begin Subd. 24. new text end

new text begin Grant Programs; Children and
Economic Support Grants
new text end

new text begin 24,315,000
new text end
new text begin 24,315,000
new text end

new text begin (a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2020 do not
cancel but are available for this purpose in
fiscal year 2021.
new text end

new text begin (b) Shelter-Linked Youth Mental Health
Grants.
$250,000 in fiscal year 2020 and
$250,000 in fiscal year 2021 are from the
general fund for shelter-linked youth mental
health grants under Minnesota Statutes, section
256K.46.
new text end

new text begin (c) Base Level Adjustment. The general fund
base is $22,815,000 in fiscal year 2022 and
$22,815,000 in fiscal year 2023.
new text end

new text begin Subd. 25. new text end

new text begin Grant Programs; Health Care Grants
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 3,711,000
new text end
new text begin 3,711,000
new text end
new text begin Health Care Access
new text end
new text begin 3,465,000
new text end
new text begin 3,465,000
new text end

new text begin Subd. 26. new text end

new text begin Grant Programs; Other Long-Term
Care Grants
new text end

new text begin 1,925,000
new text end
new text begin 1,925,000
new text end

new text begin Subd. 27. new text end

new text begin Grant Programs; Aging and Adult
Services Grants
new text end

new text begin 32,311,000
new text end
new text begin 32,495,000
new text end

new text begin Incentive-Based Grants for Customized
Living Service Providers.
$500,000 in fiscal
year 2020 and $500,000 in fiscal year 2021
are for incentive-based grants to elderly waiver
customized living service providers under
article 4, section 28.
new text end

new text begin Subd. 28. new text end

new text begin Grant Programs; Deaf and
Hard-of-Hearing Grants
new text end

new text begin 2,886,000
new text end
new text begin 2,886,000
new text end

new text begin Subd. 29. new text end

new text begin Grant Programs; Disabilities Grants
new text end

new text begin 22,431,000
new text end
new text begin 23,144,000
new text end

new text begin (a) Training of Direct Support Services
Providers.
$375,000 in fiscal year 2020 and
$375,000 in fiscal year 2021 are for stipends
to pay for training of individual providers of
direct support services as defined in Minnesota
Statutes, section 256B.0711, subdivision 1.
This training is available to individual
providers who have completed designated
voluntary trainings made available through
the State Service Employees International
Union Healthcare Minnesota Committee. This
is a onetime appropriation. This appropriation
is available only if the labor agreement
between the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
new text end

new text begin (b) Training for New Worker Orientation.
$125,000 in fiscal year 2020 and $125,000 in
fiscal year 2021 are for new worker orientation
training and is allocated to the Minnesota State
Service Employees International Union
Healthcare Minnesota Committee. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
new text end

new text begin (c) Benefits Planning Grants. $600,000 in
fiscal year 2020 and $600,000 in fiscal year
2021 are to provide grant funding to the
Disability Hub for benefits planning to people
with disabilities.
new text end

new text begin (d) Regional Support for Person-Centered
Practices Grants.
$374,000 in fiscal year
2020 and $486,000 in fiscal year 2021 are to
extend and expand regional capacity for
person-centered planning. This grant funding
must be allocated to regional cohorts for
training, coaching, and mentoring for
person-centered and collaborative safety
practices benefiting people with disabilities,
and employees, organizations, and
communities serving people with disabilities.
new text end

new text begin (e) Disability Hub for Families Grants.
$100,000 in fiscal year 2020 and $200,000 in
fiscal year 2021 are for grants to connect
families through innovation grants, life
planning tools, and website information as
they support a child or family member with
disabilities.
new text end

new text begin (f) Electronic Visit Verification. $500,000
in fiscal year 2021 is for grants to providers
who use a different vendor than the contract
with the State of Minnesota for electronic visit
verification.
new text end

new text begin (g) Day Training and Habilitation Disability
Waiver Rate System Transition Grants.

$200,000 in fiscal year 2020 and $200,000 in
fiscal year 2021 are from the general fund for
day training and habilitation disability waiver
rate system transition grants under article 5,
section 90. This is a onetime appropriation.
new text end

new text begin (h) Base Level Adjustment. The general fund
base is $22,556,000 in fiscal year 2022 and
$22,168,000 in fiscal year 2023.
new text end

new text begin Subd. 30. new text end

new text begin Grant Programs; Housing Support
Grants
new text end

new text begin 9,264,000
new text end
new text begin 10,364,000
new text end

new text begin Emergency Services Grants. $1,500,000 in
fiscal year 2020 and $1,500,000 in fiscal year
2021 are to provide emergency services grants
under Minnesota Statutes, section 256E.36.
This is a onetime appropriation.
new text end

new text begin Subd. 31. new text end

new text begin Grant Programs; Adult Mental Health
Grants
new text end

new text begin 82,302,000
new text end
new text begin 79,877,000
new text end

new text begin (a) Certified Community Behavioral Health
Center (CCBHC) Expansion.
$200,000 in
fiscal year 2021 is from the general fund for
grants for planning, staff training, and other
quality improvements that are required to
comply with federal CCBHC criteria for three
expansion sites.
new text end

new text begin (b) Mobile Mental Health Crisis Response
Team Funding.
$1,250,000 in fiscal year
2020 and $1,250,000 in fiscal year 2021 are
for adult mental health grants under Minnesota
Statutes, section 245.4661, subdivision 9,
paragraph (a), clause (1), to fund regional
mobile mental health crisis response teams
throughout the state. The base for this
appropriation is $4,896,000 in fiscal year 2022
and $4,897,000 in fiscal year 2023.
new text end

new text begin (c) Specialized Mental Health Community
Supervision Pilot Project.
$400,000 in fiscal
year 2020 is for a grant to Anoka County for
establishment of a specialized mental health
community supervision caseload pilot project.
This is a onetime appropriation.
new text end

new text begin (d) Base Level Adjustment. The general fund
base is $83,323,000 in fiscal year 2022 and
$83,324,000 in fiscal year 2023.
new text end

new text begin Subd. 32. new text end

new text begin Grant Programs; Child Mental Health
Grants
new text end

new text begin 21,826,000
new text end
new text begin 21,726,000
new text end

new text begin (a) Children's Intensive Services Reform.
$400,000 in fiscal year 2020 and $400,000 in
fiscal year 2021 are for start-up grants to
prospective psychiatric residential treatment
facility sites for administrative expenses,
consulting services, Health Insurance
Portability and Accountability Act of 1996
compliance, therapeutic resources including
evidence-based, culturally appropriate
curriculums, and training programs for staff
and clients as well as allowable physical
renovations to the property.
new text end

new text begin (b) Community-Based Children's Mental
Health Grant.
Notwithstanding Minnesota
Statutes, section 16B.97, $100,000 in fiscal
year 2020 is for a grant to the Family
Enhancement Center for staffing and
administrative support to provide children
access to expert mental health services
regardless of a child's insurance status or
income. This is a onetime appropriation and
is available until June 30, 2021.
new text end

new text begin (c) Base Level Adjustment. The general fund
base is $25,726,000 in fiscal year 2022 and
$25,726,000 in fiscal year 2023.
new text end

new text begin Subd. 33. new text end

new text begin Grant Programs; Chemical
Dependency Treatment Support Grants
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 2,636,000
new text end
new text begin 2,636,000
new text end
new text begin Lottery Prize
new text end
new text begin 1,733,000
new text end
new text begin 1,733,000
new text end

new text begin (a) Problem Gambling. $225,000 in fiscal
year 2020 and $225,000 in fiscal year 2021
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
new text end

new text begin (b) new text beginFetal Alcohol Spectrum Disorders
Grants.
new text end
(1) $500,000 in fiscal year 2020 and
$500,000 in fiscal year 2021 are from the
general fund for a grant to Proof Alliance. Of
this appropriation, Proof Alliance shall make
grants to eligible regional collaboratives for
the purposes specified in clause (3).
new text end

new text begin (2) "Eligible regional collaboratives" means
a partnership between at least one local
government and at least one community-based
organization and, where available, a family
home visiting program. For purposes of this
clause, a local government includes a county
or multicounty organization, a tribal
government, a county-based purchasing entity,
or a community health board.
new text end

new text begin (3) Eligible regional collaboratives must use
grant funds to reduce the incidence of fetal
alcohol spectrum disorders and other prenatal
drug-related effects in children in Minnesota
by identifying and serving pregnant women
suspected of or known to use or abuse alcohol
or other drugs. Eligible regional collaboratives
must provide intensive services to chemically
dependent women to increase positive birth
outcomes.
new text end

new text begin (4) Proof Alliance must make grants to eligible
regional collaboratives from both rural and
urban areas of the state.
new text end

new text begin (5) An eligible regional collaborative that
receives a grant under this paragraph must
report to Proof Alliance by January 15 of each
year on the services and programs funded by
the grant. The report must include measurable
outcomes for the previous year, including the
number of pregnant women served and the
number of toxic-free babies born. Proof
Alliance must compile the information in these
reports and report that information to the
commissioner of human services by February
15 of each year.
new text end

new text begin Subd. 34. new text end

new text begin Direct Care and Treatment -
Generally
new text end

new text begin (a) Transfer Authority. Money appropriated
to budget activities under this subdivision and
subdivisions 35, 36, 37, and 38 may be
transferred between budget activities and
between years of the biennium with the
approval of the commissioner of management
and budget.
new text end

new text begin (b) Transfer; State-Operated Services
Account.
Any balance remaining in the state
operated services account at the end of fiscal
year 2019, estimated to be $13,000,000 shall
be transferred to the general fund.
new text end

new text begin Subd. 35. new text end

new text begin Direct Care and Treatment - Mental
Health and Substance Abuse
new text end

new text begin 129,209,000
new text end
new text begin 129,201,000
new text end

new text begin (a) Transfer Authority. $6,438,000 in fiscal
year 2020 and $6,438,000 in fiscal year 2021
are for operations of the Community Addiction
Enterprise (C.A.R.E.) program and may be
transferred to the enterprise fund for C.A.R.E.
new text end

new text begin (b) new text beginBase Level Adjustment. new text end The general fund
base is $129,197,000 in fiscal year 2022 and
$129,197,000 in fiscal year 2023.
new text end

new text begin Subd. 36. new text end

new text begin Direct Care and Treatment -
Community-Based Services
new text end

new text begin 16,630,000
new text end
new text begin 17,177,000
new text end

new text begin (a) Transfer Authority. $2,393,000 in fiscal
year 2020 and $2,393,000 in fiscal year 2021
are for operations of the Minnesota State
Operated Community Services (MSOCS)
program and may be transferred to the
enterprise fund for MSOCS.
new text end

new text begin (b) MSOCS Operating Adjustment.
$1,594,000 in fiscal year 2020 and $3,729,000
in fiscal year 2021 are from the general fund
for the Minnesota State Operated Community
Services program. The commissioner shall
transfer $1,594,000 in fiscal year 2020 and
$3,729,000 in fiscal year 2021 to the enterprise
fund for MSOCS.
new text end

new text begin (c) Base Level Adjustment. The general fund
base is $17,176,000 in fiscal year 2022 and
$17,176,000 in fiscal year 2023.
new text end

new text begin Subd. 37. new text end

new text begin Direct Care and Treatment - Forensic
Services
new text end

new text begin 112,126,000
new text end
new text begin 115,342,000
new text end

new text begin Base Level Adjustment. The general fund
base is $115,944,000 in fiscal year 2022 and
$115,944,000 in fiscal year 2023.
new text end

new text begin Subd. 38. new text end

new text begin Direct Care and Treatment - Sex
Offender Program
new text end

new text begin 97,072,000
new text end
new text begin 97,621,000
new text end

new text begin (a) new text beginTransfer Authority. new text endMoney appropriated
for the Minnesota sex offender program may
be transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
new text end

new text begin (b) new text beginBase Level Adjustment.new text end The general fund
base is $98,166,000 in fiscal year 2022 and
$98,166,000 in fiscal year 2023.
new text end

new text begin Subd. 39. new text end

new text begin Direct Care and Treatment -
Operations
new text end

new text begin 47,398,000
new text end
new text begin 47,657,000
new text end

new text begin Base Level Adjustment. The general fund
base is $47,656,000 in fiscal year 2022 and
$47,656,000 in fiscal year 2023.
new text end

new text begin Subd. 40. new text end

new text begin Technical Activities
new text end

new text begin 75,884,000
new text end
new text begin 82,316,000
new text end

new text begin (a) Generally. This appropriation is from the
federal TANF fund.
new text end

new text begin (b) Base Level Adjustment. The TANF fund
base is $79,198,000 in fiscal year 2022 and
$78,254,000 in fiscal year 2023.
new text end

