1.1 	A bill for an act
1.2 	relating to health and human services; adding advanced practice registered nurses 
1.3 	and physician assistants to certain statutes;amending Minnesota Statutes 2016, 
1.4 	sections 62Q.56, subdivision 1a; 144.213, subdivision 1; 144.441, subdivision 3; 
1.5 	145.7131; 145.867, subdivision 2; 252A.21, subdivision 2; 256.9365, subdivision 
1.6 	2; 256B.056, subdivision 2; 256B.057, subdivision 9; 256B.0575, subdivision 1; 
1.7 	256B.0625, subdivision 2; 256B.0653, subdivision 4; 256B.15, subdivision 1a; 
1.8 	256D.44, subdivisions 4, 5; 256R.04, subdivision 6; 514.981, subdivision 2; 
1.9 	626.556, subdivision 11d.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	Section 1. Minnesota Statutes 2016, section 62Q.56, subdivision 1a, is amended to read:
1.12 		Subd. 1a.Change in health care provider; termination not for cause. (a) If the contract 
1.13 	termination was not for cause and the contract was terminated by the health plan company, 
1.14 	the health plan company must provide the terminated provider and all enrollees being treated 
1.15 	by that provider with notification of the enrollees' rights to continuity of care with the 
1.16 	terminated provider.
1.17 	(b) The health plan company must provide, upon request, authorization to receive services 
1.18 	that are otherwise covered under the terms of the health plan through the enrollee's current 
1.19 	provider:
1.20 	(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one 
1.21 	or more of the following conditions:
1.22 	(i) an acute condition;
1.23 	(ii) a life-threatening mental or physical illness;
1.24 	(iii) pregnancy beyond the first trimester of pregnancy;
2.1 	(iv) a physical or mental disability defined as an inability to engage in one or more major 
2.2 	life activities, provided that the disability has lasted or can be expected to last for at least 
2.3 	one year, or can be expected to result in death; or
2.4 	(v) a disabling or chronic condition that is in an acute phase; or
2.5 	(2) for the rest of the enrollee's life if a physician, advanced practice registered nurse, 
2.6 	or physician assistant certifies that the enrollee has an expected lifetime of 180 days or less.
2.7 	For all requests for authorization to receive services under this paragraph, the health plan 
2.8 	company must grant the request unless the enrollee does not meet the criteria provided in 
2.9 	this paragraph.
2.10 	(c) The health plan company shall prepare a written plan that provides a process for 
2.11 	coverage determinations regarding continuity of care of up to 120 days for enrollees who 
2.12 	request continuity of care with their former provider, if the enrollee:
2.13 	(1) is receiving culturally appropriate services and the health plan company does not 
2.14 	have a provider in its preferred provider network with special expertise in the delivery of 
2.15 	those culturally appropriate services within the time and distance requirements of section 
2.16 	62D.124, subdivision 1; or
2.17 	(2) does not speak English and the health plan company does not have a provider in its 
2.18 	preferred provider network who can communicate with the enrollee, either directly or through 
2.19 	an interpreter, within the time and distance requirements of section 62D.124, subdivision 
2.20 	1.
2.21 	The written plan must explain the criteria that will be used to determine whether a need for 
2.22 	continuity of care exists and how it will be provided.

2.23 	Sec. 2. Minnesota Statutes 2016, section 144.213, subdivision 1, is amended to read:
2.24 		Subdivision 1.Creation; state registrar; Office of Vital Records. The commissioner 
2.25 	shall establish an Office of Vital Records under the supervision of the state registrar. The 
2.26 	commissioner shall promulgate rules for the collection, filing, and registering of vital records 
2.27 	information by the state registrar, physicians, advanced practice registered nurses, physician 
2.28 	assistants, morticians, and others. Except as otherwise provided in sections 144.211 to 
2.29 	144.227, rules previously promulgated by the commissioner relating to the collection, filing 
2.30 	and registering of vital records shall remain in effect until repealed, modified or superseded 
2.31 	by a rule promulgated by the commissioner.

3.1 	Sec. 3. Minnesota Statutes 2016, section 144.441, subdivision 3, is amended to read:
3.2 		Subd. 3.Screening of students. As determined by the commissioner under subdivision 
3.3 	2, no person may enroll or remain enrolled in any school which the commissioner has 
3.4 	designated under subdivision 2 until the person has submitted to the administrator or other 
3.5 	person having general control and supervision of the school, one of the following statements:
3.6 	(1) a statement from a physician, advanced practice registered nurse, physician assistant,
3.7 	or public clinic stating that the person has had a negative Mantoux test reaction within the 
3.8 	past year, provided that the person has no symptoms suggestive of tuberculosis or evidence 
3.9 	of a new exposure to active tuberculosis;
3.10 	(2) a statement from a physician, advanced practice registered nurse, physician assistant,
3.11 	or public clinic stating that a person who has a positive Mantoux test reaction has had a 
3.12 	negative chest roentgenogram (X-ray) for tuberculosis within the past year, provided that 
3.13 	the person has no symptoms suggestive of tuberculosis or evidence of a new exposure to 
3.14 	active tuberculosis;
3.15 	(3) a statement from a physician, advanced practice registered nurse, physician assistant,
3.16 	or public health clinic stating that the person (i) has a history of adequately treated active 
3.17 	tuberculosis; (ii) is currently receiving tuberculosis preventive therapy; (iii) is currently 
3.18 	undergoing therapy for active tuberculosis and the person's presence in a school building 
3.19 	will not endanger the health of other people; or (iv) has completed a course of tuberculosis 
3.20 	preventive therapy or was intolerant to preventive therapy, provided the person has no 
3.21 	symptoms suggestive of tuberculosis or evidence of a new exposure to active tuberculosis; 
3.22 	or
3.23 	(4) a notarized statement signed by the minor child's parent or guardian or by the 
3.24 	emancipated person stating that the person has not submitted the proof of tuberculosis 
3.25 	screening as required by this subdivision because of the conscientiously held beliefs of the 
3.26 	parent or guardian of the minor child or of the emancipated person. This statement must be 
3.27 	forwarded to the commissioner.

