SF 2278

2nd Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to state government; modifying licensing
fees; expanding health care program eligibility;
enacting health care cost containment measures;
modifying mental and chemical health programs;
adjusting family support programs; reducing certain
parental fees; providing a cost-of-living adjustment
for certain human services program employees;
modifying long-term care programs; modifying
continuing care programs; allowing penalties;
appropriating money; amending Minnesota Statutes 2004,
sections 62A.65, subdivision 3; 62D.12, subdivision
19; 62J.04, subdivision 3, by adding a subdivision;
62J.041; 62J.301, subdivision 3; 62J.38; 62J.43;
62J.692, subdivision 3; 62L.08, subdivision 8; 62M.06,
subdivisions 2, 3; 62Q.37, subdivision 7; 103I.101,
subdivision 6; 103I.208, subdivisions 1, 2; 103I.235,
subdivision 1; 103I.601, subdivision 2; 119B.011, by
adding a subdivision; 119B.05, subdivision 1; 144.122;
144.147, subdivisions 1, 2; 144.148, subdivision 1;
144.1483; 144.1501, subdivisions 1, 2, 3, 4; 144.226,
subdivision 1, by adding subdivisions; 144.3831,
subdivision 1; 144.551, subdivision 1; 144.562,
subdivision 2; 144.9504, subdivision 2; 144.98,
subdivision 3; 144A.073, subdivision 10, by adding a
subdivision; 144E.101, by adding a subdivision;
145.9268; 157.15, by adding a subdivision; 157.16,
subdivisions 2, 3, by adding subdivisions; 157.20,
subdivisions 2, 2a; 241.01, by adding a subdivision;
244.054; 245.4661, by adding subdivisions; 245.4874;
245.4885, subdivisions 1, 2, by adding a subdivision;
252.27, subdivision 2a; 252.291, by adding a
subdivision; 254B.03, subdivision 4; 256.01,
subdivision 2, by adding a subdivision; 256.045,
subdivisions 3, 3a; 256.741, subdivision 4; 256.9365;
256.969, by adding a subdivision; 256B.02, subdivision
12; 256B.04, by adding a subdivision; 256B.055, by
adding a subdivision; 256B.056, subdivisions 5, 5a,
5b, 7, by adding subdivisions; 256B.057, subdivision
1; 256B.0621, subdivisions 2, 3, 4, 5, 6, 7;
256B.0622, subdivision 2; 256B.0625, subdivisions 2,
9, 13e, as amended, 13f, 17, 19c, by adding
subdivisions; 256B.0627, subdivisions 1, 4, 5, 9, by
adding a subdivision; 256B.0916, by adding a
subdivision; 256B.15, subdivisions 1, 1a, 2; 256B.19,
subdivision 1; 256B.431, by adding subdivisions;
256B.434, subdivision 4, by adding a subdivision;
256B.440, by adding a subdivision; 256B.5012, by
adding a subdivision; 256B.69, subdivisions 4, 23;
256D.03, subdivision 4; 256D.045; 256D.44, subdivision
5; 256J.021; 256J.08, subdivision 65; 256J.21,
subdivision 2; 256J.39, by adding a subdivision;
256J.521, subdivision 1; 256J.53, subdivision 2;
256J.626, subdivisions 1, 2, 3, 4, 7; 256J.95,
subdivisions 3, 9; 256L.01, subdivisions 4, 5;
256L.03, subdivisions 1, 1b, 5; 256L.04, subdivisions
2, 7, by adding subdivisions; 256L.05, subdivisions 3,
3a; 256L.07, subdivisions 1, 3, by adding a
subdivision; 256L.12, subdivision 6; 256L.15,
subdivisions 2, 3; 295.582; 326.01, by adding a
subdivision; 326.37, subdivision 1, by adding a
subdivision; 326.38; 326.40, subdivision 1; 326.42,
subdivision 2; 514.981, subdivision 6; 524.3-805;
549.02, by adding a subdivision; 549.04; 641.15,
subdivision 2; Laws 2003, First Special Session
chapter 14, article 12, section 93; article 13C,
section 2, subdivision 6; proposing coding for new law
in Minnesota Statutes, chapters 62J; 144; 145; 151;
256; 256B; 256J; 256L; 326; 501B; 641; repealing
Minnesota Statutes 2004, sections 119B.074; 144.1486;
157.215; 256B.0631; 256J.37, subdivisions 3a, 3b;
256L.035; 326.45; 514.991; 514.992; 514.993; 514.994;
514.995.

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

ARTICLE 1

HEALTH DEPARTMENT

Section 1.

new text begin [62J.495] HEALTH INFORMATION TECHNOLOGY AND
INFRASTRUCTURE ADVISORY COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; members; duties. new text end

new text begin (a) The
commissioner shall establish a Health Information Technology and
Infrastructure Advisory Committee governed by section 15.059 to
advise the commissioner on the following matters:
new text end

new text begin (1) assessment of the use of health information technology
by the state, licensed health care providers and facilities, and
local public health agencies;
new text end

new text begin (2) recommendations for implementing a statewide
interoperable health information infrastructure, to include
estimates of necessary resources, and for determining standards
for administrative data exchange, clinical support programs, and
maintenance of the security and confidentiality of individual
patient data; and
new text end

new text begin (3) other related issues as requested by the commissioner.
new text end

new text begin (b) The members of the Health Information Technology and
Infrastructure Advisory Committee shall include the
commissioners, or commissioners' designees, of health, human
services, and commerce and additional members to be appointed by
the commissioner to include persons representing Minnesota's
local public health agencies, licensed hospitals and other
licensed facilities and providers, the medical and nursing
professions, health insurers and health plans, the state quality
improvement organization, academic and research institutions,
consumer advisory organizations with an interest and expertise
in health information technology, and other stakeholders as
identified by the Health Information Technology and
Infrastructure Advisory Committee.
new text end

new text begin Subd. 2. new text end

new text begin Annual report. new text end

new text begin The commissioner shall prepare
and issue an annual report not later than January 30 of each
year outlining progress to date in implementing a statewide
health information infrastructure and recommending future
projects.
new text end

new text begin Subd. 3. new text end

new text begin Expiration. new text end

new text begin Notwithstanding section 15.059,
this section expires June 30, 2009.
new text end

Sec. 2.

Minnesota Statutes 2004, section 103I.101,
subdivision 6, is amended to read:

Subd. 6.

Fees for variances.

The commissioner shall
charge a nonrefundable application fee of deleted text begin $150 deleted text end new text begin $175 new text end to cover the
administrative cost of processing a request for a variance or
modification of rules adopted by the commissioner under this
chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 3.

Minnesota Statutes 2004, 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 a new well, deleted text begin $150 deleted text end new text begin $175 new text end , which includes the state
core function fee;

(2) for a well sealing, deleted text begin $30 deleted text end new text begin $35 new text end for each well, which
includes the state core function fee, except that for monitoring
wells constructed on a single property, having depths within a
25 foot range, and sealed within 48 hours of start of
construction, a single fee of deleted text begin $30 deleted text end new text begin $35 new text end ; and

(3) for construction of a dewatering well, deleted text begin $150 deleted text end new text begin $175 new text end , which
includes the state core function fee, for each well except a
dewatering project comprising five or more wells shall be
assessed a single fee of deleted text begin $750 deleted text end new text begin $875 new text end for the wells recorded on the
notification.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 4.

Minnesota Statutes 2004, section 103I.208,
subdivision 2, is amended to read:

Subd. 2.

Permit fee.

The permit fee to be paid by a
property owner is:

(1) for a well that is not in use under a maintenance
permit, deleted text begin $125 deleted text end new text begin $150 new text end annually;

(2) for construction of a monitoring well, deleted text begin $150 deleted text end new text begin $175 new text end , which
includes the state core function fee;

(3) for a monitoring well that is unsealed under a
maintenance permit, deleted text begin $125 deleted text end new text begin $150 new text end annually;

(4) for monitoring wells used as a leak detection device at
a single motor fuel retail outlet, a single petroleum bulk
storage site excluding tank farms, or a single agricultural
chemical facility site, the construction permit fee
is deleted text begin $150 deleted text end new text begin $175 new text end , which includes the state core function fee, per
site regardless of the number of wells constructed on the site,
and the annual fee for a maintenance permit for unsealed
monitoring wells is deleted text begin $125 deleted text end new text begin $150 new text end per site regardless of the number
of monitoring wells located on site;

(5) for a groundwater thermal exchange device, in addition
to the notification fee for wells, deleted text begin $150 deleted text end new text begin $175 new text end , which includes the
state core function fee;

(6) for a vertical heat exchanger, deleted text begin $150 deleted text end new text begin $175 new text end ;

(7) for a dewatering well that is unsealed under a
maintenance permit, deleted text begin $125 deleted text end new text begin $150 new text end annually for each well, except a
dewatering project comprising more than five wells shall be
issued a single permit for deleted text begin $625 deleted text end new text begin $750 new text end annually for wells recorded
on the permit; and

(8) for excavating holes for the purpose of installing
elevator shafts, deleted text begin $150 deleted text end new text begin $175 new text end for each hole.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 5.

Minnesota Statutes 2004, section 103I.235,
subdivision 1, is amended to read:

Subdivision 1.

Disclosure of wells to buyer.

(a) Before
signing an agreement to sell or transfer real property, the
seller must disclose in writing to the buyer information about
the status and location of all known wells on the property, by
delivering to the buyer either a statement by the seller that
the seller does not know of any wells on the property, or a
disclosure statement indicating the legal description and
county, and a map drawn from available information showing the
location of each well to the extent practicable. In the
disclosure statement, the seller must indicate, for each well,
whether the well is in use, not in use, or sealed.

(b) At the time of closing of the sale, the disclosure
statement information, name and mailing address of the buyer,
and the quartile, section, township, and range in which each
well is located must be provided on a well disclosure
certificate signed by the seller or a person authorized to act
on behalf of the seller.

(c) A well disclosure certificate need not be provided if
the seller does not know of any wells on the property and the
deed or other instrument of conveyance contains the statement:
"The Seller certifies that the Seller does not know of any wells
on the described real property."

(d) If a deed is given pursuant to a contract for deed, the
well disclosure certificate required by this subdivision shall
be signed by the buyer or a person authorized to act on behalf
of the buyer. If the buyer knows of no wells on the property, a
well disclosure certificate is not required if the following
statement appears on the deed followed by the signature of the
grantee or, if there is more than one grantee, the signature of
at least one of the grantees: "The Grantee certifies that the
Grantee does not know of any wells on the described real
property." The statement and signature of the grantee may be on
the front or back of the deed or on an attached sheet and an
acknowledgment of the statement by the grantee is not required
for the deed to be recordable.

(e) This subdivision does not apply to the sale, exchange,
or transfer of real property:

(1) that consists solely of a sale or transfer of severed
mineral interests; or

(2) that consists of an individual condominium unit as
described in chapters 515 and 515B.

(f) For an area owned in common under chapter 515 or 515B
the association or other responsible person must report to the
commissioner by July 1, 1992, the location and status of all
wells in the common area. The association or other responsible
person must notify the commissioner within 30 days of any change
in the reported status of wells.

(g) For real property sold by the state under section
92.67, the lessee at the time of the sale is responsible for
compliance with this subdivision.

(h) If the seller fails to provide a required well
disclosure certificate, the buyer, or a person authorized to act
on behalf of the buyer, may sign a well disclosure certificate
based on the information provided on the disclosure statement
required by this section or based on other available information.

(i) A county recorder or registrar of titles may not record
a deed or other instrument of conveyance dated after October 31,
1990, for which a certificate of value is required under section
272.115, or any deed or other instrument of conveyance dated
after October 31, 1990, from a governmental body exempt from the
payment of state deed tax, unless the deed or other instrument
of conveyance contains the statement made in accordance with
paragraph (c) or (d) or is accompanied by the well disclosure
certificate containing all the information required by paragraph
(b) or (d). The county recorder or registrar of titles must not
accept a certificate unless it contains all the required
information. The county recorder or registrar of titles shall
note on each deed or other instrument of conveyance accompanied
by a well disclosure certificate that the well disclosure
certificate was received. The notation must include the
statement "No wells on property" if the disclosure certificate
states there are no wells on the property. The well disclosure
certificate shall not be filed or recorded in the records
maintained by the county recorder or registrar of titles. After
noting "No wells on property" on the deed or other instrument of
conveyance, the county recorder or registrar of titles shall
destroy or return to the buyer the well disclosure certificate.
The county recorder or registrar of titles shall collect from
the buyer or the person seeking to record a deed or other
instrument of conveyance, a fee of deleted text begin $30 deleted text end new text begin $40 new text end for receipt of a
completed well disclosure certificate. By the tenth day of each
month, the county recorder or registrar of titles shall transmit
the well disclosure certificates to the commissioner of health.
By the tenth day after the end of each calendar quarter, the
county recorder or registrar of titles shall transmit to the
commissioner of health deleted text begin $27.50 deleted text end new text begin $32.50 new text end of the fee for each well
disclosure certificate received during the quarter. The
commissioner shall maintain the well disclosure certificate for
at least six years. The commissioner may store the certificate
as an electronic image. A copy of that image shall be as valid
as the original.

(j) No new well disclosure certificate is required under
this subdivision if the buyer or seller, or a person authorized
to act on behalf of the buyer or seller, certifies on the deed
or other instrument of conveyance that the status and number of
wells on the property have not changed since the last previously
filed well disclosure certificate. The following statement, if
followed by the signature of the person making the statement, is
sufficient to comply with the certification requirement of this
paragraph: "I am familiar with the property described in this
instrument and I certify that the status and number of wells on
the described real property have not changed since the last
previously filed well disclosure certificate." The
certification and signature may be on the front or back of the
deed or on an attached sheet and an acknowledgment of the
statement is not required for the deed or other instrument of
conveyance to be recordable.

(k) The commissioner in consultation with county recorders
shall prescribe the form for a well disclosure certificate and
provide well disclosure certificate forms to county recorders
and registrars of titles and other interested persons.

(l) Failure to comply with a requirement of this
subdivision does not impair:

(1) the validity of a deed or other instrument of
conveyance as between the parties to the deed or instrument or
as to any other person who otherwise would be bound by the deed
or instrument; or

(2) the record, as notice, of any deed or other instrument
of conveyance accepted for filing or recording contrary to the
provisions of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 6.

Minnesota Statutes 2004, section 103I.601,
subdivision 2, is amended to read:

Subd. 2.

License required to make borings.

(a) Except as
provided in paragraph deleted text begin (b) deleted text end new text begin (d) new text end , a person deleted text begin may deleted text end new text begin must new text end not make an
exploratory boring without an deleted text begin exploratory borer's deleted text end new text begin explorer's
new text end license. new text begin The fee for an explorer's license is $75. The
explorer's license is valid until the date prescribed in the
license by the commissioner.
new text end

(b) new text begin A person must file an application and renewal
application fee to renew the explorer's license by the date
stated in the license. The renewal application fee is $75.
new text end

new text begin (c) If the licensee submits an application fee after the
required renewal date, the licensee:
new text end

new text begin (1) must include a late fee of $75; and
new text end

new text begin (2) may not conduct activities authorized by an explorer's
license until the renewal application, renewal application fee,
late fee, and sealing reports required in subdivision 9 are
submitted.
new text end

new text begin (d) new text end An explorer deleted text begin may deleted text end new text begin must new text end designate a responsible individual
to supervise and oversee the making of exploratory borings.
Before an individual supervises or oversees an exploratory
boring, the individual must new text begin file an application and application
fee of $75 to qualify as a responsible individual. The
individual must new text end take and pass an examination relating to
construction, location, and sealing of exploratory borings. A
professional engineer deleted text begin registered deleted text end new text begin or geoscientist licensed new text end under
sections 326.02 to 326.15 or a deleted text begin certified deleted text end professional geologist
new text begin certified by the American Institute of Professional Geologists
new text end is not required to take the examination required in this
subdivision new text begin , new text end but must be deleted text begin licensed deleted text end new text begin certified as a responsible
individual new text end to deleted text begin make deleted text end new text begin supervise new text end an exploratory boring.

Sec. 7.

Minnesota Statutes 2004, section 144.122, is
amended to read:

144.122 LICENSE, PERMIT, AND SURVEY FEES.

(a) The state commissioner of health, by rule, may
prescribe deleted text begin reasonable deleted text end procedures and fees for filing with the
commissioner as prescribed by statute and for the issuance of
original and renewal permits, licenses, registrations, and
certifications issued under authority of the commissioner. The
expiration dates of the various licenses, permits,
registrations, and certifications as prescribed by the rules
shall be plainly marked thereon. Fees may include application
and examination fees and a penalty fee for renewal applications
submitted after the expiration date of the previously issued
permit, license, registration, and certification. The
commissioner may also prescribe, by rule, reduced fees for
permits, licenses, registrations, and certifications when the
application therefor is submitted during the last three months
of the permit, license, registration, or certification period.
Fees proposed to be prescribed in the rules shall be first
approved by the Department of Finance. All fees proposed to be
prescribed in rules shall be reasonable. The fees shall be in
an amount so that the total fees collected by the commissioner
will, where practical, approximate the cost to the commissioner
in administering the program. All fees collected shall be
deposited in the state treasury and credited to the state
government special revenue fund unless otherwise specifically
appropriated by law for specific purposes.

(b) new text begin The commissioner shall adopt rules establishing
criteria and procedures for refusal to grant or renew licenses
and registrations, and for suspension and revocation of licenses
and registrations.
new text end

new text begin (c) The commissioner may refuse to grant or renew licenses
and registrations, or suspend or revoke licenses and
registrations, according to the commissioner's criteria and
procedures as adopted by rule.
new text end

new text begin (d) new text end The commissioner may charge a fee for voluntary
certification of medical laboratories and environmental
laboratories, and for environmental and medical laboratory
services provided by the department, without complying with
paragraph (a) or chapter 14. Fees charged for environment and
medical laboratory services provided by the department must be
approximately equal to the costs of providing the services.

deleted text begin (c) deleted text end new text begin (e) new text end The commissioner may develop a schedule of fees for
diagnostic evaluations conducted at clinics held by the services
for children with handicaps program. All receipts generated by
the program are annually appropriated to the commissioner for
use in the maternal and child health program.

deleted text begin (d) deleted text end new text begin (f) new text end The commissioner shall set license fees for
hospitals and nursing homes that are not boarding care homes at
the following levels:

Joint Commission on Accreditation of Healthcare

Organizations (JCAHO hospitals) deleted text begin $7,055 deleted text end new text begin $7,555 plus $13 per bed
new text end

Non-JCAHO hospitals deleted text begin $4,680 deleted text end new text begin $5,180 new text end plus deleted text begin $234
deleted text end new text begin $247 new text end per bed

Nursing home $183 plus $91 per bed

The commissioner shall set license fees for outpatient
surgical centers, boarding care homes, and supervised living
facilities at the following levels:

Outpatient surgical centers deleted text begin $1,512 deleted text end new text begin $3,349
new text end

Boarding care homes $183 plus $91 per bed

Supervised living facilities $183 plus $91 per bed.

deleted text begin (e) deleted text end new text begin (g) new text end Unless prohibited by federal law, the commissioner
of health shall charge applicants the following fees to cover
the cost of any initial certification surveys required to
determine a provider's eligibility to participate in the
Medicare or Medicaid program:

Prospective payment surveys for $ 900
hospitals
Swing bed surveys for nursing homes $1,200
Psychiatric hospitals $1,400
Rural health facilities $1,100
Portable x-ray providers $ 500
Home health agencies $1,800
Outpatient therapy agencies $ 800
End stage renal dialysis providers $2,100
Independent therapists $ 800
Comprehensive rehabilitation $1,200
outpatient facilities
Hospice providers $1,700
Ambulatory surgical providers $1,800
Hospitals $4,200
Other provider categories or Actual surveyor costs:
additional resurveys required average surveyor cost x
to complete initial certification number of hours for the
survey process.

These fees shall be submitted at the time of the
application for federal certification and shall not be
refunded. All fees collected after the date that the imposition
of fees is not prohibited by federal law shall be deposited in
the state treasury and credited to the state government special
revenue fund.

new text begin (h) The commissioner shall charge the following fees for
examinations, registrations, licenses, and inspections:
new text end

new text begin Plumbing examination new text end new text begin $ new text end new text begin 50
Water conditioning examination new text end new text begin $ new text end new text begin 50
Plumbing bond registration fee new text end new text begin $ new text end new text begin 40
Water conditioning bond registration fee new text end new text begin $ new text end new text begin 40
Master plumber's license new text end new text begin $120
Restricted plumbing contractor license new text end new text begin $ new text end new text begin 90
Journeyman plumber's license new text end new text begin $ new text end new text begin 55
Apprentice registration new text end new text begin $ new text end new text begin 25
Water conditioning contractor license new text end new text begin $ new text end new text begin 70
Water conditioning installer license new text end new text begin $ new text end new text begin 35
Residential inspection fee (each visit) new text end new text begin $ new text end new text begin 50
new text end

new text begin Public, commercial, and new text end new text begin Inspection fee
industrial inspections
25 or fewer drainage
fixture units new text end new text begin $ new text end new text begin 300
26 to 50 drainage
fixture units new text end new text begin $ new text end new text begin 900
51 to 150 drainage
fixture units new text end new text begin $1,200
151 to 249 drainage
fixture units new text end new text begin $1,500
250 or more drainage
fixture units new text end new text begin $1,800
Callback fee (each visit) new text end new text begin $ new text end new text begin 100
new text end

Sec. 8.

Minnesota Statutes 2004, section 144.147,
subdivision 1, is amended to read:

Subdivision 1.

Definition.

"Eligible rural hospital"
means any nonfederal, general acute care hospital that:

(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than deleted text begin 10,000 deleted text end new text begin 15,000 new text end , according to United
States Census Bureau statistics, outside the seven-county
metropolitan area;

(2) has 50 or fewer beds; and

(3) is not for profit.

Sec. 9.

Minnesota Statutes 2004, section 144.147,
subdivision 2, is amended to read:

Subd. 2.

Grants authorized.

The commissioner shall
establish a program of grants to assist eligible rural
hospitals. The commissioner shall award grants to hospitals and
communities for the purposes set forth in paragraphs (a) and (b).

(a) Grants may be used by hospitals and their communities
to develop strategic plans for preserving or enhancing access to
health services. At a minimum, a strategic plan must consist of:

(1) a needs assessment to determine what health services
are needed and desired by the community. The assessment must
include interviews with or surveys of area health professionals,
local community leaders, and public hearings;

(2) an assessment of the feasibility of providing needed
health services that identifies priorities and timeliness for
potential changes; and

(3) an implementation plan.

The strategic plan must be developed by a committee that
includes representatives from the hospital, local public health
agencies, other health providers, and consumers from the
community.

(b) The grants may also be used by eligible rural hospitals
that have developed strategic plans to implement transition
projects to modify the type and extent of services provided, in
order to reflect the needs of that plan. Grants may be used by
hospitals under this paragraph to develop hospital-based
physician practices that integrate hospital and existing medical
practice facilities that agree to transfer their practices,
equipment, staffing, and administration to the hospital. The
grants may also be used by the hospital to establish a health
provider cooperative, a telemedicine system, new text begin an electronic
health records system, new text end or a rural health care system or to cover
expenses associated with being designated as a critical access
hospital for the Medicare rural hospital flexibility program.
Not more than one-third of any grant shall be used to offset
losses incurred by physicians agreeing to transfer their
practices to hospitals. new text begin The commissioner shall give priority to
grant applications for projects involving electronic health
records systems.
new text end

Sec. 10.

new text begin [144.1476] RURAL PHARMACY PLANNING AND
TRANSITION GRANT 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 following definitions apply.
new text end

new text begin (b) "Eligible rural community" means:
new text end

new text begin (1) a Minnesota community that is located in a rural area,
as defined in the federal Medicare regulations, Code of Federal
Regulations, title 42, section 405.1041; or
new text end

new text begin (2) a Minnesota community that has a population of less
than 10,000, according to the United States Bureau of
Statistics, and that is outside the seven-county metropolitan
area, excluding the cities of Duluth, Mankato, Moorhead,
Rochester, and St. Cloud.
new text end

new text begin (c) "Health care provider" means a hospital, clinic,
pharmacy, long-term care institution, or other health care
facility that is licensed, certified, or otherwise authorized by
the laws of this state to provide health care.
new text end

new text begin (d) "Pharmacist" means an individual with a valid license
issued under chapter 151 to practice pharmacy.
new text end

new text begin (e) "Pharmacy" has the meaning given under section 151.01,
subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Grants authorized; eligibility. new text end

new text begin (a) The
commissioner of health shall establish a program to award grants
to eligible rural communities or health care providers in
eligible rural communities for planning, establishing, keeping
in operation, or providing health care services that preserve
access to prescription medications and the skills of a
pharmacist according to sections 151.01 to 151.40.
new text end

new text begin (b) To be eligible for a grant, an applicant must develop a
strategic plan for preserving or enhancing access to
prescription medications and the skills of a pharmacist. At a
minimum, a strategic plan must consist of:
new text end

new text begin (1) a needs assessment to determine what pharmacy services
are needed and desired by the community. The assessment must
include interviews with or surveys of area and local health
professionals, local community leaders, and public officials;
new text end

new text begin (2) an assessment of the feasibility of providing needed
pharmacy services that identifies priorities and timelines for
potential changes; and
new text end

new text begin (3) an implementation plan.
new text end

new text begin (c) A grant may be used by a recipient that has developed a
strategic plan to implement transition projects to modify the
type and extent of pharmacy services provided, in order to
reflect the needs of the community. Grants may also be used by
recipients:
new text end

new text begin (1) to develop pharmacy practices that integrate pharmacy
and existing health care provider facilities; or
new text end

new text begin (2) to establish a pharmacy provider cooperative or
initiatives that maintain local access to prescription
medications and the skills of a pharmacist.
new text end

new text begin Subd. 3. new text end

new text begin Consideration of grants. new text end

new text begin In determining which
applicants shall receive grants under this section, the
commissioner of health shall appoint a committee comprised of
members with experience and knowledge about rural pharmacy
issues, including, but not limited to, two rural pharmacists
with a community pharmacy background, two health care providers
from rural communities, one representative from a statewide
pharmacist organization, and one representative of the Board of
Pharmacy. A representative of the commissioner may serve on the
committee in an ex officio status. In determining who shall
receive a grant, the committee shall take into account:
new text end

new text begin (1) improving or maintaining access to prescription
medications and the skills of a pharmacist;
new text end

new text begin (2) changes in service populations;
new text end

new text begin (3) the extent community pharmacy needs are not currently
met by other providers in the area;
new text end

new text begin (4) the financial condition of the applicant;
new text end

new text begin (5) the integration of pharmacy services into existing
health care services; and
new text end

new text begin (6) community support.
new text end

new text begin The commissioner may also take into account other relevant
factors.
new text end

new text begin Subd. 4. new text end

new text begin Allocation of grants. new text end

new text begin (a) The commissioner
shall establish a deadline for receiving applications and must
make a final decision on the funding of each application within
60 days of the deadline. An applicant must apply no later than
March 1 of each fiscal year for grants awarded for that fiscal
year.
new text end

new text begin (b) Any grant awarded must not exceed $50,000 a year and
may not exceed a one-year term.
new text end

new text begin (c) Applicants may apply to the program each year they are
eligible.
new text end

new text begin (d) Project grants may not be used to retire debt incurred
with respect to any capitol expenditure made prior to the date
on which the project is initiated.
new text end

new text begin Subd. 5. new text end

new text begin Evaluation. new text end

new text begin The commissioner shall evaluate the
overall effectiveness of the grant program and may collect
progress reports and other information from grantees needed for
program evaluation. An academic institution that has the
expertise in evaluating rural pharmacy outcomes may participate
in the program evaluation if asked by a grantee or the
commissioner. The commissioner shall compile summaries of
successful grant projects and other model community efforts to
preserve access to prescription medications and the skills of a
pharmacist, and make this information available to Minnesota
communities seeking to address local pharmacy issues.
new text end

Sec. 11.

Minnesota Statutes 2004, section 144.148,
subdivision 1, is amended to read:

Subdivision 1.

Definition.

(a) For purposes of this
section, the following definitions apply.

(b) "Eligible rural hospital" means any nonfederal, general
acute care hospital that:

(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than deleted text begin 10,000 deleted text end new text begin 15,000 new text end , according to United
States Census Bureau statistics, outside the seven-county
metropolitan area;

(2) has 50 or fewer beds; and

(3) is not for profit.

(c) "Eligible project" means a modernization project to
update, remodel, or replace aging hospital facilities and
equipment necessary to maintain the operations of a hospital new text begin ,
including establishing an electronic health records system. The
commissioner shall give priority to grant applications for
projects involving electronic health records systems new text end .

Sec. 12.

Minnesota Statutes 2004, section 144.1483, is
amended to read:

144.1483 RURAL HEALTH INITIATIVES.

The commissioner of health, through the Office of Rural
Health, and consulting as necessary with the commissioner of
human services, the commissioner of commerce, the Higher
Education Services Office, and other state agencies, shall:

(1) develop a detailed plan regarding the feasibility of
coordinating rural health care services by organizing individual
medical providers and smaller hospitals and clinics into
referral networks with larger rural hospitals and clinics that
provide a broader array of services;

(2) deleted text begin develop and implement a program to assist rural
communities in establishing community health centers, as
required by section 144.1486;
deleted text end

deleted text begin (3) deleted text end develop recommendations regarding health education and
training programs in rural areas, including but not limited to a
physician assistants' training program, continuing education
programs for rural health care providers, and rural outreach
programs for nurse practitioners within existing training
programs;

deleted text begin (4) deleted text end new text begin (3) new text end develop a statewide, coordinated recruitment
strategy for health care personnel and maintain a database on
health care personnel as required under section 144.1485;

deleted text begin (5) deleted text end new text begin (4) new text end develop and administer technical assistance
programs to assist rural communities in: (i) planning and
coordinating the delivery of local health care services; and
(ii) hiring physicians, nurse practitioners, public health
nurses, physician assistants, and other health personnel;

deleted text begin (6) deleted text end new text begin (5) new text end study and recommend changes in the regulation of
health care personnel, such as nurse practitioners and physician
assistants, related to scope of practice, the amount of on-site
physician supervision, and dispensing of medication, to address
rural health personnel shortages;

deleted text begin (7) deleted text end new text begin (6) new text end support efforts to ensure continued funding for
medical and nursing education programs that will increase the
number of health professionals serving in rural areas;

deleted text begin (8) deleted text end new text begin (7) new text end support efforts to secure higher reimbursement for
rural health care providers from the Medicare and medical
assistance programs;

deleted text begin (9) deleted text end new text begin (8) new text end coordinate the development of a statewide plan for
emergency medical services, in cooperation with the Emergency
Medical Services Advisory Council;

deleted text begin (10) deleted text end new text begin (9) new text end establish a Medicare rural hospital flexibility
program pursuant to section 1820 of the federal Social Security
Act, United States Code, title 42, section 1395i-4, by
developing a state rural health plan and designating, consistent
with the rural health plan, rural nonprofit or public hospitals
in the state as critical access hospitals. Critical access
hospitals shall include facilities that are certified by the
state as necessary providers of health care services to
residents in the area. Necessary providers of health care
services are designated as critical access hospitals on the
basis of being more than 20 miles, defined as official mileage
as reported by the Minnesota Department of Transportation, from
the next nearest hospital, being the sole hospital in the
county, being a hospital located in a county with a designated
medically underserved area or health professional shortage area,
or being a hospital located in a county contiguous to a county
with a medically underserved area or health professional
shortage area. A critical access hospital located in a county
with a designated medically underserved area or a health
professional shortage area or in a county contiguous to a county
with a medically underserved area or health professional
shortage area shall continue to be recognized as a critical
access hospital in the event the medically underserved area or
health professional shortage area designation is subsequently
withdrawn; and

deleted text begin (11) deleted text end new text begin (10) new text end carry out other activities necessary to address
rural health problems.