Sec. 3. new text beginCOMMISSIONER OF HEALTH
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
new text end

new text begin $
new text end
new text begin 231,829,000
new text end
new text begin $
new text end
new text begin 236,188,000
new text end
new text begin Appropriations by Fund
new text end
new text begin 2020
new text end
new text begin 2021
new text end
new text begin General
new text end
new text begin 124,381,000
new text end
new text begin 126,276,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 58,450,000
new text end
new text begin 61,367,000
new text end
new text begin Health Care Access
new text end
new text begin 37,285,000
new text end
new text begin 36,832,000
new text end
new text begin Federal TANF
new text end
new text begin 11,713,000
new text end
new text begin 11,713,000
new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end

new text begin Health Improvement
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 94,980,000
new text end
new text begin 96,117,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 7,614,000
new text end
new text begin 7,558,000
new text end
new text begin Health Care Access
new text end
new text begin 37,285,000
new text end
new text begin 36,832,000
new text end
new text begin Federal TANF
new text end
new text begin 11,713,000
new text end
new text begin 11,713,000
new text end

new text begin (a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2020 and $3,579,000 in fiscal year
2021 are from the TANF fund for home
visiting and nutritional services under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
new text end

new text begin (2) $2,000,000 in fiscal year 2020 and
$2,000,000 in fiscal year 2021 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
new text end

new text begin (3) $4,978,000 in fiscal year 2020 and
$4,978,000 in fiscal year 2021 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 of the funding in each
fiscal year must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding in each fiscal year must be
distributed to tribal governments according to
Minnesota Statutes, section 145A.14,
subdivision 2a;
new text end

new text begin (4) $1,156,000 in fiscal year 2020 and
$1,156,000 in fiscal year 2021 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
new text end

new text begin (5) The commissioner may use up to 6.23
percent of the amounts appropriated from the
TANF fund each year to conduct the ongoing
evaluations required under Minnesota Statutes,
section 145A.17, subdivision 7, and training
and technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end

new text begin (b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
new text end

new text begin (c) Comprehensive Suicide Prevention.
$2,730,000 in fiscal year 2020 and $2,730,000
in fiscal year 2021 are from the general fund
for a comprehensive, community-based suicide
prevention strategy. The funds are allocated
as follows:
new text end

new text begin (1) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are for community-based
suicide prevention grants authorized in
Minnesota Statutes, section 145.56,
subdivision 2. Specific emphasis must be
placed on those communities with the greatest
disparities. The base for this appropriation is
$1,291,000 in fiscal year 2022 and $1,291,000
in fiscal year 2023;
new text end

new text begin (2) $683,000 in fiscal year 2020 and $683,000
in fiscal year 2021 are to support
evidence-based training for educators and
school staff and purchase suicide prevention
curriculum for student use statewide, as
authorized in Minnesota Statutes, section
145.56, subdivision 2. The base for this
appropriation is $913,000 in fiscal year 2022
and $913,000 in fiscal year 2023;
new text end

new text begin (3) $137,000 in fiscal year 2020 and $137,000
in fiscal year 2021 are to implement the Zero
Suicide framework with up to 20 behavioral
and health care organizations each year to treat
individuals at risk for suicide and support
those individuals across systems of care upon
discharge. The base for this appropriation is
$205,000 in fiscal year 2022 and $205,000 in
fiscal year 2023;
new text end

new text begin (4) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are to develop and fund a
Minnesota-based network of National Suicide
Prevention Lifeline, providing statewide
coverage. The base for this appropriation is
$1,321,000 in fiscal year 2022 and $1,321,000
in fiscal year 2023; and
new text end

new text begin (5) the commissioner may retain up to 18.23
percent of the appropriation under this
paragraph to administer the comprehensive
suicide prevention strategy.
new text end

new text begin (d) Statewide Tobacco Cessation. $1,598,000
in fiscal year 2020 and $2,748,000 in fiscal
year 2021 are from the general fund for
statewide tobacco cessation services under
Minnesota Statutes, section 144.397. The base
for this appropriation is $2,878,000 in fiscal
year 2022 and $2,878,000 in fiscal year 2023.
new text end

new text begin (e) Health Care Access Survey. $225,000 in
fiscal year 2020 and $225,000 in fiscal year
2021 are from the health care access fund to
continue and improve the Minnesota Health
Care Access Survey. These appropriations
may be used in either year of the biennium.
new text end

new text begin (f) Community Solutions for Healthy Child
Development Grant Program.
$1,000,000
in fiscal year 2020 and $1,000,000 in fiscal
year 2021 are for the community solutions for
healthy child development grant program to
promote health and racial equity for young
children and their families under Minnesota
Statutes, section 145.9285. The commissioner
may use up to 23.5 percent of the total
appropriation for administration. The base for
this appropriation is $1,000,000 in fiscal year
2022, $1,000,000 in fiscal year 2023, and $0
in fiscal year 2024.
new text end

new text begin (g) new text beginDomestic Violence and Sexual Assault
Prevention Program.
new text end
$375,000 in fiscal year
2020 and $375,000 in fiscal year 2021 are
from the general fund for the domestic
violence and sexual assault prevention
program under Minnesota Statutes, section
145.987. This is a onetime appropriation.
new text end

new text begin (h) Skin Lightening Products Public
Awareness Grant Program.
$100,000 in
fiscal year 2020 and $100,000 in fiscal year
2021 are from the general fund for a skin
lightening products public awareness and
education grant program. This is a onetime
appropriation.
new text end

new text begin (i) Cannabinoid Products Workgroup.
$8,000 in fiscal year 2020 is from the state
government special revenue fund for the
cannabinoid products workgroup. This is a
onetime appropriation.
new text end

new text begin (j) Base Level Adjustments. The general fund
base is $96,742,000 in fiscal year 2022 and
$96,742,000 in fiscal year 2023. The health
care access fund base is $37,432,000 in fiscal
year 2022 and $36,832,000 in fiscal year 2023.
new text end

new text begin Subd. 3. new text end

new text begin Health Protection
new text end

new text begin Appropriations by Fund
new text end
new text begin General
new text end
new text begin 18,803,000
new text end
new text begin 19,774,000
new text end
new text begin State Government
Special Revenue
new text end
new text begin 50,836,000
new text end
new text begin 53,809,000
new text end

new text begin (a) Public Health Laboratory Equipment.
$840,000 in fiscal year 2020 and $655,000 in
fiscal year 2021 are from the general fund for
equipment for the public health laboratory.
This is a onetime appropriation and is
available until June 30, 2023.
new text end

new text begin (b) Base Level Adjustment. The general fund
base is $19,119,000 in fiscal year 2022 and
$19,119,000 in fiscal year 2023. The state
government special revenue fund base is
$53,782,000 in fiscal year 2022 and
$53,782,000 in fiscal year 2023.
new text end

new text begin Subd. 4. new text end

new text begin Health Operations
new text end

new text begin 10,598,000
new text end
new text begin 10,385,000
new text end

new text begin Base Level Adjustment. The general fund
base is $10,912,000 in fiscal year 2022 and
$10,912,000 in fiscal year 2023.
new text end

Sec. 4. new text beginHEALTH-RELATED BOARDS
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
new text end

new text begin $
new text end
new text begin 27,203,000
new text end
new text begin $
new text end
new text begin 26,597,000
new text end

new text begin This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end

new text begin Subd. 2. new text end

new text begin Board of Chiropractic Examiners
new text end

new text begin 629,000
new text end
new text begin 641,000
new text end

new text begin Subd. 3. new text end

new text begin Board of Dentistry
new text end

new text begin 1,503,000
new text end
new text begin 1,450,000
new text end

new text begin new text begin Emeritus Licensing Activities. new text end$8,000 in
fiscal year 2020 and $5,000 in fiscal year 2021
are for emeritus licensing activities under
Minnesota Statutes, section 150A.06.
new text end

new text begin Subd. 4. new text end

new text begin Board of Dietetics and Nutrition
Practice
new text end

new text begin 147,000
new text end
new text begin 149,000
new text end

new text begin Subd. 5. new text end

new text begin Board of Marriage and Family Therapy
new text end

new text begin 384,000
new text end
new text begin 389,000
new text end

new text begin Base Level Adjustment. The base is $384,000
in fiscal year 2022 and $384,000 in fiscal year
2023.
new text end

new text begin Subd. 6. new text end

new text begin Board of Medical Practice
new text end

new text begin 6,013,000
new text end
new text begin 5,996,000
new text end

new text begin (a) Health Professional Services Program.
This appropriation includes $1,023,000 in
fiscal year 2020 and $1,002,000 in fiscal year
2021 for the health professional services
program.
new text end

new text begin (b) Base Level Adjustment. The base is
$5,912,000 in fiscal year 2022 and $5,868,000
in fiscal year 2023.
new text end

new text begin Subd. 7. new text end

new text begin Board of Nursing
new text end

new text begin 4,993,000
new text end
new text begin 4,993,000
new text end

new text begin Subd. 8. new text end

new text begin Board of Nursing Home Administrators
new text end

new text begin 3,733,000
new text end
new text begin 3,201,000
new text end

new text begin (a) Administrative Services Unit - Operating
Costs.
Of this appropriation, $3,445,000 in
fiscal year 2020 and $2,910,000 in fiscal year
2021 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end

new text begin (b) Administrative Services Unit - Volunteer
Health Care Provider Program.
Of this
appropriation, $150,000 in fiscal year 2020
and $150,000 in fiscal year 2021 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end

new text begin (c) Administrative Services Unit -
Retirement Costs.
Of this appropriation,
$558,000 in fiscal year 2020 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.
new text end

new text begin (d) Administrative Services Unit - Contested
Cases and Other Legal Proceedings.
Of this
appropriation, $200,000 in fiscal year 2020
and $200,000 in fiscal year 2021 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of appropriations
currently available to that board, the
administrative services unit is authorized to
transfer money from this appropriation to the
board for payment of those costs with the
approval of the commissioner of management
and budget. The commissioner of management
and budget must require any board that has an
unexpended balance for an amount transferred
under this paragraph to transfer the
unexpended amount to the administrative
services unit to be deposited in the state
government special revenue fund.
new text end

new text begin Subd. 9. new text end

new text begin Board of Optometry
new text end

new text begin 222,000
new text end
new text begin 223,000
new text end

new text begin Subd. 10. new text end

new text begin Board of Pharmacy
new text end

new text begin 4,307,000
new text end
new text begin 4,341,000
new text end

new text begin Base Level Adjustment. The base is
$4,338,000 in fiscal year 2022 and $4,338,000
in fiscal year 2023.
new text end

new text begin Subd. 11. new text end

new text begin Board of Physical Therapy
new text end

new text begin 547,000
new text end
new text begin 549,000
new text end

new text begin Subd. 12. new text end

new text begin Board of Podiatric Medicine
new text end

new text begin 199,000
new text end
new text begin 199,000
new text end

new text begin Subd. 13. new text end

new text begin Board of Psychology
new text end

new text begin 1,357,000
new text end
new text begin 1,395,000
new text end

new text begin Base Level Adjustment. The base is
$1,355,000 in fiscal year 2022 and $1,355,000
in fiscal year 2023.
new text end

new text begin Subd. 14. new text end

new text begin Board of Social Work
new text end

new text begin 1,437,000
new text end
new text begin 1,404,000
new text end

new text begin Subd. 15. new text end

new text begin Board of Veterinary Medicine
new text end

new text begin 345,000
new text end
new text begin 353,000
new text end

new text begin Subd. 16. new text end

new text begin Board of Behavioral Health and
Therapy
new text end

new text begin 937,000
new text end
new text begin 858,000
new text end

new text begin new text begin Base Level Adjustment.new text end The base is $833,000
in fiscal year 2022 and $833,000 in fiscal year
2023.
new text end

new text begin Subd. 17. new text end

new text begin Board of Occupational Therapy
Practice
new text end

new text begin 450,000
new text end
new text begin 456,000
new text end

Sec. 5. new text beginEMERGENCY MEDICAL SERVICES
REGULATORY BOARD
new text end

new text begin $
new text end
new text begin 3,747,000
new text end
new text begin $
new text end
new text begin 3,809,000
new text end

new text begin (a) Cooper/Sams Volunteer Ambulance
Program.
$950,000 in fiscal year 2020 and
$950,000 in fiscal year 2021 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
new text end

new text begin (1) Of this amount, $861,000 in fiscal year
2020 and $861,000 in fiscal year 2021 are for
the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40.
new text end

new text begin (2) Of this amount, $89,000 in fiscal year 2020
and $89,000 in fiscal year 2021 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
new text end

new text begin (b) EMSRB Operations. $1,851,000 in fiscal
year 2020 and $1,913,000 in fiscal year 2021
are for board operations. The base for this
program is $1,880,000 in fiscal year 2022 and
$1,880,000 in fiscal year 2023.
new text end

new text begin (c) Regional Grants. $585,000 in fiscal year
2020 and $585,000 in fiscal year 2021 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.
new text end

new text begin (d) Ambulance Training Grant. $585,000
in fiscal year 2020 and $585,000 in fiscal year
2021 are for training grants under Minnesota
Statutes, section 144E.35.
new text end

new text begin (e) Base Level Adjustment. The base is
$3,776,000 in fiscal year 2022 and $3,776,000
in fiscal year 2023.
new text end