3.28 	Sec. 4. Minnesota Statutes 2016, section 145.7131, is amended to read:
3.29 	145.7131 EXCEPTION TO EYEGLASS PRESCRIPTION EXPIRATION.
3.30 	Notwithstanding any practice to the contrary, in an emergency situation or in the case 
3.31 	of lost glasses, an optometrist or, physician, advanced practice registered nurse, or physician 
3.32 	assistant may authorize a new pair of prescription eyeglasses using the prescription from 
3.33 	the old lenses or the last prescription available.

4.1 	Sec. 5. Minnesota Statutes 2016, section 145.867, subdivision 2, is amended to read:
4.2 		Subd. 2.Identification card for individuals needing a special diet. The commissioner 
4.3 	of health shall make special diet identification cards available to physicians, advanced 
4.4 	practice registered nurses, physician assistants, and to persons with diabetes and other 
4.5 	conditions requiring special diets. The identification card must contain spaces for: (1) the 
4.6 	person's name, address, and signature; (2) the physician's, advanced practice registered 
4.7 	nurse's, or physician assistant's name, phone number, and signature; (3) a description of the 
4.8 	person's medical condition; and (4) an expiration date. The card must also contain the 
4.9 	following provision, in identical or substantially similar language: "The owner of this card 
4.10 	is exempted by the commissioner of health from prohibitions on bringing outside food and 
4.11 	drink into a public facility." Persons with medical conditions requiring a special diet may 
4.12 	ask their physician, advanced practice registered nurse, or physician assistant to fill out and 
4.13 	sign the card. The physician, advanced practice registered nurse, or physician assistant shall 
4.14 	fill out and sign the card if, in the physician's, advanced practice registered nurse's, or 
4.15 	physician assistant's medical judgment, the person has a medical condition that requires a 
4.16 	special diet. Persons with diabetes shall be automatically assumed by physicians, advanced 
4.17 	practice registered nurses, and physician assistants to require special diets. Special diet 
4.18 	identification cards shall be valid for five years. Persons with a medical condition requiring 
4.19 	a special diet may request a new card from their physician, advanced practice registered 
4.20 	nurse, or physician assistant up to six months before the expiration date.

4.21 	Sec. 6. Minnesota Statutes 2016, section 252A.21, subdivision 2, is amended to read:
4.22 		Subd. 2.Rules. The commissioner shall adopt rules to implement this chapter. The rules 
4.23 	must include standards for performance of guardianship or conservatorship duties including, 
4.24 	but not limited to: twice a year visits with the ward; a requirement that the duties of 
4.25 	guardianship or conservatorship and case management not be performed by the same person; 
4.26 	specific standards for action on "do not resuscitate" orders, as recommended by a physician, 
4.27 	an advanced practice registered nurse, or a physician assistant; sterilization requests,; and 
4.28 	the use of psychotropic medication and aversive procedures.

4.29 	Sec. 7. Minnesota Statutes 2016, section 256.9365, subdivision 2, is amended to read:
4.30 		Subd. 2.Eligibility requirements. To be eligible for the program, an applicant must 
4.31 	satisfy the following requirements:
4.32 	(1) the applicant must provide a physician's, advanced practice registered nurse's, or 
4.33 	physician assistant's statement verifying that the applicant is infected with HIV and is, or 
5.1 	within three months is likely to become, too ill to work in the applicant's current employment 
5.2 	because of HIV-related disease;
5.3 	(2) the applicant's monthly gross family income must not exceed 300 percent of the 
5.4 	federal poverty guidelines, after deducting medical expenses and insurance premiums;
5.5 	(3) the applicant must not own assets with a combined value of more than $25,000; and
5.6 	(4) if applying for payment of group plan premiums, the applicant must be covered by 
5.7 	an employer's or former employer's group insurance plan.

5.8 	Sec. 8. Minnesota Statutes 2016, section 256B.056, subdivision 2, is amended to read:
5.9 		Subd. 2.Homestead exclusion for persons residing in a long-term care facility.  The 
5.10 	homestead shall be excluded for the first six calendar months of a person's stay in a long-term 
5.11 	care facility and shall continue to be excluded for as long as the recipient can be reasonably 
5.12 	expected to return to the homestead. For purposes of this subdivision, "reasonably expected 
5.13 	to return to the homestead" means the recipient's attending physician, advanced practice 
5.14 	registered nurse, or physician assistant has certified that the expectation is reasonable, and 
5.15 	the recipient can show that the cost of care upon returning home will be met through medical 
5.16 	assistance or other sources. The homestead shall continue to be excluded for persons residing 
5.17 	in a long-term care facility if it is used as a primary residence by one of the following 
5.18 	individuals:
5.19 	(1) the spouse;
5.20 	(2) a child under age 21;
5.21 	(3) a child of any age who is blind or permanently and totally disabled as defined in the 
5.22 	Supplemental Security Income program;
5.23 	(4) a sibling who has equity interest in the home and who resided in the home for at least 
5.24 	one year immediately before the date of the person's admission to the facility; or
5.25 	(5) a child of any age or a grandchild of any age who resided in the home for at least 
5.26 	two years immediately before the date of the person's admission to the facility, and who 
5.27 	provided care to the person that permitted the person to reside at home rather than in an 
5.28 	institution.