Sec. 13.

Minnesota Statutes 2004, section 144.1501,
subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this
section, the following definitions apply.

(b) "Designated rural area" means:

(1) an area in Minnesota outside the counties of Anoka,
Carver, Dakota, Hennepin, Ramsey, Scott, and Washington,
excluding the cities of Duluth, Mankato, Moorhead, Rochester,
and St. Cloud; or

(2) a municipal corporation, as defined under section
471.634, that is physically located, in whole or in part, in an
area defined as a designated rural area under clause (1).

(c) "Emergency circumstances" means those conditions that
make it impossible for the participant to fulfill the service
commitment, including death, total and permanent disability, or
temporary disability lasting more than two years.

(d) "Medical resident" means an individual participating in
a medical residency in family practice, internal medicine,
obstetrics and gynecology, pediatrics, or psychiatry.

(e) "Midlevel practitioner" means a nurse practitioner,
nurse-midwife, nurse anesthetist, advanced clinical nurse
specialist, or physician assistant.

(f) "Nurse" means an individual who has completed training
and received all licensing or certification necessary to perform
duties as a licensed practical nurse or registered nurse.

(g) "Nurse-midwife" means a registered nurse who has
graduated from a program of study designed to prepare registered
nurses for advanced practice as nurse-midwives.

(h) "Nurse practitioner" means a registered nurse who has
graduated from a program of study designed to prepare registered
nurses for advanced practice as nurse practitioners.

(i) new text begin "Pharmacist" means an individual with a valid license
issued under chapter 151 to practice pharmacy.
new text end

new text begin (j) new text end "Physician" means an individual who is licensed to
practice medicine in the areas of family practice, internal
medicine, obstetrics and gynecology, pediatrics, or psychiatry.

deleted text begin (j) deleted text end new text begin (k) new text end "Physician assistant" means a person registered
under chapter 147A.

deleted text begin (k) deleted text end new text begin (l) new text end "Qualified educational loan" means a government,
commercial, or foundation loan for actual costs paid for
tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a
health care professional.

deleted text begin (l) deleted text end new text begin (m) new text end "Underserved urban community" means a Minnesota
urban area or population included in the list of designated
primary medical care health professional shortage areas (HPSAs),
medically underserved areas (MUAs), or medically underserved
populations (MUPs) maintained and updated by the United States
Department of Health and Human Services.

Sec. 14.

Minnesota Statutes 2004, section 144.1501,
subdivision 2, is amended to read:

Subd. 2.

Creation of account.

new text begin (a) new text end A health professional
education loan forgiveness program account is established. The
commissioner of health shall use money from the account to
establish a loan forgiveness program new text begin :
new text end

new text begin (1) new text end for medical residents agreeing to practice in
designated rural areas or underserved urban communities deleted text begin , deleted text end new text begin or
specializing in the area of pediatric psychiatry;
new text end

new text begin (2) new text end for midlevel practitioners agreeing to practice in
designated rural areas deleted text begin , and deleted text end new text begin or to teach for at least 20 hours
per week in the nursing field in a postsecondary program;
new text end

new text begin (3) new text end for nurses who agree to practice in a Minnesota nursing
home or intermediate care facility for persons with mental
retardation or related conditions new text begin or to teach for at least 20
hours per week in the nursing field in a postsecondary program;
new text end

new text begin (4) for other health care technicians agreeing to teach for
at least 20 hours per week in their designated field in a
postsecondary program. The commissioner, in consultation with
the Healthcare Education-Industry Partnership, shall determine
the health care fields where the need is the greatest,
including, but not limited to, respiratory therapy, clinical
laboratory technology, radiologic technology, and surgical
technology; and
new text end

new text begin (5) for pharmacists who agree to practice in designated
rural areas new text end .

new text begin (b) new text end Appropriations made to the account do not cancel and
are available until expended, except that at the end of each
biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing
commitments shall cancel to the fund.

Sec. 15.

Minnesota Statutes 2004, section 144.1501,
subdivision 3, is amended to read:

Subd. 3.

Eligibility.

(a) To be eligible to participate
in the loan forgiveness program, an individual must:

(1) be a medical resident new text begin or a licensed pharmacist new text end or be
enrolled in a midlevel practitioner, registered nurse, or deleted text begin a
deleted text end licensed practical nurse training program; and

(2) submit an application to the commissioner of health.

(b) An applicant selected to participate must sign a
contract to agree to serve a minimum three-year full-time
service obligation according to subdivision 2, which shall begin
no later than March 31 following completion of required training.

Sec. 16.

Minnesota Statutes 2004, section 144.1501,
subdivision 4, is amended to read:

Subd. 4.

Loan forgiveness.

The commissioner of health
may select applicants each year for participation in the loan
forgiveness program, within the limits of available funding. The
commissioner shall distribute available funds for loan
forgiveness proportionally among the eligible professions
according to the vacancy rate for each profession in the
required geographic area deleted text begin or deleted text end new text begin , new text end facility type new text begin , teaching area, or
specialty type new text end specified in subdivision 2. The commissioner
shall allocate funds for physician loan forgiveness so that 75
percent of the funds available are used for rural physician loan
forgiveness and 25 percent of the funds available are used for
underserved urban communities new text begin and pediatric psychiatry new text end loan
forgiveness. If the commissioner does not receive enough
qualified applicants each year to use the entire allocation of
funds for urban underserved communities new text begin or pediatric psychiatry new text end ,
the remaining funds may be allocated for rural physician loan
forgiveness. Applicants are responsible for securing their own
qualified educational loans. The commissioner shall select
participants based on their suitability for practice serving the
required geographic area or facility type specified in
subdivision 2, as indicated by experience or training. The
commissioner shall give preference to applicants closest to
completing their training. For each year that a participant
meets the service obligation required under subdivision 3, up to
a maximum of four years, the commissioner shall make annual
disbursements directly to the participant equivalent to 15
percent of the average educational debt for indebted graduates
in their profession in the year closest to the applicant's
selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
Before receiving loan repayment disbursements and as requested,
the participant must complete and return to the commissioner an
affidavit of practice form provided by the commissioner
verifying that the participant is practicing as required under
subdivisions 2 and 3. The participant must provide the
commissioner with verification that the full amount of loan
repayment disbursement received by the participant has been
applied toward the designated loans. After each disbursement,
verification must be received by the commissioner and approved
before the next loan repayment disbursement is made.
Participants who move their practice remain eligible for loan
repayment as long as they practice as required under subdivision
2.

Sec. 17.

Minnesota Statutes 2004, section 144.226,
subdivision 1, is amended to read:

Subdivision 1.

Which services are for fee.

The fees for
the following services shall be the following or an amount
prescribed by rule of the commissioner:

(a) The fee for the issuance of a certified vital record or
a certification that the vital record cannot be found is deleted text begin $8 deleted text end new text begin $9 new text end .
No fee shall be charged for a certified birth or death record
that is reissued within one year of the original issue, if an
amendment is made to the vital record and if the previously
issued vital record is surrendered. new text begin The fee is nonrefundable.
new text end

(b) The fee for new text begin processing a request for new text end the replacement of
a birth record for all events, except when filing a recognition
of parentage pursuant to section 257.73, subdivision 1,
is deleted text begin $20 deleted text end new text begin $40 new text end . new text begin The fee is payable at the time of application and
is nonrefundable.
new text end

(c) The fee for new text begin processing a request for new text end the filing of a
delayed registration of birth or death is deleted text begin $20 deleted text end new text begin $40 new text end . new text begin The fee is
payable at the time of application and is nonrefundable. This
fee includes one subsequent review of the request if the request
is not acceptable upon the initial receipt.
new text end

(d) The fee for new text begin processing a request for new text end the amendment of
any vital record when requested more than 45 days after the
filing of the vital record is deleted text begin $20 deleted text end new text begin $40 new text end . No fee shall be charged
for an amendment requested within 45 days after the filing of
the vital record. new text begin The fee is payable at the time of application
and is nonrefundable. This fee includes one subsequent review
of the request if the request is not acceptable upon the initial
receipt.
new text end

(e) The fee for new text begin processing a request for new text end the verification
of information from vital records is deleted text begin $8 deleted text end new text begin $9 new text end when the applicant
furnishes the specific information to locate the vital record.
When the applicant does not furnish specific information, the
fee is $20 per hour for staff time expended. Specific
information includes the correct date of the event and the
correct name of the registrant. Fees charged shall approximate
the costs incurred in searching and copying the vital records.
The fee deleted text begin shall be deleted text end new text begin is new text end payable at the time of application new text begin and is
nonrefundable new text end .

(f) The fee for new text begin processing a request for the new text end issuance of a
copy of any document on file pertaining to a vital record or
statement that a related document cannot be found is deleted text begin $8 deleted text end new text begin $9 new text end . new text begin The
fee is payable at the time of application and is nonrefundable.
new text end

Sec. 18.

Minnesota Statutes 2004, section 144.226, is
amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Electronic verification. new text end

new text begin A fee for the
electronic verification of a vital event, when the information
being verified is obtained from a certified birth or death
record, shall be established through contractual or interagency
agreements with interested local, state, or federal government
agencies.
new text end

Sec. 19.

Minnesota Statutes 2004, section 144.226, is
amended by adding a subdivision to read:

new text begin Subd. 6. new text end

new text begin Alternative payment methods. new text end

new text begin Notwithstanding
subdivision 1, alternative payment methods may be approved and
implemented by the state registrar or a local registrar.
new text end

Sec. 20.

Minnesota Statutes 2004, 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 $5.21 deleted text end new text begin $6.36 new 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 July 1, 2006.
new text end

Sec. 21.

Minnesota Statutes 2004, section 144.551,
subdivision 1, is amended to read:

Subdivision 1.

Restricted construction or modification.

(a) The following construction or modification may not be
commenced:

(1) any erection, building, alteration, reconstruction,
modernization, improvement, extension, lease, or other
acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one
physical facility, complex, or site to another, or otherwise
results in an increase or redistribution of hospital beds within
the state; and

(2) the establishment of a new hospital.

(b) This section does not apply to:

(1) construction or relocation within a county by a
hospital, clinic, or other health care facility that is a
national referral center engaged in substantial programs of
patient care, medical research, and medical education meeting
state and national needs that receives more than 40 percent of
its patients from outside the state of Minnesota;

(2) a project for construction or modification for which a
health care facility held an approved certificate of need on May
1, 1984, regardless of the date of expiration of the
certificate;

(3) a project for which a certificate of need was denied
before July 1, 1990, if a timely appeal results in an order
reversing the denial;

(4) a project exempted from certificate of need
requirements by Laws 1981, chapter 200, section 2;

(5) a project involving consolidation of pediatric
specialty hospital services within the Minneapolis-St. Paul
metropolitan area that would not result in a net increase in the
number of pediatric specialty hospital beds among the hospitals
being consolidated;

(6) a project involving the temporary relocation of
pediatric-orthopedic hospital beds to an existing licensed
hospital that will allow for the reconstruction of a new
philanthropic, pediatric-orthopedic hospital on an existing site
and that will not result in a net increase in the number of
hospital beds. Upon completion of the reconstruction, the
licenses of both hospitals must be reinstated at the capacity
that existed on each site before the relocation;

(7) the relocation or redistribution of hospital beds
within a hospital building or identifiable complex of buildings
provided the relocation or redistribution does not result in:
(i) an increase in the overall bed capacity at that site; (ii)
relocation of hospital beds from one physical site or complex to
another; or (iii) redistribution of hospital beds within the
state or a region of the state;

(8) relocation or redistribution of hospital beds within a
hospital corporate system that involves the transfer of beds
from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the
capacity of the closed facility is transferred; (ii) the
capacity of the site or complex to which the beds are
transferred does not increase by more than 50 percent; (iii) the
beds are not transferred outside of a federal health systems
agency boundary in place on July 1, 1983; and (iv) the
relocation or redistribution does not involve the construction
of a new hospital building;

(9) a construction project involving up to 35 new beds in a
psychiatric hospital in Rice County that primarily serves
adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;

(10) a project to replace a hospital or hospitals with a
combined licensed capacity of 130 beds or less if: (i) the new
hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement
hospital, either at the time of construction of the initial
building or as the result of future expansion, will not exceed
70 licensed hospital beds, or the combined licensed capacity of
the hospitals, whichever is less;

(11) the relocation of licensed hospital beds from an
existing state facility operated by the commissioner of human
services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one
regional treatment center site to another; or from one building
or site to a new or existing building or site on the same
campus;

(12) the construction or relocation of hospital beds
deleted text begin operated by a hospital deleted text end new text begin within or among hospitals new text end having a
statutory obligation to provide hospital and medical services
for the indigent that does not result in a net increase in the
number of hospital beds;

(13) a construction project involving the addition of up to
31 new beds in an existing nonfederal hospital in Beltrami
County;

(14) a construction project involving the addition of up to
eight new beds in an existing nonfederal hospital in Otter Tail
County with 100 licensed acute care beds;

(15) a construction project involving the addition of 20
new hospital beds used for rehabilitation services in an
existing hospital in Carver County serving the southwest
suburban metropolitan area. Beds constructed under this clause
shall not be eligible for reimbursement under medical
assistance, general assistance medical care, or MinnesotaCare;

(16) a project for the construction or relocation of up to
20 hospital beds for the operation of up to two psychiatric
facilities or units for children provided that the operation of
the facilities or units have received the approval of the
commissioner of human services;

(17) a project involving the addition of 14 new hospital
beds to be used for rehabilitation services in an existing
hospital in Itasca County; deleted text begin or
deleted text end

(18) a project to add 20 licensed beds in existing space at
a hospital in Hennepin County that closed 20 rehabilitation beds
in 2002, provided that the beds are used only for rehabilitation
in the hospital's current rehabilitation building. If the beds
are used for another purpose or moved to another location, the
hospital's licensed capacity is reduced by 20 beds new text begin ; or
new text end

new text begin (19) a critical access hospital 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 delicensed beds since enactment of the Balanced Budget Act
of 1997, Public Law 105-33, to the extent that the critical
access hospital does not seek to exceed the maximum number of
beds permitted such hospital under federal law new text end .

Sec. 22.

Minnesota Statutes 2004, section 144.562,
subdivision 2, is amended to read:

Subd. 2.

Eligibility for license condition.

new text begin (a) new text end 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.

new text begin (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, new text end eligible hospitals are allowed a total of deleted text begin 1,460 deleted text end new text begin 2,000
new text end days of swing bed use per year deleted text begin , provided that no more than ten
hospital beds are used as swing beds at any one time deleted text end . new text begin 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 end

new text begin (c) Except 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, new text end the commissioner of
health deleted text begin must deleted text end new text begin may new text end approve swing bed use beyond deleted text begin 1,460 deleted text end new text begin 2,000 new text end days as
long as there are no Medicare certified skilled nursing facility
beds available within 25 miles of that hospital new text begin that are willing
to admit the patient. 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 new text end .

new text begin (d) After 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 end

new text begin (e) A 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 end

Sec. 23.

new text begin [144.602] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For purposes of sections
144.601 to 144.608, the terms defined in this section have the
meanings given them.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the
commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Major trauma. new text end

new text begin "Major trauma" means a sudden
severe injury or damage to the body caused by an external force
that results in potentially life-threatening injuries or that
could result in the following disabilities:
new text end

new text begin (1) impairment of cognitive or mental abilities;
new text end

new text begin (2) impairment of physical functioning; or
new text end

new text begin (3) disturbance of behavioral or emotional functioning.
new text end

new text begin Subd. 4. new text end

new text begin Trauma hospital. new text end

new text begin "Trauma hospital" means a
hospital that voluntarily meets the commissioner's criteria
under section 144.603 and that has been designated as a trauma
hospital under section 144.605.
new text end

Sec. 24.

new text begin [144.603] STATEWIDE TRAUMA SYSTEM CRITERIA.
new text end

new text begin Subdivision 1. new text end

new text begin Criteria established. new text end

new text begin The commissioner
shall adopt criteria to ensure that severely injured people are
promptly transported and treated at trauma hospitals appropriate
to the severity of injury. Minimum criteria shall govern
emergency medical service trauma triage and transportation
guidelines, designation of hospitals as trauma hospitals,
interhospital transfers, a trauma registry, and a trauma system
governance structure.
new text end

new text begin Subd. 2. new text end

new text begin Basis; verification. new text end

new text begin The commissioner shall
base the establishment, implementation, and modifications to the
criteria under subdivision 1 on the department-published
Minnesota comprehensive statewide trauma system plan. The
commissioner shall seek the advice of the Trauma Advisory
Council in implementing and updating the criteria, using
accepted and prevailing trauma transport, treatment, and
referral standards of the American College of Surgeons, the
American College of Emergency Physicians, the Minnesota
Emergency Medical Services Regulatory Board, the national Trauma
Resources Network, and other widely recognized trauma experts.
The commissioner shall adapt and modify the standards as
appropriate to accommodate Minnesota's unique geography and the
state's hospital and health professional distribution and shall
verify that the criteria are met by each hospital voluntarily
participating in the statewide trauma system.
new text end

new text begin Subd. 3. new text end

new text begin Rule exemption and report to legislature. new text end

new text begin In
developing and adopting the criteria under this section, the
commissioner of health is exempt from chapter 14, including
section 14.386. By September 1, 2009, the commissioner must
report to the legislature on implementation of the voluntary
trauma system, including recommendations on the need for
including the trauma system criteria in rule.
new text end

Sec. 25.

new text begin [144.604] TRAUMA TRIAGE AND TRANSPORTATION.
new text end

new text begin Subdivision 1. new text end

new text begin Transport requirement. new text end

new text begin Unless the
Emergency Medical Services Regulatory Board has approved a
licensed ambulance service's deviation from the guidelines under
section 144E.101, subdivision 14, the ambulance service must
transport major trauma patients from the scene to the highest
state-designated trauma hospital within 30 minutes' transport
time.
new text end

new text begin Subd. 2. new text end

new text begin Exceptions. new text end

new text begin Notwithstanding subdivision 1:
new text end

new text begin (1) patients with compromised airways must be transported
immediately to the nearest designated trauma hospital; and
new text end

new text begin (2) level II trauma hospitals capable of providing
definitive trauma care must not be bypassed to reach a level I
trauma hospital.
new text end

new text begin Subd. 3. new text end

new text begin Undesignated hospitals. new text end

new text begin No major trauma patient
shall be transported to a hospital not participating in the
statewide trauma system unless no trauma hospital is available
within 30 minutes' transport time.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2009.
new text end

Sec. 26.

new text begin [144.605] DESIGNATING TRAUMA HOSPITALS.
new text end

new text begin Subdivision 1. new text end

new text begin Naming privileges. new text end

new text begin Unless it has been
designated a trauma hospital by the commissioner, no hospital
shall use the term trauma center or trauma hospital in its name
or its advertising or shall otherwise indicate it has trauma
treatment capabilities.
new text end

new text begin Subd. 2. new text end

new text begin Designation; reverification. new text end

new text begin The commissioner
shall designate four levels of trauma hospitals. A hospital
that voluntarily meets the criteria for a particular level of
trauma hospital shall apply to the commissioner for designation
and, upon the commissioner's verifying the hospital meets the
criteria, be designated a trauma hospital at the appropriate
level for a three-year period. Prior to the expiration of the
three-year designation, a hospital seeking to remain part of the
voluntary system must apply for and successfully complete a
reverification process, be awaiting the site visit for the
reverification, or be awaiting the results of the site visit.
The commissioner may extend a hospital's existing designation
for up to 18 months on a provisional basis if the hospital has
applied for reverification in a timely manner but has not yet
completed the reverification process within the expiration of
the three-year designation and the extension is in the best
interest of trauma system patient safety. To be granted a
provisional extension, the hospital must be:
new text end

new text begin (1) scheduled and awaiting the site visit for
reverification;
new text end

new text begin (2) awaiting the results of the site visit; or
new text end

new text begin (3) responding to and correcting identified deficiencies
identified in the site visit.
new text end

new text begin Subd. 3. new text end

new text begin Acs verification. new text end

new text begin The commissioner shall grant
the appropriate level I, II, or III trauma hospital designation
to a hospital that successfully completes and passes the
American College of Surgeons (ACS) verification standards at the
hospital's cost, submits verification documentation to the
Trauma Advisory Council, and formally notifies the Trauma
Advisory Council of ACS verification.
new text end

new text begin Subd. 4. new text end

new text begin Level iii designation; not acs verified. new text end

new text begin (a)
The commissioner shall grant the appropriate level III trauma
hospital designation to a hospital that is not ACS verified but
that successfully completes the designation process under
paragraph (b).
new text end

new text begin (b) The hospital must complete and submit a self-reported
survey and application to the Trauma Advisory Council for
review, verifying that the hospital meets the criteria as a
level III trauma hospital. When the Trauma Advisory Council is
satisfied the application is complete, the commissioner shall
arrange a site review visit. Upon successful completion of the
site review, the review team shall make written recommendations
to the Trauma Advisory Council. If approved by the Trauma
Advisory Council, a letter of recommendation shall be sent to
the commissioner for final approval and designation.
new text end

new text begin Subd. 5. new text end

new text begin Level iv designation. new text end

new text begin (a) The commissioner
shall grant the appropriate level IV trauma hospital designation
to a hospital that successfully completes the designation
process under paragraph (b).
new text end

new text begin (b) The hospital must complete and submit a self-reported
survey and application to the Trauma Advisory Council for
review, verifying that the hospital meets the criteria as a
level IV trauma hospital. When the Trauma Advisory Council is
satisfied the application is complete, the council shall review
the application and, if the council approves the application,
send a letter of recommendation to the commissioner for final
approval and designation. The commissioner shall grant a level
IV designation and shall arrange a site review visit within
three years of the designation and every three years thereafter,
to coincide with the three-year reverification process.
new text end

new text begin Subd. 6. new text end

new text begin Changes in designation. new text end

new text begin Changes in a trauma
hospital's ability to meet the criteria for the hospital's level
of designation must be self-reported to the Trauma Advisory
Council and to other regional hospitals and local emergency
medical services providers and authorities. If the hospital
cannot correct its ability to meet the criteria for its level
within six months, the hospital may apply for redesignation at a
different level.
new text end

new text begin Subd. 7. new text end

new text begin Higher designation. new text end

new text begin A trauma hospital may apply
for a higher trauma hospital designation one time during the
hospital's three-year designation by completing the designation
process for that level of trauma hospital.
new text end

new text begin Subd. 8. new text end

new text begin Loss of designation. new text end

new text begin The commissioner may
refuse to designate or redesignate or may revoke a previously
issued trauma hospital designation if a hospital does not meet
the criteria of the statewide trauma plan, in the interests of
patient safety, or if a hospital denies or refuses a reasonable
request by the commissioner or the commissioner's designee to
verify information by correspondence or an on-site visit.
new text end

Sec. 27.

new text begin [144.606] INTERHOSPITAL TRANSFERS.
new text end

new text begin Subdivision 1. new text end

new text begin Written procedures required. new text end

new text begin A level III
or IV trauma hospital must have predetermined, written
procedures that direct the internal process for rapidly and
efficiently transferring a major trauma patient to definitive
care, including:
new text end

new text begin (1) clearly identified anatomic and physiologic criteria
that, if met, will immediately initiate transfer to definitive
care;
new text end

new text begin (2) a listing of appropriate ground and air transport
services, including primary and secondary telephone contact
numbers; and
new text end

new text begin (3) immediately available supplies, records, or other
necessary resources that will accompany a patient.
new text end

new text begin Subd. 2. new text end

new text begin Transfer agreements. new text end

new text begin (a) A level III or IV
trauma hospital may transfer patients to a hospital with which
the trauma hospital has a written transfer agreement.
new text end

new text begin (b) Each agreement must be current and with a trauma
hospital or trauma hospitals capable of caring for major trauma
injuries.
new text end

new text begin (c) A level III or IV trauma hospital must have a current
transfer agreement with a hospital that has special capabilities
in the treatment of burn injuries and a transfer agreement with
a second hospital that has special capabilities in the treatment
of burn injuries, should the primary transfer hospital be unable
to accept a burn patient.
new text end

Sec. 28.

new text begin [144.607] TRAUMA REGISTRY.
new text end

new text begin Subdivision 1. new text end

new text begin Registry participation required. new text end

new text begin A trauma
hospital must participate in the statewide trauma registry.
new text end

new text begin Subd. 2. new text end

new text begin Trauma reporting. new text end

new text begin A trauma hospital must report
major trauma injuries as part of the reporting for the traumatic
brain injury and spinal cord injury registry required in
sections 144.661 to 144.665.
new text end

new text begin Subd. 3. new text end

new text begin Application of other law. new text end

new text begin Sections 144.661 to
144.665 apply to a major trauma reported to the statewide trauma
registry, with the exception of sections 144.662, clause (2),
and 144.664, subdivision 3.
new text end

Sec. 29.

new text begin [144.608] TRAUMA ADVISORY COUNCIL.
new text end

new text begin Subdivision 1. new text end

new text begin Trauma advisory council established. new text end

new text begin (a)
A Trauma Advisory Council is established to advise, consult
with, and make recommendations to the commissioner on the
development, maintenance, and improvement of a statewide trauma
system.
new text end

new text begin (b) The council shall consist of the following members:
new text end

new text begin (1) a trauma surgeon certified by the American College of
Surgeons who practices in a level I or II trauma hospital;
new text end

new text begin (2) a general surgeon certified by the American College of
Surgeons whose practice includes trauma and who practices in a
designated rural area as defined under section 144.1501,
subdivision 1, paragraph (b);
new text end

new text begin (3) a neurosurgeon certified by the American Board of
Neurological Surgery who practices in a level I or II trauma
hospital;
new text end

new text begin (4) a trauma program nurse manager or coordinator
practicing in a level I or II trauma hospital;
new text end

new text begin (5) an emergency physician certified by the American
College of Emergency Physicians whose practice includes
emergency room care in a level I, II, III, or IV trauma
hospital;
new text end

new text begin (6) an emergency room nurse manager who practices in a
level III or IV trauma hospital;
new text end

new text begin (7) a family practice physician whose practice includes
emergency room care in a level III or IV trauma hospital located
in a designated rural area as defined under section 144.1501,
subdivision 1, paragraph (b);
new text end

new text begin (8) a nurse practitioner, as defined under section
144.1501, subdivision 1, paragraph (h), or a physician
assistant, as defined under section 144.1501, subdivision 1,
paragraph (j), whose practice includes emergency room care in a
level IV trauma hospital located in a designated rural area as
defined under section 144.1501, subdivision 1, paragraph (b);
new text end

new text begin (9) a pediatrician certified by the American Academy of
Pediatrics whose practice includes emergency room care in a
level I, II, III, or IV trauma hospital;
new text end

new text begin (10) an orthopedic surgeon certified by the American Board
of Orthopedic Surgery whose practice includes trauma and who
practices in a level I, II, or III trauma hospital;
new text end

new text begin (11) the state emergency medical services medical director
appointed by the Emergency Medical Services Regulatory Board;
new text end

new text begin (12) a hospital administrator of a level III or IV trauma
hospital located in a designated rural area as defined under
section 144.1501, subdivision 1, paragraph (b);
new text end

new text begin (13) a rehabilitation specialist whose practice includes
rehabilitation of patients with major trauma injuries or
traumatic brain injuries and spinal cord injuries as defined
under section 144.661;
new text end

new text begin (14) an attendant or ambulance director who is an EMT,
EMT-I, or EMT-P within the meaning of section 144E.001 and who
actively practices with a licensed ambulance service in a
primary service area located in a designated rural area as
defined under section 144.1501, subdivision 1, paragraph (b);
and
new text end

new text begin (15) the commissioner of public safety or the
commissioner's designee.
new text end

new text begin (c) Council members whose appointment is dependent on
practice in a level III or IV trauma hospital may be appointed
to an initial term based upon their statements that the hospital
intends to become a level III or IV facility by July 1, 2009.
new text end

new text begin Subd. 2. new text end

new text begin Council administration. new text end

new text begin (a) The council must
meet at least twice a year but may meet more frequently at the
call of the chair, a majority of the council members, or the
commissioner.
new text end

new text begin (b) The terms, compensation, and removal of members of the
council are governed by section 15.059, except that the council
expires June 30, 2015.
new text end

new text begin (c) The council may appoint subcommittees and workgroups.
Subcommittees shall consist of council members. Workgroups may
include noncouncil members. Noncouncil members shall be
compensated for workgroup activities under section 15.059,
subdivision 3, but shall receive expenses only.
new text end

new text begin Subd. 3. new text end

new text begin Regional trauma advisory councils. new text end

new text begin (a) Up to
eight regional trauma advisory councils may be formed as needed.
new text end

new text begin (b) Regional trauma advisory councils shall advise, consult
with, and make recommendation to the state Trauma Advisory
Council on suggested regional modifications to the statewide
trauma criteria that will improve patient care and accommodate
specific regional needs.
new text end

new text begin (c) Each regional advisory council must have no more than
15 members. The commissioner, in consultation with the
Emergency Medical Services Regulatory Board and the commissioner
of public safety, shall name the council members.
new text end

new text begin (d) Regional council members may receive expenses in the
same manner and amount as authorized by the plan adopted under
section 43A.18, subdivision 2.
new text end

Sec. 30.

Minnesota Statutes 2004, section 144.9504,
subdivision 2, is amended to read:

Subd. 2.

Lead risk assessment.

(a) An assessing agency
shall conduct a lead risk assessment of a residence according to
the venous blood lead level and time frame set forth in clauses
(1) to deleted text begin (5) deleted text end new text begin (4) new text end for purposes of secondary prevention:

(1) within 48 hours of a child or pregnant female in the
residence being identified to the agency as having a venous
blood lead level equal to or greater than deleted text begin 70 deleted text end new text begin 60 new text end micrograms of
lead per deciliter of whole blood;

(2) within five working days of a child or pregnant female
in the residence being identified to the agency as having a
venous blood lead level equal to or greater than 45 micrograms
of lead per deciliter of whole blood;

(3) within ten working days of a child in the residence
being identified to the agency as having a venous blood lead
level equal to or greater than deleted text begin 20 deleted text end new text begin 15 new text end micrograms of lead per
deciliter of whole blood; new text begin or
new text end

(4) deleted text begin within ten working days of a child in the residence
being identified to the agency as having a venous blood lead
level that persists in the range of 15 to 19 micrograms of lead
per deciliter of whole blood for 90 days after initial
identification; or
deleted text end

deleted text begin (5) deleted text end within ten working days of a pregnant female in the
residence being identified to the agency as having a venous
blood lead level equal to or greater than ten micrograms of lead
per deciliter of whole blood.

(b) Within the limits of available local, state, and
federal appropriations, an assessing agency may also conduct a
lead risk assessment for children with any elevated blood lead
level.

(c) In a building with two or more dwelling units, an
assessing agency shall assess the individual unit in which the
conditions of this section are met and shall inspect all common
areas accessible to a child. If a child visits one or more
other sites such as another residence, or a residential or
commercial child care facility, playground, or school, the
assessing agency shall also inspect the other sites. The
assessing agency shall have one additional day added to the time
frame set forth in this subdivision to complete the lead risk
assessment for each additional site.

(d) Within the limits of appropriations, the assessing
agency shall identify the known addresses for the previous 12
months of the child or pregnant female with venous blood lead
levels of at least deleted text begin 20 deleted text end new text begin 15 new text end micrograms per deciliter for the child
or at least ten micrograms per deciliter for the pregnant
female; notify the property owners, landlords, and tenants at
those addresses that an elevated blood lead level was found in a
person who resided at the property; and give them primary
prevention information. Within the limits of appropriations,
the assessing agency may perform a risk assessment and issue
corrective orders in the properties, if it is likely that the
previous address contributed to the child's or pregnant female's
blood lead level. The assessing agency shall provide the notice
required by this subdivision without identifying the child or
pregnant female with the elevated blood lead level. The
assessing agency is not required to obtain the consent of the
child's parent or guardian or the consent of the pregnant female
for purposes of this subdivision. This information shall be
classified as private data on individuals as defined under
section 13.02, subdivision 12.