Sec. 6. new text beginCOUNCIL ON DISABILITY
new text end

new text begin $
new text end
new text begin 1,014,000
new text end
new text begin $
new text end
new text begin 1,006,000
new text end

Sec. 7. new text beginOMBUDSMAN FOR MENTAL
HEALTH AND DEVELOPMENTAL
DISABILITIES
new text end

new text begin $
new text end
new text begin 2,438,000
new text end
new text begin $
new text end
new text begin 2,438,000
new text end

new text begin Department of Psychiatry Monitoring.
$100,000 in fiscal year 2020 and $100,000 in
fiscal year 2021 are for monitoring the
Department of Psychiatry at the University of
Minnesota.
new text end

Sec. 8. new text beginOMBUDSPERSONS FOR FAMILIES
new text end

new text begin $
new text end
new text begin 714,000
new text end
new text begin $
new text end
new text begin 723,000
new text end

Sec. 9. new text beginCOMMISSIONER OF COMMERCE
new text end

new text begin $
new text end
new text begin 27,000
new text end
new text begin $
new text end
new text begin 27,000
new text end

Sec. 10. new text beginBOARD OF DIRECTORS OF
MNSURE
new text end

new text begin $
new text end
new text begin 8,000,000
new text end
new text begin $
new text end
new text begin 0
new text end

new text begin This appropriation shall be transferred to the
MNsure enterprise fund.
new text end

Sec. 11. new text beginCOMMISSIONER OF
MANAGEMENT AND BUDGET
new text end

new text begin $
new text end
new text begin 498,000
new text end
new text begin $
new text end
new text begin 498,000
new text end

new text begin (a) Proven-Effective Practices Evaluation
Activities.
$498,000 in fiscal year 2020 and
$498,000 in fiscal year 2021 are from the
general fund for evaluation activities under
Minnesota Statutes, section 16A.055,
subdivision 1a.
new text end

new text begin (b) Transfer; Premium Security Account.
By August 30, 2020, the commissioner of
commerce shall transfer $142,000,000 from
the premium security account to the general
fund. This is a onetime transfer.
new text end

new text begin (c) Transfer Cancellation. The commissioner
of management and budget shall not make the
$50,000,000 transfer authorized under
Minnesota Statutes, section 62U.10,
subdivision 8, in fiscal year 2019 resulting
from the December 2017 report conducted
under Minnesota Statutes, section 62U.10,
subdivision 7.
new text end

new text begin (d) Savings Determination. (1) When
preparing the forecast for state revenues and
expenditures under Minnesota Statutes, section
16A.103, the commissioner of management
and budget shall assume a reduction of health
and human services spending of $100,000,000
for the biennium beginning July 1, 2022, until
the end of the legislative session that enacts a
budget for the Department of Health and the
Department of Human Services for that
biennium.
new text end

new text begin (2) Upon enactment of a budget for the
Department of Health and the Department of
Human Services for the biennium beginning
July 1, 2022, the legislature shall identify
enacted provisions that were recommended
by or based on the recommendation of the
Blue Ribbon Commission on Health and
Human Services.
new text end

new text begin (3) To the extent the net savings attributable
to the provisions in clause (2) for the biennium
beginning July 1, 2022, are less than
$100,000,000, the commissioner shall reduce
the balance of the general fund budget reserve
established under Minnesota Statutes, section
16A.152, subdivision 1a, by an amount equal
to the difference between the savings
identified in clause (2) and the assumed
$100,000,000 of savings in clause (1).
new text end

Sec. 12. new text beginTRANSFERS.
new text end

new text begin Subdivision 1. new text end

new text begin Forecasted programs. new text end

new text begin The commissioner of human services, with the
approval of the commissioner of management and budget, may transfer unencumbered
appropriation balances for the biennium ending June 30, 2021, within fiscal years among
the MFIP, general assistance, medical assistance, MinnesotaCare, MFIP child care assistance
under Minnesota Statutes, section 119B.05, Minnesota supplemental aid program, housing
support, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Committee
and the house of representatives Health and Human Services Finance Division quarterly
about transfers made under this subdivision.
new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin Positions, salary money, and nonsalary administrative money
may be transferred within the Departments of Health and Human Services as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioner shall inform the chairs and ranking minority
members of the senate Health and Human Services Finance Committee and the house of
representatives Health and Human Services Finance Division quarterly about transfers made
under this subdivision.
new text end

Sec. 13. new text beginINDIRECT COSTS NOT TO FUND PROGRAMS.
new text end

new text begin The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
new text end

Sec. 14. new text beginEXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2021, unless a
different expiration date is explicit.
new text end

Sec. 15. new text beginEFFECTIVE DATE.
new text end

new text begin This article is effective July 1, 2019, unless a different effective date is specified.
new text end

APPENDIX

Repealed Minnesota Statutes: 19-5223

119B.125 PROVIDER REQUIREMENTS.

Subd. 8.

Overpayment claim for failure to comply with access to records requirement.

(a) In establishing an overpayment claim under subdivision 6 for failure to provide access to attendance records, the county or commissioner is limited to the six years prior to the date the county or the commissioner requested the attendance records.

(b) When the commissioner or county establishes an overpayment claim against a current or former provider, the commissioner or county must provide notice of the claim to the provider. A notice of overpayment claim must specify the reason for the overpayment, the authority for making the overpayment claim, the time period in which the overpayment occurred, the amount of the overpayment, and the provider's right to appeal.

(c) The commissioner or county may seek to recover overpayments paid to a current or former provider. When a provider has been convicted of fraud under section 256.98, theft under section 609.52, or a federal crime relating to theft of state funds or fraudulent billing for a program administered by the commissioner or a county, recovery may be sought regardless of the amount of overpayment.

119B.16 FAIR HEARING PROCESS.

Subd. 2.

Informal conference.

The county agency shall offer an informal conference to applicants and recipients adversely affected by an agency action to attempt to resolve the dispute. The county agency shall offer an informal conference to providers to whom the county agency has assigned responsibility for an overpayment in an attempt to resolve the dispute. The county agency or the provider may ask the family in whose case the overpayment arose to participate in the informal conference, but the family may refuse to do so. The county agency shall advise adversely affected applicants, recipients, and providers that a request for a conference with the agency is optional and does not delay or replace the right to a fair hearing.

144.414 PROHIBITIONS.

Subd. 5.

Electronic cigarettes.

(a) The use of electronic cigarettes, including the inhaling or exhaling of vapor from any electronic delivery device, as defined in section 609.685, subdivision 1, is prohibited in the following locations:

(1) any building owned or operated by the state, home rule charter or statutory city, county, township, school district, or other political subdivision;

(2) any facility owned by Minnesota State Colleges and Universities and the University of Minnesota;

(3) any facility licensed by the commissioner of human services; or

(4) any facility licensed by the commissioner of health, but only if the facility is also subject to federal licensing requirements.

(b) Nothing in this subdivision shall prohibit political subdivisions or businesses from adopting more stringent prohibitions on the use of electronic cigarettes or electronic delivery devices.

144A.45 REGULATION OF HOME CARE SERVICES.

Subd. 6.

Home care providers; tuberculosis prevention and control.

(a) A home care provider must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in CDC's Morbidity and Mortality Weekly Report (MMWR). This program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and volunteers. The Department of Health shall provide technical assistance regarding implementation of the guidelines.

(b) Written compliance with this subdivision must be maintained by the home care provider.

144A.481 HOME CARE LICENSING IMPLEMENTATION FOR NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.

Subdivision 1.

Temporary home care licenses and changes of ownership.

(a) Beginning January 1, 2014, all temporary license applicants must apply for either a temporary basic or comprehensive home care license.

(b) Temporary home care licenses issued beginning January 1, 2014, shall be issued according to sections 144A.43 to 144A.4798, and the fees in section 144A.472. Temporary licensees must comply with the requirements of this chapter.

(c) No temporary license applications will be accepted nor temporary licenses issued between December 1, 2013, and December 31, 2013.

(d) Beginning October 1, 2013, changes in ownership applications will require payment of the new fees listed in section 144A.472. Providers who are providing nursing, delegated nursing, or professional health care services, must submit the fee for comprehensive home care providers, and all other providers must submit the fee for basic home care providers as provided in section 144A.472. Change of ownership applicants will be issued a new home care license based on the licensure law in effect on June 30, 2013.

Subd. 2.

Current home care licensees with licenses as of December 31, 2013.

(a) Beginning July 1, 2014, department licensed home care providers must apply for either the basic or comprehensive home care license on their regularly scheduled renewal date.

(b) By June 30, 2015, all home care providers must either have a basic or comprehensive home care license or temporary license.

Subd. 3.

Renewal application of home care licensure during transition period.

(a) Renewal and change of ownership applications of home care licenses issued beginning July 1, 2014, will be issued according to sections 144A.43 to 144A.4798 and, upon license renewal or issuance of a new license for a change of ownership, providers must comply with sections 144A.43 to 144A.4798. Prior to renewal, providers must comply with the home care licensure law in effect on June 30, 2013.

(b) The fees charged for licenses renewed between July 1, 2014, and June 30, 2016, shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000 increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.

(c) For fiscal year 2014 only, the fees for providers with revenues greater than $25,000 and no more than $100,000 will be $313 and for providers with revenues no more than $25,000 the fee will be $125.

151.42 CITATION.

Sections 151.42 to 151.51 may be cited as the "Wholesale Drug Distribution Licensing Act of 1990."

151.44 DEFINITIONS.

As used in sections 151.43 to 151.51, the following terms have the meanings given in paragraphs (a) to (h):

(a) "Wholesale drug distribution" means distribution of prescription or nonprescription drugs to persons other than a consumer or patient or reverse distribution of such drugs, but does not include:

(1) a sale between a division, subsidiary, parent, affiliated, or related company under the common ownership and control of a corporate entity;

(2) the purchase or other acquisition, by a hospital or other health care entity that is a member of a group purchasing organization, of a drug for its own use from the organization or from other hospitals or health care entities that are members of such organizations;

(3) the sale, purchase, or trade of a drug or an offer to sell, purchase, or trade a drug by a charitable organization described in section 501(c)(3) of the Internal Revenue Code of 1986, as amended through December 31, 1988, to a nonprofit affiliate of the organization to the extent otherwise permitted by law;

(4) the sale, purchase, or trade of a drug or offer to sell, purchase, or trade a drug among hospitals or other health care entities that are under common control;

(5) the sale, purchase, or trade of a drug or offer to sell, purchase, or trade a drug for emergency medical reasons;

(6) the sale, purchase, or trade of a drug, an offer to sell, purchase, or trade a drug, or the dispensing of a drug pursuant to a prescription;

(7) the transfer of prescription or nonprescription drugs by a retail pharmacy to another retail pharmacy to alleviate a temporary shortage;

(8) the distribution of prescription or nonprescription drug samples by manufacturers representatives; or

(9) the sale, purchase, or trade of blood and blood components.