5.29 	Sec. 9. Minnesota Statutes 2016, section 256B.057, subdivision 9, is amended to read:
5.30 		Subd. 9.Employed persons with disabilities. (a) Medical assistance may be paid for 
5.31 	a person who is employed and who:
6.1 	(1) but for excess earnings or assets, meets the definition of disabled under the 
6.2 	Supplemental Security Income program;
6.3 	(2) meets the asset limits in paragraph (d); and
6.4 	(3) pays a premium and other obligations under paragraph (e).
6.5 	(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible 
6.6 	for medical assistance under this subdivision, a person must have more than $65 of earned 
6.7 	income. Earned income must have Medicare, Social Security, and applicable state and 
6.8 	federal taxes withheld. The person must document earned income tax withholding. Any 
6.9 	spousal income or assets shall be disregarded for purposes of eligibility and premium 
6.10 	determinations.
6.11 	(c) After the month of enrollment, a person enrolled in medical assistance under this 
6.12 	subdivision who:
6.13 	(1) is temporarily unable to work and without receipt of earned income due to a medical 
6.14 	condition, as verified by a physician, advanced practice registered nurse, or physician 
6.15 	assistant; or
6.16 	(2) loses employment for reasons not attributable to the enrollee, and is without receipt 
6.17 	of earned income may retain eligibility for up to four consecutive months after the month 
6.18 	of job loss. To receive a four-month extension, enrollees must verify the medical condition 
6.19 	or provide notification of job loss. All other eligibility requirements must be met and the 
6.20 	enrollee must pay all calculated premium costs for continued eligibility.
6.21 	(d) For purposes of determining eligibility under this subdivision, a person's assets must 
6.22 	not exceed $20,000, excluding:
6.23 	(1) all assets excluded under section 256B.056;
6.24 	(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh 
6.25 	plans, and pension plans;
6.26 	(3) medical expense accounts set up through the person's employer; and
6.27 	(4) spousal assets, including spouse's share of jointly held assets.
6.28 	(e) All enrollees must pay a premium to be eligible for medical assistance under this 
6.29 	subdivision, except as provided under clause (5).
6.30 	(1) An enrollee must pay the greater of a $35 premium or the premium calculated based 
6.31 	on the person's gross earned and unearned income and the applicable family size using a 
6.32 	sliding fee scale established by the commissioner, which begins at one percent of income 
7.1 	at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for 
7.2 	those with incomes at or above 300 percent of the federal poverty guidelines.
7.3 	(2) Annual adjustments in the premium schedule based upon changes in the federal 
7.4 	poverty guidelines shall be effective for premiums due in July of each year.
7.5 	(3) All enrollees who receive unearned income must pay one-half of one percent of 
7.6 	unearned income in addition to the premium amount, except as provided under clause (5).
7.7 	(4) Increases in benefits under title II of the Social Security Act shall not be counted as 
7.8 	income for purposes of this subdivision until July 1 of each year.
7.9 	(5) Effective July 1, 2009, American Indians are exempt from paying premiums as 
7.10 	required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public 
7.11 	Law 111-5. For purposes of this clause, an American Indian is any person who meets the 
7.12 	definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
7.13 	(f) A person's eligibility and premium shall be determined by the local county agency. 
7.14 	Premiums must be paid to the commissioner. All premiums are dedicated to the 
7.15 	commissioner.
7.16 	(g) Any required premium shall be determined at application and redetermined at the 
7.17 	enrollee's six-month income review or when a change in income or household size is reported. 
7.18 	Enrollees must report any change in income or household size within ten days of when the 
7.19 	change occurs. A decreased premium resulting from a reported change in income or 
7.20 	household size shall be effective the first day of the next available billing month after the 
7.21 	change is reported. Except for changes occurring from annual cost-of-living increases, a 
7.22 	change resulting in an increased premium shall not affect the premium amount until the 
7.23 	next six-month review.
7.24 	(h) Premium payment is due upon notification from the commissioner of the premium 
7.25 	amount required. Premiums may be paid in installments at the discretion of the commissioner.
7.26 	(i) Nonpayment of the premium shall result in denial or termination of medical assistance 
7.27 	unless the person demonstrates good cause for nonpayment. Good cause exists if the 
7.28 	requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to D, are 
7.29 	met. Except when an installment agreement is accepted by the commissioner, all persons 
7.30 	disenrolled for nonpayment of a premium must pay any past due premiums as well as current 
7.31 	premiums due prior to being reenrolled. Nonpayment shall include payment with a returned, 
7.32 	refused, or dishonored instrument. The commissioner may require a guaranteed form of 
7.33 	payment as the only means to replace a returned, refused, or dishonored instrument.
8.1 	(j) For enrollees whose income does not exceed 200 percent of the federal poverty 
8.2 	guidelines and who are also enrolled in Medicare, the commissioner shall reimburse the 
8.3 	enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, paragraph 
8.4 	(a).