(e) The assessing agency shall conduct the lead risk
assessment according to rules adopted by the commissioner under
section 144.9508. An assessing agency shall have lead risk
assessments performed by lead risk assessors licensed by the
commissioner according to rules adopted under section 144.9508.
If a property owner refuses to allow a lead risk assessment, the
assessing agency shall begin legal proceedings to gain entry to
the property and the time frame for conducting a lead risk
assessment set forth in this subdivision no longer applies. A
lead risk assessor or assessing agency may observe the
performance of lead hazard reduction in progress and shall
enforce the provisions of this section under section 144.9509.
Deteriorated painted surfaces, bare soil, and dust must be
tested with appropriate analytical equipment to determine the
lead content, except that deteriorated painted surfaces or bare
soil need not be tested if the property owner agrees to engage
in lead hazard reduction on those surfaces. The lead content of
drinking water must be measured if another probable source of
lead exposure is not identified. Within a standard metropolitan
statistical area, an assessing agency may order lead hazard
reduction of bare soil without measuring the lead content of the
bare soil if the property is in a census tract in which soil
sampling has been performed according to rules established by
the commissioner and at least 25 percent of the soil samples
contain lead concentrations above the standard in section
144.9508.

(f) Each assessing agency shall establish an administrative
appeal procedure which allows a property owner to contest the
nature and conditions of any lead order issued by the assessing
agency. Assessing agencies must consider appeals that propose
lower cost methods that make the residence lead safe. The
commissioner shall use the authority and appeal procedure
granted under sections 144.989 to 144.993.

(g) Sections 144.9501 to 144.9509 neither authorize nor
prohibit an assessing agency from charging a property owner for
the cost of a lead risk assessment.

Sec. 31.

Minnesota Statutes 2004, section 144.98,
subdivision 3, is amended to read:

Subd. 3.

Fees.

(a) An application for certification
under subdivision 1 must be accompanied by the biennial fee
specified in this subdivision. The fees are for:

(1) deleted text begin nonrefundable deleted text end base certification fee, deleted text begin $1,200
deleted text end new text begin $1,600 new text end ; deleted text begin and
deleted text end

(2) new text begin sample preparation techniques fees, $100 per technique;
and
new text end

new text begin (3) new text end test category certification fees:

Test Category Certification Fee

Clean water program bacteriology deleted text begin $600 deleted text end new text begin $800
new text end Safe drinking water program bacteriology deleted text begin $600 deleted text end new text begin $800
new text end Clean water program inorganic chemistry deleted text begin $600 deleted text end new text begin $800
new text end Safe drinking water program inorganic chemistry deleted text begin $600 deleted text end new text begin $800
new text end Clean water program chemistry metals deleted text begin $800 deleted text end new text begin $1,200
new text end Safe drinking water program chemistry metals deleted text begin $800 deleted text end new text begin $1,200
new text end Resource conservation and recovery program
chemistry metals deleted text begin $800 deleted text end new text begin $1,200
new text end Clean water program volatile organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Safe drinking water program
volatile organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Resource conservation and recovery program
volatile organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Underground storage tank program
volatile organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Clean water program other organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Safe drinking water program other organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
new text end Resource conservation and recovery program
other organic compounds deleted text begin $1,200 deleted text end new text begin $1,500
Clean water program radiochemistry new text end new text begin $2,500
Safe drinking water program radiochemistry new text end new text begin $2,500
Resource conservation and recovery program
agricultural contaminants new text end new text begin $2,500
Resource conservation and recovery program
emerging contaminants new text end new text begin $2,500
new text end

(b) deleted text begin The total biennial certification fee is the base fee
plus the applicable test category fees.
deleted text end

deleted text begin (c) deleted text end Laboratories located outside of this state that require
an on-site deleted text begin survey will deleted text end new text begin inspection shall new text end be assessed an
additional deleted text begin $2,500 deleted text end new text begin $3,750 new text end fee.

new text begin (c) The total biennial certification fee includes the base
fee, the sample preparation techniques fees, the test category
fees, and, when applicable, the on-site inspection fee.
new text end

(d) Fees must be set so that the total fees support the
laboratory certification program. Direct costs of the
certification service include program administration,
inspections, the agency's general support costs, and attorney
general costs attributable to the fee function.

(e) A change fee shall be assessed if a laboratory requests
additional analytes or methods at any time other than when
applying for or renewing its certification. The change fee is
equal to the test category certification fee for the analyte.

(f) A variance fee shall be assessed if a laboratory
requests and is granted a variance from a rule adopted under
this section. The variance fee is $500 per variance.

(g) Refunds or credits shall not be made for analytes or
methods requested but not approved.

(h) Certification of a laboratory shall not be awarded
until all fees are paid.

Sec. 32.

Minnesota Statutes 2004, section 144E.101, is
amended by adding a subdivision to read:

new text begin Subd. 14. new text end

new text begin Trauma triage and transport guidelines. new text end

new text begin A
licensee shall have written age appropriate trauma triage and
transport guidelines consistent with the criteria established by
the Trauma Advisory Council established under section 144.608,
and approved by the board. The board may approve a licensee's
requested deviations to the guidelines due to the availability
of local or regional trauma resources if the changes are in the
best interest of the patient's health.
new text end

Sec. 33.

new text begin [145.906] POSTPARTUM DEPRESSION EDUCATION AND
INFORMATION.
new text end

new text begin (a) The commissioner of health shall work with health care
facilities, licensed health and mental health care
professionals, mental health advocates, consumers, and families
in the state to develop materials and information about
postpartum depression, including treatment resources, and
develop policies and procedures to comply with this section.
new text end

new text begin (b) Physicians, traditional midwives, and other licensed
health care professionals providing prenatal care to women must
have available to women and their families information about
postpartum depression.
new text end

new text begin (c) Hospitals and other health care facilities in the state
must provide departing new mothers and fathers and other family
members, as appropriate, with written information about
postpartum depression, including its symptoms, methods of coping
with the illness, and treatment resources.
new text end

Sec. 34.

Minnesota Statutes 2004, section 145.9268, is
amended to read:

145.9268 COMMUNITY CLINIC GRANTS.

Subdivision 1.

Definition.

For purposes of this section,
"eligible community clinic" means:

(1) a new text begin nonprofit new text end clinic that deleted text begin provides deleted text end new text begin is established to
provide health new text end services deleted text begin under conditions as defined in Minnesota
Rules, part 9505.0255, deleted text end new text begin to low income or rural population groups;
provides medical, preventive, dental, or mental health primary
care services; new text end and utilizes a sliding fee scale new text begin or other
procedure new text end to determine eligibility for charity care new text begin or to ensure
that no person will be denied services because of inability to
pay new text end ;

(2) new text begin a governmental entity or new text end an Indian tribal government or
Indian health service unit new text begin that provides services and utilizes a
sliding fee scale or other procedure as described under clause
(1) new text end ; deleted text begin or
deleted text end

(3) a consortium of clinics comprised of entities under
clause (1) or (2) new text begin ; or
new text end

new text begin (4) a nonprofit, tribal, or governmental entity proposing
the establishment of a clinic that will provide services and
utilize a sliding fee scale or other procedure as described
under clause (1) new text end .

Subd. 2.

Grants authorized.

The commissioner of health
shall award grants to eligible community clinics to new text begin plan,
establish, or operate services to new text end improve the ongoing viability
of Minnesota's clinic-based safety net providers. Grants shall
be awarded to support the capacity of eligible community clinics
to serve low-income populations, reduce current or future
uncompensated care burdens, or provide for improved care
delivery infrastructure. The commissioner shall award grants to
community clinics in metropolitan and rural areas of the state,
and shall ensure geographic representation in grant awards among
all regions of the state.

Subd. 3.

Allocation of grants.

(a) To receive a grant
under this section, an eligible community clinic must submit an
application to the commissioner of health by the deadline
established by the commissioner. A grant may be awarded upon
the signing of a grant contract. Community clinics may apply
for and the commissioner may award grants for one-year or
two-year periods.

(b) An application must be on a form and contain
information as specified by the commissioner but at a minimum
must contain:

(1) a description of the purpose or project for which grant
funds will be used;

(2) a description of the problem or problems the grant
funds will be used to address; deleted text begin and
deleted text end

(3) a description of achievable objectives, a workplan, and
a timeline for implementation and completion of processes or
projects enabled by the grant new text begin ; and
new text end

new text begin (4) a process for documenting and evaluating results of the
grant new text end .

(c) The commissioner shall review each application to
determine whether the application is complete and whether the
applicant and the project are eligible for a grant. In
evaluating applications according to paragraph (d), the
commissioner shall establish criteria including, but not limited
to: the deleted text begin priority level deleted text end new text begin eligibility new text end of the project; the
applicant's thoroughness and clarity in describing the problem
grant funds are intended to address; a description of the
applicant's proposed project; new text begin a description of the population
demographics and service area of the proposed project; new text end the
manner in which the applicant will demonstrate the effectiveness
of any projects undertaken; and evidence of efficiencies and
effectiveness gained through collaborative efforts. The
commissioner may also take into account other relevant factors,
including, but not limited to, the percentage for which
uninsured patients represent the applicant's patient base and
the degree to which grant funds will be used to support services
increasing new text begin or maintaining new text end access to health care services.
During application review, the commissioner may request
additional information about a proposed project, including
information on project cost. Failure to provide the information
requested disqualifies an applicant. The commissioner has
discretion over the number of grants awarded.

(d) In determining which eligible community clinics will
receive grants under this section, the commissioner shall give
preference to those grant applications that show evidence of
collaboration with other eligible community clinics, hospitals,
health care providers, or community organizations. deleted text begin In addition,
the commissioner shall give priority, in declining order, to
grant applications for projects that: deleted text end new text begin In addition, the
commissioner shall give priority to grant applications for
projects involving electronic health records systems.
new text end

new text begin Subd. 3a. new text end

new text begin Awarding grants. new text end

new text begin (a) The commissioner may
award grants for activities to:
new text end

(1) provide a direct offset to expenses incurred for
services provided to the clinic's target population;

(2) establish, update, or improve information, data
collection, or billing systems new text begin , including electronic health
records systems new text end ;

(3) procure, modernize, remodel, or replace equipment used
in the delivery of direct patient care at a clinic;

(4) provide improvements for care delivery, such as
increased translation and interpretation services; deleted text begin or
deleted text end

(5) new text begin build a new clinic or expand an existing facility; or
new text end

new text begin (6) new text end other projects determined by the commissioner to
improve the ability of applicants to provide care to the
vulnerable populations they serve.

deleted text begin (e) deleted text end new text begin (b) new text end A grant awarded to an eligible community clinic may
not exceed $300,000 per eligible community clinic. For an
applicant applying as a consortium of clinics, a grant may not
exceed $300,000 per clinic included in the consortium. The
commissioner has discretion over the number of grants awarded.

Subd. 4.

Evaluation and report.

The commissioner of
health shall evaluate the overall effectiveness of the grant
program. The commissioner shall collect progress reports to
evaluate the grant program from the eligible community clinics
receiving grants. Every two years, as part of this evaluation,
the commissioner shall report to the legislature on deleted text begin priority
areas for grants set under subdivision 3 deleted text end new text begin the needs of community
clinics new text end and provide any recommendations for adding or
changing deleted text begin priority areas deleted text end new text begin eligible activities new text end .

Sec. 35.

Minnesota Statutes 2004, section 157.15, is
amended by adding a subdivision to read:

new text begin Subd. 19. new text end

new text begin Statewide hospitality fee. new text end

new text begin "Statewide
hospitality fee" means a fee to fund statewide food, beverage,
and lodging program development activities, including training
for inspection staff, technical assistance, maintenance of a
statewide integrated food safety and security information
system, and other related statewide activities that support the
food, beverage, and lodging program activities.
new text end

Sec. 36.

Minnesota Statutes 2004, section 157.16,
subdivision 2, is amended to read:

Subd. 2.

License renewal.

Initial and renewal licenses
for all food and beverage service establishments, hotels,
motels, lodging establishments, and resorts shall be issued for
the calendar year for which application is made and shall expire
on December 31 of such year. Any person who operates a place of
business after the expiration date of a license or without
having submitted an application and paid the fee shall be deemed
to have violated the provisions of this chapter and shall be
subject to enforcement action, as provided in the Health
Enforcement Consolidation Act, sections 144.989 to 144.993. In
addition, a penalty of deleted text begin $25 deleted text end new text begin $50 new text end shall be added to the total of
the license fee for any food and beverage service establishment
operating without a license as a mobile food unit, a seasonal
temporary or seasonal permanent food stand, or a special event
food stand, and a penalty of deleted text begin $50 deleted text end new text begin $100 new text end shall be added to the
total of the license fee for all restaurants, food carts,
hotels, motels, lodging establishments, and resorts operating
without a license new text begin for a period of up to 30 days. A late fee of
$300 shall be added to the license fee for establishments
operating more than 30 days without a license new text end .

Sec. 37.

Minnesota Statutes 2004, section 157.16, is
amended by adding a subdivision to read:

new text begin Subd. 2a. new text end

new text begin Food manager certification. new text end

new text begin An applicant for
certification or certification renewal as a food manager must
submit to the commissioner a $28 nonrefundable certification fee
payable to the Department of Health.
new text end

Sec. 38.

Minnesota Statutes 2004, section 157.16,
subdivision 3, is amended to read:

Subd. 3.

Establishment fees; definitions.

(a) The
following fees are required for food and beverage service
establishments, hotels, motels, lodging establishments, and
resorts licensed under this chapter. Food and beverage service
establishments must pay the highest applicable fee under
paragraph deleted text begin (e) deleted text end new text begin (d) new text end , clause (1), (2), (3), or (4), and
establishments serving alcohol must pay the highest applicable
fee under paragraph deleted text begin (e) deleted text end new text begin (d) new text end , clause (6) or (7). The license fee
for new operators previously licensed under this chapter for the
same calendar year is one-half of the appropriate annual license
fee, plus any penalty that may be required. The license fee for
operators opening on or after October 1 is one-half of the
appropriate annual license fee, plus any penalty that may be
required.

(b) All food and beverage service establishments, except
special event food stands, and all hotels, motels, lodging
establishments, and resorts shall pay an annual base fee of
deleted text begin $145 deleted text end new text begin $150 new text end .

(c) A special event food stand shall pay a flat fee
of deleted text begin $35 deleted text end new text begin $40 new text end annually. "Special event food stand" means a fee
category where food is prepared or served in conjunction with
celebrations, county fairs, or special events from a special
event food stand as defined in section 157.15.

(d) In addition to the base fee in paragraph (b), each food
and beverage service establishment, other than a special event
food stand, and each hotel, motel, lodging establishment, and
resort shall pay an additional annual fee for each fee category
deleted text begin as deleted text end new text begin , additional food service, or required additional inspection
new text end specified in this paragraph:

(1) Limited food menu selection, deleted text begin $40 deleted text end new text begin $50 new text end . "Limited food
menu selection" means a fee category that provides one or more
of the following:

(i) prepackaged food that receives heat treatment and is
served in the package;

(ii) frozen pizza that is heated and served;

(iii) a continental breakfast such as rolls, coffee, juice,
milk, and cold cereal;

(iv) soft drinks, coffee, or nonalcoholic beverages; or

(v) cleaning for eating, drinking, or cooking utensils,
when the only food served is prepared off site.

(2) Small establishment, including boarding establishments,
deleted text begin $75 deleted text end new text begin $100 new text end . "Small establishment" means a fee category that has
no salad bar and meets one or more of the following:

(i) possesses food service equipment that consists of no
more than a deep fat fryer, a grill, two hot holding containers,
and one or more microwave ovens;

(ii) serves dipped ice cream or soft serve frozen desserts;

(iii) serves breakfast in an owner-occupied bed and
breakfast establishment;

(iv) is a boarding establishment; or

(v) meets the equipment criteria in clause (3), item (i) or
(ii), and has a maximum patron seating capacity of not more than
50.

(3) Medium establishment, deleted text begin $210 deleted text end new text begin $260 new text end . "Medium establishment"
means a fee category that meets one or more of the following:

(i) possesses food service equipment that includes a range,
oven, steam table, salad bar, or salad preparation area;

(ii) possesses food service equipment that includes more
than one deep fat fryer, one grill, or two hot holding
containers; or

(iii) is an establishment where food is prepared at one
location and served at one or more separate locations.

Establishments meeting criteria in clause (2), item (v),
are not included in this fee category.

(4) Large establishment, deleted text begin $350 deleted text end new text begin $460 new text end . "Large establishment"
means either:

(i) a fee category that (A) meets the criteria in clause
(3), items (i) or (ii), for a medium establishment, (B) seats
more than 175 people, and (C) offers the full menu selection an
average of five or more days a week during the weeks of
operation; or

(ii) a fee category that (A) meets the criteria in clause
(3), item (iii), for a medium establishment, and (B) prepares
and serves 500 or more meals per day.

(5) Other food and beverage service, including food carts,
mobile food units, seasonal temporary food stands, and seasonal
permanent food stands, deleted text begin $40 deleted text end new text begin $50 new text end .

(6) Beer or wine table service, deleted text begin $40 deleted text end new text begin $50 new text end . "Beer or wine
table service" means a fee category where the only alcoholic
beverage service is beer or wine, served to customers seated at
tables.

(7) Alcoholic beverage service, other than beer or wine
table service, deleted text begin $105 deleted text end new text begin $135 new text end .

"Alcohol beverage service, other than beer or wine table
service" means a fee category where alcoholic mixed drinks are
served or where beer or wine are served from a bar.

(8) Lodging per sleeping accommodation unit, deleted text begin $6 deleted text end new text begin $8 new text end ,
including hotels, motels, lodging establishments, and resorts,
up to a maximum of deleted text begin $600 deleted text end new text begin $800 new text end . "Lodging per sleeping
accommodation unit" means a fee category including the number of
guest rooms, cottages, or other rental units of a hotel, motel,
lodging establishment, or resort; or the number of beds in a
dormitory.

(9) First public swimming pool, deleted text begin $140 deleted text end new text begin $180 new text end ; each additional
public swimming pool, deleted text begin $80 deleted text end new text begin $100 new text end . "Public swimming pool" means a
fee category that has the meaning given in Minnesota Rules, part
4717.0250, subpart 8.

(10) First spa, deleted text begin $80 deleted text end new text begin $110 new text end ; each additional spa, deleted text begin $40 deleted text end new text begin $50 new text end .
"Spa pool" means a fee category that has the meaning given in
Minnesota Rules, part 4717.0250, subpart 9.

(11) Private sewer or water, deleted text begin $40 deleted text end new text begin $50 new text end . "Individual private
water" means a fee category with a water supply other than a
community public water supply as defined in Minnesota Rules,
chapter 4720. "Individual private sewer" means a fee category
with an individual sewage treatment system which uses subsurface
treatment and disposal.

new text begin (12) Additional food service, $130. "Additional food
service" means a location at a food service establishment, other
than the primary food preparation and service area, used to
prepare or serve food to the public.
new text end

new text begin (13) Additional inspection fee, $300. "Additional
inspection fee" means a fee to conduct the second inspection
each year for elementary and secondary education facility school
lunch programs when required by the Richard B. Russell National
School Lunch Act.
new text end

(e) A fee of deleted text begin $150 deleted text end new text begin $350 new text end for review of the construction plans
must accompany the initial license application for deleted text begin food and
beverage service establishments deleted text end new text begin restaurants new text end , hotels, motels,
lodging establishments, or resorts new text begin with five or more sleeping
units new text end .

(f) When existing food and beverage service establishments,
hotels, motels, lodging establishments, or resorts are
extensively remodeled, a fee of deleted text begin $150 deleted text end new text begin $250 new text end must be submitted with
the remodeling plans. new text begin A fee of $250 must be submitted for new
construction or remodeling for a restaurant with a limited food
menu selection, a seasonal permanent food stand, a mobile food
unit, or a food cart, or for a hotel, motel, resort, or lodging
establishment addition of less than five sleeping units.
new text end

(g) Seasonal temporary food stands and special event food
stands are not required to submit construction or remodeling
plans for review.

Sec. 39.

Minnesota Statutes 2004, section 157.16, is
amended by adding a subdivision to read:

new text begin Subd. 3a. new text end

new text begin Statewide hospitality fee. new text end

new text begin Every person, firm,
or corporation that operates a licensed boarding establishment,
food and beverage service establishment, seasonal temporary or
permanent food stand, special event food stand, mobile food
unit, food cart, resort, hotel, motel, or lodging establishment
in Minnesota must submit to the commissioner a $35 annual
statewide hospitality fee for each licensed activity. The fee
for establishments licensed by the Department of Health is
required at the same time the licensure fee is due. For
establishments licensed by local governments, the fee is due by
July 1 of each year.
new text end

Sec. 40.

Minnesota Statutes 2004, section 157.20,
subdivision 2, is amended to read:

Subd. 2.

Inspection frequency.

The frequency of
inspections of the establishments shall be based on the degree
of health risk.

(a) High-risk establishments must be inspected at least
once deleted text begin a year deleted text end new text begin every 12 months new text end .

(b) Medium-risk establishments must be inspected at least
once every 18 months.

(c) Low-risk establishments must be inspected at least once
every deleted text begin two years deleted text end new text begin 24 months new text end .

Sec. 41.

Minnesota Statutes 2004, section 157.20,
subdivision 2a, is amended to read:

Subd. 2a.

Risk categories.

(a) [HIGH-RISK
ESTABLISHMENT.] "High-risk establishment" means any food and
beverage service establishment, hotel, motel, lodging
establishment, or resort that:

(1) serves potentially hazardous foods that require
extensive processing on the premises, including manual handling,
cooling, reheating, or holding for service;

(2) prepares foods several hours or days before service;

(3) serves menu items that epidemiologic experience has
demonstrated to be common vehicles of food-borne illness;

(4) has a public swimming pool; or

(5) draws its drinking water from a surface water supply.

(b) [MEDIUM-RISK ESTABLISHMENT.] "Medium-risk
establishment" means a food and beverage service establishment,
hotel, motel, lodging establishment, or resort that:

(1) serves potentially hazardous foods but with minimal
holding between preparation and service; or

(2) serves foods, such as pizza, that require extensive
handling followed by heat treatment.

(c) [LOW-RISK ESTABLISHMENT.] "Low-risk establishment"
means a food and beverage service establishment, hotel, motel,
lodging establishment, or resort that is not a high-risk or
medium-risk establishment.

(d) [RISK EXCEPTIONS.] Mobile food units, seasonal
permanent and seasonal temporary food stands, food carts, and
special event food stands are not inspected on an established
schedule and therefore are not defined as high-risk,
medium-risk, or low-risk establishments.

new text begin (e) new text end [SCHOOL INSPECTION FREQUENCY.] new text begin Elementary and
secondary school food service establishments must be inspected
according to the assigned risk category or by the frequency
required in the Richard B. Russell National School Lunch Act,
whichever frequency is more restrictive.
new text end

Sec. 42.

Minnesota Statutes 2004, section 326.01, is
amended by adding a subdivision to read:

new text begin Subd. 9a. new text end

new text begin Restricted plumbing contractor. new text end

new text begin A "restricted
plumbing contractor" is any person skilled in the planning,
superintending, and practical installation of plumbing who is
otherwise lawfully qualified to contract for plumbing and
installations and to conduct the business of plumbing, who is
familiar with the laws and rules governing the business of
plumbing, and who performs the plumbing trade in cities and
towns with a population of fewer than 5,000 according to federal
census.
new text end

Sec. 43.

Minnesota Statutes 2004, section 326.37,
subdivision 1, is amended to read:

Subdivision 1.

Rules.

The state commissioner of
health deleted text begin may deleted text end new text begin shall new text end , by rule, prescribe minimum new text begin uniform new text end standards
deleted text begin which shall be uniform, and which standards shall thereafter be
deleted text end effective for all new plumbing installations, including
additions, extensions, alterations, and replacements deleted text begin connected
with any water or sewage disposal system owned or operated by or
for any municipality, institution, factory, office building,
hotel, apartment building, or any other place of business
regardless of location or the population of the city or town in
which located deleted text end . Notwithstanding the provisions of Minnesota
Rules, part 4715.3130, as they apply to review of plans and
specifications, the commissioner may allow plumbing
construction, alteration, or extension to proceed without
approval of the plans or specifications by the commissioner.

The commissioner shall administer the provisions of
sections 326.37 to deleted text begin 326.45 deleted text end new text begin 326.451 new text end and for such purposes may
employ plumbing inspectors and other assistants.

Sec. 44.

Minnesota Statutes 2004, section 326.37, is
amended by adding a subdivision to read:

new text begin Subd. 1a. new text end

new text begin Inspection. new text end

new text begin All new plumbing installations,
including additions, extensions, alterations, and replacements,
shall be inspected by the commissioner for compliance with
accepted standards of construction for health, safety to life
and property, and compliance with applicable codes. The
Department of Health must have full implementation of its
inspections plan in place and operational July 1, 2007. This
subdivision does not apply where a political subdivision
requires, by ordinance, plumbing inspections similar to the
requirements of this subdivision.
new text end

Sec. 45.

Minnesota Statutes 2004, section 326.38, is
amended to read:

326.38 LOCAL REGULATIONS.

Any city having a system of waterworks or sewerage, or any
town in which reside over 5,000 people exclusive of any
statutory cities located therein, or the metropolitan airports
commission, may, by ordinance, adopt local regulations providing
for plumbing permits, bonds, approval of plans, and inspections
of plumbing, which regulations are not in conflict with the
plumbing standards on the same subject prescribed by the state
commissioner of health. No city or such town shall prohibit
plumbers licensed by the state commissioner of health from
engaging in or working at the business, except cities and
statutory cities which, prior to April 21, 1933, by ordinance
required the licensing of plumbers. new text begin No city or such town may
require a license for persons performing building sewer or water
service installation who have completed pipe laying training as
prescribed by the commissioner of health. new text end Any city by ordinance
may prescribe regulations, reasonable standards, and inspections
and grant permits to any person, firm, or corporation engaged in
the business of installing water softeners, who is not licensed
as a master plumber or journeyman plumber by the state
commissioner of health, to connect water softening and water
filtering equipment to private residence water distribution
systems, where provision has been previously made therefor and
openings left for that purpose or by use of cold water
connections to a domestic water heater; where it is not
necessary to rearrange, make any extension or alteration of, or
addition to any pipe, fixture or plumbing connected with the
water system except to connect the water softener, and provided
the connections so made comply with minimum standards prescribed
by the state commissioner of health.

Sec. 46.

Minnesota Statutes 2004, section 326.40,
subdivision 1, is amended to read:

Subdivision 1.

deleted text begin plumbers must be licensed in certain
cities; master and journeyman plumbers deleted text end new text begin master, journeyman, and
restricted plumbing contractors new text end ; plumbing on one's own premises;
rules for examination.

deleted text begin In any city now or hereafter having
5,000 or more population, according to the last federal census,
and having a system of waterworks or sewerage, no person, firm,
or corporation shall engage in or work at the business of a
master plumber or journeyman plumber unless licensed to do so by
the state commissioner of health. deleted text end new text begin No person, firm, or
corporation may engage in or work at the business of a master
plumber, restricted plumbing contractor, or journeyman plumber
unless licensed to do so by the commissioner of health under
sections 326.37 to 326.451. A license is not required for:
new text end

new text begin (1) persons performing building sewer or water service
installation who have completed pipe laying training as
prescribed by the commissioner of health; or
new text end

new text begin (2) persons selling an appliance plumbing installation
service at point of sale if the installation work is performed
by a plumber licensed under sections 326.37 to 326.451.
new text end

A master plumber may also work as a journeyman plumber.
Anyone not so licensed may do plumbing work which complies with
the provisions of the minimum standard prescribed by the state
commissioner of health on premises or that part of premises
owned and actually occupied by the worker as a residence, unless
otherwise forbidden to do so by a local ordinance.

deleted text begin In any such city deleted text end No person, firm, or corporation shall
engage in the business of installing plumbing nor install
plumbing in connection with the dealing in and selling of
plumbing material and supplies unless at all times a licensed
master plumber new text begin or restricted plumbing contractor new text end , who shall be
responsible for proper installation, is in charge of the
plumbing work of the person, firm, or corporation.

The Department of Health shall prescribe rules, not
inconsistent herewith, for the examination and licensing of
plumbers.

Sec. 47.

new text begin [326.402] RESTRICTED PLUMBING CONTRACTOR
LICENSE.
new text end

new text begin Subdivision 1. new text end

new text begin Licensure. new text end

new text begin The commissioner shall grant a
restricted plumbing contractor license to any person who applies
to the commissioner and provides evidence of having at least two
years of practical plumbing experience in the plumbing trade
preceding application for licensure.
new text end

new text begin Subd. 2. new text end

new text begin Use of license. new text end

new text begin A restricted plumbing
contractor may engage in the plumbing trade only in cities and
towns with a population of fewer than 5,000 according to federal
census.
new text end

new text begin Subd. 3. new text end

new text begin Application period. new text end

new text begin Applications for restricted
plumbing contractor licenses must be submitted to the
commissioner prior to January 1, 2006.
new text end

new text begin Subd. 4. new text end

new text begin Use period for restricted plumbing contractor
license. new text end

new text begin A restricted plumbing contractor license does not
expire and remains in effect for as long as that person engages
in the plumbing trade.
new text end

new text begin Subd. 5. new text end

new text begin Prohibition of transference. new text end

new text begin A restricted
plumbing contractor license must not be transferred or sold to
any other person.
new text end

new text begin Subd. 6. new text end

new text begin Restricted plumbing contractor license renewal.
new text end

new text begin The commissioner shall adopt rules for renewal of the restricted
plumbing contractor license.
new text end

Sec. 48.

Minnesota Statutes 2004, section 326.42,
subdivision 2, is amended to read:

Subd. 2.

Fees.

Plumbing system plans and specifications
that are submitted to the commissioner for review shall be
accompanied by the appropriate plan examination fees. If the
commissioner determines, upon review of the plans, that
inadequate fees were paid, the necessary additional fees shall
be paid prior to plan approval. The commissioner shall charge
the following fees for plan reviews and audits of plumbing
installations for public, commercial, and industrial buildings:

(1) systems with both water distribution and drain, waste,
and vent systems and having:

(i) 25 or fewer drainage fixture units, $150;

(ii) 26 to 50 drainage fixture units, $250;

(iii) 51 to 150 drainage fixture units, $350;

(iv) 151 to 249 drainage fixture units, $500;

(v) 250 or more drainage fixture units, $3 per drainage
fixture unit to a maximum of $4,000; and

(vi) interceptors, separators, or catch basins, $70 per
interceptor, separator, or catch basin new text begin design new text end ;

(2) building sewer service only, $150;

(3) building water service only, $150;

(4) building water distribution system only, no drainage
system, $5 per supply fixture unit or $150, whichever is
greater;

(5) storm drainage system, a minimum fee of $150 or:

(i) $50 per drain opening, up to a maximum of $500; and

(ii) $70 per interceptor, separator, or catch basin new text begin design new text end ;

(6) manufactured home park or campground, one to 25 sites,
$300;

(7) manufactured home park or campground, 26 to 50 sites,
$350;

(8) manufactured home park or campground, 51 to 125 sites,
$400;

(9) manufactured home park or campground, more than 125
sites, $500;

(10) accelerated review, double the regular fee, one-half
to be refunded if no response from the commissioner within 15
business days; and

(11) revision to previously reviewed or incomplete plans:

(i) review of plans for which commissioner has issued two
or more requests for additional information, per review, $100 or
ten percent of the original fee, whichever is greater;

(ii) proposer-requested revision with no increase in
project scope, $50 or ten percent of original fee, whichever is
greater; and

(iii) proposer-requested revision with an increase in
project scope, $50 plus the difference between the original
project fee and the revised project fee.