(b) "Wholesale drug distributor" means anyone engaged in wholesale drug distribution including, but not limited to, manufacturers; repackagers; own-label distributors; jobbers; brokers; warehouses, including manufacturers' and distributors' warehouses, chain drug warehouses, and wholesale drug warehouses; independent wholesale drug traders; and pharmacies that conduct wholesale drug distribution. A wholesale drug distributor does not include a common carrier or individual hired primarily to transport prescription or nonprescription drugs.

(c) "Manufacturer" has the meaning provided in section 151.01, subdivision 14a.

(d) "Prescription drug" means a drug required by federal or state law or regulation to be dispensed only by a prescription, including finished dosage forms and active ingredients subject to United States Code, title 21, sections 811 and 812.

(e) "Blood" means whole blood collected from a single donor and processed either for transfusion or further manufacturing.

(f) "Blood components" means that part of blood separated by physical or mechanical means.

(g) "Reverse distribution" means the receipt of prescription or nonprescription drugs received from or shipped to Minnesota locations for the purpose of returning the drugs to their producers or distributors.

(h) "Reverse distributor" means a person engaged in the reverse distribution of drugs.

151.49 LICENSE RENEWAL APPLICATION PROCEDURES.

Application blanks or notices for renewal of a license required by sections 151.42 to 151.51 shall be mailed or otherwise provided to each licensee on or before the first day of the month prior to the month in which the license expires and, if application for renewal of the license with the required fee and supporting documents is not made before the expiration date, the existing license or renewal shall lapse and become null and void upon the date of expiration.

151.50 RULES.

The board shall adopt rules to carry out the purposes and enforce the provisions of sections 151.42 to 151.51. All rules adopted under this section shall conform to wholesale drug distributor licensing guidelines formally adopted by the United States Food and Drug Administration; and in case of conflict between a rule adopted by the board and a Food and Drug Administration wholesale drug distributor guideline, the latter shall control.

151.51 BOARD ACCESS TO WHOLESALE DRUG DISTRIBUTOR RECORDS.

Wholesale drug distributors may keep records at a central location apart from the principal office of the wholesale drug distributor or the location at which the drugs were stored and from which they were shipped, provided that the records shall be made available for inspection within two working days of a request by the board. The records may be kept in any form permissible under federal law applicable to prescription drugs record keeping.

151.55 CANCER DRUG REPOSITORY PROGRAM.

Subdivision 1.

Definitions.

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

(b) "Board" means the Board of Pharmacy.

(c) "Cancer drug" means a prescription drug that is used to treat:

(1) cancer or the side effects of cancer; or

(2) the side effects of any prescription drug that is used to treat cancer or the side effects of cancer.

(d) "Cancer drug repository" means a medical facility or pharmacy that has notified the board of its election to participate in the cancer drug repository program.

(e) "Cancer supply" or "supplies" means prescription and nonprescription cancer supplies needed to administer a cancer drug.

(f) "Dispense" has the meaning given in section 151.01, subdivision 30.

(g) "Distribute" means to deliver, other than by administering or dispensing.

(h) "Donor" means an individual and not a drug manufacturer or wholesale drug distributor who donates a cancer drug or supply according to the requirements of the cancer drug repository program.

(i) "Medical facility" means an institution defined in section 144.50, subdivision 2.

(j) "Medical supplies" means any prescription and nonprescription medical supply needed to administer a cancer drug.

(k) "Pharmacist" has the meaning given in section 151.01, subdivision 3.

(l) "Pharmacy" means any pharmacy registered with the Board of Pharmacy according to section 151.19, subdivision 1.

(m) "Practitioner" has the meaning given in section 151.01, subdivision 23.

(n) "Prescription drug" means a legend drug as defined in section 151.01, subdivision 17.

(o) "Side effects of cancer" means symptoms of cancer.

(p) "Single-unit-dose packaging" means a single-unit container for articles intended for administration as a single dose, direct from the container.

(q) "Tamper-evident unit dose packaging" means a container within which a drug is sealed so that the contents cannot be opened without obvious destruction of the seal.

Subd. 2.

Establishment.

The Board of Pharmacy shall establish and maintain a cancer drug repository program, under which any person may donate a cancer drug or supply for use by an individual who meets the eligibility criteria specified under subdivision 4. Under the program, donations may be made on the premises of a medical facility or pharmacy that elects to participate in the program and meets the requirements specified under subdivision 3.

Subd. 3.

Requirements for participation by pharmacies and medical facilities.

(a) To be eligible for participation in the cancer drug repository program, a pharmacy or medical facility must be licensed and in compliance with all applicable federal and state laws and administrative rules.

(b) Participation in the cancer drug repository program is voluntary. A pharmacy or medical facility may elect to participate in the cancer drug repository program by submitting the following information to the board, in a form provided by the board:

(1) the name, street address, and telephone number of the pharmacy or medical facility;

(2) the name and telephone number of a pharmacist who is employed by or under contract with the pharmacy or medical facility, or other contact person who is familiar with the pharmacy's or medical facility's participation in the cancer drug repository program; and

(3) a statement indicating that the pharmacy or medical facility meets the eligibility requirements under paragraph (a) and the chosen level of participation under paragraph (c).

(c) A pharmacy or medical facility may fully participate in the cancer drug repository program by accepting, storing, and dispensing or administering donated drugs and supplies, or may limit its participation to only accepting and storing donated drugs and supplies. If a pharmacy or facility chooses to limit its participation, the pharmacy or facility shall distribute any donated drugs to a fully participating cancer drug repository according to subdivision 8.

(d) A pharmacy or medical facility may withdraw from participation in the cancer drug repository program at any time upon notification to the board. A notice to withdraw from participation may be given by telephone or regular mail.

Subd. 4.

Individual eligibility requirements.

Any Minnesota resident who is diagnosed with cancer is eligible to receive drugs or supplies under the cancer drug repository program. Drugs and supplies shall be dispensed or administered according to the priority given under subdivision 6, paragraph (d).

Subd. 5.

Donations of cancer drugs and supplies.

(a) Any one of the following persons may donate legally obtained cancer drugs or supplies to a cancer drug repository, if the drugs or supplies meet the requirements under paragraph (b) or (c) as determined by a pharmacist who is employed by or under contract with a cancer drug repository:

(1) an individual who is 18 years old or older; or

(2) a pharmacy, medical facility, drug manufacturer, or wholesale drug distributor, if the donated drugs have not been previously dispensed.

(b) A cancer drug is eligible for donation under the cancer drug repository program only if the following requirements are met:

(1) the donation is accompanied by a cancer drug repository donor form described under paragraph (d) that is signed by the person making the donation or that person's authorized representative;

(2) the drug's expiration date is at least six months later than the date that the drug was donated;

(3) the drug is in its original, unopened, tamper-evident unit dose packaging that includes the drug's lot number and expiration date. Single-unit dose drugs may be accepted if the single-unit-dose packaging is unopened; and

(4) the drug is not adulterated or misbranded.

(c) Cancer supplies are eligible for donation under the cancer drug repository program only if the following requirements are met:

(1) the supplies are not adulterated or misbranded;

(2) the supplies are in their original, unopened, sealed packaging; and

(3) the donation is accompanied by a cancer drug repository donor form described under paragraph (d) that is signed by the person making the donation or that person's authorized representative.

(d) The cancer drug repository donor form must be provided by the board and shall state that to the best of the donor's knowledge the donated drug or supply has been properly stored and that the drug or supply has never been opened, used, tampered with, adulterated, or misbranded. The board shall make the cancer drug repository donor form available on the Board of Pharmacy's website.

(e) Controlled substances and drugs and supplies that do not meet the criteria under this subdivision are not eligible for donation or acceptance under the cancer drug repository program.

(f) Drugs and supplies may be donated on the premises of a cancer drug repository to a pharmacist designated by the repository. A drop box may not be used to deliver or accept donations.

(g) Cancer drugs and supplies donated under the cancer drug repository program must be stored in a secure storage area under environmental conditions appropriate for the drugs or supplies being stored. Donated drugs and supplies may not be stored with nondonated inventory.

Subd. 6.

Dispensing requirements.

(a) Drugs and supplies must be dispensed by a licensed pharmacist pursuant to a prescription by a practitioner or may be dispensed or administered by a practitioner according to the requirements of this chapter and within the practitioner's scope of practice.

(b) Cancer drugs and supplies shall be visually inspected by the pharmacist or practitioner before being dispensed or administered for adulteration, misbranding, and date of expiration. Drugs or supplies that have expired or appear upon visual inspection to be adulterated, misbranded, or tampered with in any way may not be dispensed or administered.

(c) Before a cancer drug or supply may be dispensed or administered to an individual, the individual must sign a cancer drug repository recipient form provided by the board acknowledging that the individual understands the information stated on the form. The form shall include the following information:

(1) that the drug or supply being dispensed or administered has been donated and may have been previously dispensed;

(2) that a visual inspection has been conducted by the pharmacist or practitioner to ensure that the drug has not expired, has not been adulterated or misbranded, and is in its original, unopened packaging; and

(3) that the dispensing pharmacist, the dispensing or administering practitioner, the cancer drug repository, the Board of Pharmacy, and any other participant of the cancer drug repository program cannot guarantee the safety of the drug or supply being dispensed or administered and that the pharmacist or practitioner has determined that the drug or supply is safe to dispense or administer based on the accuracy of the donor's form submitted with the donated drug or supply and the visual inspection required to be performed by the pharmacist or practitioner before dispensing or administering.

The board shall make the cancer drug repository form available on the Board of Pharmacy's website.

(d) Drugs and supplies shall only be dispensed or administered to individuals who meet the eligibility requirements in subdivision 4 and in the following order of priority:

(1) individuals who are uninsured;

(2) individuals who are enrolled in medical assistance, MinnesotaCare, Medicare, or other public assistance health care; and

(3) all other individuals who are otherwise eligible under subdivision 4 to receive drugs or supplies from a cancer drug repository.

Subd. 7.

Handling fees.

A cancer drug repository may charge the individual receiving a drug or supply a handling fee of no more than 250 percent of the medical assistance program dispensing fee for each cancer drug or supply dispensed or administered.

Subd. 8.

Distribution of donated cancer drugs and supplies.

(a) Cancer drug repositories may distribute drugs and supplies donated under the cancer drug repository program to other repositories if requested by a participating repository.

(b) A cancer drug repository that has elected not to dispense donated drugs or supplies shall distribute any donated drugs and supplies to a participating repository upon request of the repository.

(c) If a cancer drug repository distributes drugs or supplies under paragraph (a) or (b), the repository shall complete a cancer drug repository donor form provided by the board. The completed form and a copy of the donor form that was completed by the original donor under subdivision 5 shall be provided to the fully participating cancer drug repository at the time of distribution.

Subd. 9.

Resale of donated drugs or supplies.

Donated drugs and supplies may not be resold.

Subd. 10.

Record-keeping requirements.

(a) Cancer drug repository donor and recipient forms shall be maintained for at least five years.

(b) A record of destruction of donated drugs and supplies that are not dispensed under subdivision 6 shall be maintained by the dispensing repository for at least five years. For each drug or supply destroyed, the record shall include the following information:

(1) the date of destruction;

(2) the name, strength, and quantity of the cancer drug destroyed;

(3) the name of the person or firm that destroyed the drug; and

(4) the source of the drugs or supplies destroyed.

Subd. 11.

Liability.

(a) The manufacturer of a drug or supply is not subject to criminal or civil liability for injury, death, or loss to a person or to property for causes of action described in clauses (1) and (2). A manufacturer is not liable for:

(1) the intentional or unintentional alteration of the drug or supply by a party not under the control of the manufacturer; or

(2) the failure of a party not under the control of the manufacturer to transfer or communicate product or consumer information or the expiration date of the donated drug or supply.

(b) A medical facility or pharmacy participating in the program, a pharmacist dispensing a drug or supply pursuant to the program, a practitioner dispensing or administering a drug or supply pursuant to the program, or a donor of a cancer drug or supply as defined in subdivision 1 is immune from civil liability for an act or omission that causes injury to or the death of an individual to whom the cancer drug or supply is dispensed and no disciplinary action shall be taken against a pharmacist or practitioner so long as the drug or supply is donated, accepted, distributed, and dispensed according to the requirements of this section. This immunity does not apply if the act or omission involves reckless, wanton, or intentional misconduct, or malpractice unrelated to the quality of the cancer drug or supply.