8.5 	Sec. 10. Minnesota Statutes 2016, section 256B.0575, subdivision 1, is amended to read:
8.6 		Subdivision 1.Income deductions. When an institutionalized person is determined 
8.7 	eligible for medical assistance, the income that exceeds the deductions in paragraphs (a) 
8.8 	and (b) must be applied to the cost of institutional care.
8.9 	(a) The following amounts must be deducted from the institutionalized person's income 
8.10 	in the following order:
8.11 	(1) the personal needs allowance under section 256B.35 or, for a veteran who does not 
8.12 	have a spouse or child, or a surviving spouse of a veteran having no child, the amount of 
8.13 	an improved pension received from the veteran's administration not exceeding $90 per 
8.14 	month;
8.15 	(2) the personal allowance for disabled individuals under section 256B.36;
8.16 	(3) if the institutionalized person has a legally appointed guardian or conservator, five 
8.17 	percent of the recipient's gross monthly income up to $100 as reimbursement for guardianship 
8.18 	or conservatorship services;
8.19 	(4) a monthly income allowance determined under section 256B.058, subdivision 2, but 
8.20 	only to the extent income of the institutionalized spouse is made available to the community 
8.21 	spouse;
8.22 	(5) a monthly allowance for children under age 18 which, together with the net income 
8.23 	of the children, would provide income equal to the medical assistance standard for families 
8.24 	and children according to section 256B.056, subdivision 4, for a family size that includes 
8.25 	only the minor children. This deduction applies only if the children do not live with the 
8.26 	community spouse and only to the extent that the deduction is not included in the personal 
8.27 	needs allowance under section 256B.35, subdivision 1, as child support garnished under a 
8.28 	court order;
8.29 	(6) a monthly family allowance for other family members, equal to one-third of the 
8.30 	difference between 122 percent of the federal poverty guidelines and the monthly income 
8.31 	for that family member;
9.1 	(7) reparations payments made by the Federal Republic of Germany and reparations 
9.2 	payments made by the Netherlands for victims of Nazi persecution between 1940 and 1945;
9.3 	(8) all other exclusions from income for institutionalized persons as mandated by federal 
9.4 	law; and
9.5 	(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for necessary 
9.6 	medical or remedial care for the institutionalized person that are recognized under state law, 
9.7 	not medical assistance covered expenses, and not subject to payment by a third party.
9.8 	For purposes of clause (6), "other family member" means a person who resides with the 
9.9 	community spouse and who is a minor or dependent child, dependent parent, or dependent 
9.10 	sibling of either spouse. "Dependent" means a person who could be claimed as a dependent 
9.11 	for federal income tax purposes under the Internal Revenue Code.
9.12 	(b) Income shall be allocated to an institutionalized person for a period of up to three 
9.13 	calendar months, in an amount equal to the medical assistance standard for a family size of 
9.14 	one if:
9.15 	(1) a physician, advanced practice registered nurse, or physician assistant certifies that 
9.16 	the person is expected to reside in the long-term care facility for three calendar months or 
9.17 	less;
9.18 	(2) if the person has expenses of maintaining a residence in the community; and
9.19 	(3) if one of the following circumstances apply:
9.20 	(i) the person was not living together with a spouse or a family member as defined in 
9.21 	paragraph (a) when the person entered a long-term care facility; or
9.22 	(ii) the person and the person's spouse become institutionalized on the same date, in 
9.23 	which case the allocation shall be applied to the income of one of the spouses.
9.24 	For purposes of this paragraph, a person is determined to be residing in a licensed nursing 
9.25 	home, regional treatment center, or medical institution if the person is expected to remain 
9.26 	for a period of one full calendar month or more.

9.27 	Sec. 11. Minnesota Statutes 2016, section 256B.0625, subdivision 2, is amended to read:
9.28 		Subd. 2.Skilled and intermediate nursing care. (a) Medical assistance covers skilled 
9.29 	nursing home services and services of intermediate care facilities, including training and 
9.30 	habilitation services, as defined in section 252.41, subdivision 3, for persons with 
9.31 	developmental disabilities who are residing in intermediate care facilities for persons with 
9.32 	developmental disabilities. Medical assistance must not be used to pay the costs of nursing 
10.1 	care provided to a patient in a swing bed as defined in section 144.562, unless (1) the facility 
10.2 	in which the swing bed is located is eligible as a sole community provider, as defined in 
10.3 	Code of Federal Regulations, title 42, section 412.92, or the facility is a public hospital 
10.4 	owned by a governmental entity with 15 or fewer licensed acute care beds; (2) the Centers 
10.5 	for Medicare and Medicaid Services approves the necessary state plan amendments; (3) the 
10.6 	patient was screened as provided by law; (4) the patient no longer requires acute care 
10.7 	services; and (5) no nursing home beds are available within 25 miles of the facility. The 
10.8 	commissioner shall exempt a facility from compliance with the sole community provider 
10.9 	requirement in clause (1) if, as of January 1, 2004, the facility had an agreement with the 
10.10 	commissioner to provide medical assistance swing bed services.
10.11 	(b) Medical assistance also covers up to ten days of nursing care provided to a patient 
10.12 	in a swing bed if: (1) the patient's physician, advanced practice registered nurse, or physician 
10.13 	assistant certifies that the patient has a terminal illness or condition that is likely to result 
10.14 	in death within 30 days and that moving the patient would not be in the best interests of the 
10.15 	patient and patient's family; (2) no open nursing home beds are available within 25 miles 
10.16 	of the facility; and (3) no open beds are available in any Medicare hospice program within 
10.17 	50 miles of the facility. The daily medical assistance payment for nursing care for the patient 
10.18 	in the swing bed is the statewide average medical assistance skilled nursing care per diem 
10.19 	as computed annually by the commissioner on July 1 of each year.