Sec. 49.

new text begin [326.451] INSPECTORS.
new text end

new text begin (a) The commissioner shall set all reasonable criteria and
procedures by rule for inspector certification, certification
period, examinations, examination fees, certification fees, and
renewal of certifications.
new text end

new text begin (b) The commissioner shall adopt reasonable rules
establishing criteria and procedures for refusal to grant or
renew inspector certifications, and for suspension and
revocation of inspector certifications.
new text end

new text begin (c) The commissioner shall refuse to renew or grant
inspector certifications, or suspend or revoke inspector
certifications, in accordance with the commissioner's criteria
and procedures as adopted by rule.
new text end

Sec. 50. new text begin CERVICAL CANCER ELIMINATION STUDY.
new text end

new text begin (a) The commissioner of health shall develop a statewide
integrated and comprehensive cervical cancer prevention plan,
including strategies for promoting and implementing the plan.
The plan must include activities that identify and implement
methods to improve the cervical cancer screening rates in
Minnesota, including, but not limited to:
new text end

new text begin (1) identifying and disseminating appropriate
evidence-based cervical cancer screening guidelines to be used
in Minnesota;
new text end

new text begin (2) increasing the use of appropriate screening based on
these guidelines for patients seen by medical groups in
Minnesota and monitoring results of these medical groups; and
new text end

new text begin (3) reducing the number of women who should but have not
been screened.
new text end

new text begin (b) In developing the plan, the commissioner shall also
identify and examine limitations and barriers in providing
cervical cancer screening, diagnosis tools, and treatment,
including, but not limited to, medical care reimbursement,
treatment costs, and the availability of insurance coverage.
new text end

new text begin (c) The commissioner may work with a nonprofit quality
improvement organization in Minnesota to identify evidence-based
guidelines for cervical cancer screening and to identify methods
to improve the cervical cancer screening rates among medical
groups; and may work with a nonprofit health care result
reporting organization to monitor results by medical groups in
Minnesota.
new text end

new text begin (d) The commissioner may convene an advisory committee that
includes representatives of health care providers, the American
Cancer Society, health plan companies, the University of
Minnesota Academic Health Center, community health boards, and
the general public.
new text end

new text begin (e) The commissioner shall submit a report to the
legislature by January 15, 2006, on:
new text end

new text begin (1) the statewide cervical cancer prevention plan,
including a description of the plan activities and strategies
developed for promoting and implementing the plan;
new text end

new text begin (2) methods for monitoring the results by medical groups
and by the entire state of cervical cancer screening improvement
activities; and
new text end

new text begin (3) recommended changes to existing laws, programs, or
services in terms of reducing the occurrence of cervical cancer
by improving insurance coverage for the prevention, diagnosis,
and treatment for cervical cancer.
new text end

Sec. 51. new text begin CLINICAL TRIAL WORK GROUP; REPORT.
new text end

new text begin The commissioners of health and commerce shall, in
consultation with the commissioner of employee relations,
convene a work group regarding health plan coverage of routine
care associated with clinical trials. The work group must
explore what high-quality clinical trials beyond cancer-only
clinical trials should be covered by health plans. All other
types of clinical trials, disease-based or technology-based such
as drug trials or device trials should be considered. The work
group shall use the current, cancer-only model voluntary
agreement that includes definitions of high-quality clinical
trials, protocol induced costs, and routine care costs as a
starting point for discussions. As determined appropriate, the
work group shall establish model voluntary agreement guidelines
for health plan coverage of routine patient care costs incurred
by patients participating in high quality clinical trials. The
work group shall be made up of representatives of consumers,
patient advocates, health plan companies, fully insured and
self-insured purchasers, providers, and other health care
professionals involved in the care and treatment of patients.
The commissioners shall submit the findings and recommendations
of the work group to the chairs of the senate and house
committees having jurisdiction over health policy and finance by
January 15, 2006.
new text end

Sec. 52. new text begin PUBLIC HEALTH INFORMATION NETWORK.
new text end

new text begin (a) The commissioner of health shall work with local public
health departments to develop a public health information
network. The development of the network must be consistent with
the recommendations, goals, and strategies of the Minnesota
public health information network report to the 2005 legislature
and the e-health initiative.
new text end

new text begin (b) The commissioner of health shall work with the
commissioner of human services to determine how data from care
systems can be utilized to assist with population health needs
assessments and targeted prevention efforts. The commissioner
of health shall incorporate these findings into the development
of a Minnesota public health information network and the
e-health initiative.
new text end

Sec. 53. new text begin REPORT TO LEGISLATURE ON SWING BED USAGE.
new text end

new text begin The commissioner of health shall review swing bed and
related data reported under Minnesota Statutes, sections
144.562, subdivision 3, paragraph (f); 144.564; and 144.698.
The commissioner shall report and make any appropriate
recommendations to the legislature by January 31, 2007, on:
new text end

new text begin (1) the use of swing bed days by all hospitals and by
critical access hospitals;
new text end

new text begin (2) occupancy rates in skilled nursing facilities within 25
miles of hospitals with swing beds; and
new text end

new text begin (3) information provided by rural providers on the use of
swing beds and the adequacy of rural services across the
continuum of care.
new text end

Sec. 54. new text begin IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORDS
SYSTEM.
new text end

new text begin The commissioner of health, in consultation with the
electronic health record planning work group established in Laws
2004, chapter 288, article 7, section 7, shall develop a
statewide plan for all hospitals and physician group practices
to have in place an interoperable electronic health records
system by January 1, 2015. In developing the plan, the
commissioner shall consider:
new text end

new text begin (1) creating financial assistance to hospitals and
providers for implementing or updating an electronic health
records system, including, but not limited to, the establishment
of grants, financial incentives, or low-interest loans;
new text end

new text begin (2) addressing specific needs and concerns of safety-net
hospitals, community health clinics, and other health care
providers who serve low-income patients in implementing an
electronic records system within the hospital or practice; and
new text end

new text begin (3) providing assistance in the development of possible
alliances or collaborations among providers.
new text end

new text begin The commissioner shall provide preliminary reports to the
chairs of the senate and house committees with jurisdiction over
health care policy and finance biennially beginning January 15,
2007, on the status of reaching the goal for all hospitals and
physician group practices to have an interoperable electronic
health records system in place by January 1, 2015. The reports
shall include recommendations on statutory language necessary to
implement the plan, including possible financing options.
new text end

Sec. 55. new text begin RULE AMENDMENT.
new text end

new text begin The commissioner of health shall amend Minnesota Rules,
part 4626.2015, subparts 3, item C; and 6, item B, to conform
with Minnesota Statutes, section 157.16, subdivision 2a. The
commissioner may use the good cause exemption under Minnesota
Statutes, section 14.388, subdivision 1, clause (3). Minnesota
Statutes, section 14.386, does not apply, except to the extent
provided under Minnesota Statutes, section 14.388.
new text end

Sec. 56. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall change all references to
Minnesota Statutes, section 326.45, to Minnesota Statutes,
section 326.451, in Minnesota Statutes, sections 144.99, 326.44,
326.61, and 326.65.
new text end

Sec. 57. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 144.1486; 157.215; and
326.45, are repealed.
new text end

ARTICLE 2

HEALTH CARE - DEPARTMENT OF HUMAN SERVICES

Section 1.

Minnesota Statutes 2004, section 62D.12,
subdivision 19, is amended to read:

Subd. 19.

Coverage of service.

A health maintenance
organization may not deny or limit coverage of a service which
the enrollee has already received solely on the basis of lack of
prior authorization or second opinion, to the extent that the
service would otherwise have been covered under the member's
contract by the health maintenance organization had prior
authorization or second opinion been obtained. new text begin This subdivision
does not apply to health maintenance organizations for services
provided in the prepaid health programs administered under
chapter 256B, 256D, or 256L.
new text end

Sec. 2.

Minnesota Statutes 2004, section 62J.43, is
amended to read:

62J.43 deleted text begin BEST PRACTICES deleted text end new text begin EVIDENCE-BASED HEALTH CARE
GUIDELINES new text end AND QUALITY IMPROVEMENT.

deleted text begin (a) deleted text end new text begin Subdivision 1. new text end [ADOPTION OF deleted text begin BEST
PRACTICES deleted text end new text begin EVIDENCE-BASED HEALTH CARE GUIDELINES new text end .] To improve
quality and reduce health care costs, state agencies shall
encourage the deleted text begin adoption deleted text end new text begin use new text end of deleted text begin best practice deleted text end new text begin evidence-based
health care new text end guidelines and participation in deleted text begin best practices
deleted text end new text begin quality of care new text end measurement activities by deleted text begin physicians deleted text end new text begin medical
groups, hospitals new text end , other health care providers, and health plan
companies. The commissioner of health shall facilitate access
to deleted text begin best practice deleted text end new text begin evidence-based health care new text end guidelines and
quality of care measurement information deleted text begin to deleted text end new text begin for new text end providers,
purchasers, and consumers by:

(1) identifying and promoting deleted text begin local community-based,
physician-designed best practices care deleted text end new text begin evidence-based health
care guidelines new text end across the Minnesota health care system new text begin using
local community-based, physician-designed guidelines whenever
they are available and meet the criteria set forth in
subdivision 2 new text end ;

(2) disseminating information available to the commissioner
on deleted text begin adherence to best practices care by physicians deleted text end new text begin the
performance of Minnesota medical groups, hospitals, new text end and other
health care providers deleted text begin in Minnesota deleted text end new text begin in providing care in
accordance with evidence-based health care guidelines new text end ;

(3) educating consumers and purchasers on how to
deleted text begin effectively deleted text end use this information new text begin effectively new text end in choosing their
providers and in making purchasing decisions; and

(4) making deleted text begin best practices deleted text end new text begin evidence-based health care
guidelines new text end and quality new text begin of new text end care measurement information available
to enrollees and program participants through the Department of
Health's Web site. The commissioner may convene an advisory
committee to ensure that the Web site is designed to provide
user friendly and easy accessibility.

deleted text begin (b) The commissioner of health shall collaborate with a
nonprofit Minnesota quality improvement organization
specializing in best practices and quality of care measurements
to provide best practices criteria and assist in the collection
of the data.
deleted text end

deleted text begin (c) deleted text end new text begin Subd. 2. new text end [CRITERIA FOR EVIDENCE-BASED HEALTH CARE
GUIDELINES.] new text begin Guidelines identified under this section must meet
the following criteria:
new text end

new text begin (1) the scope and intended use of the guideline are clearly
stated;
new text end

new text begin (2) the authors are listed and any conflicts of interest
are disclosed;
new text end

new text begin (3) the authors represent all pertinent clinical fields or
other means of input have been used for pertinent clinical
fields not represented among the authors;
new text end

new text begin (4) the development process is explicitly stated;
new text end

new text begin (5) the guideline is grounded in evidence;
new text end

new text begin (6) the evidence is cited and graded with respect to its
strength;
new text end

new text begin (7) the document itself is clear and practical;
new text end

new text begin (8) the document is flexible in use, with exceptions noted
or provided for with general statements;
new text end

new text begin (9) measures are included for use in systems improvement
pursued to improve the likelihood that health care will be
provided in accordance with the guideline; and
new text end

new text begin (10) the document provides for scheduled reviews and
updating.
new text end

new text begin Subd. 3. new text end

new text begin Identification of evidence-based health care
guidelines. new text end

new text begin In order to identify evidence-based guidelines for
promotion under this section, the commissioner of health shall
collaborate with a nonprofit Minnesota quality improvement
organization that specializes in producing guidelines and using
them to improve health care. The guidelines identified may be
ones produced by that organization or ones produced by other
nonprofit Minnesota or national organizations, provided that the
guidelines fulfill the criteria set forth in subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Initial evidence-based health care guidelines.
new text end

The deleted text begin initial best practices and quality of care measurement
criteria developed deleted text end new text begin topics of the evidence-based health care
guidelines initially identified and promoted new text end shall include
asthma, diabetes, deleted text begin and at least two other preventive health
measures. Hypertension and coronary artery disease shall be
included within one year following availability deleted text end new text begin hypertension,
coronary artery disease, depression, preventive services, acute
myocardial infarction, heart failure, pneumonia, and surgical
infections. The guidelines on these topics shall be identified
and promotion begun by December 15, 2005 new text end .

deleted text begin (d) The commissioners of human services and employee
relations may use the data to make decisions about contracts
they enter into with health plan companies.
deleted text end

deleted text begin (e) deleted text end new text begin Subd. 5. new text end [LIMITATIONS.] This section does not apply if
the deleted text begin best practices deleted text end new text begin evidence-based health care new text end guidelines
authorize or recommend denial of treatment, food, or fluids
necessary to sustain life on the basis of the patient's age or
expected length of life or the patient's present or predicted
disability, degree of medical dependency, or quality of life.

deleted text begin (f) The commissioner of health, human services, and
employee relations shall report to the legislature by January
15, 2005, on the status of best practices and quality of care
initiatives, and shall present recommendations to the
legislature on any statutory changes needed to increase the
effectiveness of these initiatives.
deleted text end

deleted text begin (g) This section expires June 30, 2006.
deleted text end

Sec. 3.

Minnesota Statutes 2004, section 62M.06,
subdivision 2, is amended to read:

Subd. 2.

Expedited appeal.

(a) When an initial
determination not to certify a health care service is made prior
to or during an ongoing service requiring review and the
attending health care professional believes that the
determination warrants an expedited appeal, the utilization
review organization must ensure that the enrollee and the
attending health care professional have an opportunity to appeal
the determination over the telephone on an expedited basis. In
such an appeal, the utilization review organization must ensure
reasonable access to its consulting physician or health care
provider. new text begin For review of initial determinations not to certify a
service for prepaid health care programs under chapter 256B,
256D, or 256L, the health care provider conducting the review
must follow coverage policies adopted by the health plan company
that are based upon published evidence-based health care
guidelines as established by a nonprofit Minnesota quality
improvement organization, a nationally recognized guideline
development organization, or by the professional association of
the specialty that typically provides the service provided that
the guidelines meet the criteria set forth in section 62J.43,
subdivision 2.
new text end

(b) The utilization review organization shall notify the
enrollee and attending health care professional by telephone of
its determination on the expedited appeal as expeditiously as
the enrollee's medical condition requires, but no later than 72
hours after receiving the expedited appeal.

(c) If the determination not to certify is not reversed
through the expedited appeal, the utilization review
organization must include in its notification the right to
submit the appeal to the external appeal process described in
section 62Q.73 and the procedure for initiating the process.
This information must be provided in writing to the enrollee and
the attending health care professional as soon as practical.

Sec. 4.

Minnesota Statutes 2004, section 62M.06,
subdivision 3, is amended to read:

Subd. 3.

Standard appeal.

The utilization review
organization must establish procedures for appeals to be made
either in writing or by telephone.

(a) A utilization review organization shall notify in
writing the enrollee, attending health care professional, and
claims administrator of its determination on the appeal within
30 days upon receipt of the notice of appeal. If the
utilization review organization cannot make a determination
within 30 days due to circumstances outside the control of the
utilization review organization, the utilization review
organization may take up to 14 additional days to notify the
enrollee, attending health care professional, and claims
administrator of its determination. If the utilization review
organization takes any additional days beyond the initial 30-day
period to make its determination, it must inform the enrollee,
attending health care professional, and claims administrator, in
advance, of the extension and the reasons for the extension.

(b) The documentation required by the utilization review
organization may include copies of part or all of the medical
record and a written statement from the attending health care
professional.

(c) Prior to upholding the initial determination not to
certify for clinical reasons, the utilization review
organization shall conduct a review of the documentation by a
physician who did not make the initial determination not to
certify. new text begin For review of initial determinations not to certify a
service for prepaid health care programs under chapter 256B,
256D, or 256L, the physician conducting the review must follow
coverage policies adopted by the health plan company that are
based upon publicly available evidence-based health care
guidelines as established by a nonprofit Minnesota quality
improvement organization, a nationally recognized guideline
development organization, or by the professional association of
the specialty that typically provides the service provided that
the guidelines meet the criteria set forth in section 62J.43,
subdivision 2.
new text end

(d) The process established by a utilization review
organization may include defining a period within which an
appeal must be filed to be considered. The time period must be
communicated to the enrollee and attending health care
professional when the initial determination is made.

(e) An attending health care professional or enrollee who
has been unsuccessful in an attempt to reverse a determination
not to certify shall, consistent with section 72A.285, be
provided the following:

(1) a complete summary of the review findings;

(2) qualifications of the reviewers, including any license,
certification, or specialty designation; and

(3) the relationship between the enrollee's diagnosis and
the review criteria used as the basis for the decision,
including the specific rationale for the reviewer's decision.

(f) In cases of appeal to reverse a determination not to
certify for clinical reasons, the utilization review
organization must ensure that a physician of the utilization
review organization's choice in the same or a similar specialty
as typically manages the medical condition, procedure, or
treatment under discussion is reasonably available to review the
case.

(g) If the initial determination is not reversed on appeal,
the utilization review organization must include in its
notification the right to submit the appeal to the external
review process described in section 62Q.73 and the procedure for
initiating the external process.

Sec. 5.

Minnesota Statutes 2004, section 256.045,
subdivision 3, is amended to read:

Subd. 3.

State agency hearings.

(a) State agency
hearings are available for the following: (1) any person
applying for, receiving or having received public assistance,
medical care, or a program of social services granted by the
state agency or a county agency or the federal Food Stamp Act
whose application for assistance is denied, not acted upon with
reasonable promptness, or whose assistance is suspended,
reduced, terminated, or claimed to have been incorrectly paid;
(2) any patient or relative aggrieved by an order of the
commissioner under section 252.27; (3) a party aggrieved by a
ruling of a prepaid health plan; (4) except as provided under
chapter 245C, any individual or facility determined by a lead
agency to have maltreated a vulnerable adult under section
626.557 after they have exercised their right to administrative
reconsideration under section 626.557; (5) any person whose
claim for foster care payment according to a placement of the
child resulting from a child protection assessment under section
626.556 is denied or not acted upon with reasonable promptness,
regardless of funding source; (6) any person to whom a right of
appeal according to this section is given by other provision of
law; (7) an applicant aggrieved by an adverse decision to an
application for a hardship waiver under section 256B.15; (8) new text begin an
applicant aggrieved by an adverse decision to an application or
redetermination for a Medicare Part D prescription drug subsidy
under section 256B.04, subdivision 4a; (9) new text end except as provided
under chapter 245A, an individual or facility determined to have
maltreated a minor under section 626.556, after the individual
or facility has exercised the right to administrative
reconsideration under section 626.556; or deleted text begin (9) deleted text end new text begin (10) new text end except as
provided under chapter 245C, an individual disqualified under
sections 245C.14 and 245C.15, on the basis of serious or
recurring maltreatment; a preponderance of the evidence that the
individual has committed an act or acts that meet the definition
of any of the crimes listed in section 245C.15, subdivisions 1
to 4; or for failing to make reports required under section
626.556, subdivision 3, or 626.557, subdivision 3. Hearings
regarding a maltreatment determination under clause (4)
or deleted text begin (8) deleted text end new text begin (9) new text end and a disqualification under this clause in which the
basis for a disqualification is serious or recurring
maltreatment, which has not been set aside under sections
245C.22 and 245C.23, shall be consolidated into a single fair
hearing. In such cases, the scope of review by the human
services referee shall include both the maltreatment
determination and the disqualification. The failure to exercise
the right to an administrative reconsideration shall not be a
bar to a hearing under this section if federal law provides an
individual the right to a hearing to dispute a finding of
maltreatment. Individuals and organizations specified in this
section may contest the specified action, decision, or final
disposition before the state agency by submitting a written
request for a hearing to the state agency within 30 days after
receiving written notice of the action, decision, or final
disposition, or within 90 days of such written notice if the
applicant, recipient, patient, or relative shows good cause why
the request was not submitted within the 30-day time limit.

The hearing for an individual or facility under clause (4),
deleted text begin (8) deleted text end new text begin (9) new text end , or deleted text begin (9) deleted text end new text begin (10) new text end is the only administrative appeal to the
final agency determination specifically, including a challenge
to the accuracy and completeness of data under section 13.04.
Hearings requested under clause (4) apply only to incidents of
maltreatment that occur on or after October 1, 1995. Hearings
requested by nursing assistants in nursing homes alleged to have
maltreated a resident prior to October 1, 1995, shall be held as
a contested case proceeding under the provisions of chapter 14.
Hearings requested under clause deleted text begin (8) deleted text end new text begin (9) new text end apply only to incidents
of maltreatment that occur on or after July 1, 1997. A hearing
for an individual or facility under clause deleted text begin (8) deleted text end new text begin (9) new text end is only
available when there is no juvenile court or adult criminal
action pending. If such action is filed in either court while
an administrative review is pending, the administrative review
must be suspended until the judicial actions are completed. If
the juvenile court action or criminal charge is dismissed or the
criminal action overturned, the matter may be considered in an
administrative hearing.

For purposes of this section, bargaining unit grievance
procedures are not an administrative appeal.

The scope of hearings involving claims to foster care
payments under clause (5) shall be limited to the issue of
whether the county is legally responsible for a child's
placement under court order or voluntary placement agreement
and, if so, the correct amount of foster care payment to be made
on the child's behalf and shall not include review of the
propriety of the county's child protection determination or
child placement decision.

(b) A vendor of medical care as defined in section 256B.02,
subdivision 7, or a vendor under contract with a county agency
to provide social services is not a party and may not request a
hearing under this section, except if assisting a recipient as
provided in subdivision 4.

(c) An applicant or recipient is not entitled to receive
social services beyond the services included in the amended
community social services plan.

(d) The commissioner may summarily affirm the county or
state agency's proposed action without a hearing when the sole
issue is an automatic change due to a change in state or federal
law.

Sec. 6.

Minnesota Statutes 2004, section 256.045,
subdivision 3a, is amended to read:

Subd. 3a.

Prepaid health plan appeals.

(a) All prepaid
health plans under contract to the commissioner under chapter
256B or 256D must provide for a complaint system according to
section 62D.11. When a prepaid health plan denies, reduces, or
terminates a health service or denies a request to authorize a
previously authorized health service, the prepaid health plan
must notify the recipient of the right to file a complaint or an
appeal. The notice must include the name and telephone number
of the ombudsman and notice of the recipient's right to request
a hearing under paragraph (b). deleted text begin When a complaint is filed, the
prepaid health plan must notify the ombudsman within three
working days. deleted text end Recipients may request the assistance of the
ombudsman in the complaint system process. The prepaid health
plan must issue a written resolution of the complaint to the
recipient within 30 days after the complaint is filed with the
prepaid health plan. A recipient is not required to exhaust the
complaint system procedures in order to request a hearing under
paragraph (b).

(b) Recipients enrolled in a prepaid health plan under
chapter 256B or 256D may contest a prepaid health plan's denial,
reduction, or termination of health services, a prepaid health
plan's denial of a request to authorize a previously authorized
health service, or the prepaid health plan's written resolution
of a complaint by submitting a written request for a hearing
according to subdivision 3. A state human services referee
shall conduct a hearing on the matter and shall recommend an
order to the commissioner of human services. new text begin The referee may
not overturn a decision by a prepaid health plan to deny or
limit coverage for services if the prepaid health plan has used
coverage policies adopted by the health plan company that are
based upon published evidence-based health care guidelines that
meet the criteria set forth in section 62J.43, subdivision 2, in
making the determination unless the recipient can show by clear
and convincing evidence that the determination should be
overturned. new text end The commissioner need not grant a hearing if the
sole issue raised by a recipient is the commissioner's authority
to require mandatory enrollment in a prepaid health plan in a
county where prepaid health plans are under contract with the
commissioner. The state human services referee may order a
second medical opinion from the prepaid health plan or may order
a second medical opinion from a nonprepaid health plan provider
at the expense of the prepaid health plan. Recipients may
request the assistance of the ombudsman in the appeal process.

(c) In the written request for a hearing to appeal from a
prepaid health plan's denial, reduction, or termination of a
health service, a prepaid health plan's denial of a request to
authorize a previously authorized service, or the prepaid health
plan's written resolution to a complaint, a recipient may
request an expedited hearing. If an expedited appeal is
warranted, the state human services referee shall hear the
appeal and render a decision within a time commensurate with the
level of urgency involved, based on the individual circumstances
of the case.

Sec. 7.

Minnesota Statutes 2004, section 256.9365, is
amended to read:

256.9365 deleted text begin PURCHASE OF CONTINUATION COVERAGE FOR AIDS
PATIENTS deleted text end new text begin HIV HEALTH CARE ACCESS PROGRAMS new text end .

Subdivision 1.

new text begin insurance assistance new text end program established.

The commissioner of human services shall establish a deleted text begin program to
pay private health plan premiums for persons who have contracted
human immunodeficiency virus (HIV) to enable them to continue
coverage under a group or individual health plan. If a person
is determined to be eligible under subdivision 2, the
commissioner shall pay the portion 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. The commissioner shall not
pay for that portion of a premium that is attributable to other
family members or dependents deleted text end new text begin health care access program for
low-income Minnesotans living with HIV that provides access to
HIV treatment consistent with the guidelines of the United
States Public Health Service. The program shall provide
assistance with medical insurance premiums to secure or maintain
necessary health care insurance coverage new text end .

Subd. 2.

Eligibility requirements.

To be eligible for
the new text begin HIV health care access new text end program, an applicant must deleted text begin satisfy
the following requirements deleted text end :

(1) deleted text begin the applicant must deleted text end provide a physician's statement
verifying that the applicant is infected with HIV deleted text begin 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 ;

(2) deleted text begin the applicant's deleted text end new text begin have a new text end monthly gross family income deleted text begin must
deleted text end new text begin that does new text end not exceed 300 percent of the federal poverty
guidelines, after deducting medical expenses and insurance
premiums;

(3) deleted text begin the applicant must deleted text end not own assets with a combined value
of more than $25,000 new text begin , excluding:
new text end

new text begin (i) all assets excluded under section 256B.056;
new text end

new text begin (ii) retirement accounts, Keogh plans, and pension plans;
and
new text end

new text begin (iii) medical expense accounts set up through the
individual's employer new text end ; deleted text begin and
deleted text end

(4) deleted text begin 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 new text begin have no health insurance coverage; have no
health insurance coverage because of ineligibility due to a
preexisting condition; or face loss of health insurance coverage
due to a change in employment status;
new text end

new text begin (5) reside in Minnesota;
new text end

new text begin (6) have been determined ineligible for Medicare, Medicaid,
MinnesotaCare, and general assistance medical care; and
new text end

new text begin (7) meet monthly cost-sharing obligations as provided for
in subdivision 4 new text end .

Subd. 3.

deleted text begin cost-effective coverage deleted text end new text begin benefits new text end .

new text begin (a) For
individuals who are uninsured or insured with 50 percent or less
of the premium by an employer, the commissioner shall pay that
portion of the group plan premium for which the individual is
responsible or shall pay the individual plan premium. The
commissioner shall not pay for that portion of a premium that is
attributable to other family members or dependents.
new text end

new text begin (b) new text end Requirements for the payment of individual plan
premiums under subdivision deleted text begin 2, clause (5), deleted text end new text begin 1 new 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 or general assistance medical
care program. The commissioner shall purchase the most
cost-effective coverage available for eligible
individuals. new text begin Efforts shall be made to obtain coverage that is
consistent with the guidelines of the United States Public
Health Service for HIV treatment, and to the extent possible,
provides comprehensive coverage that includes medical, mental
health, and substance abuse treatment.
new text end

new text begin Subd. 4. new text end

new text begin Cost-sharing responsibilities. new text end

new text begin The commissioner
may establish cost-sharing responsibilities for individuals
determined to be eligible for the HIV health care access program
that are consistent with guidelines established in the federal
Ryan White Care Act. These obligations, when appropriate for
efficient program administration, should be consistent with
cost-sharing requirements for other Minnesota health care
programs.
new text end

new text begin Subd. 5. new text end

new text begin Fiscal integrity. new text end

new text begin (a) The commissioner shall
manage the HIV health care access program to assure that the
program spending does not exceed the resources made available by
the federal government and the legislature.
new text end

new text begin (b) The commissioner shall make necessary program changes
to assure the fiscal integrity of the program.
new text end

new text begin (c) Each year following the release of the November revenue
forecast, the commissioner shall report to the chairs of the
appropriate health and human services finance committees the
forecasted need for the HIV health care access programs included
in this section. The report shall include information about the
anticipated enrollment, service utilization, service costs,
state, federal, and special revenue resources available to fund
the program needs, and any anticipated funding shortfall.
new text end

new text begin (d) When a shortfall of funding is projected,
recommendations should be included to assure that the program
expenditures are maintained within the anticipated available
funding.
new text end

new text begin Subd. 6. new text end

new text begin Continuation of care. new text end

new text begin (a) The commissioner
shall establish policies and procedures to ensure that initial
and continued access to HIV treatment is provided to recipients
who meet the eligibility requirements in subdivision 2.
new text end

new text begin (b) The policies and procedures shall consider the impacts
of continued HIV treatment on:
new text end

new text begin (1) reducing the risk for HIV transmission;
new text end

new text begin (2) preventing program recipients from becoming drug
resistant; and
new text end

new text begin (3) the prevention of the development of drug-resistant
strains of HIV.
new text end

new text begin Subd. 7. new text end

new text begin Coordination with federally funded hiv health
care access programs. new text end

new text begin (a) The commissioner shall administer the
HIV health care access program in coordination with funding
received from the Ryan White Care Act.
new text end

new text begin (b) Within the limits of the federal funding available for
these purposes, the commissioner may provide access to drugs
that treat HIV and manage the side effects of HIV treatment to
persons who meet the eligibility requirements in subdivision 2.
new text end

new text begin (c) The commissioner may establish co-payment obligations
for drugs purchased under this section.
new text end

new text begin Subd. 8. new text end

new text begin Community advisory process. new text end

new text begin The commissioner
shall establish a community advisory process for assessing the
effectiveness of the policies and procedures established for the
HIV health care access program. As appropriate to minimize
duplicative efforts, the process shall include consultation
with, coordination with, and reporting to the Minnesota HIV
Services Planning Council. Public notification shall be made of
the committee's members and meetings.
new text end

Sec. 8.