214.17 HIV, HBV, AND HCV PREVENTION PROGRAM; PURPOSE AND SCOPE.

Sections 214.17 to 214.25 are intended to promote the health and safety of patients and regulated persons by reducing the risk of infection in the provision of health care.

214.18 DEFINITIONS.

Subdivision 1.

Board.

"Board" means the Boards of Dentistry, Medical Practice, Nursing, and Podiatric Medicine. For purposes of sections 214.19, subdivisions 4 and 5; 214.20, paragraph (1); and 214.24, board also includes the Board of Chiropractic Examiners.

Subd. 2.

Commissioner.

"Commissioner" means the commissioner of health.

Subd. 3.

HBV.

"HBV" means the hepatitis B virus with the e antigen present in the most recent blood test.

Subd. 3a.

HCV.

"HCV" means the hepatitis C virus.

Subd. 4.

HIV.

"HIV" means the human immunodeficiency virus.

Subd. 5.

Regulated person.

"Regulated person" means a licensed dental hygienist, dentist, physician, nurse who is currently registered as a registered nurse or licensed practical nurse, podiatrist, a registered dental assistant, a physician assistant, and for purposes of sections 214.19, subdivisions 4 and 5; 214.20, paragraph (a); and 214.24, a chiropractor.

214.19 REPORTING OBLIGATIONS.

Subdivision 1.

Permission to report.

A person with actual knowledge that a regulated person has been diagnosed as infected with HIV, HBV, or HCV may file a report with the commissioner.

Subd. 2.

Self-reporting.

A regulated person who is diagnosed as infected with HIV, HBV, or HCV shall report that information to the commissioner promptly, and as soon as medically necessary for disease control purposes but no more than 30 days after learning of the diagnosis or 30 days after becoming licensed or registered by the state.

Subd. 3.

Mandatory reporting.

A person or institution required to report HIV, HBV, or HCV status to the commissioner under Minnesota Rules, parts 4605.7030, subparts 1 to 4 and 6, and 4605.7040, shall, at the same time, notify the commissioner if the person or institution knows that the reported person is a regulated person.

Subd. 4.

Infection control reporting.

A regulated person shall, within ten days, report to the appropriate board personal knowledge of a serious failure or a pattern of failure by another regulated person to comply with accepted and prevailing infection control procedures related to the prevention of HIV, HBV, and HCV transmission. In lieu of reporting to the board, the regulated person may make the report to a designated official of the hospital, nursing home, clinic, or other institution or agency where the failure to comply with accepted and prevailing infection control procedures occurred. The designated official shall report to the appropriate board within 30 days of receiving a report under this subdivision. The report shall include specific information about the response by the institution or agency to the report. A regulated person shall not be discharged or discriminated against for filing a complaint in good faith under this subdivision.

Subd. 5.

Immunity.

A person is immune from civil liability or criminal prosecution for submitting a report in good faith to the commissioner or to a board under this section.

214.20 GROUNDS FOR DISCIPLINARY OR RESTRICTIVE ACTION.

A board may refuse to grant a license or registration or may impose disciplinary or restrictive action against a regulated person who:

(1) fails to follow accepted and prevailing infection control procedures, including a failure to conform to current recommendations of the Centers for Disease Control for preventing the transmission of HIV, HBV, and HCV, or fails to comply with infection control rules promulgated by the board. Injury to a patient need not be established;

(2) fails to comply with any requirement of sections 214.17 to 214.24; or

(3) fails to comply with any monitoring or reporting requirement.

214.21 TEMPORARY SUSPENSION.

The board may, without hearing, temporarily suspend the right to practice of a regulated person if the board finds that the regulated person has refused to submit to or comply with monitoring under section 214.23. The suspension shall take effect upon written notice to the regulated person specifying the statute or rule violated. The suspension shall remain in effect until the board issues a final order based on a stipulation or after a hearing. At the time the board issues the suspension notice, the board shall schedule a disciplinary hearing to be held under chapter 14. The regulated person shall be provided with at least 20 days' notice of a hearing held under this section. The hearing shall be scheduled to begin no later than 30 days after the issuance of the suspension order.

214.22 NOTICE; ACTION.

If the board has reasonable grounds to believe a regulated person infected with HIV, HBV, or HCV has done or omitted doing any act that would be grounds for disciplinary action under section 214.20, the board may take action after giving notice three business days before the action, or a lesser time if deemed necessary by the board. The board may:

(1) temporarily suspend the regulated person's right to practice under section 214.21;

(2) require the regulated person to appear personally at a conference with representatives of the board and to provide information relating to the regulated person's health or professional practice; and

(3) take any other lesser action deemed necessary by the board for the protection of the public.

214.23 MONITORING.

Subdivision 1.

Commissioner of health.

The board shall enter into a contract with the commissioner to perform the functions in subdivisions 2 and 3. The contract shall provide that:

(1) unless requested to do otherwise by a regulated person, a board shall refer all regulated persons infected with HIV, HBV, or HCV to the commissioner;

(2) the commissioner may choose to refer any regulated person who is infected with HIV, HBV, or HCV as well as all information related thereto to the person's board at any time for any reason, including but not limited to: the degree of cooperation and compliance by the regulated person; the inability to secure information or the medical records of the regulated person; or when the facts may present other possible violations of the regulated persons practices act. Upon request of the regulated person who is infected with HIV, HBV, or HCV the commissioner shall refer the regulated person and all information related thereto to the person's board. Once the commissioner has referred a regulated person to a board, the board may not thereafter submit it to the commissioner to establish a monitoring plan unless the commissioner of health consents in writing;

(3) a board shall not take action on grounds relating solely to the HIV, HBV, or HCV status of a regulated person until after referral by the commissioner; and

(4) notwithstanding sections 13.39 and 13.41 and chapters 147, 147A, 148, 150A, 153, and 214, a board shall forward to the commissioner any information on a regulated person who is infected with HIV, HBV, or HCV that the Department of Health requests.

Subd. 2.

Monitoring plan.

After receiving a report that a regulated person is infected with HIV, HBV, or HCV, the board or the commissioner acting on behalf of the board shall evaluate the past and current professional practice of the regulated person to determine whether there has been a violation under section 214.20. After evaluation of the regulated person's past and current professional practice, the board or the commissioner, acting on behalf of the board, shall establish a monitoring plan for the regulated person. The monitoring plan may:

(1) address the scope of a regulated person's professional practice when the board or the commissioner, acting on behalf of the board, determines that the practice constitutes an identifiable risk of transmission of HIV, HBV, or HCV from the regulated person to the patient;

(2) include the submission of regular reports at a frequency determined by the board or the commissioner, acting on behalf of the board, regarding the regulated person's health status; and

(3) include any other provisions deemed reasonable by the board or the commissioner of health, acting on behalf of the board.

The board or commissioner, acting on behalf of the board, may enter into agreements with qualified persons to perform monitoring on its behalf. The regulated person shall comply with any monitoring plan established under this subdivision.

Subd. 3.

Expert review panel.

The board or the commissioner acting on behalf of the board may appoint an expert review panel to assist in the performance of the responsibilities under this section. In consultations with the expert review panel, the commissioner or board shall, to the extent possible, protect the identity of the regulated person. When an expert review panel is appointed, it must contain at least one member appointed by the commissioner and one professional member appointed by the board. The panel shall provide expert assistance to the board, or to the commissioner acting on behalf of the board, in the subjects of infectious diseases, epidemiology, practice techniques used by regulated persons, and other subjects determined by the board or by the commissioner acting on behalf of the board. Members of the expert review panel are subject to those provisions of chapter 13 that restrict the commissioner or the board under Laws 1992, chapter 559, article 1.

Subd. 4.

Immunity.

Members of the board or the commissioner acting on behalf of the board, and persons who participate on an expert review panel or who assist the board or the commissioner in monitoring the practice of a regulated person, are immune from civil liability or criminal prosecution for any actions, transactions, or publications made in good faith and in execution of, or relating to, their duties under sections 214.17 to 214.24, except that no immunity shall be available for persons who have knowingly violated any provision of chapter 13.

214.24 INSPECTION OF PRACTICE.

Subdivision 1.

Authority.

The board is authorized to conduct inspections of the clinical practice of a regulated person to determine whether the regulated person is following accepted and prevailing infection control procedures. The board shall provide at least three business days' notice to the clinical practice prior to the inspection. The clinical practice of a regulated person includes any location where the regulated person practices that is not an institution licensed and subject to inspection by the commissioner of health. During the course of inspections the privacy and confidentiality of patients and regulated persons shall be maintained. The board may require on license renewal forms that regulated persons inform the board of all locations where they practice.

Subd. 2.

Access; records.

An inspector from the board shall have access, during reasonable business hours for purposes of inspection, to all areas of the practice setting where patient care is rendered or drugs or instruments are held that come into contact with a patient. An inspector is authorized to interview employees and regulated persons in the performance of an inspection, to observe infection control procedures, test equipment used to sterilize instruments, and to review and copy all relevant records, excluding patient health records. In performing these responsibilities, inspectors shall make reasonable efforts to respect and preserve patient privacy and the privacy of the regulated person. Boards are authorized to conduct joint inspections and to share information obtained under this section. The boards shall contract with the commissioner to perform the duties under this subdivision.

Subd. 3.

Board action.

If accepted and prevailing infection control techniques are not being followed, the board may educate the regulated person or take other actions. The board and the inspector shall maintain patient confidentiality in any action resulting from the inspection.

Subd. 4.

Rulemaking.

A board is authorized to adopt rules setting standards for infection control procedures. Boards shall engage in joint rulemaking. Boards must seek and consider the advice of the commissioner of health before adopting rules. No inspections shall be conducted under this section until after infection control rules have been adopted. Each board is authorized to provide educational information and training to regulated persons regarding infection control. All regulated persons who are employers shall make infection control rules available to employees who engage in functions related to infection control.

245E.06 ADMINISTRATIVE SANCTIONS.

Subd. 2.

Written notice of department sanction; sanction effective date; informal meeting.

(a) The department shall give notice in writing to a person of an administrative sanction that is to be imposed. The notice shall be sent by mail as defined in section 245E.01, subdivision 11.

(b) The notice shall state:

(1) the factual basis for the department's determination;

(2) the sanction the department intends to take;

(3) the dollar amount of the monetary recovery or recoupment, if any;

(4) how the dollar amount was computed;

(5) the right to dispute the department's determination and to provide evidence;

(6) the right to appeal the department's proposed sanction; and

(7) the option to meet informally with department staff, and to bring additional documentation or information, to resolve the issues.

(c) In cases of determinations resulting in denial or termination of payments, in addition to the requirements of paragraph (b), the notice must state:

(1) the length of the denial or termination;

(2) the requirements and procedures for reinstatement; and

(3) the provider's right to submit documents and written arguments against the denial or termination of payments for review by the department before the effective date of denial or termination.

(d) The submission of documents and written argument for review by the department under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the deadline for filing an appeal.

(e) Notwithstanding section 245E.03, subdivision 4, the effective date of the proposed sanction shall be 30 days after the license holder's, provider's, controlling individual's, or recipient's receipt of the notice, unless timely appealed. If a timely appeal is made, the proposed sanction shall be delayed pending the final outcome of the appeal. Implementation of a proposed sanction following the resolution of a timely appeal may be postponed if, in the opinion of the department, the delay of sanction is necessary to protect the health or safety of children in care. The department may consider the economic hardship of a person in implementing the proposed sanction, but economic hardship shall not be a determinative factor in implementing the proposed sanction.

(f) Requests for an informal meeting to attempt to resolve issues and requests for appeals must be sent or delivered to the department's Office of Inspector General, Financial Fraud and Abuse Division.

Subd. 4.

Consolidated hearings with licensing sanction.

If a financial misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing sanction exists for which there is an appeal hearing right and the sanction is timely appealed, and the overpayment recovery action and licensing sanction involve the same set of facts, the overpayment recovery action and licensing sanction must be consolidated in the contested case hearing related to the licensing sanction.

Subd. 5.

Effect of department's administrative determination or sanction.

Unless a timely and proper appeal is received by the department, the department's administrative determination or sanction shall be considered a final department determination.

245H.10 BACKGROUND STUDIES.

Subd. 2.

Direct contact.

(a) The subject of the background study may not provide direct contact services to a child served by a certified center unless the subject is under continuous direct supervision pending completion of the background study.