10.20 	Sec. 12. Minnesota Statutes 2016, section 256B.0653, subdivision 4, is amended to read:
10.21 		Subd. 4.Skilled nurse visit services. (a) Skilled nurse visit services must be provided 
10.22 	by a registered nurse or a licensed practical nurse under the supervision of a registered nurse, 
10.23 	according to the written plan of care and accepted standards of medical and nursing practice 
10.24 	according to chapter 148. Skilled nurse visit services must be ordered by a physician, 
10.25 	advanced practice registered nurse, or physician assistant and documented in a plan of care 
10.26 	that is reviewed and approved by the ordering physician, advanced practice registered nurse, 
10.27 	or physician assistant at least once every 60 days. All skilled nurse visits must be medically 
10.28 	necessary and provided in the recipient's home residence except as allowed under section 
10.29 	256B.0625, subdivision 6a.
10.30 	(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up 
10.31 	to two visits per day per recipient. All visits must be based on assessed needs.
10.32 	(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can 
10.33 	be accurately measured and assessed without a need for a face-to-face, hands-on encounter. 
11.1 	All telehomecare skilled nurse visits must have authorization and are paid at the same 
11.2 	allowable rates as face-to-face skilled nurse visits.
11.3 	(d) The provision of telehomecare must be made via live, two-way interactive audiovisual 
11.4 	technology and may be augmented by utilizing store-and-forward technologies. Individually 
11.5 	identifiable patient data obtained through real-time or store-and-forward technology must 
11.6 	be maintained as health records according to sections 144.291 to 144.298. If the video is 
11.7 	used for research, training, or other purposes unrelated to the care of the patient, the identity 
11.8 	of the patient must be concealed.
11.9 	(e) Authorization for skilled nurse visits must be completed under section 256B.0652. 
11.10 	A total of nine face-to-face skilled nurse visits per calendar year do not require authorization. 
11.11 	All telehomecare skilled nurse visits require authorization.

11.12 	Sec. 13. Minnesota Statutes 2016, section 256B.15, subdivision 1a, is amended to read:
11.13 		Subd. 1a.Estates subject to claims. (a) If a person receives medical assistance hereunder, 
11.14 	on the person's death, if single, or on the death of the survivor of a married couple, either 
11.15 	or both of whom received medical assistance, or as otherwise provided for in this section, 
11.16 	the amount paid for medical assistance as limited under subdivision 2 for the person and 
11.17 	spouse shall be filed as a claim against the estate of the person or the estate of the surviving 
11.18 	spouse in the court having jurisdiction to probate the estate or to issue a decree of descent 
11.19 	according to sections 525.31 to 525.313.
11.20 	(b) For the purposes of this section, the person's estate must consist of:
11.21 	(1) the person's probate estate;
11.22 	(2) all of the person's interests or proceeds of those interests in real property the person 
11.23 	owned as a life tenant or as a joint tenant with a right of survivorship at the time of the 
11.24 	person's death;
11.25 	(3) all of the person's interests or proceeds of those interests in securities the person 
11.26 	owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time 
11.27 	of the person's death, to the extent the interests or proceeds of those interests become part 
11.28 	of the probate estate under section 524.6-307;
11.29 	(4) all of the person's interests in joint accounts, multiple-party accounts, and pay-on-death 
11.30 	accounts, brokerage accounts, investment accounts, or the proceeds of those accounts, as 
11.31 	provided under sections 524.6-201 to 524.6-214 at the time of the person's death to the 
11.32 	extent the interests become part of the probate estate under section 524.6-207; and
12.1 	(5) assets conveyed to a survivor, heir, or assign of the person through survivorship, 
12.2 	living trust, or other arrangements.
12.3 	(c) For the purpose of this section and recovery in a surviving spouse's estate for medical 
12.4 	assistance paid for a predeceased spouse, the estate must consist of all of the legal title and 
12.5 	interests the deceased individual's predeceased spouse had in jointly owned or marital 
12.6 	property at the time of the spouse's death, as defined in subdivision 2b, and the proceeds of 
12.7 	those interests, that passed to the deceased individual or another individual, a survivor, an 
12.8 	heir, or an assign of the predeceased spouse through a joint tenancy, tenancy in common, 
12.9 	survivorship, life estate, living trust, or other arrangement. A deceased recipient who, at 
12.10 	death, owned the property jointly with the surviving spouse shall have an interest in the 
12.11 	entire property.
12.12 	(d) For the purpose of recovery in a single person's estate or the estate of a survivor of 
12.13 	a married couple, "other arrangement" includes any other means by which title to all or any 
12.14 	part of the jointly owned or marital property or interest passed from the predeceased spouse 
12.15 	to another including, but not limited to, transfers between spouses which are permitted, 
12.16 	prohibited, or penalized for purposes of medical assistance.
12.17 	(e) A claim shall be filed if medical assistance was rendered for either or both persons 
12.18 	under one of the following circumstances:
12.19 	(1) the person was over 55 years of age, and received services under this chapter prior 
12.20 	to January 1, 2014;
12.21 	(2) the person resided in a medical institution for six months or longer, received services 
12.22 	under this chapter, and, at the time of institutionalization or application for medical assistance, 
12.23 	whichever is later, the person could not have reasonably been expected to be discharged 
12.24 	and returned home, as certified in writing by the person's treating physician, advanced 
12.25 	practice registered nurse, or physician assistant. For purposes of this section only, a "medical 
12.26 	institution" means a skilled nursing facility, intermediate care facility, intermediate care 
12.27 	facility for persons with developmental disabilities, nursing facility, or inpatient hospital;
12.28 	(3) the person received general assistance medical care services under the program 
12.29 	formerly codified under chapter 256D; or
12.30 	(4) the person was 55 years of age or older and received medical assistance services on 
12.31 	or after January 1, 2014, that consisted of nursing facility services, home and 
12.32 	community-based services, or related hospital and prescription drug benefits.
13.1 	(f) The claim shall be considered an expense of the last illness of the decedent for the 
13.2 	purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or 
13.3 	county agency with a claim under this section must be a creditor under section 524.6-307. 
13.4 	Any statute of limitations that purports to limit any county agency or the state agency, or 
13.5 	both, to recover for medical assistance granted hereunder shall not apply to any claim made 
13.6 	hereunder for reimbursement for any medical assistance granted hereunder. Notice of the 
13.7 	claim shall be given to all heirs and devisees of the decedent, and to other persons with an 
13.8 	ownership interest in the real property owned by the decedent at the time of the decedent's 
13.9 	death, whose identity can be ascertained with reasonable diligence. The notice must include 
13.10 	procedures and instructions for making an application for a hardship waiver under subdivision 
13.11 	5; time frames for submitting an application and determination; and information regarding 
13.12 	appeal rights and procedures. Counties are entitled to one-half of the nonfederal share of 
13.13 	medical assistance collections from estates that are directly attributable to county effort. 
13.14 	Counties are entitled to ten percent of the collections for alternative care directly attributable 
13.15 	to county effort.