new text begin [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; administration. new text end

new text begin The
commissioner shall establish and administer the prescription
drug discount program.
new text end

new text begin Subd. 2. new text end [COMMISSIONER'S AUTHORITY.] new text begin The commissioner
shall administer a drug rebate program for drugs purchased
according to the prescription drug discount program. The
commissioner shall execute a rebate agreement from all
manufacturers that choose to participate in the program for
those drugs covered under the medical assistance program. For
each drug, the amount of the rebate shall be equal to the rebate
as defined for purposes of the federal rebate program in United
States Code, title 42, section 1396r-8. The rebate program
shall utilize the terms and conditions used for the federal
rebate program established according to section 1927 of title
XIX of the federal Social Security Act.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For the purpose of this section,
the following terms have the meanings given them.
new text end

new text begin (a) "Commissioner" means the commissioner of human services.
new text end

new text begin (b) "Participating manufacturer" means a manufacturer as
defined in section 151.44, paragraph (c), that agrees to
participate in the prescription drug discount program.
new text end

new text begin (c) "Covered prescription drug" means a prescription drug
as defined in section 151.44, paragraph (d), that is covered
under medical assistance as described in section 256B.0625,
subdivision 13, and that is provided by a participating
manufacturer that has a fully executed rebate agreement with the
commissioner under this section and complies with that agreement.
new text end

new text begin (d) "Health carrier" means an insurance company licensed
under chapter 60A to offer, sell, or issue an individual or
group policy of accident and sickness insurance as defined in
section 62A.01; a nonprofit health service plan corporation
operating under chapter 62C; a health maintenance organization
operating under chapter 62D; a joint self-insurance employee
health plan operating under chapter 62H; a community integrated
service network licensed under chapter 62N; a fraternal benefit
society operating under chapter 64B; a city, county, school
district, or other political subdivision providing self-insured
health coverage under section 471.617 or sections 471.98 to
471.982; and a self-funded health plan under the Employee
Retirement Income Security Act of 1974, as amended.
new text end

new text begin (e) "Participating pharmacy" means a pharmacy as defined in
section 151.01, subdivision 2, that agrees to participate in the
prescription drug discount program.
new text end

new text begin (f) "Enrolled individual" means a person who is eligible
for the program under subdivision 4 and has enrolled in the
program according to subdivision 5.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility. new text end

new text begin To be eligible for the program, an
applicant must:
new text end

new text begin (1) be a permanent resident of Minnesota as defined in
section 256L.09, subdivision 4;
new text end

new text begin (2) not be enrolled in Medicare, medical assistance,
general assistance medical care, or MinnesotaCare;
new text end

new text begin (3) not be enrolled in and have currently available
prescription drug coverage under a health plan offered by a
health carrier or employer or under a pharmacy benefit program
offered by a pharmaceutical manufacturer; and
new text end

new text begin (4) not be enrolled in and have currently available
prescription drug coverage under a Medicare supplement plan, as
defined in sections 62A.31 to 62A.44, or policies, contracts, or
certificates that supplement Medicare issued by health
maintenance organizations or those policies, contracts, or
certificates governed by section 1833 or 1876 of the federal
Social Security Act, United States Code, title 42, section 1395,
et seq., as amended.
new text end

new text begin Subd. 5. new text end

new text begin Application procedure. new text end

new text begin (a) Applications and
information on the program must be made available at county
social services agencies, health care provider offices, and
agencies and organizations serving senior citizens. Individuals
shall submit applications and any information specified by the
commissioner as being necessary to verify eligibility directly
to the commissioner. The commissioner shall determine an
applicant's eligibility for the program within 30 days from the
date the application is received. Upon notice of approval, the
applicant must submit to the commissioner the enrollment fee
specified in subdivision 10. Eligibility begins the month after
the enrollment fee is received by the commissioner.
new text end

new text begin (b) An enrollee's eligibility must be renewed every 12
months with the 12-month period beginning in the month after the
application is approved.
new text end

new text begin (c) The commissioner shall develop an application form that
does not exceed one page in length and requires information
necessary to determine eligibility for the program.
new text end

new text begin Subd. 6. new text end

new text begin Participating pharmacy. new text end

new text begin (a) Upon implementation
of the prescription drug discount program, until January 1,
2008, a participating pharmacy, in accordance with a valid
prescription, must sell a covered prescription drug to an
enrolled individual at the medical assistance rate.
new text end

new text begin (b) After January 1, 2008, a participating pharmacy, in
accordance with a valid prescription, must sell a covered
prescription drug to an enrolled individual at the medical
assistance rate, minus an amount that is equal to the rebate
amount described in subdivision 8, plus the amount of any switch
fee established by the commissioner under subdivision 10,
paragraph (b).
new text end

new text begin (c) Each participating pharmacy shall provide the
commissioner with all information necessary to administer the
program, including, but not limited to, information on
prescription drug sales to enrolled individuals and usual and
customary retail prices.
new text end

new text begin Subd. 7. new text end

new text begin Notification of rebate amount. new text end

new text begin The commissioner
shall notify each participating manufacturer, each calendar
quarter or according to a schedule to be established by the
commissioner, of the amount of the rebate owed on the
prescription drugs sold by participating pharmacies to enrolled
individuals.
new text end

new text begin Subd. 8. new text end

new text begin Provision of rebate. new text end

new text begin To the extent that a
participating manufacturer's prescription drugs are prescribed
to a resident of this state, the manufacturer must provide a
rebate equal to the rebate provided under the medical assistance
program for any prescription drug distributed by the
manufacturer that is purchased by an enrolled individual at a
participating pharmacy. The participating manufacturer must
provide full payment within 38 days of receipt of the state
invoice for the rebate, or according to a schedule to be
established by the commissioner. The commissioner shall deposit
all rebates received into the Minnesota prescription drug
dedicated fund established under subdivision 11. The
manufacturer must provide the commissioner with any information
necessary to verify the rebate determined per drug.
new text end

new text begin Subd. 9. new text end

new text begin Payment to pharmacies. new text end

new text begin Beginning January 1,
2008, the commissioner shall distribute on a biweekly basis an
amount that is equal to an amount collected under subdivision 8
to each participating pharmacy based on the prescription drugs
sold by that pharmacy to enrolled individuals on or after
January 1, 2008.
new text end

new text begin Subd. 10. new text end

new text begin Enrollment fee; switch fee. new text end

new text begin (a) The
commissioner shall establish an annual enrollment fee that
covers the commissioner's expenses for enrollment, processing
claims, and distributing rebates under this program.
new text end

new text begin (b) The commissioner shall establish a reasonable switch
fee that covers expenses incurred by participating pharmacies in
formatting for electronic submission claims for prescription
drugs sold to enrolled individuals.
new text end

new text begin Subd. 11. new text end

new text begin Dedicated fund; creation; use of fund. new text end

new text begin (a) The
Minnesota prescription drug dedicated fund is established as an
account in the state treasury. The commissioner of finance
shall credit to the dedicated fund all rebates paid under
subdivision 8, any federal funds received for the program, all
enrollment fees paid by the enrollees, and any appropriations or
allocations designated for the fund. The commissioner of
finance shall ensure that fund money is invested under section
11A.25. All money earned by the fund must be credited to the
fund. The fund shall earn a proportionate share of the total
state annual investment income.
new text end

new text begin (b) Money in the fund is appropriated to the commissioner
to reimburse participating pharmacies for prescription drugs the
rebate discount provided to enrolled individuals under
subdivision 6, paragraph (b); to reimburse the commissioner for
costs related to enrollment, processing claims, and distributing
rebates and for other reasonable administrative costs related to
administration of the prescription drug discount program; and to
repay the appropriation provided for this section. The
commissioner must administer the program so that the costs total
no more than funds appropriated plus the drug rebate proceeds.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256.969, is
amended by adding a subdivision to read:

new text begin Subd. 27. new text end

new text begin Annual nonmedical assistance payment. new text end

new text begin (a) In
addition to any other payment under this section, the
commissioner shall make the following payments:
new text end

new text begin (1) for a hospital located in Minnesota and not eligible
for payments under subdivision 20, with a medical assistance
inpatient utilization rate greater than 19 percent of total
patient days during the base year, a payment equal to 13 percent
of the total of the operating and payment rates;
new text end

new text begin (2) for a hospital located in Minnesota in a specified
urban area outside of the seven-county metropolitan area and not
eligible for payments under subdivision 20, with a medical
assistance inpatient utilization rate less than or equal to 19
percent of total patient days during the base year, a payment
equal to ten percent of the total of the operating and property
payment rates. For purposes of this clause, the following
cities are specified urban areas: Detroit Lakes, Rochester,
Willmar, Hutchinson, Alexandria, Austin, Cambridge, Brainerd,
Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, Wyoming,
Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls,
and Wadena; and
new text end

new text begin (3) for a hospital located in Minnesota but not located in
a specified urban area under clause (2) and not eligible for
payments under subdivision 20, with a medical assistance
inpatient utilization rate less than or equal to 19 percent of
total patient days during the base year, a payment equal to five
percent of the total of the operating and property payment rates.
new text end

new text begin (b) The payments under paragraph (a) shall be 100 percent
state dollars derived from federal reimbursements to the
commissioner to reimburse nonstate expenditures reported under
section 256B.199.
new text end

new text begin (c) The payments under paragraph (a) shall be paid annually
on July 1, beginning July 1, 2005, or upon the receipt of
federal reimbursements under section 256B.199, whichever occurs
last, for services to be rendered in the fiscal year beginning
on July 1, based on services rendered in the previous calendar
year.
new text end

new text begin (d) The commissioner shall not adjust rates paid to a
prepaid health plan under contract with the commissioner to
reflect payments provided in paragraph (a).
new text end

new text begin (e) If federal reimbursements are not available under
section 256B.199 for all payments under paragraph (a), the
commissioner shall reduce payments under paragraph (a) on a pro
rata basis so that payments under paragraph (a) do not exceed
the federal reimbursements.
new text end

new text begin (f) For purposes of this subdivision, medical assistance
does not include general assistance medical care.
new text end

new text begin (g) The commissioner may ratably reduce or increase the
payments under this subdivision in order to ensure that these
total payments equal the amount of reimbursement received by the
commissioner under section 256B.199.
new text end

new text begin (h) The commissioner may, in consultation with the nonstate
entities identified in section 256B.199, adjust the amounts
reported by nonstate entities under section 256B.199 when
application for reimbursement is made to the federal government,
and otherwise adjust the provisions of this subdivision in order
to maximize payments to qualifying hospitals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day
following final enactment. The commissioner of human services
shall submit necessary medical assistance plan amendments to
implement this section within 30 days of enactment.
new text end

Sec. 10.

Minnesota Statutes 2004, section 256B.02,
subdivision 12, is amended to read:

Subd. 12.

Third new text begin - new text end party payer.

"Third new text begin - new text end party payer" means a
person, entity, or agency or government program that has a
probable obligation to pay all or part of the costs of a medical
assistance recipient's health services. new text begin Third-party payer
includes an entity under contract with the recipient to cover
all or part of the recipient's medical costs.
new text end

Sec. 11.

Minnesota Statutes 2004, section 256B.04, is
amended by adding a subdivision to read:

new text begin Subd. 4a. new text end

new text begin Medicare prescription drug subsidy. new text end

new text begin The
commissioner shall perform all duties necessary to administer
eligibility determinations for the Medicare Part D prescription
drug subsidy and facilitate the enrollment of eligible medical
assistance recipients into Medicare prescription drug plans as
required by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA), Public Law 108-173, and Code of
Federal Regulations, title 42, sections 423.30 to 423.56 and
423.771 to 423.800.
new text end

Sec. 12.

Minnesota Statutes 2004, section 256B.055, is
amended by adding a subdivision to read:

new text begin Subd. 14. new text end

new text begin Persons detained by law. new text end

new text begin (a) An inmate of a
correctional facility who is conditionally released as
authorized under section 241.26, 244.065, or 631.425 may be
eligible for medical assistance if the individual does not
require the security of a public detention facility and is
housed in a halfway house or community correction center, or
under house arrest and monitored by electronic surveillance in a
residence approved by the commissioner of corrections.
new text end

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

Sec. 13.

Minnesota Statutes 2004, section 256B.056, is
amended by adding a subdivision to read:

new text begin Subd. 3d. new text end

new text begin Reduction of excess assets. new text end

new text begin Assets in excess
of the limits in subdivisions 3 to 3c may be reduced to
allowable limits as follows:
new text end

new text begin (a) Assets may be reduced in any of the three calendar
months before the month of application in which the applicant
seeks coverage by:
new text end

new text begin (1) designating burial funds up to $1,500 for each
applicant, spouse, and MA-eligible dependent child; and
new text end

new text begin (2) paying health service bills incurred in the retroactive
period for which the applicant seeks eligibility, starting with
the oldest bill. After assets are reduced to allowable limits,
eligibility begins with the next dollar of MA-covered health
services incurred in the retroactive period. Applicants
reducing assets under this subdivision who also have excess
income shall first spend excess assets to pay health service
bills and may meet the income spenddown on remaining bills.
new text end

new text begin (b) Assets may be reduced beginning the month of
application by:
new text end

new text begin (1) paying bills for health services that would otherwise
be paid by medical assistance; and
new text end

new text begin (2) using any means other than a transfer of assets for
less than fair market value as defined in section 256B.0595,
subdivision 1, paragraph (b).
new text end

Sec. 14.

Minnesota Statutes 2004, section 256B.056,
subdivision 5, is amended to read:

Subd. 5.

Excess income.

A person who has excess income
is eligible for medical assistance if the person has expenses
for medical care that are more than the amount of the person's
excess income, computed by deducting incurred medical expenses
from the excess income to reduce the excess to the income
standard specified in subdivision 5c. The person shall elect to
have the medical expenses deducted at the beginning of a
one-month budget period or at the beginning of a six-month
budget period. The commissioner shall allow persons eligible
for assistance on a one-month spenddown basis under this
subdivision to elect to pay the monthly spenddown amount in
advance of the month of eligibility to the state agency in order
to maintain eligibility on a continuous basis. If the recipient
does not pay the spenddown amount on or before the deleted text begin 20th deleted text end new text begin last
business day new text end of the month, the recipient is ineligible for this
option for the following month. The local agency shall code the
Medicaid Management Information System (MMIS) to indicate that
the recipient has elected this option. The state agency shall
convey recipient eligibility information relative to the
collection of the spenddown to providers through the Electronic
Verification System (EVS). A recipient electing advance payment
must pay the state agency the monthly spenddown amount on or
before new text begin noon on new text end the deleted text begin 20th deleted text end new text begin last business day new text end of the month in order
to be eligible for this option in the following month.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 15.

Minnesota Statutes 2004, section 256B.056,
subdivision 5a, is amended to read:

Subd. 5a.

Individuals on fixed or excluded income.

Recipients of medical assistance who receive only fixed unearned
or excluded income, when that income is excluded from
consideration as income or unvarying in amount and timing of
receipt throughout the year, shall report and verify their
income deleted text begin annually deleted text end new text begin every 12 months. The 12-month period begins
with the month of application new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 16.

Minnesota Statutes 2004, section 256B.056,
subdivision 5b, is amended to read:

Subd. 5b.

Individuals with low income.

Recipients of
medical assistance not residing in a long-term care facility who
have slightly fluctuating income which is below the medical
assistance income limit shall report and verify their income deleted text begin on
a semiannual basis deleted text end new text begin every six months. The six-month period
begins the month of application new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 17.

Minnesota Statutes 2004, section 256B.056,
subdivision 7, is amended to read:

Subd. 7.

Period of eligibility.

Eligibility is available
for the month of application and for three months prior to
application if the person was eligible in those prior
months. new text begin Eligibility for months prior to application is
determined independently from eligibility for the month of
application and future months. new text end A redetermination of eligibility
must occur every 12 months. new text begin The 12-month period begins with the
month of application.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 18.

Minnesota Statutes 2004, section 256B.056, is
amended by adding a subdivision to read:

new text begin Subd. 9. new text end

new text begin Notice. new text end

new text begin The state agency must be given notice
of monetary claims against a person, entity, or corporation that
may be liable to pay all or part of the cost of medical care
when the state agency has paid or becomes liable for the cost of
that care. Notice must be given according to paragraphs (a) to
(d).
new text end

new text begin (a) An applicant for medical assistance shall notify the
state or local agency of any possible claims when the applicant
submits the application. A recipient of medical assistance
shall notify the state or local agency of any possible claims
when those claims arise.
new text end

new text begin (b) A person providing medical care services to a recipient
of medical assistance shall notify the state agency when the
person has reason to believe that a third party may be liable
for payment of the cost of medical care.
new text end

new text begin (c) A party to a claim that may be assigned to the state
agency under this section shall notify the state agency of its
potential assignment claim in writing at each of the following
stages of a claim:
new text end

new text begin (1) when a claim is filed;
new text end

new text begin (2) when an action is commenced; and
new text end

new text begin (3) when a claim is concluded by payment, award, judgment,
settlement, or otherwise.
new text end

new text begin (d) Every party involved in any stage of a claim under this
subdivision is required to provide notice to the state agency at
that stage of the claim. However, when one of the parties to
the claim provides notice at that stage, every other party to
the claim is deemed to have provided the required notice for
that stage of the claim. If the required notice under this
paragraph is not provided to the state agency, all parties to
the claim are deemed to have failed to provide the required
notice. A party to the claim includes the injured person or the
person's legal representative, the plaintiff, the defendants, or
persons alleged to be responsible for compensating the injured
person or plaintiff, and any other party to the cause of action
or claim, regardless of whether the party knows the state agency
has a potential or actual assignment claim.
new text end

Sec. 19.

Minnesota Statutes 2004, section 256B.057,
subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

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

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

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

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

(c) deleted text begin Dependent care and child support paid under court order
shall be deducted from the countable income of pregnant
women. deleted text end new text begin An amount equal to the amount of earned income exceeding
275 percent of the federal poverty guideline plus the earned
income disregards and deductions of the AFDC program under the
state's AFDC plan as of July 16, 1996, as required by the
Personal Responsibility and Work Opportunity Reconciliation Act
of 1996 (PRWORA), Public Law 104-193, that exceeds 275 percent
of the federal poverty guideline will be deducted for pregnant
women and infants less than one year of age.
new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to paragraphs (a) and (b)
are effective retroactively from July 1, 2004, and the amendment
to paragraph (c) is effective retroactively from October 1, 2003.
new text end

Sec. 20.

Minnesota Statutes 2004, section 256B.0625,
subdivision 9, is amended to read:

Subd. 9.

Dental services.

deleted text begin (a) deleted text end Medical assistance covers
dental services. Dental services include, with prior
authorization, fixed bridges that are cost-effective for persons
who cannot use removable dentures because of their medical
condition.

deleted text begin (b) Coverage of dental services for adults age 21 and over
who are not pregnant is subject to a $500 annual benefit limit
and covered services are limited to:
deleted text end

deleted text begin (1) diagnostic and preventative services;
deleted text end

deleted text begin (2) restorative services; and
deleted text end

deleted text begin (3) emergency services.
deleted text end

deleted text begin Emergency services, dentures, and extractions related to
dentures are not included in the $500 annual benefit limit.
deleted text end

Sec. 21.

Minnesota Statutes 2004, section 256B.0625,
subdivision 13e, as amended by 2005 S.F. No. 1879, article 13,
section 7, subdivision 13e, if enacted, is amended to read:

Subd. 13e.

Payment rates.

(a) The basis for determining
the amount of payment shall be the lower of the actual
acquisition costs of the drugs plus a fixed dispensing fee; the
maximum allowable cost set by the federal government or by the
commissioner plus the fixed dispensing fee; or the usual and
customary price charged to the public. The amount of payment
basis must be reduced to reflect all discount amounts applied to
the charge by any provider/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 pharmacy dispensing fee shall be $3.65,
except that the dispensing fee for intravenous solutions which
must be compounded by the pharmacist shall be $8 per bag, $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. 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 average
wholesale price minus 11.5 percent deleted text begin , except that where a drug has
had its wholesale price reduced as a result of the actions of
the National Association of Medicaid Fraud Control Units, the
estimated actual acquisition cost shall be the reduced average
wholesale price, without the 11.5 percent deduction deleted text end . The actual
acquisition cost of antihemophilic factor drugs shall be
estimated at the average wholesale price minus 30 percent. The
maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable to, but no higher than,
the maximum amount paid by other third-party payors in this
state who have maximum allowable cost programs. Establishment
of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) An 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. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available,
payment shall be on the basis of the actual acquisition cost of
the generic drug, or on the maximum allowable cost established
by the commissioner.

(d) 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 or the
amount established for Medicare by the United States Department
of Health and Human Services pursuant to title XVIII, section
1847a of the federal Social Security Act.

(e) The commissioner may negotiate lower reimbursement
rates for specialty pharmacy products than the rates 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, 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 this paragraph. new text begin In
consulting with the formulary committee in developing this list,
the commissioner shall take into consideration the population
served by special pharmacy products, the current delivery system
and standard of care in the state, and any access to care issues
that lower reimbursement rates may create. The commissioner
shall have the discretion to adjust the reimbursement rate to
prevent access to care issues.
new text end

Sec. 22.

Minnesota Statutes 2004, 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) 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.

(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 begin This paragraph expires July 1, 2005.
deleted text end

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 30, 2005.
new text end

Sec. 23.

Minnesota Statutes 2004, section 256B.0625, is
amended by adding a subdivision to read:

new text begin Subd. 13h. new text end

new text begin Medication therapy management care. new text end

new text begin (a)
Medical assistance covers medication therapy management services
for a recipient taking four or more prescriptions to treat or
prevent two or more chronic medical conditions, or a recipient
with a drug therapy problem that is identified or prior
authorized by the commissioner that has resulted or is likely to
result in significant nondrug program costs. For purposes of
this subdivision, "medication therapy management" means the
provision of the following pharmaceutical care services by a
licensed pharmacist to optimize the therapeutic outcomes of the
patient's medications:
new text end

new text begin (1) performing or obtaining necessary assessments of the
patient's health status;
new text end

new text begin (2) formulating a medication treatment plan;
new text end

new text begin (3) monitoring and evaluating the patient's response to
therapy, including safety and effectiveness;
new text end

new text begin (4) performing a comprehensive medication review to
identify, resolve, and prevent medication-related problems,
including adverse drug events;
new text end

new text begin (5) documenting the care delivered and communicating
essential information to the patient's other primary care
providers;
new text end

new text begin (6) providing verbal education and training designed to
enhance patient understanding and appropriate use of the
patient's medications;
new text end

new text begin (7) providing information, support services, and resources
designed to enhance patient adherence with the patient's
therapeutic regimens; and
new text end

new text begin (8) coordinating and integrating medication therapy
management services within the broader health care management
services being provided to the patient.
new text end

new text begin Nothing in this subdivision shall be construed to expand or
modify the scope of practice of the pharmacist as defined in
section 151.01, subdivision 27.
new text end

new text begin (b) To be eligible for reimbursement for services under
this subdivision, a pharmacist must meet the following
requirements:
new text end

new text begin (1) have a valid license issued under chapter 151;
new text end

new text begin (2) have graduated from an accredited college of pharmacy
on or after May 1996 or completed a structured and comprehensive
education program approved by the Board of Pharmacy and the
American Council of Pharmaceutical Education for the provision
and documentation of pharmaceutical care management services
that has both clinical and didactic elements;
new text end

new text begin (3) be practicing in an ambulatory care setting as part of
a multidisciplinary team or have developed a structured patient
care process that is offered in a private or semiprivate patient
care area that is separate from the commercial business that
also occurs in the setting; and
new text end

new text begin (4) make use of an electronic patient record system that
meets state standards.
new text end

new text begin (c) For the purposes of reimbursement for medication
therapy management services, the commissioner may enroll
individual pharmacists as medical assistance providers. The
commissioner may also establish contact requirements between the
pharmacist and recipient, including limiting the number of
reimbursable consultations per recipient.
new text end

new text begin (d) The commissioner, after receiving recommendations from
professional medical associations, professional pharmacy
associations, and consumer groups shall convene an 11-member
Medication Therapy Management Advisory Committee, to advise the
commissioner on the implementation and administration of
medication therapy management services. The committee shall be
comprised of two licensed physicians; two licensed pharmacists;
two consumer representatives; two health plan representatives;
and three members with expertise in the area of medication
therapy management, who may be licensed physicians or licensed
pharmacists. The committee is governed by section 15.059,
except that committee members do not receive compensation or
reimbursement for expenses. The advisory committee shall expire
on June 30, 2007.
new text end

new text begin (e) The commissioner shall evaluate the effect of
medication therapy management on quality of care, patient
outcomes, and program costs, and shall include a description of
any savings generated in the medical assistance program that can
be attributable to this coverage. The evaluation shall be
submitted to the legislature by December 15, 2007. The
commissioner may contract with a vendor or an academic
institution that has expertise in evaluating health care
outcomes for the purpose of completing the evaluation.
new text end

Sec. 24.

Minnesota Statutes 2004, section 256B.0625,
subdivision 17, is amended to read:

Subd. 17.

Transportation costs.

(a) Medical assistance
covers 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, common carrier,
or other recognized providers of transportation services.

(b) Medical assistance covers special transportation, as
defined in Minnesota Rules, part 9505.0315, subpart 1, item F,
if the recipient has a physical or mental impairment that would
prohibit the recipient from safely accessing and using a bus,
taxi, other commercial transportation, or private automobile.

The commissioner may use an order by the recipient's attending
physician to certify that the recipient requires special
transportation services. Special transportation includes
driver-assisted service to eligible individuals.
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
or stretchers in the vehicle. Special transportation providers
must obtain written documentation from the health care service
provider who is serving the recipient being transported,
identifying the time that the recipient arrived. Special
transportation providers may not bill for separate base rates
for the continuation of a trip beyond the original destination.
Special transportation providers must take recipients to the
nearest appropriate health care provider, using the most direct
route available. The maximum medical assistance reimbursement
rates for special transportation services are:

(1) deleted text begin $18 deleted text end new text begin $16.50 new text end for the base rate and deleted text begin $1.40 deleted text end new text begin $1.35 new text end per mile
for services to eligible persons who need a
wheelchair-accessible van;

(2) deleted text begin $12 deleted text end new text begin $11.50 new text end for the base rate and deleted text begin $1.35 deleted text end new text begin $1.30 new text end per mile
for services to eligible persons who do not need a
wheelchair-accessible van; and

(3) deleted text begin $36 deleted text end new text begin $60 new text end for the base rate and deleted text begin $1.40 deleted text end new text begin $2.40 new text end per mile, and
an attendant rate of $9 per trip, for services to eligible
persons who need a stretcher-accessible vehicle.

Sec. 25.

new text begin [256B.072] PERFORMANCE REPORTING AND QUALITY
IMPROVEMENT PAYMENT SYSTEM.
new text end

new text begin (a) The commissioner of human services shall establish a
performance reporting and propose a payment system for health
care providers who provide health care services to public
program recipients covered under chapters 256B, 256D, and 256L,
reporting separately for managed care and fee-for-service
recipients.
new text end

new text begin (b) The measures used for the performance reporting and
payment system for medical groups shall include, but are not
limited to, measures of care for asthma, diabetes, hypertension,
and coronary artery disease and measures of preventive care
services. The measures used for the performance reporting and
payment system for inpatient hospitals shall include, but are
not limited to, measures of care for acute myocardial
infarction, heart failure, and pneumonia, and measures of care
and prevention of surgical infections. In the case of a medical
group, the measures used shall be consistent with measures
published by nonprofit Minnesota or national organizations that
produce and disseminate health care quality measures or
evidence-based health care guidelines and that meet the criteria
set forth in section 62J.43, subdivision 2. In the case of
inpatient hospital measures, the commissioner shall appoint the
Minnesota Hospital Association and Stratis Health to advise on
the development of the performance measures to be used for
hospital reporting. To enable a consistent measurement process
across the community, the commissioner may use measures of care
provided for patients in addition to those identified in
paragraph (a). The commissioner shall ensure collaboration with
other health care reporting organizations so that the measures
described in this section are consistent with those reported by
those organizations and used by other purchasers in Minnesota.
new text end

new text begin (c) For recipients seen on or after January 1, 2007, the
commissioner shall propose a performance bonus payment to
providers who have achieved certain levels of performance
established by the commissioner with respect to the measures or
who have achieved certain rates of improvement established by
the commissioner with respect to the measures or whose rates of
achievement have increased over a previous period, as
established by the commissioner. The performance bonus payment
may be a fixed dollar amount per patient, paid quarterly or
annually, or alternatively payment may be made as a percentage
increase over payments allowed elsewhere in statute for the
recipients identified in paragraph (a). In order for providers
to be eligible for a performance bonus payment under this
section, the commissioner may require the providers to submit
information in a required format to a health care reporting
organization or to cooperate with the information collection
procedures of that organization. The commissioner may contract
with a reporting organization to assist with the collection of
reporting information and to prevent duplication of reporting.
The commissioner may limit application of the performance bonus
payment system to providers that provide a sufficiently large
volume of care to permit adequate statistical precision in the
measurement of that care, as established by the commissioner,
after consulting with other health care quality reporting
organizations.
new text end

new text begin (d) The commissioner shall publish a description of the
proposed performance reporting and proposed payment system for
the calendar year beginning January 1, 2007, and each subsequent
calendar year, at least three months prior to the beginning of
that calendar year.
new text end

new text begin (e) By October 1, 2007, and annually thereafter, the
commissioner shall report through a public Web site the results
by medical group and hospitals where possible of the measures
and when feasible the performance payments under this section,
and shall compare the results by medical group and hospital for
patients enrolled in public programs to patients enrolled in
private health plans. To achieve this reporting, the
commissioner may contract with a health care reporting
organization that operates a Web site suitable for this purpose.
new text end

Sec. 26.

Minnesota Statutes 2004, section 256B.0916, is
amended by adding a subdivision to read:

new text begin Subd. 10. new text end

new text begin Transitional supports allowance. new text end

new text begin A
transitional supports allowance shall be available to all
persons under a home and community-based waiver who are moving
from a licensed setting to a community setting. "Transitional
supports allowance" means a onetime payment of up to $3,000, to
cover the costs, not covered by other sources, associated with
moving from a licensed setting to a community setting. Covered
costs include:
new text end

new text begin (1) lease or rent deposits;
new text end

new text begin (2) security deposits;
new text end

new text begin (3) utilities set-up costs, including telephone;
new text end

new text begin (4) essential furnishings and supplies; and
new text end

new text begin (5) personal supports and transports needed to locate and
transition to community settings.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal
approval and to the extent approved as a federal waiver
amendment.
new text end

Sec. 27.

new text begin [256B.0918] EMPLOYEE SCHOLARSHIP COSTS AND
TRAINING IN ENGLISH AS A SECOND LANGUAGE.
new text end

new text begin (a) For the fiscal year beginning July 1, 2005, the
commissioner shall provide to each provider listed in paragraph
(c) a scholarship reimbursement increase of two-tenths percent
of the reimbursement rate for that provider to be used:
new text end

new text begin (1) for employee scholarships that satisfy the following
requirements:
new text end

new text begin (i) scholarships are available to all employees who work an
average of at least 20 hours per week for the provider, except
administrators, department supervisors, and registered nurses;
and
new text end

new text begin (ii) the course of study is expected to lead to career
advancement with the provider or in long-term care, including
home care or care of persons with disabilities, including
medical care interpreter services and social work; and
new text end

new text begin (2) to provide job-related training in English as a second
language.
new text end

new text begin (b) A provider receiving a rate adjustment under this
subdivision with an annualized value of at least $1,000 shall
maintain documentation to be submitted to the commissioner on a
schedule determined by the commissioner and on a form supplied
by the commissioner of the scholarship rate increase received,
including:
new text end

new text begin (1) the amount received from this reimbursement increase;
new text end

new text begin (2) the amount used for training in English as a second
language;
new text end

new text begin (3) the number of persons receiving the training;
new text end

new text begin (4) the name of the person or entity providing the
training; and
new text end

new text begin (5) for each scholarship recipient, the name of the
recipient, the amount awarded, the educational institution
attended, the nature of the educational program, the program
completion date, and a determination of the amount spent as a
percentage of the provider's reimbursement.
new text end

new text begin The commissioner shall report to the legislature annually,
beginning January 15, 2006, with information on the use of these
funds.
new text end

new text begin (c) The rate increases described in this section shall be
provided to home and community-based waivered services for
persons with mental retardation or related conditions under
section 256B.501; home and community-based waivered services for
the elderly under section 256B.0915; waivered services under
community alternatives for disabled individuals under section
256B.49; community alternative care waivered services under
section 256B.49; traumatic brain injury waivered services under
section 256B.49; nursing services and home health services under
section 256B.0625, subdivision 6a; personal care services and
nursing supervision of personal care services under section
256B.0625, subdivision 19a; private duty nursing services under
section 256B.0625, subdivision 7; day training and habilitation
services for adults with mental retardation or related
conditions under sections 252.40 to 252.46; alternative care
services under section 256B.0913; adult residential program
grants under Minnesota Rules, parts 9535.2000 to 9535.3000;
semi-independent living services (SILS) under section 252.275,
including SILS funding under county social services grants
formerly funded under chapter 256I; community support services
for deaf and hard-of-hearing adults with mental illness who use
or wish to use sign language as their primary means of
communication; the group residential housing supplementary
service rate under section 256I.05, subdivision 1a; chemical
dependency residential and nonresidential service providers
under section 254B.03; and intermediate care facilities for
persons with mental retardation under section 256B.5012.
new text end

new text begin (d) These increases shall be included in the provider's
reimbursement rate for the purpose of determining future rates
for the provider.
new text end

Sec. 28.

new text begin [256B.199] PAYMENTS REPORTED BY GOVERNMENTAL
ENTITIES.
new text end

new text begin (a) Hennepin County, Hennepin County Medical Center, Ramsey
County, Regions Hospital, the University of Minnesota, and
Fairview-University Medical Center shall annually report to the
commissioner by June 1, beginning June 1, 2005, payments made
during the previous calendar year that may qualify for
reimbursement under federal law. Subject to the reports due
June 1, 2005, the amounts for calendar year 2004 are expected to
be as follows:
new text end

new text begin (1) Hennepin County and Hennepin County Medical Center,
$31,980,000;
new text end

new text begin (2) Ramsey County and Regions Hospital, $20,980,000; and
new text end

new text begin (3) University of Minnesota and Fairview-University Medical
Center, $11,050,000.
new text end

new text begin (b) Based on these reports, the commissioner shall apply
for federal matching funds. These funds are appropriated to the
commissioner for the annual payments under section 256.969,
subdivision 27.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day
following final enactment. The commissioner of human services
shall submit necessary medical assistance plan amendments to
implement this section within 30 days of enactment.
new text end

Sec. 29.