(b) The certified center must document in the staff person's personnel file the date the program initiates a background study and the date the subject of the study first had direct contact with a child served by the center.

246.18 DISPOSAL OF FUNDS.

Subd. 8.

State-operated services account.

(a) The state-operated services account is established in the special revenue fund. Revenue generated by new state-operated services listed under this section established after July 1, 2010, that are not enterprise activities must be deposited into the state-operated services account, unless otherwise specified in law:

(1) intensive residential treatment services;

(2) foster care services; and

(3) psychiatric extensive recovery treatment services.

(b) Funds deposited in the state-operated services account are appropriated to the commissioner of human services for the purposes of:

(1) providing services needed to transition individuals from institutional settings within state-operated services to the community when those services have no other adequate funding source; and

(2) funding the operation of the intensive residential treatment service program in Willmar.

Subd. 9.

Transfers.

The commissioner may transfer state mental health grant funds to the account in subdivision 8 for noncovered allowable costs of a provider certified and licensed under section 256B.0622 and operating under section 246.014.

252.41 DEFINITIONS.

Subd. 8.

Supported employment.

"Supported employment" means employment of a person with a disability so severe that the person needs ongoing training and support to get and keep a job in which:

(1) the person engages in paid work at a work site where individuals without disabilities who do not require public subsidies also may be employed;

(2) public funds are necessary to provide ongoing training and support services throughout the period of the person's employment; and

(3) the person has the opportunity for social interaction with individuals who do not have disabilities and who are not paid caregivers.

252.431 SUPPORTED EMPLOYMENT SERVICES; DEPARTMENTAL DUTIES; COORDINATION.

The commissioners of employment and economic development, human services, and education shall ensure that supported employment services provided as part of a comprehensive service system will:

(1) provide the necessary supports to assist persons with severe disabilities to obtain and maintain employment in normalized work settings available to the general work force that:

(i) maximize community and social integration; and

(ii) provide job opportunities that meet the individual's career potential and interests;

(2) allow persons with severe disabilities to actively participate in the planning and delivery of community-based employment services at the individual, local, and state level; and

(3) be coordinated among the Departments of Human Services, Employment and Economic Development, and Education to:

(i) promote the most efficient and effective funding;

(ii) avoid duplication of services; and

(iii) improve access and transition to employability services.

The commissioners of employment and economic development, human services, and education shall report to the legislature by January 1993 on the steps taken to implement this section.

252.451 BUSINESS AGREEMENTS; SUPPORT AND SUPERVISION OF PERSONS WITH DISABILITIES.

Subdivision 1.

Definition.

For the purposes of this section, "qualified business" means a business that employs primarily nondisabled persons and will employ persons with developmental disabilities. For purposes of this section, licensed providers of residential services for persons with developmental disabilities are not a qualified business. A qualified business and its employees are exempt from Minnesota Rules, parts 9525.1800 to 9525.1930.

Subd. 2.

Vendor participation and reimbursement.

Notwithstanding requirements in chapters 245A and 245D, and sections 252.28, 252.41 to 252.46, and 256B.501, vendors of day training and habilitation services may enter into written agreements with qualified businesses to provide additional training and supervision needed by individuals to maintain their employment.

Subd. 3.

Agreement specifications.

Agreements must include the following:

(1) the type and amount of supervision and support to be provided by the business to the individual in accordance with their needs as identified in their individual service plan;

(2) the methods used to periodically assess the individual's satisfaction with their work, training, and support;

(3) the measures taken by the qualified business and the vendor to ensure the health, safety, and protection of the individual during working hours, including the reporting of abuse and neglect under state law and rules;

(4) the training and support services the vendor will provide to the qualified business, including the frequency of on-site supervision and support; and

(5) any payment to be made to the qualified business by the vendor. Payment to the business must be limited to:

(i) additional costs of training coworkers and managers that exceed ordinary and customary training costs and are a direct result of employing a person with a developmental disability; and

(ii) additional costs for training, supervising, and assisting the person with a developmental disability that exceed normal and customary costs required for performing similar tasks or duties.

Payments made to a qualified business under this section must not include incentive payments to the qualified business or salary supplementation for the person with a developmental disability.

Subd. 4.

Client protection.

Persons receiving training and support under this section may not be denied their rights or procedural protections under section 256.045, subdivision 4a, or 256B.092, including the county agency's responsibility to arrange for appropriate services, as necessary, in the event that persons lose their job or the contract with the qualified business is terminated.

Subd. 5.

Vendor payment.

(a) For purposes of this section, the vendor shall bill and the commissioner shall reimburse the vendor for full-day or partial-day services to a client that would otherwise have been paid to the vendor for providing direct services, provided that both of the following criteria are met:

(1) the vendor provides services and payments to the qualified business that enable the business to perform support and supervision services for the client that the vendor would otherwise need to perform; and

(2) the client for whom a rate will be billed will receive full-day or partial-day services from the vendor and the rate to be paid the vendor will allow the client to work with this support and supervision at the qualified business instead of receiving these services from the vendor.

(b) Medical assistance reimbursement of services provided to persons receiving day training and habilitation services under this section is subject to the limitations on reimbursement for vocational services under federal law and regulation.

254B.03 RESPONSIBILITY TO PROVIDE CHEMICAL DEPENDENCY TREATMENT.

Subd. 4a.

Division of costs for medical assistance services.

Notwithstanding subdivision 4, for chemical dependency services provided on or after October 1, 2008, and reimbursed by medical assistance, the county share is 30 percent of the nonfederal share.

256B.0625 COVERED SERVICES.

Subd. 31c.

Preferred incontinence product program.

The commissioner shall implement a preferred incontinence product program by July 1, 2018. The program shall require the commissioner to volume purchase incontinence products and related supplies in accordance with section 256B.04, subdivision 14. Medical assistance coverage for incontinence products and related supplies shall conform to the limitations established under the program.

Subd. 63.

Payment for multiple services provided on the same day.

The commissioner shall not prohibit payment, including supplemental payments, for mental health services or dental services provided to a patient by a clinic or health care professional solely because the mental health or dental services were provided on the same day as other covered health services furnished by the same provider.

256B.0659 PERSONAL CARE ASSISTANCE PROGRAM.

Subd. 22.

Annual review for personal care providers.

(a) All personal care assistance provider agencies shall resubmit, on an annual basis, the information specified in subdivision 21, in a format determined by the commissioner, and provide a copy of the personal care assistance provider agency's most current version of its grievance policies and procedures along with a written record of grievances and resolutions of the grievances that the personal care assistance provider agency has received in the previous year and any other information requested by the commissioner.

(b) The commissioner shall send annual review notification to personal care assistance provider agencies 30 days prior to renewal. The notification must:

(1) list the materials and information the personal care assistance provider agency is required to submit;

(2) provide instructions on submitting information to the commissioner; and

(3) provide a due date by which the commissioner must receive the requested information.

Personal care assistance provider agencies shall submit required documentation for annual review within 30 days of notification from the commissioner. If no documentation is submitted, the personal care assistance provider agency enrollment number must be terminated or suspended.

(c) Personal care assistance provider agencies also currently licensed under section 144A.471, subdivision 6 or 7, or currently certified for participation in Medicare as a home health agency are deemed in compliance with the personal care assistance requirements for enrollment, annual review process, and documentation.

256B.0705 PERSONAL CARE ASSISTANCE SERVICES; MANDATED SERVICE VERIFICATION.

Subdivision 1.

Definitions.

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

(b) "Personal care assistance services" or "PCA services" means services provided according to section 256B.0659.

(c) "Personal care assistant" or "PCA" has the meaning given in section 256B.0659, subdivision 1.

(d) "Service verification" means a random, unscheduled telephone call made for the purpose of verifying that the individual personal care assistant is present at the location where personal care assistance services are being provided and is providing services as scheduled.

Subd. 2.

Verification schedule.

An agency that submits claims for reimbursement for PCA services under this chapter must develop and implement administrative policies and procedures by which the agency verifies the services provided by a PCA. For each service recipient, the agency must conduct at least one service verification every 90 days. If more than one PCA provides services to a single service recipient, the agency must conduct a service verification for each PCA providing services before conducting a service verification for a PCA whose services were previously verified by the agency. Service verification must occur on an ongoing basis while the agency provides PCA services to the recipient. During service verification, the agency must speak with both the PCA and the service recipient or recipient's authorized representative. Only qualified professional service verifications are eligible for reimbursement. An agency may substitute a visit by a qualified professional that is eligible for reimbursement under section 256B.0659, subdivision 14 or 19.

Subd. 3.

Documentation of verification.

An agency must fully document service verifications in a legible manner and must maintain the documentation on site for at least five years from the date of documentation. For each service verification, documentation must include:

(1) the names and signatures of the service recipient or recipient's authorized representative, the PCA and any other agency staff present with the PCA during the service verification, and the staff person conducting the service verification; and

(2) the start and end time, day, month, and year of the service verification, and the corresponding PCA time sheet.

Subd. 4.

Variance.

The Office of Inspector General at the Department of Human Services may grant a variance to the service verification requirements in this section if an agency uses an electronic monitoring system or other methods that verify a PCA is present at the location where services are provided and is providing services according to the prescribed schedule. A decision to grant or deny a variance request is final and not subject to appeal under chapter 14.

256B.431 RATE DETERMINATION.

Subd. 3i.

Property costs for the rate year beginning July 1, 1990.

Notwithstanding Minnesota Rules, part 9549.0060, subpart 13, item H, the commissioner shall determine property-related payment rates for nursing facilities for the rate year beginning July 1, 1990, as follows:

(a) The property-related payment rate for a nursing facility that qualifies under subdivision 3g is the greater of the rate determined under that subdivision or the rate determined under paragraph (c), (d), or (e), whichever is applicable.

(b) Nursing facilities shall be grouped according to the type of property-related payment rate the commissioner determined for the rate year beginning July 1, 1989. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item A (full rental reimbursement), shall be considered group A. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item B (phase-down to full rental reimbursement), shall be considered group B. A nursing facility whose property-related payment rate was determined under Minnesota Rules, part 9549.0060, subpart 13, item C or D (phase-up to full rental reimbursement), shall be considered group C.

(c) For the rate year beginning July 1, 1990, a group A nursing facility shall receive its property-related payment rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.

(d) For the rate year beginning July 1, 1990, a Group B nursing facility shall receive the greater of 87 percent of the property-related payment rate in effect on July 1, 1989; or the rental per diem rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section in effect on July 1, 1990; or the sum of 100 percent of the nursing facility's allowable principal and interest expense, plus its equipment allowance multiplied by the resident days for the reporting year ending September 30, 1989, divided by the nursing facility's capacity days as determined under Minnesota Rules, part 9549.0060, subpart 11, as modified by subdivision 3f, paragraph (c); except that the nursing facility's property-related payment rate must not exceed its property-related payment rate in effect on July 1, 1989.

(e) For the rate year beginning July 1, 1990, a group C nursing facility shall receive its property-related payment rate determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section, except the rate must not exceed the lesser of its property-related payment rate determined for the rate year beginning July 1, 1989, multiplied by 116 percent or its rental per diem rate determined effective July 1, 1990.

(f) The property-related payment rate for a nursing facility that qualifies for a rate adjustment under Minnesota Rules, part 9549.0060, subpart 13, item G (special reappraisals), shall have the property-related payment rate determined in paragraphs (a) to (e) adjusted according to the provisions in that rule.

(g) Except as provided in subdivision 4, paragraph (f), and subdivision 11, a nursing facility that has a change in ownership or a reorganization of provider entity is subject to the provisions of Minnesota Rules, part 9549.0060, subpart 13, item F.

Subd. 15.

Capital repair and replacement cost reporting and rate calculation.

For rate years beginning after June 30, 1993, a nursing facility's capital repair and replacement payment rate shall be established annually as provided in paragraphs (a) to (e).

(a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 12, the costs of any of the following items not included in the equity incentive computations under subdivision 16 or reported as a capital asset addition under subdivision 18, paragraph (b), including cash payment for equity investment and principal and interest expense for debt financing, must be reported in the capital repair and replacement cost category:

(1) wall coverings;

(2) paint;

(3) floor coverings;

(4) window coverings;

(5) roof repair; and

(6) window repair or replacement.