13.16 	Sec. 14. Minnesota Statutes 2016, section 256D.44, subdivision 4, is amended to read:
13.17 		Subd. 4.Temporary absence due to illness. For the purposes of this subdivision, "home" 
13.18 	means a residence owned or rented by a recipient or the recipient's spouse. Home does not 
13.19 	include a group residential housing facility. Assistance payments for recipients who are 
13.20 	temporarily absent from their home due to hospitalization for illness must continue at the 
13.21 	same level of payment during their absence if the following criteria are met:
13.22 	(1) a physician, advanced practice registered nurse, or physician assistant certifies that 
13.23 	the absence is not expected to continue for more than three months;
13.24 	(2) a physician, advanced practice registered nurse, or physician assistant certifies that 
13.25 	the recipient will be able to return to independent living; and
13.26 	(3) the recipient has expenses associated with maintaining a residence in the community.

13.27 	Sec. 15. Minnesota Statutes 2016, section 256D.44, subdivision 5, is amended to read:
13.28 		Subd. 5.Special needs. In addition to the state standards of assistance established in 
13.29 	subdivisions 1 to 4, payments are allowed for the following special needs of recipients of 
13.30 	Minnesota supplemental aid who are not residents of a nursing home, a regional treatment 
13.31 	center, or a group residential housing facility.
14.1 	(a) The county agency shall pay a monthly allowance for medically prescribed diets if 
14.2 	the cost of those additional dietary needs cannot be met through some other maintenance 
14.3 	benefit. The need for special diets or dietary items must be prescribed by a licensed physician, 
14.4 	advanced practice registered nurse, or physician assistant. Costs for special diets shall be 
14.5 	determined as percentages of the allotment for a one-person household under the thrifty 
14.6 	food plan as defined by the United States Department of Agriculture. The types of diets and 
14.7 	the percentages of the thrifty food plan that are covered are as follows:
14.8 	(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
14.9 	(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent of 
14.10 	thrifty food plan;
14.11 	(3) controlled protein diet, less than 40 grams and requires special products, 125 percent 
14.12 	of thrifty food plan;
14.13 	(4) low cholesterol diet, 25 percent of thrifty food plan;
14.14 	(5) high residue diet, 20 percent of thrifty food plan;
14.15 	(6) pregnancy and lactation diet, 35 percent of thrifty food plan;
14.16 	(7) gluten-free diet, 25 percent of thrifty food plan;
14.17 	(8) lactose-free diet, 25 percent of thrifty food plan;
14.18 	(9) antidumping diet, 15 percent of thrifty food plan;
14.19 	(10) hypoglycemic diet, 15 percent of thrifty food plan; or
14.20 	(11) ketogenic diet, 25 percent of thrifty food plan.
14.21 	(b) Payment for nonrecurring special needs must be allowed for necessary home repairs 
14.22 	or necessary repairs or replacement of household furniture and appliances using the payment 
14.23 	standard of the AFDC program in effect on July 16, 1996, for these expenses, as long as 
14.24 	other funding sources are not available.
14.25 	(c) A fee for guardian or conservator service is allowed at a reasonable rate negotiated 
14.26 	by the county or approved by the court. This rate shall not exceed five percent of the 
14.27 	assistance unit's gross monthly income up to a maximum of $100 per month. If the guardian 
14.28 	or conservator is a member of the county agency staff, no fee is allowed.
14.29 	(d) The county agency shall continue to pay a monthly allowance of $68 for restaurant 
14.30 	meals for a person who was receiving a restaurant meal allowance on June 1, 1990, and 
14.31 	who eats two or more meals in a restaurant daily. The allowance must continue until the 
15.1 	person has not received Minnesota supplemental aid for one full calendar month or until 
15.2 	the person's living arrangement changes and the person no longer meets the criteria for the 
15.3 	restaurant meal allowance, whichever occurs first.
15.4 	(e) A fee of ten percent of the recipient's gross income or $25, whichever is less, is 
15.5 	allowed for representative payee services provided by an agency that meets the requirements 
15.6 	under SSI regulations to charge a fee for representative payee services. This special need 
15.7 	is available to all recipients of Minnesota supplemental aid regardless of their living 
15.8 	arrangement.
15.9 	(f)(1) Notwithstanding the language in this subdivision, an amount equal to the maximum 
15.10 	allotment authorized by the federal Food Stamp Program for a single individual which is 
15.11 	in effect on the first day of July of each year will be added to the standards of assistance 
15.12 	established in subdivisions 1 to 4 for adults under the age of 65 who qualify as shelter needy 
15.13 	and are: (i) relocating from an institution, or an adult mental health residential treatment 
15.14 	program under section 256B.0622; or (ii) home and community-based waiver recipients 
15.15 	living in their own home or rented or leased apartment which is not owned, operated, or 
15.16 	controlled by a provider of service not related by blood or marriage, unless allowed under 
15.17 	paragraph (g).