Minnesota Statutes 2004, 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;

(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; and

(9) persons with access to cost-effective
employer-sponsored private health insurance or persons enrolled
in deleted text begin an deleted text end new text begin non-Medicare new text end individual health plan determined to be
cost-effective according to section 256B.0625, subdivision 15.

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. 30.

Minnesota Statutes 2004, section 256D.03,
subdivision 4, is amended to read:

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation
agencies;

(4) prescription drugs and other products recommended
through the process established in section 256B.0625,
subdivision 13;

(5) equipment necessary to administer insulin and
diagnostic supplies and equipment for diabetics to monitor blood
sugar level;

(6) eyeglasses and eye examinations provided by a physician
or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical
assistance program;

(13) podiatric services;

(14) dental services deleted text begin and dentures, subject to the
limitations specified in section 256B.0625, subdivision 9 deleted text end new text begin as
covered under the medical assistance program new text end ;

(15) outpatient services provided by a mental health center
or clinic that is under contract with the county board and is
established under section 245.62;

(16) day treatment services for mental illness provided
under contract with the county board;

(17) prescribed medications for persons who have been
diagnosed as mentally ill as necessary to prevent more
restrictive institutionalization;

(18) psychological services, medical supplies and
equipment, and Medicare premiums, coinsurance and deductible
payments;

(19) medical equipment not specifically listed in this
paragraph when the use of the equipment will prevent the need
for costlier services that are reimbursable under this
subdivision;

(20) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified
adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or
a certified geriatric nurse practitioner in independent
practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an
inpatient basis is not included as part of the cost for
inpatient services included in the operating payment rate, and
(3) the service is within the scope of practice of the nurse
practitioner's license as a registered nurse, as defined in
section 148.171;

(21) services of a certified public health nurse or a
registered nurse practicing in a public health nursing clinic
that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the
scope of practice of the public health nurse's license as a
registered nurse, as defined in section 148.171; and

(22) telemedicine consultations, to the extent they are
covered under section 256B.0625, subdivision 3b.

(ii) Effective October 1, 2003, for a person who is
eligible under subdivision 3, paragraph (a), clause (2), item
(ii), general assistance medical care coverage is limited to
inpatient hospital services, including physician services
provided during the inpatient hospital stay. A $1,000
deductible is required for each inpatient hospitalization.

(b) Gender reassignment surgery and related services are
not covered services under this subdivision unless the
individual began receiving gender reassignment services prior to
July 1, 1995.

(c) In order to contain costs, the commissioner of human
services shall select vendors of medical care who can provide
the most economical care consistent with high medical standards
and shall where possible contract with organizations on a
prepaid capitation basis to provide these services. The
commissioner shall consider proposals by counties and vendors
for prepaid health plans, competitive bidding programs, block
grants, or other vendor payment mechanisms designed to provide
services in an economical manner or to control utilization, with
safeguards to ensure that necessary services are provided.
Before implementing prepaid programs in counties with a county
operated or affiliated public teaching hospital or a hospital or
clinic operated by the University of Minnesota, the commissioner
shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to
participate in the program in a manner that reflects the risk of
adverse selection and the nature of the patients served by the
hospital, provided the terms of participation in the program are
competitive with the terms of other participants considering the
nature of the population served. Payment for services provided
pursuant to this subdivision shall be as provided to medical
assistance vendors of these services under sections 256B.02,
subdivision 8, and 256B.0625. For payments made during fiscal
year 1990 and later years, the commissioner shall consult with
an independent actuary in establishing prepayment rates, but
shall retain final control over the rate methodology.

deleted text begin (d) Recipients eligible under subdivision 3, paragraph (a),
clause (2), item (i), shall pay the following co-payments for
services provided on or after October 1, 2003:
deleted text end

deleted text begin (1) $3 per nonpreventive visit. For purposes of this
subdivision, a visit means an episode of service which is
required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory
setting by a physician or physician ancillary, chiropractor,
podiatrist, nurse midwife, advanced practice nurse, audiologist,
optician, or optometrist;
deleted text end

deleted text begin (2) $25 for eyeglasses;
deleted text end

deleted text begin (3) $25 for nonemergency visits to a hospital-based
emergency room;
deleted text end

deleted text begin (4) $3 per brand-name drug prescription and $1 per generic
drug prescription, subject to a $20 per month maximum for
prescription drug co-payments. No co-payments shall apply to
antipsychotic drugs when used for the treatment of mental
illness; and
deleted text end

deleted text begin (5) 50 percent coinsurance on restorative dental services.
deleted text end

deleted text begin (e) Co-payments shall be limited to one per day per
provider for nonpreventive visits, eyeglasses, and nonemergency
visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all
co-payments in this subdivision. The general assistance medical
care reimbursement to the provider shall be reduced by the
amount of the co-payment, except that reimbursement for
prescription drugs shall not be reduced once a recipient has
reached the $20 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the
recipient. Providers may not deny services to recipients who
are unable to pay the co-payment, except as provided in
paragraph (f).
deleted text end

deleted text begin (f) If it is the routine business practice of a provider to
refuse service to an individual with uncollected debt, the
provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient
with uncollected debt before services can be denied.
deleted text end

deleted text begin (g) deleted text end new text begin (d) new text end Any county may, from its own resources, provide
medical payments for which state payments are not made.

deleted text begin (h) deleted text end new text begin (e) new text end Chemical dependency services that are reimbursed
under chapter 254B must not be reimbursed under general
assistance medical care.

deleted text begin (i) deleted text end new text begin (f) new text end The maximum payment for new vendors enrolled in the
general assistance medical care program after the base year
shall be determined from the average usual and customary charge
of the same vendor type enrolled in the base year.

deleted text begin (j) deleted text end new text begin (g) new text end The conditions of payment for services under this
subdivision are the same as the conditions specified in rules
adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.

deleted text begin (k) deleted text end new text begin (h) new text end Inpatient and outpatient payments shall be reduced
by five percent, effective July 1, 2003. This reduction is in
addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph deleted text begin (i) deleted text end new text begin (f) new text end .

deleted text begin (l) deleted text end new text begin (i) new text end Payments for all other health services except
inpatient, outpatient, and pharmacy services shall be reduced by
five percent, effective July 1, 2003.

deleted text begin (m) deleted text end new text begin (j) new text end Payments to managed care plans shall be reduced by
five percent for services provided on or after October 1, 2003.

deleted text begin (n) deleted text end new text begin (k) new text end A hospital receiving a reduced payment as a result
of this section may apply the unpaid balance toward satisfaction
of the hospital's bad debts.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 31.

Minnesota Statutes 2004, section 256D.045, is
amended to read:

256D.045 SOCIAL SECURITY NUMBER REQUIRED.

To be eligible for general assistance under sections
256D.01 to 256D.21, an individual must provide the individual's
Social Security number to the county agency or submit proof that
an application has been made. new text begin An individual who refuses to
provide a Social Security number because of a well-established
religious objection as described in Code of Federal Regulations,
title 42, section 435.910, may be eligible for general
assistance medical care under section 256D.03. new text end The provisions
of this section do not apply to the determination of eligibility
for emergency general assistance under section 256D.06,
subdivision 2. This provision applies to eligible children
under the age of 18 effective July 1, 1997.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 32.

Minnesota Statutes 2004, section 256L.01,
subdivision 4, is amended to read:

Subd. 4.

Gross individual or gross family income.

(a)
"Gross individual or gross family income" for nonfarm
self-employed means income calculated new text begin for the six-month period
of eligibility new text end using as the baseline the adjusted gross income
reported on the applicant's federal income tax form for the
previous year and adding back in reported depreciation,
carryover loss, and net operating loss amounts that apply to the
business in which the family is currently engaged.

(b) "Gross individual or gross family income" for farm
self-employed means income calculated new text begin for the six-month period
of eligibility new text end using as the baseline the adjusted gross income
reported on the applicant's federal income tax form for the
previous year deleted text begin and adding back in reported depreciation amounts
that apply to the business in which the family is currently
engaged deleted text end .

(c) deleted text begin Applicants shall report the most recent financial
situation of the family if it has changed from the period of
time covered by the federal income tax form. The report may be
in the form of percentage increase or decrease deleted text end new text begin "Gross individual
or gross family income" means the total income for all family
members, calculated for the six-month period of eligibility new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 33.

Minnesota Statutes 2004, section 256L.01,
subdivision 5, is amended to read:

Subd. 5.

Income.

new text begin (a) new text end "Income" has the meaning given for
earned and unearned income for families and children in the
medical assistance program, according to the state's aid to
families with dependent children plan in effect as of July 16,
1996. The definition does not include medical assistance income
methodologies and deeming requirements. The earned income of
full-time and part-time students under age 19 is not counted as
income. Public assistance payments and supplemental security
income are not excluded income.

new text begin (b) For purposes of this subdivision, and unless otherwise
specified in this section, the commissioner shall use reasonable
methods to calculate gross earned and unearned income including,
but not limited to, projecting income based on income received
within the past 30 days, the last 90 days, or the last 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 34.

Minnesota Statutes 2004, section 256L.03,
subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

deleted text begin For individuals
under section 256L.04, subdivision 7, with income no greater
than 75 percent of the federal poverty guidelines or for
families with children under section 256L.04, subdivision 1, all
subdivisions of this section apply. deleted text end "Covered health services"
means the health services reimbursed under chapter 256B, with
the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care
services other than services covered under section 256B.0625,
subdivision 9, deleted text begin paragraph (b), deleted text end orthodontic services, nonemergency
medical transportation services, personal care assistant and
case management services, nursing home or intermediate care
facilities services, inpatient mental health services, and
chemical dependency services. Outpatient mental health services
covered under the MinnesotaCare program are limited to
diagnostic assessments, psychological testing, explanation of
findings, medication management by a physician, day treatment,
partial hospitalization, and individual, family, and group
psychotherapy.

No public funds shall be used for coverage of abortion
under MinnesotaCare except where the life of the female would be
endangered or substantial and irreversible impairment of a major
bodily function would result if the fetus were carried to term;
or where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in
this section.

new text begin EFFECTIVE DATE. new text end

new text begin Notwithstanding section 256B.69,
subdivision 5a, paragraph (b), this section is effective July 1,
2005.
new text end

Sec. 35.

Minnesota Statutes 2004, section 256L.03,
subdivision 1b, is amended to read:

Subd. 1b.

Pregnant women; eligibility for full medical
assistance services.

deleted text begin Beginning January 1, 1999, deleted text end A new text begin pregnant
new text end woman deleted text begin who is deleted text end enrolled in MinnesotaCare deleted text begin when her pregnancy is
diagnosed deleted text end is eligible for coverage of all services provided
under the medical assistance program according to chapter 256B
retroactive to the date deleted text begin the pregnancy is medically diagnosed deleted text end new text begin of
conception new text end . Co-payments totaling $30 or more, paid after the
date deleted text begin the pregnancy is diagnosed deleted text end new text begin of conception new text end , shall be refunded.

Sec. 36.

Minnesota Statutes 2004, section 256L.03,
subdivision 5, is amended to read:

Subd. 5.

Co-payments and coinsurance.

(a) Except as
provided in paragraphs (b) and (c), the MinnesotaCare benefit
plan shall include the following co-payments and coinsurance
requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital
services for adult enrollees, subject to an annual inpatient
out-of-pocket maximum of $1,000 per individual and $3,000 per
family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees; and

(4) 50 percent of the fee-for-service rate for adult dental
care services other than preventive care services for persons
eligible under section 256L.04, subdivisions 1 to 7, with income
deleted text begin equal to or less deleted text end new text begin greater new text end than deleted text begin 175 deleted text end new text begin 190 new text end percent of the federal
poverty guidelines.

(b) Paragraph (a), clause (1), does not apply to parents
and relative caretakers of children under the age of 21 in
households with family income equal to or less than 175 percent
of the federal poverty guidelines. Paragraph (a), clause (1),
does not apply to parents and relative caretakers of children
under the age of 21 in households with family income greater
than 175 percent of the federal poverty guidelines for inpatient
hospital admissions occurring on or after January 1, 2001.

(c) Paragraph (a), clauses (1) to (4), do not apply to
pregnant women and children under the age of 21.

(d) Adult enrollees with family gross income that exceeds
175 percent of the federal poverty guidelines and who are not
pregnant shall be financially responsible for the coinsurance
amount, if applicable, and amounts which exceed the $10,000
inpatient hospital benefit limit.

(e) When a MinnesotaCare enrollee becomes a member of a
prepaid health plan, or changes from one prepaid health plan to
another during a calendar year, any charges submitted towards
the $10,000 annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient
services, that were submitted or incurred prior to enrollment,
or prior to the change in health plans, shall be disregarded.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 37.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 1a. new text end

new text begin Social security number required. new text end

new text begin (a)
Individuals and families applying for MinnesotaCare coverage
must provide a Social Security number.
new text end

new text begin (b) The commissioner shall not deny eligibility to an
otherwise eligible applicant who has applied for a Social
Security number and is awaiting issuance of that Social Security
number.
new text end

new text begin (c) Newborns enrolled under section 256L.05, subdivision 3,
are exempt from the requirements of this subdivision.
new text end

new text begin (d) Individuals who refuse to provide a Social Security
number because of well-established religious objections are
exempt from the requirements of this subdivision. The term
"well-established religious objections" has the meaning given in
Code of Federal Regulations, title 42, section 435.910.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 38.

Minnesota Statutes 2004, section 256L.04,
subdivision 2, is amended to read:

Subd. 2.

Cooperation in establishing third-party
liability, paternity, and other medical support.

(a) To be
eligible for MinnesotaCare, individuals and families must
cooperate with the state agency to identify potentially liable
third-party payers and assist the state in obtaining third-party
payments. "Cooperation" includes, but is not limited
to, new text begin complying with the notice requirements in section 256B.056,
subdivision 9, new text end identifying any third party who may be liable for
care and services provided under MinnesotaCare to the enrollee,
providing relevant information to assist the state in pursuing a
potentially liable third party, and completing forms necessary
to recover third-party payments.

(b) A parent, guardian, relative caretaker, or child
enrolled in the MinnesotaCare program must cooperate with the
Department of Human Services and the local agency in
establishing the paternity of an enrolled child and in obtaining
medical care support and payments for the child and any other
person for whom the person can legally assign rights, in
accordance with applicable laws and rules governing the medical
assistance program. A child shall not be ineligible for or
disenrolled from the MinnesotaCare program solely because the
child's parent, relative caretaker, or guardian fails to
cooperate in establishing paternity or obtaining medical support.

Sec. 39.

Minnesota Statutes 2004, section 256L.04, is
amended by adding a subdivision to read:

new text begin Subd. 2a. new text end

new text begin Applications for other benefits. new text end

new text begin To be
eligible for MinnesotaCare, individuals and families must take
all necessary steps to obtain other benefits as described in
Code of Federal Regulations, title 42, section 435.608.
Applicants and enrollees must apply for other benefits within 30
days.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 40.

Minnesota Statutes 2004, section 256L.04,
subdivision 7, is amended to read:

Subd. 7.

Single adults and households with no children.

The definition of eligible persons includes all individuals and
households with no children who have gross family incomes that
are equal to or less than deleted text begin 175 deleted text end new text begin 190 new text end percent of the federal poverty
guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 41.

Minnesota Statutes 2004, section 256L.05,
subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective
date of coverage is the first day of the month following the
month in which eligibility is approved and the first premium
payment has been received. As provided in section 256B.057,
coverage for newborns is automatic from the date of birth and
must be coordinated with other health coverage. The effective
date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the deleted text begin date of entry
into the family deleted text end new text begin month of placement new text end . The effective date of
coverage for other new deleted text begin recipients deleted text end new text begin members new text end added to the family
deleted text begin receiving covered health services deleted text end is the first day of the month
following the month in which deleted text begin eligibility is approved or at
renewal, whichever the family receiving covered health services
prefers deleted text end new text begin the change is reported new text end . All eligibility criteria must
be met by the family at the time the new family member is
added. The income of the new family member is included with the
family's gross income and the adjusted premium begins in the
month the new family member is added.

(b) The initial premium must be received by the last
working day of the month for coverage to begin the first day of
the following month.

(c) Benefits are not available until the day following
discharge if an enrollee is hospitalized on the first day of
coverage.

(d) Notwithstanding any other law to the contrary, benefits
under sections 256L.01 to 256L.18 are secondary to a plan of
insurance or benefit program under which an eligible person may
have coverage and the commissioner shall use cost avoidance
techniques to ensure coordination of any other health coverage
for eligible persons. The commissioner shall identify eligible
persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 42.

Minnesota Statutes 2004, section 256L.05,
subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning January
1, 1999, an enrollee's eligibility must be renewed every 12
months. The 12-month period begins in the month after the month
the application is approved.

(b) Beginning October 1, 2004, an enrollee's eligibility
must be renewed every six months. The first six-month period of
eligibility begins deleted text begin in the month after deleted text end the month the application
is deleted text begin approved deleted text end new text begin received by the commissioner new text end . new text begin The effective date of
coverage within the first six-month period of eligibility is as
provided in subdivision 3. new text end Each new period of eligibility must
take into account any changes in circumstances that impact
eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first
day of the month that ends the eligibility period. The premium
for the new period of eligibility must be received as provided
in section 256L.06 in order for eligibility to continue.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 43.

Minnesota Statutes 2004, section 256L.07,
subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children
enrolled in the original children's health plan as of September
30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in
subdivision 3, as long as they maintain continuous coverage in
the MinnesotaCare program or medical assistance. Children who
apply for MinnesotaCare on or after the implementation date of
the employer-subsidized health coverage program as described in
Laws 1998, chapter 407, article 5, section 45, who have family
gross incomes that are equal to or less than 150 percent of the
federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.

(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1, whose income increases above 275 percent
of the federal poverty guidelines, are no longer eligible for
the program and shall be disenrolled by the commissioner.
Individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 7, whose income increases above 175 percent of the
federal poverty guidelines are no longer eligible for the
program and shall be disenrolled by the commissioner. For
persons disenrolled under this subdivision, MinnesotaCare
coverage terminates the last day of the calendar month following
the month in which the commissioner determines that the income
of a family or individual exceeds program income limits.

(c)(1) Notwithstanding paragraph (b), families enrolled in
MinnesotaCare under section 256L.04, subdivision 1, may remain
enrolled in MinnesotaCare if ten percent of their annual income
is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health
Association. Families who are no longer eligible for
MinnesotaCare under this subdivision shall be given an 18-month
notice period from the date that ineligibility is determined
before disenrollment. This clause expires February 1, 2004.

(2) Effective February 1, 2004, notwithstanding paragraph
(b), children may remain enrolled in MinnesotaCare if ten
percent of their deleted text begin annual deleted text end new text begin gross individual or gross new text end family income
new text begin as defined in section 256L.01, subdivision 4, new text end is less than the
deleted text begin annual deleted text end premium for a new text begin six-month new text end policy with a $500 deductible
available through the Minnesota Comprehensive Health
Association. Children who are no longer eligible for
MinnesotaCare under this clause shall be given a 12-month notice
period from the date that ineligibility is determined before
disenrollment. The premium for children remaining eligible
under this clause shall be the maximum premium determined under
section 256L.15, subdivision 2, paragraph (b).

(d) Effective July 1, 2003, notwithstanding paragraphs (b)
and (c), parents are no longer eligible for MinnesotaCare if
gross household income exceeds deleted text begin $50,000 deleted text end new text begin $25,000 for the six-month
period of eligibility new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 44.

Minnesota Statutes 2004, section 256L.07,
subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and
individuals enrolled in the MinnesotaCare program must have no
health coverage while enrolled or for at least four months prior
to application and renewal. Children enrolled in the original
children's health plan and children in families with income
equal to or less than 150 percent of the federal poverty
guidelines, who have other health insurance, are eligible if the
coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per
year; or

(3) lacks coverage because the child has exceeded the
maximum coverage for a particular diagnosis or the policy
excludes a particular diagnosis.

The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of
available appropriations. The requirement of no health coverage
does not apply to newborns.

(b) Medical assistance, general assistance medical care,
and the Civilian Health and Medical Program of the Uniformed
Service, CHAMPUS, or other coverage provided under United States
Code, title 10, subtitle A, part II, chapter 55, are not
considered insurance or health coverage for purposes of the
four-month requirement described in this subdivision.

(c) For purposes of this subdivision, new text begin an applicant or
enrollee who is entitled to new text end Medicare Part A or new text begin enrolled in
Medicare Part new text end B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c
to deleted text begin 1395w-4 deleted text end new text begin 1395w-152 new text end , is considered new text begin to have new text end health coverage. An
applicant or enrollee new text begin who is entitled to premium-free Medicare
Part A new text end may not refuse new text begin to apply for or enroll in new text end Medicare
coverage to establish eligibility for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application
must meet the provisions of this subdivision and subdivision 2.

(e) deleted text begin Effective October 1, 2003, applicants who were
recipients of medical assistance and had deleted text end Cost-effective health
insurance deleted text begin which deleted text end new text begin that new text end was paid for by medical assistance deleted text begin are
exempt from deleted text end new text begin is not considered health coverage for purposes of
new text end the four-month requirement under this section new text begin , except if the
insurance continued after medical assistance no longer
considered it cost-effective or after medical assistance closed new text end .

Sec. 45.

Minnesota Statutes 2004, section 256L.07, is
amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Voluntary disenrollment for members of
military. new text end

new text begin Notwithstanding section 256L.05, subdivision 3b,
MinnesotaCare enrollees who are members of the military and
their families, who choose to voluntarily disenroll from the
program when one or more family members are called to active
duty, may reenroll during or following that member's tour of
active duty. Those individuals and families shall be considered
to have good cause for voluntary termination under section
256L.06, subdivision 3, paragraph (d). Income and asset
increases reported at the time of reenrollment shall be
disregarded. All provisions of sections 256L.01 to 256L.18,
shall apply to individuals and families enrolled under this
subdivision upon six-month renewal.
new text end

Sec. 46.

Minnesota Statutes 2004, section 256L.12,
subdivision 6, is amended to read:

Subd. 6.

Co-payments and benefit limits.

Enrollees are
responsible for all co-payments in deleted text begin sections deleted text end new text begin section new text end 256L.03,
subdivision 5, deleted text begin and 256L.035, deleted text end and shall pay co-payments to the
managed care plan or to its participating providers. The
enrollee is also responsible for payment of inpatient hospital
charges which exceed the MinnesotaCare benefit limit.

Sec. 47.

Minnesota Statutes 2004, section 256L.15,
subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale to determine percentage of
new text begin monthly new text end gross individual or family income.

(a) The commissioner
shall establish a sliding fee scale to determine the percentage
of new text begin monthly new text end gross individual or family income that households at
different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on
the enrollee's new text begin monthly new text end gross individual or family income. The
sliding fee scale must contain separate tables based on
enrollment of one, two, or three or more persons. The sliding
fee scale begins with a premium of 1.5 percent of new text begin monthly new text end gross
individual or family income for individuals or families with
incomes below the limits for the medical assistance program for
families and children in effect on January 1, 1999, and proceeds
through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8,
4.8, 5.9, 7.4, and 8.8 percent. These percentages are matched
to evenly spaced income steps ranging from the medical
assistance income limit for families and children in effect on
January 1, 1999, to 275 percent of the federal poverty
guidelines for the applicable family size, up to a family size
of five. The sliding fee scale for a family of five must be
used for families of more than five. Effective October 1, 2003,
the commissioner shall increase each percentage by 0.5
percentage points for enrollees with income greater than 100
percent but not exceeding 200 percent of the federal poverty
guidelines and shall increase each percentage by 1.0 percentage
points for families and children with incomes greater than 200
percent of the federal poverty guidelines. The sliding fee
scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income
after enrollment, premiums shall not be adjusted until
eligibility renewal.

(b)(1) Enrolled families whose gross annual income
increases above 275 percent of the federal poverty guideline
shall pay the maximum premium. This clause expires effective
February 1, 2004.

(2) Effective February 1, 2004, children in families whose
gross income is above 275 percent of the federal poverty
guidelines shall pay the maximum premium.

(3) The maximum premium is defined as a base charge for
one, two, or three or more enrollees so that if all
MinnesotaCare cases paid the maximum premium, the total revenue
would equal the total cost of MinnesotaCare medical coverage and
administration. In this calculation, administrative costs shall
be assumed to equal ten percent of the total. The costs of
medical coverage for pregnant women and children under age two
and the enrollees in these groups shall be excluded from the
total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or
more enrollees shall be three times the maximum premium for one.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 48.

Minnesota Statutes 2004, section 256L.15,
subdivision 3, is amended to read:

Subd. 3.

Exceptions to sliding scale.

deleted text begin An annual premium
of $48 is required for all deleted text end Children in families with income at
or deleted text begin less than deleted text end new text begin below new text end 150 percent of new text begin the new text end federal poverty guidelines
new text begin pay a monthly premium of $4 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 49.

new text begin [256L.20] MINNESOTACARE OPTION FOR SMALL
EMPLOYERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purpose of this
section, the terms used have the meanings given them.
new text end

new text begin (b) "Dependent" means an unmarried child under 21 years of
age.
new text end

new text begin (c) "Eligible employer" means a business that employs at
least two, but not more than 50, eligible employees, the
majority of whom are employed in the state, and includes a
municipality that has 50 or fewer employees.
new text end

new text begin (d) "Eligible employee" means an employee who works at
least 20 hours per week for an eligible employer. Eligible
employee does not include an employee who works on a temporary
or substitute basis or who does not work more than 26 weeks
annually.
new text end

new text begin (e) "Maximum premium" has the meaning given under section
256L.15, subdivision 2, paragraph (b), clause (3).
new text end

new text begin (f) "Participating employer" means an eligible employer who
meets the requirements in subdivision 3 and applies to the
commissioner to enroll its eligible employees and their
dependents in the MinnesotaCare program.
new text end

new text begin (g) "Program" means the MinnesotaCare program.
new text end

new text begin Subd. 2. new text end

new text begin Option. new text end

new text begin Eligible employees and their dependents
may enroll in MinnesotaCare if the eligible employer meets the
requirements of subdivision 3. The effective date of coverage
is according to section 256L.05, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Employer requirements. new text end

new text begin The commissioner shall
establish procedures for an eligible employer to apply for
coverage through the program. In order to participate, an
eligible employer must meet the following requirements:
new text end

new text begin (1) agrees to contribute toward the cost of the premium for
the employee and the employee's dependents according to
subdivision 4;
new text end

new text begin (2) certifies that at least 75 percent of its eligible
employees who do not have other creditable health coverage are
enrolled in the program;
new text end

new text begin (3) offers coverage to all eligible employees and the
dependents of eligible employees; and
new text end

new text begin (4) has not provided employer-subsidized health coverage as
an employee benefit during the previous 12 months, as defined in
section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Premiums. new text end

new text begin (a) The premium for MinnesotaCare
coverage provided under this section is equal to the maximum
premium regardless of the income of the eligible employee.
new text end

new text begin (b) For eligible employees without dependents with income
equal to or less than 175 percent of the federal poverty
guidelines and for eligible employees with dependents with
income equal to or less than 275 percent of the federal poverty
guidelines, the participating employer shall pay 50 percent of
the maximum premium for the eligible employee and any
dependents, if applicable.
new text end

new text begin (c) For eligible employees without dependents with income
over 175 percent of the federal poverty guidelines and for
eligible employees with dependents with income over 275 percent
of the federal poverty guidelines, the participating employer
shall pay the full cost of the maximum premium for the eligible
employee and any dependents, if applicable. The participating
employer may require the employee to pay a portion of the cost
of the premium so long as the employer pays 50 percent of the
cost. If the employer requires the employee to pay a portion of
the premium, the employee shall pay the portion of the cost to
the employer.
new text end

new text begin (d) The commissioner shall collect premium payments from
participating employers for eligible employees and their
dependents who are covered by the program as provided under this
section. All premiums collected shall be deposited in the
health care access fund.
new text end

new text begin Subd. 5. new text end

new text begin Coverage. new text end

new text begin The coverage offered to those
enrolled in the program under this section must include all
health services described under section 256L.03 and all
co-payments and coinsurance requirements under section 256L.03,
subdivision 5, apply.
new text end

new text begin Subd. 6. new text end

new text begin Enrollment. new text end

new text begin Upon payment of the premium, in
accordance with this section and section 256L.06, eligible
employees and their dependents shall be enrolled in
MinnesotaCare. For purposes of enrollment under this section,
income eligibility limits established under sections 256L.04 and
256L.07, subdivision 1, and asset limits established under
section 256L.17 do not apply. The barriers established under
section 256L.07, subdivision 2 or 3, do not apply to enrollees
eligible under this section. The commissioner may require
eligible employees to provide income verification to determine
premiums.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2006,
or upon HealthMatch implementation, whichever is later.
new text end

Sec. 50.

Minnesota Statutes 2004, section 549.02, is
amended by adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Limitation. new text end

new text begin Notwithstanding subdivisions 1 and
2, where the state agency is named or intervenes as a party to
enforce the agency's rights under section 256B.056, the agency
shall not be liable for costs to any prevailing defendant.
new text end

Sec. 51.

Minnesota Statutes 2004, section 549.04, is
amended to read:

549.04 DISBURSEMENTS; TAXATION AND ALLOWANCE.

new text begin Subdivision 1. new text end

new text begin Generally. new text end

In every action in a district
court, the prevailing party, including any public employee who
prevails in an action for wrongfully denied or withheld
employment benefits or rights, shall be allowed reasonable
disbursements paid or incurred, including fees and mileage paid
for service of process by the sheriff or by a private person.

new text begin Subd. 2. new text end

new text begin Limitation. new text end

new text begin Notwithstanding subdivision 1,
where the state agency is named or intervenes as a party to
enforce the agency's rights under section 256B.056, the agency
shall not be liable for disbursements to any prevailing
defendant.
new text end

Sec. 52.