(b) Notwithstanding Minnesota Rules, part 9549.0060, subpart 12, the repair or replacement of a capital asset not included in the equity incentive computations under subdivision 16 or reported as a capital asset addition under subdivision 18, paragraph (b), must be reported under this subdivision when the cost of the item exceeds $500, or in the plant operations and maintenance cost category when the cost of the item is equal to or less than $500.

(c) To compute the capital repair and replacement payment rate, the allowable annual repair and replacement costs for the reporting year must be divided by actual resident days for the reporting year. The annual allowable capital repair and replacement costs shall not exceed $150 per licensed bed. The excess of the allowed capital repair and replacement costs over the capital repair and replacement limit shall be a cost carryover to succeeding cost reporting periods, except that sale of a facility, under subdivision 14, shall terminate the carryover of all costs except those incurred in the most recent cost reporting year. The termination of the carryover shall have effect on the capital repair and replacement rate on the same date as provided in subdivision 14, paragraph (f), for the sale. For rate years beginning after June 30, 1994, the capital repair and replacement limit shall be subject to the index provided in subdivision 3f, paragraph (a). For purposes of this subdivision, the number of licensed beds shall be the number used to calculate the nursing facility's capacity days. The capital repair and replacement rate must be added to the nursing facility's total payment rate.

(d) Capital repair and replacement costs under this subdivision shall not be counted as either care-related or other operating costs, nor subject to care-related or other operating limits.

(e) If costs otherwise allowable under this subdivision are incurred as the result of a project approved under the moratorium exception process in section 144A.073, or in connection with an addition to or replacement of buildings, attached fixtures, or land improvements for which the total historical cost of these assets exceeds the lesser of $150,000 or ten percent of the nursing facility's appraised value, these costs must be claimed under subdivision 16 or 17, as appropriate.

Subd. 16.

Major additions and replacements; equity incentive.

For rate years beginning after June 30, 1993, if a nursing facility acquires capital assets in connection with a project approved under the moratorium exception process in section 144A.073 or in connection with an addition to or replacement of buildings, attached fixtures, or land improvements for which the total historical cost of those capital asset additions exceeds the lesser of $150,000 or ten percent of the most recent appraised value, the nursing facility shall be eligible for an equity incentive payment rate as in paragraphs (a) to (d). This computation is separate from the determination of the nursing facility's rental rate. An equity incentive payment rate as computed under this subdivision is limited to one in a 12-month period.

(a) An eligible nursing facility shall receive an equity incentive payment rate equal to the allowable historical cost of the capital asset acquired, minus the allowable debt directly identified to that capital asset, multiplied by the equity incentive factor as described in paragraphs (b) and (c), and divided by the nursing facility's occupancy factor under subdivision 3f, paragraph (c). This amount shall be added to the nursing facility's total payment rate and shall be effective the same day as the incremental increase in paragraph (d) or subdivision 17. The allowable historical cost of the capital assets and the allowable debt shall be determined as provided in Minnesota Rules, parts 9549.0010 to 9549.0080, and this section.

(b) The equity incentive factor shall be determined under clauses (1) to (4):

(1) divide the initial allowable debt in paragraph (a) by the initial historical cost of the capital asset additions referred to in paragraph (a), then cube the quotient,

(2) subtract the amount calculated in clause (1) from the number one,

(3) determine the difference between the rental factor and the lesser of two percentage points above the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan Mortgage Corporation as published in the Wall Street Journal and in effect on the first day of the month the debt or cost is incurred, or 16 percent,

(4) multiply the amount calculated in clause (2) by the amount calculated in clause (3).

(c) The equity incentive payment rate shall be limited to the term of the allowable debt in paragraph (a), not greater than 20 years nor less than ten years. If no debt is incurred in acquiring the capital asset, the equity incentive payment rate shall be paid for ten years. The sale of a nursing facility under subdivision 14 shall terminate application of the equity incentive payment rate effective on the date provided in subdivision 14, paragraph (f), for the sale.

(d) A nursing facility with an addition to or a renovation of its buildings, attached fixtures, or land improvements meeting the criteria in this subdivision and not receiving the property-related payment rate adjustment in subdivision 17, shall receive the incremental increase in the nursing facility's rental rate as determined under Minnesota Rules, parts 9549.0010 to 9549.0080, and this section. The incremental increase shall be added to the nursing facility's property-related payment rate. The effective date of this incremental increase shall be the first day of the month of January or July, whichever occurs first following the date on which the addition or replacement is completed.

256B.434 ALTERNATIVE PAYMENT DEMONSTRATION PROJECT.

Subd. 6.

Contract payment rates; appeals.

If an appeal is pending concerning the cost-based payment rates that are the basis for the calculation of the payment rate under the alternative payment demonstration project, the commissioner and the nursing facility may agree on an interim contract rate to be used until the appeal is resolved. When the appeal is resolved, the contract rate must be adjusted retroactively in accordance with the appeal decision.

Subd. 10.

Exemptions.

A facility that is under contract with the commissioner under this section is not subject to the moratorium on licensure or certification of new nursing home beds in section 144A.071, unless the project results in a net increase in bed capacity or involves relocation of beds from one site to another. Contract payment rates must not be adjusted to reflect any additional costs that a nursing facility incurs as a result of a construction project undertaken under this subdivision. In addition, as a condition of entering into a contract under this section, a nursing facility must agree that any future medical assistance payments for nursing facility services will not reflect any additional costs attributable to the sale of a nursing facility under this section and to construction undertaken under this subdivision that otherwise would not be authorized under the moratorium in section 144A.073. Nothing in this section prevents a nursing facility participating in the alternative payment demonstration project under this section from seeking approval of an exception to the moratorium through the process established in section 144A.073, and if approved the facility's rates shall be adjusted to reflect the cost of the project. Nothing in this section prevents a nursing facility participating in the alternative payment demonstration project from seeking legislative approval of an exception to the moratorium under section 144A.071, and, if enacted, the facility's rates shall be adjusted to reflect the cost of the project.

256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.

Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision, "implementation period" means the period beginning January 1, 2014, and ending on the last day of the month in which the rate management system is populated with the data necessary to calculate rates for substantially all individuals receiving home and community-based waiver services under sections 256B.092 and 256B.49. "Banding period" means the time period beginning on January 1, 2014, and ending upon the expiration of the 12-month period defined in paragraph (c), clause (5).

(b) For purposes of this subdivision, the historical rate for all service recipients means the individual reimbursement rate for a recipient in effect on December 1, 2013, except that:

(1) for a day service recipient who was not authorized to receive these waiver services prior to January 1, 2014; added a new service or services on or after January 1, 2014; or changed providers on or after January 1, 2014, the historical rate must be the weighted average authorized rate for the provider number in the county of service, effective December 1, 2013; or

(2) for a unit-based service with programming or a unit-based service without programming recipient who was not authorized to receive these waiver services prior to January 1, 2014; added a new service or services on or after January 1, 2014; or changed providers on or after January 1, 2014, the historical rate must be the weighted average authorized rate for each provider number in the county of service, effective December 1, 2013; or

(3) for residential service recipients who change providers on or after January 1, 2014, the historical rate must be set by each lead agency within their county aggregate budget using their respective methodology for residential services effective December 1, 2013, for determining the provider rate for a similarly situated recipient being served by that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under this section so that the unit rate is no higher or lower than:

(1) 0.5 percent from the historical rate for the implementation period;

(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately following the time period of clause (1);

(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately following the time period of clause (2);

(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately following the time period of clause (3);

(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately following the time period of clause (4);

(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately following the time period of clause (5). During this banding rate period, the commissioner shall not enforce any rate decrease or increase that would otherwise result from the end of the banding period. The commissioner shall, upon enactment, seek federal approval for the addition of this banding period; and

(7) one percent from the rate in effect in clause (6) for the 12-month period immediately following the time period of clause (6).

(d) The commissioner shall review all changes to rates that were in effect on December 1, 2013, to verify that the rates in effect produce the equivalent level of spending and service unit utilization on an annual basis as those in effect on October 31, 2013.

(e) By December 31, 2014, the commissioner shall complete the review in paragraph (d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.

(f) During the banding period, the Medicaid Management Information System (MMIS) service agreement rate must be adjusted to account for change in an individual's need. The commissioner shall adjust the Medicaid Management Information System (MMIS) service agreement rate by:

(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the individual with variables reflecting the level of service in effect on December 1, 2013;

(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the individual with variables reflecting the updated level of service at the time of application; and

(3) adding to or subtracting from the Medicaid Management Information System (MMIS) service agreement rate, the difference between the values in clauses (1) and (2).

(g) This subdivision must not apply to rates for recipients served by providers new to a given county after January 1, 2014. Providers of personal supports services who also acted as fiscal support entities must be treated as new providers as of January 1, 2014.

Subd. 5.

Stakeholder consultation and county training.

(a) The commissioner shall continue consultation on regular intervals with the existing stakeholder group established as part of the rate-setting methodology process and others, to gather input, concerns, and data, to assist in the full implementation of the new rate payment system and to make pertinent information available to the public through the department's website.

(b) The commissioner shall offer training at least annually for county personnel responsible for administering the rate-setting framework in a manner consistent with this section and section 256B.4914.

(c) The commissioner shall maintain an online instruction manual explaining the rate-setting framework. The manual shall be consistent with this section and section 256B.4914, and shall be accessible to all stakeholders including recipients, representatives of recipients, county or tribal agencies, and license holders.

(d) The commissioner shall not defer to the county or tribal agency on matters of technical application of the rate-setting framework, and a county or tribal agency shall not set rates in a manner that conflicts with this section or section 256B.4914.

Subd. 6.

Implementation.

(a) The commissioner shall implement changes on January 1, 2014, to payment rates for individuals receiving home and community-based waivered services after the enactment of legislation that establishes specific payment methodology frameworks, processes for rate calculations, and specific values to populate the disability waiver rates system.

(b) On January 1, 2014, all new service authorizations must use the disability waiver rates system. Beginning January 1, 2014, all renewing individual service plans must use the disability waiver rates system as reassessment and reauthorization occurs. By December 31, 2014, data for all recipients must be entered into the disability waiver rates system.

Subd. 7.

New services.

A service added to section 256B.4914 after January 1, 2014, is not subject to rate stabilization adjustment in this section.

256B.79 INTEGRATED CARE FOR HIGH-RISK PREGNANT WOMEN.

Subd. 7.

Expiration.

This section expires June 30, 2019.

256I.05 MONTHLY RATES.

Subd. 3.

Limits on rates.

When a room and board rate is used to pay for an individual's room and board, the rate payable to the residence must not exceed the rate paid by an individual not receiving a room and board rate under this chapter.

256L.11 PROVIDER PAYMENT.

Subd. 2a.

Payment rates; services for families and children under the MinnesotaCare health care reform waiver.

Subdivision 2 shall not apply to services provided to families with children who are eligible according to section 256L.04, subdivision 1, paragraph (a).

256R.53 FACILITY SPECIFIC EXEMPTIONS.

Subd. 2.

Nursing facility in Breckenridge.

The operating payment rate of a nonprofit nursing facility that exists on January 1, 2015, is located within the boundaries of the city of Breckenridge, and is reimbursed under this chapter, is equal to the greater of:

(1) the operating payment rate determined under section 256R.21, subdivision 3; or

(2) the median case mix adjusted rates, including comparable rate components as determined by the median case mix adjusted rates, including comparable rate components as determined by the commissioner, for the equivalent case mix indices of the nonprofit nursing facility or facilities located in an adjacent city in another state and in cities contiguous to the adjacent city. The Minnesota facility's operating payment rate with a case mix index of 1.0 is computed by dividing the adjacent city's nursing facility or facilities' median operating payment rate with an index of 1.02 by 1.02.

Repealed Minnesota Rule: 19-5223

2960.3030 CAPACITY LIMITS.

Subp. 3.

Exceptions to capacity limits.

A variance may be granted to allow up to eight foster children in addition to the license holder's own children if the conditions in items A to E are met:

A.

placement is necessary to keep a sibling group together, to keep a child in the child's home community, or is necessary because the foster child was formerly living in the home and it would be in the child's best interest to be placed there again;

B.

there is no risk of harm to the children currently in the home;

C.

the structural characteristics of the home, including sleeping space, can accommodate the additional foster children;

D.

the home remains in compliance with applicable zoning, health, fire, and building codes; and

E.

the statement of intended use states the conditions for the exception to capacity limits and explains how the license holder will maintain a ratio of adults to children which ensures the safety and appropriate supervision of all the children in the foster home.