15.18 	(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter 
15.19 	needy benefit under this paragraph is considered a household of one. An eligible individual 
15.20 	who receives this benefit prior to age 65 may continue to receive the benefit after the age 
15.21 	of 65.
15.22 	(3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that exceed 
15.23 	40 percent of the assistance unit's gross income before the application of this special needs 
15.24 	standard. "Gross income" for the purposes of this section is the applicant's or recipient's 
15.25 	income as defined in section 256D.35, subdivision 10, or the standard specified in subdivision 
15.26 	3, paragraph (a) or (b), whichever is greater. A recipient of a federal or state housing subsidy, 
15.27 	that limits shelter costs to a percentage of gross income, shall not be considered shelter 
15.28 	needy for purposes of this paragraph.
15.29 	(g) Notwithstanding this subdivision, to access housing and services as provided in 
15.30 	paragraph (f), the recipient may choose housing that may be owned, operated, or controlled 
15.31 	by the recipient's service provider. When housing is controlled by the service provider, the 
15.32 	individual may choose the individual's own service provider as provided in section 256B.49, 
15.33 	subdivision 23, clause (3). When the housing is controlled by the service provider, the 
15.34 	service provider shall implement a plan with the recipient to transition the lease to the 
16.1 	recipient's name. Within two years of signing the initial lease, the service provider shall 
16.2 	transfer the lease entered into under this subdivision to the recipient. In the event the landlord 
16.3 	denies this transfer, the commissioner may approve an exception within sufficient time to 
16.4 	ensure the continued occupancy by the recipient. This paragraph expires June 30, 2016.

16.5 	Sec. 16. Minnesota Statutes 2016, section 256R.04, subdivision 6, is amended to read:
16.6 		Subd. 6.Refusing readmissions. A nursing facility is not eligible to receive medical 
16.7 	assistance payments unless it refrains from refusing, for more than 24 hours, to accept a 
16.8 	resident returning to the same bed or a bed certified for the same level of care, in accordance 
16.9 	with a physician's, advanced practice registered nurse's, or physician assistant's order 
16.10 	authorizing transfer, after receiving inpatient hospital services.

16.11 	Sec. 17. Minnesota Statutes 2016, section 514.981, subdivision 2, is amended to read:
16.12 		Subd. 2.Attachment. (a) A medical assistance lien attaches and becomes enforceable 
16.13 	against specific real property as of the date when the following conditions are met:
16.14 	(1) payments have been made by an agency for a medical assistance benefit;
16.15 	(2) notice and an opportunity for a hearing have been provided under paragraph (b);
16.16 	(3) a lien notice has been filed as provided in section 514.982;
16.17 	(4) if the property is registered property, the lien notice has been memorialized on the 
16.18 	certificate of title of the property affected by the lien notice; and
16.19 	(5) all restrictions against enforcement have ceased to apply.
16.20 	(b) An agency may not file a medical assistance lien notice until the medical assistance 
16.21 	recipient or the recipient's legal representative has been sent, by certified or registered mail, 
16.22 	written notice of the agency's lien rights and there has been an opportunity for a hearing 
16.23 	under section 256.045. In addition, the agency may not file a lien notice unless the agency 
16.24 	determines as medically verified by the recipient's attending physician, advanced practice 
16.25 	registered nurse, or physician assistant that the medical assistance recipient cannot reasonably 
16.26 	be expected to be discharged from a medical institution and return home.
16.27 	(c) An agency may not file a medical assistance lien notice against real property while 
16.28 	it is the home of the recipient's spouse.
16.29 	(d) An agency may not file a medical assistance lien notice against real property that 
16.30 	was the homestead of the medical assistance recipient or the recipient's spouse when the 
17.1 	medical assistance recipient received medical institution services if any of the following 
17.2 	persons are lawfully residing in the property:
17.3 	(1) a child of the medical assistance recipient if the child is under age 21 or is blind or 
17.4 	permanently and totally disabled according to the Supplemental Security Income criteria;
17.5 	(2) a child of the medical assistance recipient if the child resided in the homestead for 
17.6 	at least two years immediately before the date the medical assistance recipient received 
17.7 	medical institution services, and the child provided care to the medical assistance recipient 
17.8 	that permitted the recipient to live without medical institution services; or
17.9 	(3) a sibling of the medical assistance recipient if the sibling has an equity interest in 
17.10 	the property and has resided in the property for at least one year immediately before the 
17.11 	date the medical assistance recipient began receiving medical institution services.
17.12 	(e) A medical assistance lien applies only to the specific real property described in the 
17.13 	lien notice.