Laws 2003, First Special Session chapter 14,
article 12, section 93, is amended to read:

Sec. 93 new text begin REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY
CRITERIA AND POTENTIAL COST SAVINGS.
new text end

The commissioner of human services, in consultation with
the commissioner of transportation and special transportation
service providers, shall review eligibility criteria for medical
assistance special transportation services and shall evaluate
whether the level of special transportation services provided
should be based on the degree of impairment of the client, as
well as the medical diagnosis. The commissioner shall also
evaluate methods for reducing the cost of special transportation
services, including, but not limited to:

(1) requiring providers to maintain a daily log book
confirming delivery of clients to medical facilities;

(2) requiring providers to implement commercially available
computer mapping programs to calculate mileage for purposes of
reimbursement;

(3) restricting special transportation service from being
provided solely for trips to pharmacies;

(4) modifying eligibility for special transportation;

(5) expanding alternatives to the use of special
transportation services;

(6) improving the process of certifying persons as eligible
for special transportation services; and

(7) examining the feasibility and benefits of licensing
special transportation providers.

The commissioner shall present recommendations for changes
in the eligibility criteria and potential cost-savings for
special transportation services to the chairs and ranking
minority members of the house and senate committees having
jurisdiction over health and human services spending by January
15, 2004. The commissioner is prohibited from using a broker or
coordinator to manage special transportation services until July
1, deleted text begin 2005 deleted text end new text begin 2006 new text end , except for the purposes of checking for recipient
eligibility, authorizing recipients for appropriate level of
transportation, and monitoring provider compliance with
Minnesota Statutes, section 256B.0625, subdivision 17. This
prohibition does not apply to the purchase or management of
common carrier transportation.

Sec. 53. new text begin ADVISORY COMMITTEE ON NONEMERGENCY
TRANSPORTATION SERVICES.
new text end

new text begin The commissioner of human services may establish a
seven-member advisory committee on medical assistance
nonemergency transportation services. The committee may consist
of: a representative of the commissioner of human services, who
may serve as chair; two special transportation service
providers, appointed by the trade associations representing
special transportation service providers; two representatives of
nursing facilities, one appointed by the Minnesota Health and
Housing Alliance and the other appointed by Care Providers of
Minnesota; and one house of representatives and one senate
member, appointed respectively by the chairs of the house of
representatives and senate committees with jurisdiction over
medical assistance funding. The advisory committee may monitor
and evaluate the provision of medical assistance nonemergency
medical transportation services, and present recommendations for
any necessary changes to the commissioner.
new text end

Sec. 54. new text begin EMPLOYER DISCLOSURE FOR MINNESOTA HEALTH CARE
PROGRAM.
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) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Minnesota health care program" means the prescription
drug program under section 256.955, medical assistance under
chapter 256B, general assistance medical care under section
256D.03, subdivision 3, and MinnesotaCare under chapter 256L.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin (a) By January 15, 2007, for the
previous fiscal year, the commissioner shall submit to the
legislature a report identifying all employers that employ 50 or
more employees who are Minnesota health care program
recipients. In determining whether the 50-employee threshold is
met, the commissioner shall include all employees employed by an
employer and its subsidiaries at all locations within the
state. The report shall include the following information:
new text end

new text begin (1) the name of the employer and, as appropriate, the names
of its subsidiaries that employ Minnesota health care program
recipients;
new text end

new text begin (2) the number of Minnesota health care program recipients
who are employees of the employer;
new text end

new text begin (3) the number of Minnesota health care program recipients
who are spouses or dependents of employees of the employer; and
new text end

new text begin (4) the cost to the state of providing health care benefits
for these employers' employees and enrolled dependents.
new text end

new text begin (b) In preparing and publishing the report, the
commissioner shall take reasonable precautions to protect the
identity of Minnesota health care program recipients:
new text end

new text begin (1) the report shall include only nonindividually
identifiable summary data as defined in section 13.02,
subdivision 19;
new text end

new text begin (2) the commissioner shall employ generally accepted
statistical and scientific principles and methods for rendering
information as not individually identifiable. The commissioner
must determine that there is an insignificant risk that
information in the report could be used, alone or in combination
with other reasonably available information, to identify any
Minnesota health care program recipient; and
new text end

new text begin (3) the commissioner shall comply with all other applicable
privacy and security provisions of the Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191,
and its corresponding regulations, Code of Federal Regulations,
title 45, sections 160, 162, and 164; Minnesota Statutes,
chapter 13; section 144.335; and any other applicable state and
federal law.
new text end

new text begin (c) The commissioner shall make the report available to the
public on the Department of Human Services' Web site, and shall
provide a copy of the report to any member of the public upon
request.
new text end

Sec. 55. new text begin LIMITING COVERAGE OF HEALTH CARE SERVICES FOR
MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND
MINNESOTACARE PROGRAMS.
new text end

new text begin Subdivision 1. new text end

new text begin Prior authorization of services. new text end

new text begin (a)
Effective July 1, 2005, prior authorization is required for the
services described in subdivision 2 for reimbursement under
chapters 256B, 256D, and 256L.
new text end

new text begin (b) Prior authorization shall be conducted under the
direction of the medical director of the Department of Human
Services in conjunction with a medical policy advisory council.
To the extent available, the medical director shall use publicly
available evidence-based guidelines developed by an independent,
nonprofit organization or by the professional association of the
specialty that typically provides the service or by a multistate
Medicaid evidence-based practice center. If the commissioner
does not have a medical director and medical policy director in
place, the commissioner shall contract prior authorization to a
Minnesota-licensed utilization review organization or to another
entity such as a peer review organization eligible to operate in
Minnesota.
new text end

new text begin (c) A prepaid health plan shall use prior authorization for
the services described in subdivision 2 unless the prepaid
health plan is otherwise using evidence-based practices to
address these services.
new text end

new text begin Subd. 2. new text end

new text begin Services requiring prior authorization. new text end

new text begin The
following services require prior authorization:
new text end

new text begin (1) elective outpatient high-technology imaging to include
positive emission tomography (PET) scans, magnetic resonance
imaging (MRI), computed tomography (CT), and nuclear cardiology;
new text end

new text begin (2) spinal fusion, unless in an emergency situation related
to trauma;
new text end

new text begin (3) bariatric surgery;
new text end

new text begin (4) chiropractic visits beyond ten visits;
new text end

new text begin (5) circumcision; and
new text end

new text begin (6) orthodontia.
new text end

new text begin Subd. 3. new text end

new text begin Rate reduction. new text end

new text begin Effective for the services
identified in subdivision 2, rendered on or after July 1, 2005,
the payment rate shall be reduced by ten percent from the rate
in effect on June 30, 2005.
new text end

new text begin Subd. 4. new text end

new text begin Expiration. new text end

new text begin This section shall expire July 1,
2006, or upon the completion of the prior authorization system
required under subdivision 1, whichever is earlier.
new text end

Sec. 56. new text begin ORAL HEALTH CARE PILOT PROJECT.
new text end

new text begin The commissioner shall implement a two-year pilot project
to provide services for state program recipients through a new
oral health care delivery system. The commissioner shall
contract with a qualified entity or entities to administer the
pilot project.
new text end

Sec. 57. new text begin SOLE-SOURCE MANAGED CARE CONTRACT.
new text end

new text begin Notwithstanding Minnesota Statutes, section 256B.692,
subdivision 6, the commissioner of human services shall not
reject a county-based purchasing health plan proposal that
requires county-based purchasing on a sole-source basis if the
implementation of the sole-source purchasing proposal does not
limit an enrollee's provider choice or access to services. The
commissioner shall request federal approval, if necessary, to
permit or maintain a sole-source purchasing option even if
choice is available in the area.
new text end

Sec. 58. new text begin PLANNING PROCESS FOR MANAGED CARE.
new text end

new text begin The commissioner of human services shall develop a planning
process for the purposes of implementing at least one additional
managed care arrangement to provide medical assistance services,
excluding continuing care services, to recipients enrolled in
the medical assistance fee-for-service program, effective
January 1, 2007. This planning process shall include an
advisory committee composed of current fee-for-service
consumers, consumer advocates, and providers, as well as
representatives of health plans and other provider organizations
qualified to provide basic health care services to persons with
disabilities. The commissioner shall seek any additional
federal authority necessary to provide basic health care
services through contracted managed care arrangements.
new text end

Sec. 59. new text begin REPEALER.
new text end

new text begin (a) Notwithstanding Minnesota Statutes, section 256B.69,
subdivision 5a, paragraph (b), Minnesota Statutes 2004, section
256L.035, is repealed effective July 1, 2005.
new text end

new text begin (b) Minnesota Statutes 2004, section 256B.0631, is repealed
effective January 1, 2006.
new text end

ARTICLE 3

HEALTH CARE COST CONTAINMENT

Section 1.

Minnesota Statutes 2004, section 62A.65,
subdivision 3, is amended to read:

Subd. 3.

Premium rate restrictions.

No individual health
plan may be offered, sold, issued, or renewed to a Minnesota
resident unless the premium rate charged is determined in
accordance with the following requirements:

(a) Premium rates must be no more than 25 percent above and
no more than 25 percent below the index rate charged to
individuals for the same or similar coverage, adjusted pro rata
for rating periods of less than one year. The premium
variations permitted by this paragraph must be based only upon
health status, claims experience, and occupation. For purposes
of this paragraph, health status includes refraining from
tobacco use or other actuarially valid lifestyle factors
associated with good health, provided that the lifestyle factor
and its effect upon premium rates have been determined by the
commissioner to be actuarially valid and have been approved by
the commissioner. Variations permitted under this paragraph
must not be based upon age or applied differently at different
ages. This paragraph does not prohibit use of a constant
percentage adjustment for factors permitted to be used under
this paragraph.

(b) Premium rates may vary based upon the ages of covered
persons only as provided in this paragraph. In addition to the
variation permitted under paragraph (a), each health carrier may
use an additional premium variation based upon age of up to plus
or minus 50 percent of the index rate.

(c) A health carrier may request approval by the
commissioner to establish no more than three geographic regions
and to establish separate index rates for each region, provided
that the index rates do not vary between any two regions by more
than 20 percent. Health carriers that do not do business in the
Minneapolis/St. Paul metropolitan area may request approval for
no more than two geographic regions, and clauses (2) and (3) do
not apply to approval of requests made by those health
carriers. The commissioner may grant approval if the following
conditions are met:

(1) the geographic regions must be applied uniformly by the
health carrier;

(2) one geographic region must be based on the
Minneapolis/St. Paul metropolitan area;

(3) for each geographic region that is rural, the index
rate for that region must not exceed the index rate for the
Minneapolis/St. Paul metropolitan area; and

(4) the health carrier provides actuarial justification
acceptable to the commissioner for the proposed geographic
variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of
providing coverage.

(d) Health carriers may use rate cells and must file with
the commissioner the rate cells they use. Rate cells must be
based upon the number of adults or children covered under the
policy and may reflect the availability of Medicare coverage.
The rates for different rate cells must not in any way reflect
generalized differences in expected costs between principal
insureds and their spouses.

(e) In developing its index rates and premiums for a health
plan, a health carrier shall take into account only the
following factors:

(1) actuarially valid differences in rating factors
permitted under paragraphs (a) and (b); and

(2) actuarially valid geographic variations if approved by
the commissioner as provided in paragraph (c).

(f) All premium variations must be justified in initial
rate filings and upon request of the commissioner in rate
revision filings. All rate variations are subject to approval
by the commissioner.

(g) The loss ratio must comply with the section 62A.021
requirements for individual health plans.

(h) new text begin Notwithstanding paragraphs (a) to (g), new text end the rates must
not be approved deleted text begin , deleted text end unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the
commissioner shall deleted text begin consider the growth rates applied under
section 62J.04, subdivision 1, paragraph (b) deleted text end new text begin apply the premium
growth limits established under section 62J.04, subdivision 1b new text end ,
to the calendar year or years that the proposed premium rate
would be in effect, new text begin and shall consider new text end actuarially valid changes
in risks associated with the enrollee populations deleted text begin , deleted text end and
actuarially valid changes as a result of statutory changes in
Laws 1992, chapter 549.

Sec. 2.

Minnesota Statutes 2004, section 62J.04, is
amended by adding a subdivision to read:

new text begin Subd. 1b. new text end

new text begin Premium growth limits. new text end

new text begin (a) For calendar year
2005 and each year thereafter, the commissioner shall set annual
premium growth limits for health plan companies. The premium
limits set by the commissioner for calendar years 2005 to 2010
shall not exceed the regional Consumer Price Index for urban
consumers for the preceding calendar year plus two percentage
points and an additional one percentage point to be used to
finance the implementation of the electronic medical record
system. The commissioner shall ensure that the additional
percentage point is being used to provide financial assistance
to health care providers to implement electronic medical record
systems either directly or through an increase in reimbursement.
new text end

new text begin (b) For the calendar years beyond 2010, the rate of premium
growth shall be limited to the change in the Consumer Price
Index for urban consumers for the previous calendar year plus
two percentage points. The commissioners of health and commerce
shall make a recommendation to the legislature by January 15,
2009, regarding the continuation of the additional percentage
point to the growth limit described in paragraph (a). The
recommendation shall be based on the progress made by health
care providers in instituting an electronic medical record
system and in creating a statewide interactive electronic health
record system.
new text end

new text begin (c) The commissioner may add additional percentage points
as needed to the premium limit for a calendar year if a major
disaster, bioterrorism, or a public health emergency occurs that
results in higher health care costs. Any additional percentage
points must reflect the additional cost to the health care
system directly attributed to the disaster or emergency.
new text end

new text begin (d) The commissioner shall publish the annual premium
growth limits in the State Register by January 31 of the year
that the limits are to be in effect.
new text end

new text begin (e) For the purpose of this subdivision, premium growth is
measured as the percentage change in per member, per month
premium revenue from the current year to the previous year.
Premium growth rates shall be calculated for the following lines
of business: individual, small group, and large group. Data
used for premium growth rate calculations shall be submitted as
part of the cost containment filing under section 62J.38.
new text end

new text begin (f) For purposes of this subdivision, "health plan company"
has the meaning given in section 62J.041.
new text end

new text begin (g) A health plan company may reduce reimbursement to
providers in order to meet the premium growth limitations
required by this section.
new text end

Sec. 3.

Minnesota Statutes 2004, section 62J.04,
subdivision 3, is amended to read:

Subd. 3.

Cost containment duties.

The commissioner shall:

(1) establish statewide and regional cost containment goals
for total health care spending under this section and collect
data as described in sections 62J.38 to 62J.41 to monitor
statewide achievement of the cost containment goals new text begin and premium
growth limits new text end ;

(2) divide the state into no fewer than four regions, with
one of those regions being the Minneapolis/St. Paul metropolitan
statistical area but excluding Chisago, Isanti, Wright, and
Sherburne Counties, for purposes of fostering the development of
regional health planning and coordination of health care
delivery among regional health care systems and working to
achieve the cost containment goals;

(3) monitor the quality of health care throughout the state
and take action as necessary to ensure an appropriate level of
quality;

(4) issue recommendations regarding uniform billing forms,
uniform electronic billing procedures and data interchanges,
patient identification cards, and other uniform claims and
administrative procedures for health care providers and private
and public sector payers. In developing the recommendations,
the commissioner shall review the work of the work group on
electronic data interchange (WEDI) and the American National
Standards Institute (ANSI) at the national level, and the work
being done at the state and local level. The commissioner may
adopt rules requiring the use of the Uniform Bill 82/92 form,
the National Council of Prescription Drug Providers (NCPDP) 3.2
electronic version, the Centers for Medicare and Medicaid
Services 1500 form, or other standardized forms or procedures;

(5) undertake health planning responsibilities;

(6) authorize, fund, or promote research and
experimentation on new technologies and health care procedures;

(7) within the limits of appropriations for these purposes,
administer or contract for statewide consumer education and
wellness programs that will improve the health of Minnesotans
and increase individual responsibility relating to personal
health and the delivery of health care services, undertake
prevention programs including initiatives to improve birth
outcomes, expand childhood immunization efforts, and provide
start-up grants for worksite wellness programs;

(8) undertake other activities to monitor and oversee the
delivery of health care services in Minnesota with the goal of
improving affordability, quality, and accessibility of health
care for all Minnesotans; and

(9) make the cost containment goal new text begin and premium growth limit
new text end data available to the public in a consumer-oriented manner.

Sec. 4.

Minnesota Statutes 2004, section 62J.041, is
amended to read:

62J.041 deleted text begin INTERIM deleted text end HEALTH PLAN COMPANY deleted text begin COST CONTAINMENT GOALS
deleted text end new text begin HEALTH CARE EXPENDITURE LIMITS new text end .

Subdivision 1.

Definitions.

(a) For purposes of this
section, the following definitions apply.

(b) "Health plan company" has the definition provided in
section 62Q.01. new text begin This definition does not include the state
employee health plan offered under chapter 43A.
new text end

(c) " deleted text begin Total deleted text end new text begin Health care new text end expenditures" means incurred claims
or expenditures on health care services deleted text begin , administrative
expenses, charitable contributions, and all other payments deleted text end made
by health plan companies deleted text begin out of premium revenues deleted text end .

(d) deleted text begin "Net expenditures" means total expenditures minus
exempted taxes and assessments and payments or allocations made
to establish or maintain reserves.
deleted text end

deleted text begin (e) "Exempted taxes and assessments" means direct payments
for taxes to government agencies, contributions to the Minnesota
Comprehensive Health Association, the medical assistance
provider's surcharge under section 256.9657, the MinnesotaCare
provider tax under section 295.52, assessments by the Health
Coverage Reinsurance Association, assessments by the Minnesota
Life and Health Insurance Guaranty Association, assessments by
the Minnesota Risk Adjustment Association, and any new
assessments imposed by federal or state law.
deleted text end

deleted text begin (f) deleted text end "Consumer cost-sharing or subscriber liability" means
enrollee coinsurance, co-payment, deductible payments, and
amounts in excess of benefit plan maximums.

Subd. 2.

Establishment.

The commissioner of health shall
establish deleted text begin cost containment goals deleted text end new text begin health care expenditure limits
new text end for deleted text begin the increase in net deleted text end new text begin calendar year 2006, and each year
thereafter, for health care new text end expenditures by each health plan
company deleted text begin for calendar years 1994, 1995, 1996, and 1997. The cost
containment goals must be the same as the annual cost
containment goals for health care spending established under
section 62J.04, subdivision 1, paragraph (b) deleted text end . Health plan
companies that are affiliates may elect to meet one
combined deleted text begin cost containment goal deleted text end new text begin health care expenditure limit.
The limits set by the commissioner shall not exceed the premium
limits established in section 62J.04, subdivision 1b new text end .

Subd. 3.

Determination of expenditures.

Health plan
companies shall submit to the commissioner of health, by April
deleted text begin 1, 1994, for calendar year 1993; April 1, 1995, for calendar
year 1994; April 1, 1996, for calendar year 1995; April 1, 1997,
for calendar year 1996; and April 1, 1998, for calendar year
1997 deleted text end new text begin of each year beginning 2006, new text end all information the
commissioner determines to be necessary to implement this
section. The information must be submitted in the form
specified by the commissioner. The information must include,
but is not limited to, new text begin health care new text end expenditures per member per
month or cost per employee per month, and detailed information
on revenues and reserves. The commissioner, to the extent
possible, shall coordinate the submittal of the information
required under this section with the submittal of the financial
data required under chapter 62J, to minimize the administrative
burden on health plan companies. The commissioner may adjust
final expenditure figures for demographic changes, risk
selection, changes in basic benefits, and legislative
initiatives that materially change health care costs, as long as
these adjustments are consistent with the methodology submitted
by the health plan company to the commissioner, and approved by
the commissioner as actuarially justified. deleted text begin The methodology to
be used for adjustments and the election to meet one cost
containment goal for affiliated health plan companies must be
submitted to the commissioner by September 1, 1994. Community
integrated service networks may submit the information with
their application for licensure. The commissioner shall also
accept changes to methodologies already submitted. The
adjustment methodology submitted and approved by the
commissioner must apply to the data submitted for calendar years
1994 and 1995. The commissioner may allow changes to accepted
adjustment methodologies for data submitted for calendar years
1996 and 1997. Changes to the adjustment methodology must be
received by September 1, 1996, and must be approved by the
commissioner.
deleted text end

Subd. 4.

Monitoring of reserves.

(a) The commissioners
of health and commerce shall monitor health plan company
reserves and net worth as established under chapters 60A, 62C,
62D, 62H, and 64B, with respect to the health plan companies
that each commissioner respectively regulates to assess the
degree to which savings resulting from the establishment of cost
containment goals are passed on to consumers in the form of
lower premium rates.

(b) Health plan companies shall fully reflect in the
premium rates the savings generated by the cost containment
goals. No premium rate, currently reviewed by the Department of
Health or Commerce, may be approved for those health plan
companies unless the health plan company establishes to the
satisfaction of the commissioner of commerce or the commissioner
of health, as appropriate, that the proposed new rate would
comply with this paragraph.

(c) Health plan companies, except those licensed under
chapter 60A to sell accident and sickness insurance under
chapter 62A, shall annually before the end of the fourth fiscal
quarter provide to the commissioner of health or commerce, as
applicable, a projection of the level of reserves the company
expects to attain during each quarter of the following fiscal
year. These health plan companies shall submit with required
quarterly financial statements a calculation of the actual
reserve level attained by the company at the end of each quarter
including identification of the sources of any significant
changes in the reserve level and an updated projection of the
level of reserves the health plan company expects to attain by
the end of the fiscal year. In cases where the health plan
company has been given a certificate to operate a new health
maintenance organization under chapter 62D, or been licensed as
a community integrated service network under chapter 62N, or
formed an affiliation with one of these organizations, the
health plan company shall also submit with its quarterly
financial statement, total enrollment at the beginning and end
of the quarter and enrollment changes within each service area
of the new organization. The reserve calculations shall be
maintained by the commissioners as trade secret information,
except to the extent that such information is also required to
be filed by another provision of state law and is not treated as
trade secret information under such other provisions.

(d) Health plan companies in paragraph (c) whose reserves
are less than the required minimum or more than the required
maximum at the end of the fiscal year shall submit a plan of
corrective action to the commissioner of health or commerce
under subdivision 7.

(e) The commissioner of commerce, in consultation with the
commissioner of health, shall report to the legislature no later
than January 15, 1995, as to whether the concept of a reserve
corridor or other mechanism for purposes of monitoring reserves
is adaptable for use with indemnity health insurers that do
business in multiple states and that must comply with their
domiciliary state's reserves requirements.

Subd. 5.

Notice.

The commissioner of health shall
publish in the State Register and make available to the public
by July 1, deleted text begin 1995 deleted text end new text begin 2007 new text end , new text begin and each year thereafter, new text end a list of all
health plan companies that exceeded their deleted text begin cost containment goal
deleted text end new text begin health care expenditure limit new text end for the deleted text begin 1994 deleted text end new text begin previous new text end calendar
year. deleted text begin The commissioner shall publish in the State Register and
make available to the public by July 1, 1996, a list of all
health plan companies that exceeded their combined cost
containment goal for calendar years 1994 and 1995. deleted text end The
commissioner shall notify each health plan company that the
commissioner has determined that the health plan company
exceeded its deleted text begin cost containment goal, deleted text end new text begin health care expenditure
limit new text end at least 30 days before publishing the list, and shall
provide each health plan company deleted text begin with deleted text end ten days to provide an
explanation for exceeding the deleted text begin cost containment goal deleted text end new text begin health care
expenditure limit new text end . The commissioner shall review the
explanation and may change a determination if the commissioner
determines the explanation to be valid.

Subd. 6.

Assistance by the commissioner of commerce.

The
commissioner of commerce shall provide assistance to the
commissioner of health in monitoring health plan companies
regulated by the commissioner of commerce.

Sec. 5.

new text begin [62J.255] HEALTH RISK INFORMATION SHEET.
new text end

new text begin (a) A health plan company shall provide to each enrollee on
an annual basis information on the increased personal health
risks and the additional costs to the health care system due to
obesity and to the use of tobacco.
new text end

new text begin (b) The commissioner, in consultation with the Minnesota
Medical Association, shall develop an information sheet on the
personal health risks of obesity and smoking and on the
additional costs to the health care system due to obesity and
due to smoking. The information sheet shall be posted on the
Minnesota Department of Health's Web site.
new text end

new text begin (c) When providing the information required in paragraph
(a), the health plan company must also provide each enrollee
with information on the best practices care guidelines and
quality of care measurement criteria identified in section
62J.43 as well as the availability of this information on the
department's Web site.
new text end

new text begin (d) This section does not apply to health plan companies
offering only limited dental or vision plans.
new text end

Sec. 6.

Minnesota Statutes 2004, section 62J.301,
subdivision 3, is amended to read:

Subd. 3.

General duties.

The commissioner shall:

(1) collect and maintain data which enable population-based
monitoring and trending of the access, utilization, quality, and
cost of health care services within Minnesota;

(2) collect and maintain data for the purpose of estimating
total Minnesota health care expenditures and trends;

(3) collect and maintain data for the purposes of setting
cost containment goals new text begin and premium growth limits new text end under section
62J.04, and measuring cost containment goal new text begin and premium growth
limit new text end compliance;

(4) conduct applied research using existing and new data
and promote applications based on existing research;

(5) develop and implement data collection procedures to
ensure a high level of cooperation from health care providers
and health plan companies, as defined in section 62Q.01,
subdivision 4;

(6) work closely with health plan companies and health care
providers to promote improvements in health care efficiency and
effectiveness; and

(7) participate as a partner or sponsor of private sector
initiatives that promote publicly disseminated applied research
on health care delivery, outcomes, costs, quality, and
management.

Sec. 7.

Minnesota Statutes 2004, section 62J.38, is
amended to read:

62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.

(a) The commissioner shall require group purchasers to
submit detailed data on total health care spending for each
calendar year. Group purchasers shall submit data for the 1993
calendar year by April 1, 1994, and each April 1 thereafter
shall submit data for the preceding calendar year.

(b) The commissioner shall require each group purchaser to
submit data on revenue, expenses, and member months, as
applicable. Revenue data must distinguish between premium
revenue and revenue from other sources and must also include
information on the amount of revenue in reserves and changes in
reserves. new text begin Premium revenue data, information on aggregate
enrollment, and data on member months must be broken down to
distinguish between individual market, small group market, and
large group market. Filings under this section for calendar
year 2005 must also include information broken down by
individual market, small group market, and large group market
for calendar year 2004. new text end Expenditure data must distinguish
between costs incurred for patient care and administrative
costs. Patient care and administrative costs must include only
expenses incurred on behalf of health plan members and must not
include the cost of providing health care services for
nonmembers at facilities owned by the group purchaser or
affiliate. Expenditure data must be provided separately for the
following categories and for other categories required by the
commissioner: physician services, dental services, other
professional services, inpatient hospital services, outpatient
hospital services, emergency, pharmacy services and other
nondurable medical goods, mental health, and chemical dependency
services, other expenditures, subscriber liability, and
administrative costs. Administrative costs must include costs
for marketing; advertising; overhead; salaries and benefits of
central office staff who do not provide direct patient care;
underwriting; lobbying; claims processing; provider contracting
and credentialing; detection and prevention of payment for
fraudulent or unjustified requests for reimbursement or
services; clinical quality assurance and other types of medical
care quality improvement efforts; concurrent or prospective
utilization review as defined in section 62M.02; costs incurred
to acquire a hospital, clinic, or health care facility, or the
assets thereof; capital costs incurred on behalf of a hospital
or clinic; lease payments; or any other costs incurred pursuant
to a partnership, joint venture, integration, or affiliation
agreement with a hospital, clinic, or other health care
provider. Capital costs and costs incurred must be recorded
according to standard accounting principles. The reports of
this data must also separately identify expenses for local,
state, and federal taxes, fees, and assessments. The
commissioner may require each group purchaser to submit any
other data, including data in unaggregated form, for the
purposes of developing spending estimates, setting spending
limits, and monitoring actual spending and costs. In addition
to reporting administrative costs incurred to acquire a
hospital, clinic, or health care facility, or the assets
thereof; or any other costs incurred pursuant to a partnership,
joint venture, integration, or affiliation agreement with a
hospital, clinic, or other health care provider; reports
submitted under this section also must include the payments made
during the calendar year for these purposes. The commissioner
shall make public, by group purchaser data collected under this
paragraph in accordance with section 62J.321, subdivision 5.
Workers' compensation insurance plans and automobile insurance
plans are exempt from complying with this paragraph as it
relates to the submission of administrative costs.

(c) The commissioner may collect information on:

(1) premiums, benefit levels, managed care procedures, and
other features of health plan companies;

(2) prices, provider experience, and other information for
services less commonly covered by insurance or for which
patients commonly face significant out-of-pocket expenses; and

(3) information on health care services not provided
through health plan companies, including information on prices,
costs, expenditures, and utilization.

(d) All group purchasers shall provide the required data
using a uniform format and uniform definitions, as prescribed by
the commissioner.

Sec. 8.

new text begin [62J.82] CHARGES TO UNINSURED; PROVIDER
RECOURSE.
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 terms defined in this subdivision have the meanings
given them.
new text end

new text begin (b) "Covered individual" means an individual who has health
plan company or public health care program coverage for health
care services.
new text end

new text begin (c) "CPT code" means a code contained in the most current
edition of the Physician's Current Procedural Terminology (CPT)
manual published by the American Medical Association.
new text end

new text begin (d) "Dependent" has the meaning given under section 62L.02,
subdivision 11.
new text end

new text begin (e) "Health care service" has the meaning given under
section 62J.17, subdivision 2.
new text end

new text begin (f) "Health plan company" has the meaning given under
section 62Q.01, subdivision 4.
new text end

new text begin (g) "Person" means an individual, corporation, firm,
partnership, incorporated or unincorporated association, or any
other legal or commercial entity.
new text end

new text begin (h) "Provider" means a hospital or outpatient surgical
center licensed under chapter 144.
new text end

new text begin (i) "Third-party payer" means a health plan company or a
public health care plan or program.
new text end

new text begin (j) "Uninsured individual" means a person or dependent who
does not have health plan company coverage or who is not
otherwise covered by a third-party payer.
new text end

new text begin Subd. 2. new text end

new text begin Notice to uninsured. new text end

new text begin (a) A provider may attempt
to obtain from a person or the person's representative
information about whether any third-party payer may fully or
partially cover the charges for health care services rendered by
the provider to the person.
new text end

new text begin (b) A provider shall inform each person, both orally and in
writing, immediately upon first meeting with that person, or as
soon as practicable thereafter, that uninsured individuals will
be charged or billed for health care services in amounts that do
not exceed the amounts described in subdivision 3.
new text end

new text begin (c) If, at the time health care services are provided, a
person has not provided proof of coverage by a third-party payer
or a provider otherwise determines that the person is an
uninsured individual, the provider, as part of any billing to
the person, shall provide the person with a clear and
conspicuous notice that includes:
new text end

new text begin (1) a statement of charges for health care services
rendered by the provider; and
new text end

new text begin (2) a statement that uninsured individuals will be charged
or billed for health care services in amounts that do not exceed
the amounts described in subdivision 3.
new text end

new text begin (d) For purposes of the notice required under paragraph
(c), a provider may incorporate the items into the provider's
existing billing statements and is not required to develop a
separate notice. All communications to a person required by
this subdivision must be language appropriate.
new text end

new text begin Subd. 3. new text end

new text begin Provider charges to uninsured. new text end

new text begin In billing or
charging an uninsured individual or the individual's
representative for medically necessary health care services, a
provider must bill by CPT code, or other billing identifier as
may be routinely used for billing that health care service. A
provider shall not bill or charge an uninsured individual or the
individual's representative more than the amount the provider is
paid for that service by the nongovernmental third-party payer
that provided the most revenue to the provider during the
previous calendar year, plus any applicable cost sharing
payments payable by an individual covered by that provider's
highest volume plan. After a bill or charge is issued under
this subdivision, a provider may not increase the bill or charge.
new text end

new text begin Subd. 4. new text end

new text begin Limitations. new text end

new text begin Notwithstanding any other
provision of law, the amounts paid by uninsured individuals for
health care services according to subdivision 3 does not
constitute a provider's uniform, published, prevailing, or
customary charges, or its usual fees to the general public, for
purposes of any payment limit under the Medicare or medical
assistance programs or any other federal or state financed
health care program.
new text end

new text begin Subd. 5. new text end

new text begin Recourse limited. new text end

new text begin (a) Providers under agreement
with a health plan company or public health care plan or program
to provide health care services shall not have recourse against
covered individuals, or persons acting on their behalf, for
amounts above those specified in the evidence of coverage or
other plan or program document as co-payments or coinsurance for
health care services. This subdivision applies only to health
plans that provide coverage equivalent to or greater than a
number two qualified plan described under section 62E.08, and is
not limited to the following events:
new text end

new text begin (1) nonpayment by the health plan company;
new text end

new text begin (2) insolvency of the health plan company; and
new text end

new text begin (3) breach of the agreement between the health plan company
and the provider.
new text end

new text begin (b) This subdivision does not limit a provider's ability to
seek payment from any person other than the covered individual,
the covered individual's guardian or conservator, the covered
individual's immediate family members, or the covered
individual's legal representative in the event of nonpayment by
a health plan company.
new text end

new text begin Subd. 6. new text end

new text begin Remedies. new text end

new text begin A person may file an action in
district court seeking injunctive relief and damages for
violations of this section. In any such action, a person may
also recover costs and disbursements and reasonable attorney
fees.
new text end

new text begin Subd. 7. new text end

new text begin Grounds for disciplinary action. new text end

new text begin Violations of
this section may be grounds for disciplinary or regulatory
action against a provider by the appropriate licensing board or
agency.
new text end

new text begin Subd. 8. new text end

new text begin Authority of attorney general. new text end

new text begin The attorney
general may investigate violations of this section under section
8.31. The attorney general may file an action for violations of
this section according to section 8.31 or may pursue other
remedies available to the attorney general.
new text end

new text begin Subd. 9. new text end

new text begin Income and asset limitations. new text end

new text begin The provisions of
this section shall not apply to uninsured individuals with an
annual family income above $125,000.
new text end

Sec. 9.

new text begin [62J.84] HOSPITAL CHARGE DISCLOSURE.
new text end

new text begin The Minnesota Hospital Association shall develop a
Web-based system, available to the public free of charge, for
reporting charge information, including, but not limited to,
number of discharges, average length of stay, average charge,
average charge per day, and median charge, for each of the 50
most common inpatient diagnosis-related groups and the 25 most
common outpatient surgical procedures as specified by the
Minnesota Hospital Association. The Web site must provide
information that compares hospital-specific data to hospital
statewide data. The Web site must be established by October 1,
2006, and must be updated annually. If a hospital does not
provide this information to the Minnesota Hospital Association,
the commissioner may require the hospital to do so. The
commissioner shall provide a link to this information on the
department's Web site.
new text end

Sec. 10.