A foster home licensed by the Department of Corrections need not meet the requirement in item A.

3400.0185 TERMINATION AND ADVERSE ACTIONS; NOTICE REQUIRED.

Subp. 5.

Notice to providers of actions adverse to the provider.

The county must give a provider written notice of the following actions adverse to the provider: a denial of authorization, a termination of authorization, a reduction in the number of hours of care with that provider, and a determination that the provider has an overpayment. The notice must include the following information:

A.

a description of the adverse action;

B.

the effective date of the adverse action; and

C.

a statement that unless a family appeals the adverse action before the effective date or the provider appeals the overpayment determination, the adverse action will occur on the effective date. The notice must be mailed to the provider at least 15 calendar days before the effective date of the adverse action.

6400.6970 FEES.

Subpart 1.

Payment types and nonrefundability.

The fees imposed in this part shall be paid by cash, personal check, bank draft, cashier's check, or money order made payable to the Board of Examiners for Nursing Home Administrators. All fees are nonrefundable.

Subp. 2.

Amounts.

The amount of fees may be set by the board with the approval of the Department of Management and Budget up to the limits provided in this part depending upon the total amount required to sustain board operations under Minnesota Statutes, section 16A.1285, subdivision 2. Information about fees in effect at any time is available from the board office. The maximum amounts of fees are:

A.

application for licensure, $150;

B.

for a prospective applicant for a review of education and experience advisory to the license application, $50, to be applied to the fee for application for licensure if the latter is submitted within one year of the request for review of education and experience;

C.

state examination, $75;

D.

initial license, $200 if issued between July 1 and December 31, $100 if issued between January 1 and June 30;

E.

acting administrator permit, $250;

F.

renewal license, $200;

G.

duplicate license, $10;

H.

fee to a sponsor for review of individual continuing education seminars, institutes, workshops, or home study courses:

(1)

for less than seven clock hours, $30; and

(2)

for seven or more clock hours, $50;

I.

fee to a licensee for review of continuing education seminars, institutes, workshops, or home study courses not previously approved for a sponsor and submitted with an application for license renewal:

(1)

for less than seven clock hours total, $30; and

(2)

for seven or more clock hours total, $50;

J.

late renewal fee, $50;

K.

fee to a licensee for verification of licensure status and examination scores, $30; and

L.

registration as a registered continuing education sponsor, $1,000.

7200.6100 FEES.

The nonrefundable fees for licensure payable to the board are as follows:

A.

application for admission to national standardized examination, $150;

B.

application for professional responsibility examination, $150;

C.

application for licensure as a licensed psychologist, $500;

D.

renewal of license for a licensed psychologist, $500;

E.

late renewal of license for a licensed psychologist, $250;

F.

application for converting from master's to doctoral level licensure, $150; and

G.

application for guest licensure, $150.

7200.6105 CONTINUING EDUCATION SPONSOR FEE.

A sponsor applying for approval of a continuing education activity pursuant to part 7200.3830, subpart 2, shall submit with the application a fee of $80 for each activity.

9502.0425 PHYSICAL ENVIRONMENT.

Subp. 4.

Means of escape.

From each room of the residence used by children, there must be two means of escape. One means of escape must be a stairway or door leading to the floor of exit discharge. The other must be a door or window leading directly outside. The window must be openable without special knowledge. It must have a clear opening of not less than 5.7 square feet and have a minimum clear opening dimension of 20 inches wide and 24 inches high. The window must be within 48 inches from the floor.

Subp. 16.

Extinguishers.

A portable, operational, multipurpose, dry chemical fire extinguisher with a minimum 2 A 10 BC rating must be maintained in the kitchen and cooking areas of the residence at all times. All caregivers shall know how to use the fire extinguisher.

Subp. 17.

Smoke detection systems.

Smoke detectors that have been listed by the Underwriter Laboratory must be properly installed and maintained on all levels.

9503.0155 FACILITY.

Subp. 8.

Telephone; posted numbers.

A telephone that is not coin operated must be located within the center. A list of emergency numbers must be posted next to the telephone. If a 911 emergency number is not available, the numbers listed must be those of the local fire department, police department, emergency transportation, and poison control center.

9549.0057 DETERMINATION OF INTERIM AND SETTLE UP OPERATING COST PAYMENT RATES.

Subpart 1.

Conditions.

To receive an interim payment rate, a nursing facility must comply with the requirements and is subject to the conditions in part 9549.0060, subpart 14, items A to C. The commissioner shall determine interim and settle up operating cost payment rates for a newly constructed nursing facility, or one with an increase in licensed capacity of 50 percent or more according to subparts 2 and 3.

Subp. 2.

Interim operating cost payment rate.

For the rate year or portion of an interim period beginning on or after July 1, 1986, the interim total operating cost payment rate must be determined according to parts 9549.0050 to 9549.0059 (Temporary) in effect on March 1, 1987. For the rate year or portion of an interim period beginning on or after July 1, 1987, the interim total operating cost payment rate must be determined according to parts 9549.0051 to 9549.0059, except that:

A.

The nursing facility must project its anticipated resident days for each resident class. The anticipated resident days for each resident class must be multiplied by the weight for that resident class as listed in part 9549.0058 to determine the anticipated standardized resident days for the reporting period.

B.

The commissioner shall use anticipated standardized resident days in determining the allowable historical case mix operating cost standardized per diem.

C.

The commissioner shall use the anticipated resident days in determining both the allowable historical other care related operating cost per diem and the allowable historical other operating cost per diem.

D.

The annual adjustment factors determined in part 9549.0055, subpart 1, must not be applied to the nursing facility's allowable historical per diems as provided in part 9549.0056, subparts 2 and 4.

E.

The limits established in part 9549.0055, subpart 2, items C and E, as indexed in part 9549.0055, subpart 3 and in effect at the beginning of the interim period, must be increased by ten percent.

F.

The efficiency incentive in part 9549.0056, subpart 4, item A or B, must not apply.

G.

The phase in provisions in part 9549.0056, subpart 7, must not apply.

Subp. 3.

Settle up operating cost payment rate.

The settle up total operating cost payment rate must be determined according to items A to C.

A.

The settle up operating cost payment rate for interim periods before July 1, 1987, is subject to the rule parts that were in effect during the interim period.

B.

To determine the settle up operating cost payment rate for interim periods or the portion of an interim period occurring after July 1, 1987, subitems (1) to (7) must be applied.

(1)

The standardized resident days as determined in part 9549.0054, subpart 2, must be used for the interim period.

(2)

The commissioner shall use the standardized resident days in subitem (1) in determining the allowable historical case mix operating cost standardized per diem.

(3)

The commissioner shall use the actual resident days in determining both the allowable historical other care related operating cost per diem and the allowable historical other operating cost per diem.

(4)

The annual adjustment factors determined in part 9549.0055, subpart 1, must not be applied to the nursing facility's allowable historical per diems as provided in part 9549.0056, subparts 2 and 4.

(5)

The limits established in part 9549.0055, subpart 2, item E, must be the limits for the settle up reporting periods occurring after July 1, 1987. If the interim period includes more than one July 1 date, the commissioner shall use the limit established in part 9549.0055, subpart 2, items C and E, as indexed in part 9549.0055, subpart 3, increased by ten percent for the second July 1 date.

(6)

The efficiency incentive in part 9549.0056, subpart 4, item A or B, must not apply.

(7)

The phase in provisions in part 9549.0056, subpart 7 must not apply.

C.

For the nine month period following the settle up reporting period, the total operating cost payment rate must be determined according to item B except that the efficiency incentive as computed in part 9549.0056, subpart 4, item A or B, applies.

D.

The total operating cost payment rate for the rate year beginning July 1 following the nine month period in item C must be determined under parts 9549.0050 to 9549.0059.

E.

A newly constructed nursing facility or one with an increase in licensed capacity of 50 percent or more must continue to receive the interim total operating cost payment rate until the settle up total operating cost payment rate is determined under this subpart.

9549.0060 DETERMINATION OF THE PROPERTY-RELATED PAYMENT RATE.

Subp. 14.

Determination of interim and settle-up payment rates.

The commissioner shall determine interim and settle-up payment rates according to items A to J.

A.

A newly constructed nursing facility, or one with a capacity increase of 50 percent or more, may submit a written application to the commissioner to receive an interim payment rate. The nursing facility shall submit cost reports and other supporting information as required in parts 9549.0010 to 9549.0080 for the reporting year in which the nursing facility plans to begin operation at least 60 days before the first day a resident is admitted to the newly constructed nursing facility bed. The nursing facility shall state the reasons for noncompliance with parts 9549.0010 to 9549.0080. The effective date of the interim payment rate is the earlier of either the first day a resident is admitted to the newly constructed nursing facility or the date the nursing facility bed is certified for medical assistance. The interim payment rate for a newly constructed nursing facility, or a nursing facility with a capacity increase of 50 percent or more, is determined under items B to D.

B.

The interim payment rate must not be in effect more than 17 months. When the interim payment rate begins between May 1 and September 30, the nursing facility shall file settle-up cost reports for the period from the beginning of the interim payment rate through September 30 of the following year. When the interim payment rate begins between October 1 and April 30, the nursing facility shall file settle-up cost reports for the period from the beginning of the interim payment rate to the first September 30 following the beginning of the interim payment rate.

C.

The interim payment rate for a nursing facility which commenced construction prior to July 1, 1985, is determined by 12 MCAR S 2.05014 [Temporary] except that capital assets must be classified under parts 9549.0010 to 9549.0080.

D.

The interim property-related payment rate for a nursing facility which commences construction after June 30, 1985, is determined as follows:

(1)

At least 60 days before the first day a resident is admitted to the newly constructed nursing facility bed and upon receipt of written application from the nursing facility, the commissioner shall establish the nursing facility's appraised value according to subparts 1 and 4.

(2)

The nursing facility shall project the allowable debt and the allowable interest expense according to subparts 5 and 7.

(3)

The interim building capital allowance must be determined under subpart 8 or 9.

(4)

The equipment allowance during the interim period must be the equipment allowance computed in accordance with subpart 10 which is in effect on the effective date of the interim property-related payment rate.

(5)

The interim property-related payment rate must be the sum of subitems (3) and (4).

(6)

Anticipated resident days may be used instead of 96 percent capacity days.

E.

The settle-up property-related payment rate and the property-related payment rate for the nine months following the settle up for a nursing facility which commenced construction before July 1, 1985, is determined under 12 MCAR S 2.05014 [Temporary]. The property-related payment rate for the rate year beginning July 1 following the nine month period is determined under part 9549.0060.

F.

The settle-up property-related payment rate for a nursing facility which commenced construction after June 30, 1985, shall be established as follows:

(1)

The appraised value determined in item D, subitem (1), must be updated in accordance with subpart 2, item B prorated for each rate year, or portion of a rate year, included in the interim payment rate period.

(2)

The nursing facility's allowable debt, allowable interest rate, and allowable interest expense for the interim rate period shall be computed in accordance with subparts 5, 6, and 7.

(3)

The settle-up building capital allowance shall be determined in accordance with subpart 8 or 9.

(4)

The equipment allowance shall be updated in accordance with subpart 10 prorated for each rate year, or portion of a rate year, included in the interim payment rate period.

(5)

The settle-up property-related payment rate must be the sum of subitems (3) and (4).

(6)

Resident days may be used instead of 96 percent capacity days.

G.

The property-related payment rate for the nine months following the settle up for a nursing facility which commenced construction after June 30, 1985, shall be established in accordance with item F except that 96 percent capacity days must be used.

H.

The property-related payment rate for the rate year beginning July 1 following the nine month period in item G must be determined under this part.

I.

A newly constructed nursing facility or one with a capacity increase of 50 percent or more must continue to receive the interim property-related payment rate until the settle-up property-related payment rate is determined under this subpart.

J.

The interim real estate taxes and special assessments payment rate shall be established using the projected real estate taxes and special assessments cost divided by anticipated resident days. The settle-up real estate taxes and special assessments payment rate shall be established using the real estate taxes and special assessments divided by resident days. The real estate and special assessments payment rate for the nine months following the settle up shall be equal to the settle-up real estate taxes and special assessments payment rate.