17.14 	Sec. 18. Minnesota Statutes 2016, section 626.556, subdivision 11d, is amended to read:
17.15 		Subd. 11d.Disclosure in child fatality or near-fatality cases. (a) The definitions in 
17.16 	this paragraph apply to this section.
17.17 	(1) "Child fatality" means the death of a child from child abuse or neglect.
17.18 	(2) "Near fatality" means a case in which a physician, advanced practice registered nurse, 
17.19 	or physician assistant determines that a child is in serious or critical condition as the result 
17.20 	of sickness or injury caused by child abuse or neglect.
17.21 	(3) "Findings and information" means a written summary described in paragraph (c) of 
17.22 	actions taken or services rendered by a local social services agency following receipt of a 
17.23 	report.
17.24 	(b) Notwithstanding any other provision of law and subject to this subdivision, a public 
17.25 	agency shall disclose to the public, upon request, the findings and information related to a 
17.26 	child fatality or near fatality if:
17.27 	(1) a person is criminally charged with having caused the child fatality or near fatality;
17.28 	(2) a county attorney certifies that a person would have been charged with having caused 
17.29 	the child fatality or near fatality but for that person's death; or
17.30 	(3) a child protection investigation resulted in a determination of child abuse or neglect.
18.1 	(c) Findings and information disclosed under this subdivision consist of a written 
18.2 	summary that includes any of the following information the agency is able to provide:
18.3 	(1) the cause and circumstances regarding the child fatality or near fatality;
18.4 	(2) the age and gender of the child;
18.5 	(3) information on any previous reports of child abuse or neglect that are pertinent to 
18.6 	the abuse or neglect that led to the child fatality or near fatality;
18.7 	(4) information on any previous investigations that are pertinent to the abuse or neglect 
18.8 	that led to the child fatality or near fatality;
18.9 	(5) the results of any investigations described in clause (4);
18.10 	(6) actions of and services provided by the local social services agency on behalf of a 
18.11 	child that are pertinent to the child abuse or neglect that led to the child fatality or near 
18.12 	fatality; and
18.13 	(7) the results of any review of the state child mortality review panel, a local child 
18.14 	mortality review panel, a local community child protection team, or any public agency.
18.15 	(d) Nothing in this subdivision authorizes access to the private data in the custody of a 
18.16 	local social services agency, or the disclosure to the public of the records or content of any 
18.17 	psychiatric, psychological, or therapeutic evaluations, or the disclosure of information that 
18.18 	would reveal the identities of persons who provided information related to abuse or neglect 
18.19 	of the child.
18.20 	(e) A person whose request is denied may apply to the appropriate court for an order 
18.21 	compelling disclosure of all or part of the findings and information of the public agency. 
18.22 	The application must set forth, with reasonable particularity, factors supporting the 
18.23 	application. The court has jurisdiction to issue these orders. Actions under this section must 
18.24 	be set down for immediate hearing, and subsequent proceedings in those actions must be 
18.25 	given priority by the appellate courts.
18.26 	(f) A public agency or its employees acting in good faith in disclosing or declining to 
18.27 	disclose information under this section are immune from criminal or civil liability that might 
18.28 	otherwise be incurred or imposed for that action.

18.29 	Sec. 19. RULE CHANGE.
 18.30 	The commissioner of health shall amend Minnesota Rules, part 4601.1800, so that the 
18.31 	rule reads as follows:
19.1 	"Cause of death information for each death that occurs in Minnesota may be provided 
19.2 	only by a physician, advanced practice registered nurse, physician assistant, coroner, or 
19.3 	medical examiner. The physician, advanced practice registered nurse, or physician assistant 
19.4 	who provides the cause of death must be the physician, advanced practice registered nurse, 
19.5 	or physician assistant who was present at the time of death; the physician, advanced practice 
19.6 	registered nurse, physician assistant, or an associate of the physician, advanced practice 
19.7 	registered nurse, or physician assistant who provided medical treatment for the deceased 
19.8 	before death; or a physician, advanced practice registered nurse, or physician assistant who 
19.9 	has direct knowledge of the circumstances and cause of death and has access to the medical 
19.10 	record of the deceased. Cause of death information must be provided to a registrar according 
19.11 	to parts 4601.0100 to 4601.2600."