Minnesota Statutes 2004, section 62L.08,
subdivision 8, is amended to read:

Subd. 8.

Filing requirement.

new text begin (a) new text end No later than July 1,
1993, and each year thereafter, a health carrier that offers,
sells, issues, or renews a health benefit plan for small
employers shall file with the commissioner the index rates and
must demonstrate that all rates shall be within the rating
restrictions defined in this chapter. Such demonstration must
include the allowable range of rates from the index rates and a
description of how the health carrier intends to use demographic
factors including case characteristics in calculating the
premium rates.

new text begin (b) Notwithstanding paragraph (a), new text end the rates shall not be
approved deleted text begin , deleted text end unless the commissioner has determined that the rates
are reasonable. In determining reasonableness, the commissioner
shall deleted text begin consider the growth rates applied under section 62J.04,
subdivision 1, paragraph (b) deleted text end new text begin apply the premium growth limits
established under section 62J.04, subdivision 1b new text end , to the
calendar year or years that the proposed premium rate would be
in effect, new text begin and shall consider new text end actuarially valid changes in risk
associated with the enrollee population, and actuarially valid
changes as a result of statutory changes in Laws 1992, chapter
549. deleted text begin For premium rates proposed to go into effect between July
1, 1993 and December 31, 1993, the pertinent growth rate is the
growth rate applied under section 62J.04, subdivision 1,
paragraph (b), to calendar year 1994.
deleted text end

Sec. 11.

Minnesota Statutes 2004, section 62Q.37,
subdivision 7, is amended to read:

Subd. 7.

Human services.

new text begin (a) new text end The commissioner of human
services shall implement this section in a manner that is
consistent with applicable federal laws and regulations new text begin and that
avoids the duplication of review activities performed by a
nationally recognized independent organization new text end .

new text begin (b) By December 31 of each year, the commissioner shall
submit to the legislature a written report identifying the
number of audits performed by a nationally recognized
independent organization that were accepted, partially accepted,
or rejected by the commissioner under this section. The
commissioner shall provide the rationale for partial acceptance
or rejection. If the rationale for the partial acceptance or
rejection was based on the commissioner's determination that the
standards used in the audit were not equivalent to state law,
regulation, or contract requirement, the report must document
the variances between the audit standards and the applicable
state requirements.
new text end

ARTICLE 4

LONG-TERM CARE AND CONTINUING CARE

Section 1.

Minnesota Statutes 2004, section 144A.073, is
amended by adding a subdivision to read:

new text begin Subd. 3d. new text end

new text begin Project amendment authorized. new text end

new text begin Notwithstanding
the provisions of subdivision 3b:
new text end

new text begin (1) a nursing facility located in the city of Duluth with
42 licensed beds as of January 1, 2005, that received approval
under this section in 2002 for a moratorium exception project
may reduce the number of resident rooms in the new addition from
13 to nine and may reduce the common space by more than five
percent; and
new text end

new text begin (2) a nursing facility located in the city of Duluth with
127 licensed beds as of January 1, 2005, that received approval
under this section in 2002 for a moratorium exception project
may reduce the number of single rooms from 46 to 42 and may
reduce the common space by more than five percent.
new text end

Sec. 2.

Minnesota Statutes 2004, section 144A.073,
subdivision 10, is amended to read:

Subd. 10.

Extension of approval of moratorium exception.

Notwithstanding subdivision 3, the commissioner of health shall
extend project approval for an additional deleted text begin 18 deleted text end new text begin 36 new text end months for any
proposed exception to the nursing home licensure and
certification moratorium if the proposal was approved under this
section between July 1, 2001, and June 30, 2003.

Sec. 3.

Minnesota Statutes 2004, section 252.291, is
amended by adding a subdivision to read:

new text begin Subd. 2b. new text end

new text begin Exception for brown county facility. new text end

new text begin (a) The
commissioner shall authorize and grant a new license under
chapter 245A to a new intermediate care facility for persons
with mental retardation under the following circumstances:
new text end

new text begin (1) the new facility replaces an existing six-bed
intermediate care facility for the mentally retarded located in
Brown County that has been operating since June 1982;
new text end

new text begin (2) the new facility is located on an already purchased
parcel of land; and
new text end

new text begin (3) the new facility is handicapped accessible.
new text end

new text begin (b) The medical assistance payment rate for the new
facility shall be the higher of the rate specified in paragraph
(c) or as otherwise provided by law.
new text end

new text begin (c) The new facility shall be considered a newly
established facility for rate-setting purposes and shall be
eligible for the investment per bed limit specified in section
256B.501, subdivision 11, paragraph (c), and the interest
expense limitation specified in section 256B.501, subdivision
11, paragraph (d). Notwithstanding section 256B.5011, the newly
established facility's initial payment rate shall be set
according to Minnesota Rules, part 9553.0075, and shall not be
subject to the provisions of section 256B.501, subdivision 5b.
new text end

new text begin (d) During the construction of the new facility, Brown
County shall work with residents, families, and service
providers to explore all service options open to current
residents of the facility.
new text end

Sec. 4.

Minnesota Statutes 2004, section 256B.0621,
subdivision 2, is amended to read:

Subd. 2.

Targeted case management; definitions.

For
purposes of subdivisions 3 to 10, the following terms have the
meanings given them:

(1) "home care service recipients" means those individuals
receiving the following services under section 256B.0627:
skilled nursing visits, home health aide visits, private duty
nursing, personal care assistants, or therapies provided through
a home health agency;

(2) "home care targeted case management" means the
provision of targeted case management services for the purpose
of assisting home care service recipients to gain access to
needed services and supports so that they may remain in the
community;

(3) "institutions" means hospitals, consistent with Code of
Federal Regulations, title 42, section 440.10; regional
treatment center inpatient services, consistent with section
245.474; nursing facilities; and intermediate care facilities
for persons with mental retardation;

(4) "relocation targeted case management" deleted text begin means deleted text end new text begin includes
new text end the provision of new text begin both county new text end targeted case management new text begin and public
or private vendor service coordination new text end services for the purpose
of assisting recipients to gain access to needed services and
supports if they choose to move from an institution to the
community. Relocation targeted case management may be provided
during the last 180 consecutive days of an eligible recipient's
institutional stay; and

(5) "targeted case management" means case management
services provided to help recipients gain access to needed
medical, social, educational, and other services and supports.

Sec. 5.

Minnesota Statutes 2004, section 256B.0621,
subdivision 3, is amended to read:

Subd. 3.

Eligibility.

The following persons are eligible
for relocation targeted case management or home deleted text begin care-targeted
deleted text end new text begin care targeted new text end case management:

(1) medical assistance eligible persons residing in
institutions who choose to move into the community are eligible
for relocation targeted case management services; and

(2) medical assistance eligible persons receiving home care
services, who are not eligible for any other medical assistance
reimbursable case management service, are eligible for home
deleted text begin care-targeted deleted text end new text begin care targeted new text end case management services beginning
deleted text begin January 1, 2003 deleted text end new text begin July 1, 2005 new text end .

Sec. 6.

Minnesota Statutes 2004, section 256B.0621,
subdivision 4, is amended to read:

Subd. 4.

Relocation targeted new text begin county new text end case management
provider qualifications.

(a) A relocation targeted new text begin county new text end case
management provider is an enrolled medical assistance provider
who is determined by the commissioner to have all of the
following characteristics:

(1) the legal authority to provide public welfare under
sections 393.01, subdivision 7; and 393.07; or a federally
recognized Indian tribe;

(2) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;

(3) the administrative capacity and experience to serve the
target population for whom it will provide services and ensure
quality of services under state and federal requirements;

(4) the legal authority to provide complete investigative
and protective services under section 626.556, subdivision 10;
and child welfare and foster care services under section 393.07,
subdivisions 1 and 2; or a federally recognized Indian tribe;

(5) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements; and

(6) the capacity to document and maintain individual case
records under state and federal requirements.

(b) A provider of targeted case management under section
256B.0625, subdivision 20, may be deemed a certified provider of
relocation targeted case management.

(c) A relocation targeted new text begin county new text end case management provider
may subcontract with another provider to deliver relocation
targeted case management services. Subcontracted providers must
demonstrate the ability to provide the services outlined in
subdivision 6, and have a procedure in place that notifies the
recipient and the recipient's legal representative of any
conflict of interest if the contracted targeted case management
provider also provides, or will provide, the recipient's
services and supports. new text begin Counties must require that new text end contracted
providers must provide information on all conflicts of interest
and obtain the recipient's informed consent or provide the
recipient with alternatives.

Sec. 7.

Minnesota Statutes 2004, section 256B.0621,
subdivision 5, is amended to read:

Subd. 5.

Home care targeted case management new text begin and
relocation service coordination new text end provider qualifications.

deleted text begin The
following qualifications and certification standards must be met
by deleted text end Providers of home care targeted case management new text begin and
relocation service coordination must meet the qualifications
under subdivision 4 for county vendors or the following
qualifications and certification standards for private vendors new text end .

(a) The commissioner must certify each provider of home
care targeted case management new text begin and relocation service
coordination new text end before enrollment. The certification process shall
examine the provider's ability to meet the requirements in this
subdivision and other state and federal requirements of this
service.

(b) deleted text begin A deleted text end new text begin Both new text end home care targeted case management deleted text begin provider is
an deleted text end new text begin providers and relocation service coordination providers are
new text end enrolled medical assistance deleted text begin provider deleted text end new text begin providers new text end who deleted text begin has deleted text end new text begin have new text end a
minimum of a bachelor's degree or a license in a health or human
services field new text begin , or comparable training and two years of
experience in human services new text end , and deleted text begin is deleted text end new text begin have been new text end determined by the
commissioner to have all of the following characteristics:

(1) the demonstrated capacity and experience to provide the
components of case management to coordinate and link community
resources needed by the eligible population;

(2) the administrative capacity and experience to serve the
target population for whom it will provide services and ensure
quality of services under state and federal requirements;

(3) a financial management system that provides accurate
documentation of services and costs under state and federal
requirements;

(4) the capacity to document and maintain individual case
records under state and federal requirements; deleted text begin and
deleted text end

(5) the capacity to coordinate with county administrative
functions new text begin ;
new text end

new text begin (6) have no financial interest in the provision of
out-of-home residential services to persons for whom targeted
case management or relocation service coordination is provided;
and
new text end

new text begin (7) if a provider has a financial interest in services
other than out-of-home residential services provided to persons
for whom targeted case management or relocation service
coordination is also provided, the county must determine each
year that:
new text end

new text begin (i) any possible conflict of interest is explained annually
at a face-to-face meeting and in writing and the person provides
written informed consent consistent with section 256B.77,
subdivision 2, paragraph (p); and
new text end

new text begin (ii) information on a range of other feasible service
provider options has been provided new text end .

new text begin (c) The State of Minnesota, a county board, or agency
acting on behalf of a county board shall not be liable for
damages, injuries, or liabilities sustained because of services
provided to a client by a private service coordination vendor.
new text end

Sec. 8.

Minnesota Statutes 2004, section 256B.0621,
subdivision 6, is amended to read:

Subd. 6.

Eligible services.

new text begin (a) new text end Services eligible for
medical assistance reimbursement as targeted case management
include:

(1) assessment of the recipient's need for targeted case
management services new text begin and for persons choosing to relocate, the
county must provide service coordination provider options at the
first contact and upon request new text end ;

(2) development, completion, and regular review of a
written individual service plan, which is based upon the
assessment of the recipient's needs and choices, and which will
ensure access to medical, social, educational, and other related
services and supports;

(3) routine contact or communication with the recipient,
recipient's family, primary caregiver, legal representative,
substitute care provider, service providers, or other relevant
persons identified as necessary to the development or
implementation of the goals of the individual service plan;

(4) coordinating referrals for, and the provision of, case
management services for the recipient with appropriate service
providers, consistent with section 1902(a)(23) of the Social
Security Act;

(5) coordinating and monitoring the overall service
delivery new text begin and engaging in advocacy as needed new text end to ensure quality of
services, appropriateness, and continued need;

(6) completing and maintaining necessary documentation that
supports and verifies the activities in this subdivision;

(7) deleted text begin traveling deleted text end new text begin assisting individuals in order to access
needed services, including travel new text end to conduct a visit with the
recipient or other relevant person necessary to develop or
implement the goals of the individual service plan; and

(8) coordinating with the institution discharge planner in
the 180-day period before the recipient's discharge.

new text begin (b) Relocation targeted county case management includes
services under paragraph (a), clauses (1), (2), and (4).
Relocation service coordination includes services under
paragraph (a), clauses (3) and (5) to (8). Home care targeted
case management includes services under paragraph (a), clauses
(1) to (8).
new text end

Sec. 9.

Minnesota Statutes 2004, section 256B.0621,
subdivision 7, is amended to read:

Subd. 7.

Time lines.

The following time lines must be
met for assigning a case manager:

(a) For relocation targeted case management, an eligible
recipient must be assigned a new text begin county new text end case manager who visits the
person within 20 working days of requesting a case manager from
their county of financial responsibility as determined under
chapter 256G.

(1) If a county agency, its contractor, or federally
recognized tribe does not provide case management services as
required, the recipient may obtain deleted text begin targeted relocation case
management services deleted text end new text begin relocation service coordination new text end from deleted text begin an
alternative deleted text end new text begin a new text end provider deleted text begin of targeted case management services
enrolled by the commissioner deleted text end new text begin qualified under subdivision 5 new text end .

(2) The commissioner may waive the provider requirements in
subdivision 4, paragraph (a), clauses (1) and (4), to ensure
recipient access to the assistance necessary to move from an
institution to the community. The recipient or the recipient's
legal guardian shall provide written notice to the county or
tribe of the decision to obtain services from an alternative
provider.

(3) Providers of relocation targeted case management
enrolled under this subdivision shall:

(i) meet the provider requirements under subdivision 4 that
are not waived by the commissioner;

(ii) be qualified to provide the services specified in
subdivision 6;

(iii) coordinate efforts with local social service agencies
and tribes; and

(iv) comply with the conflict of interest provisions
established under subdivision 4, paragraph (c).

(4) Local social service agencies and federally recognized
tribes shall cooperate with providers certified by the
commissioner under this subdivision to facilitate the
recipient's successful relocation from an institution to the
community.

(b) For home care targeted case management, an eligible
recipient must be assigned a case manager within 20 working days
of requesting a case manager from a home care targeted case
management provider, as defined in subdivision 5.

Sec. 10.

Minnesota Statutes 2004, section 256B.0625,
subdivision 2, is amended to read:

Subd. 2.

Skilled and intermediate nursing care.

Medical
assistance covers skilled nursing home services and services of
intermediate care facilities, including training and
habilitation services, as defined in section 252.41, subdivision
3, for persons with mental retardation or related conditions who
are residing in intermediate care facilities for persons with
mental retardation or related conditions. Medical assistance
must not be used to pay the costs of nursing care provided to a
patient in a swing bed as defined in section 144.562, unless (a)
the facility in which the swing bed is located is eligible as a
sole community provider, as defined in Code of Federal
Regulations, title 42, section 412.92, or the facility is a
public hospital owned by a governmental entity with 15 or fewer
licensed acute care beds; (b) the Centers for Medicare and
Medicaid Services approves the necessary state plan amendments;
(c) the patient was screened as provided by law; (d) the patient
no longer requires acute care services; and (e) no nursing home
beds are available within 25 miles of the facility. new text begin The
commissioner shall exempt a facility from compliance with the
sole community provider requirement in clause (a) if, as of
January 1, 2004, the facility had an agreement with the
commissioner to provide medical assistance swing bed services.
new text end Medical assistance also covers up to ten days of nursing care
provided to a patient in a swing bed if: (1) the patient's
physician certifies that the patient has a terminal illness or
condition that is likely to result in death within 30 days and
that moving the patient would not be in the best interests of
the patient and patient's family; (2) no open nursing home beds
are available within 25 miles of the facility; and (3) no open
beds are available in any Medicare hospice program within 50
miles of the facility. The daily medical assistance payment for
nursing care for the patient in the swing bed is the statewide
average medical assistance skilled nursing care per diem as
computed annually by the commissioner on July 1 of each year.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day
following final enactment and applies to medical assistance
payments for swing bed services provided on or after March 5,
2005.
new text end

Sec. 11.

Minnesota Statutes 2004, section 256B.0625,
subdivision 19c, is amended to read:

Subd. 19c.

Personal care.

Medical assistance covers
personal care assistant services provided by an individual who
is qualified to provide the services according to subdivision
19a and section 256B.0627, where the services are deleted text begin prescribed
deleted text end new text begin determined to be medically necessary new text end by a physician new text begin , provided new text end in
accordance with a new text begin service new text end plan deleted text begin of treatment deleted text end new text begin , new text end and are supervised
by the recipient or a qualified professional. new text begin The physician's
determination of medical necessity for personal care assistant
services shall be documented on a form approved by the
commissioner and include the diagnosis or condition of the
person that results in a need for personal care assistant
services and be updated either when the person's medical
condition requires a change or at least annually if the medical
need for personal care services is ongoing.
new text end

"Qualified professional" means a mental health professional as
defined in section 245.462, subdivision 18, or 245.4871,
subdivision 27; or a registered nurse as defined in sections
148.171 to 148.285, or a licensed social worker as defined in
section 148B.21. As part of the assessment, the county public
health nurse will assist the recipient or responsible party to
identify the most appropriate person to provide supervision of
the personal care assistant. The qualified professional shall
perform the duties described in Minnesota Rules, part 9505.0335,
subpart 4.

Sec. 12.

Minnesota Statutes 2004, section 256B.0627,
subdivision 1, is amended to read:

Subdivision 1.

Definition.

(a) "Activities of daily
living" includes eating, toileting, grooming, dressing, bathing,
transferring, mobility, and positioning.

(b) "Assessment" means a review and evaluation of a
recipient's need for home care services conducted in person.
Assessments for private duty nursing shall be conducted by a
registered private duty nurse. Assessments for home health
agency services shall be conducted by a home health agency
nurse. Assessments for personal care assistant services shall
be conducted by the county public health nurse or a certified
public health nurse under contract with the county. A
face-to-face 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 assistant 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. A face-to-face assessment for personal care
assistant services is conducted on those recipients who have
never had a county public health nurse assessment. A
face-to-face 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 assistant
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
assistant service. 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 for medical assistance home
care services for mental retardation or related conditions and
alternative care services for developmentally disabled home and
community-based waivered recipients may be conducted by the
county public health nurse to ensure coordination and avoid
duplication. Assessments 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.

(c) "Care plan" means a written description of personal
care assistant services developed by the qualified professional
or the recipient's physician with the recipient or responsible
party to be used by the personal care assistant with a copy
provided to the recipient or responsible party.

(d) "Complex and regular private duty nursing care" means:

(1) complex care is private duty nursing provided to
recipients who are ventilator dependent or for whom a physician
has certified that were it not for private duty nursing the
recipient would meet the criteria for inpatient hospital
intensive care unit (ICU) level of care; and

(2) regular care is private duty nursing provided to all
other recipients.

(e) "Health-related functions" means functions that can be
delegated or assigned by a licensed health care professional
under state law to be performed by a personal care attendant.

(f) "Home care services" means a health service, determined
by the commissioner as medically necessary, that is ordered by a
physician and documented in a service plan that is reviewed by
the physician at least once every 60 days for the provision of
home health services, or private duty nursing, or at least once
every 365 days for personal care. Home care services are
provided to the recipient at the recipient's residence that is a
place other than a hospital or long-term care facility or as
specified in section 256B.0625.

(g) "Instrumental activities of daily living" includes meal
planning and preparation, managing finances, shopping for food,
clothing, and other essential items, performing essential
household chores, communication by telephone and other media,
and getting around and participating in the community.

(h) "Medically necessary" has the meaning given in
Minnesota Rules, parts 9505.0170 to 9505.0475.

(i) "Personal care assistant" means a person who:

(1) is at least 18 years old, except for persons 16 to 18
years of age who participated in a related school-based job
training program or have completed a certified home health aide
competency evaluation;

(2) is able to effectively communicate with the recipient
and personal care provider organization;

(3) effective July 1, 1996, has completed one of the
training requirements as specified in Minnesota Rules, part
9505.0335, subpart 3, items A to D;

(4) has the ability to, and provides covered personal care
assistant services according to the recipient's care plan,
responds appropriately to recipient needs, and reports changes
in the recipient's condition to the supervising qualified
professional or physician;

(5) is not a consumer of personal care assistant services;
deleted text begin and
deleted text end

(6) new text begin maintains daily written records detailing:
new text end

new text begin (i) the actual services provided to the recipient; and
new text end

new text begin (ii) the amount of time spent providing the services; and
new text end

new text begin (7) new text end is subject to criminal background checks and procedures
specified in chapter 245C.

(j) "Personal care provider organization" means an
organization enrolled to provide personal care assistant
services under the medical assistance program that complies with
the following:

(1) owners who have a five percent interest or more, and
managerial officials are subject to a background study as
provided in chapter 245C. This applies to currently enrolled
personal care provider organizations and those agencies seeking
enrollment as a personal care provider organization. An
organization will be barred from enrollment if an owner or
managerial official of the organization has been convicted of a
crime specified in chapter 245C, or a comparable crime in
another jurisdiction, unless the owner or managerial official
meets the reconsideration criteria specified in chapter 245C;

(2) the organization must maintain a surety bond and
liability insurance throughout the duration of enrollment and
provides proof thereof. The insurer must notify the Department
of Human Services of the cancellation or lapse of policy deleted text begin ; deleted text end and
deleted text begin (3) the organization deleted text end must maintain documentation of services as
specified in Minnesota Rules, part 9505.2175, subpart 7, as well
as evidence of compliance with personal care assistant training
requirements new text begin ;
new text end

new text begin (3) the organization must maintain documentation and a
recipient file and satisfy communication requirements in
subdivision 4, paragraph (f); and
new text end

new text begin (4) the organization must comply with all laws and rules
governing the provision of personal care services new text end .

(k) "Responsible party" means an individual who is capable
of providing the support necessary to assist the recipient to
live in the community, is at least 18 years old, actively
participates in planning and directing of personal care
assistant services, and is not the personal care assistant. The
responsible party must be accessible to the recipient and the
personal care assistant when personal care services are being
provided and monitor the services at least weekly according to
the plan of care. The responsible party must be identified at
the time of assessment and listed on the recipient's service
agreement and care plan. Responsible parties new text begin who are parents of
minors or guardians of minors or incapacitated persons new text end may
delegate the responsibility to another adult who is not the
personal care assistant new text begin during a temporary absence of at least
24 hours but not more than six months. The person delegated as
a responsible party must be able to meet the definition of
responsible party, except that the delegated responsible party
is required to reside with the recipient only while serving as
the responsible party. The delegated responsible party is not
required to reside with the recipient while serving as the
responsible party if adequate supervision and monitoring are
provided for as part of the person's individual service plan
under a home and community-based waiver program or in
conjunction with a home care targeted case management service
provider or other case manager new text end . The responsible party must
assure that the delegate performs the functions of the
responsible party, is identified at the time of the assessment,
and is listed on the service agreement and the care plan.
Foster care license holders may be designated the responsible
party for residents of the foster care home if case management
is provided as required in section 256B.0625, subdivision 19a.
For persons who, as of April 1, 1992, are sharing personal care
assistant services in order to obtain the availability of
24-hour coverage, an employee of the personal care provider
organization may be designated as the responsible party if case
management is provided as required in section 256B.0625,
subdivision 19a.

(l) "Service plan" means a written description of the
services needed based on the assessment developed by the nurse
who conducts the assessment together with the recipient or
responsible party. The service plan shall include a description
of the covered home care services, frequency and duration of
services, and expected outcomes and goals. The recipient and
the provider chosen by the recipient or responsible party must
be given a copy of the completed service plan within 30 calendar
days of the request for home care services by the recipient or
responsible party.

(m) "Skilled nurse visits" are provided in a recipient's
residence under a plan of care or service plan that specifies a
level of care which the nurse is qualified to provide. These
services are:

(1) nursing services according to the written plan of care
or service plan and accepted standards of medical and nursing
practice in accordance with chapter 148;

(2) services which due to the recipient's medical condition
may only be safely and effectively provided by a registered
nurse or a licensed practical nurse;

(3) assessments performed only by a registered nurse; and

(4) teaching and training the recipient, the recipient's
family, or other caregivers requiring the skills of a registered
nurse or licensed practical nurse.

(n) "Telehomecare" means the use of telecommunications
technology by a home health care professional to deliver home
health care services, within the professional's scope of
practice, to a patient located at a site other than the site
where the practitioner is located.

Sec. 13.

Minnesota Statutes 2004, section 256B.0627,
subdivision 4, is amended to read:

Subd. 4.

Personal care assistant services.

(a) The
personal care assistant services that are eligible for payment
are services and supports furnished to an individual, as needed,
to assist in accomplishing activities of daily living;
instrumental activities of daily living; health-related
functions through hands-on assistance, supervision, and cuing;
and redirection and intervention for behavior including
observation and monitoring.

(b) Payment for services will be made within the limits
approved using the prior authorized process established in
subdivision 5.

(c) The amount and type of services authorized shall be
based on an assessment of the recipient's needs in these areas:

(1) bowel and bladder care;

(2) skin care to maintain the health of the skin;

(3) repetitive maintenance range of motion, muscle
strengthening exercises, and other tasks specific to maintaining
a recipient's optimal level of function;

(4) respiratory assistance;

(5) transfers and ambulation;

(6) bathing, grooming, and hairwashing necessary for
personal hygiene;

(7) turning and positioning;

(8) assistance with furnishing medication that is
self-administered;

(9) application and maintenance of prosthetics and
orthotics;

(10) cleaning medical equipment;

(11) dressing or undressing;

(12) assistance with eating and meal preparation and
necessary grocery shopping;

(13) accompanying a recipient to obtain medical diagnosis
or treatment;

(14) assisting, monitoring, or prompting the recipient to
complete the services in clauses (1) to (13);

(15) redirection, monitoring, and observation that are
medically necessary and an integral part of completing the
personal care assistant services described in clauses (1) to
(14);

(16) redirection and intervention for behavior, including
observation and monitoring;

(17) interventions for seizure disorders, including
monitoring and observation if the recipient has had a seizure
that requires intervention within the past three months;

(18) tracheostomy suctioning using a clean procedure if the
procedure is properly delegated by a registered nurse. Before
this procedure can be delegated to a personal care assistant, a
registered nurse must determine that the tracheostomy suctioning
can be accomplished utilizing a clean rather than a sterile
procedure and must ensure that the personal care assistant has
been taught the proper procedure; and

(19) incidental household services that are an integral
part of a personal care service described in clauses (1) to (18).

For purposes of this subdivision, monitoring and observation
means watching for outward visible signs that are likely to
occur and for which there is a covered personal care service or
an appropriate personal care intervention. For purposes of this
subdivision, a clean procedure refers to a procedure that
reduces the numbers of microorganisms or prevents or reduces the
transmission of microorganisms from one person or place to
another. A clean procedure may be used beginning 14 days after
insertion.

(d) The personal care assistant services that are not
eligible for payment are the following:

(1) services deleted text begin not ordered by the physician deleted text end new text begin provided without
a physician's determination of medical necessity as required by
section 256B.0625, subdivision 19c. The determination must be
in the recipient's file at the time claims are submitted for
payment new text end ;

(2) assessments by personal care assistant provider
organizations or by independently enrolled registered nurses;

(3) services that are not in the service plan;

(4) services provided by the recipient's spouse, legal
guardian for an adult or child recipient, or parent of a
recipient under age 18;

(5) services provided by a foster care provider of a
recipient who cannot direct the recipient's own care, unless
monitored by a county or state case manager under section
256B.0625, subdivision 19a;

(6) services provided by the residential or program license
holder in a residence for more than four persons;

(7) services that are the responsibility of a residential
or program license holder under the terms of a service agreement
and administrative rules;

(8) sterile procedures;

(9) injections of fluids into veins, muscles, or skin;

(10) homemaker services that are not an integral part of a
personal care assistant services;

(11) home maintenance or chore services;

(12) services not specified under paragraph (a); and

(13) services not authorized by the commissioner or the
commissioner's designee.

(e) The recipient or responsible party may choose to
supervise the personal care assistant or to have a qualified
professional, as defined in section 256B.0625, subdivision 19c,
provide the supervision. As required under section 256B.0625,
subdivision 19c, the county public health nurse, as a part of
the assessment, will assist the recipient or responsible party
to identify the most appropriate person to provide supervision
of the personal care assistant. Health-related delegated tasks
performed by the personal care assistant will be under the
supervision of a qualified professional or the direction of the
recipient's physician. If the recipient has a qualified
professional, Minnesota Rules, part 9505.0335, subpart 4,
applies.

new text begin (f) In order to be paid for personal care services,
personal care provider organizations, and personal care choice
providers are required:
new text end

new text begin (1) to maintain a recipient file for each recipient for
whom services are being billed that contains:
new text end

new text begin (i) the current physician's determination of medical
necessity as required by section 256B.0625, subdivision 19c;
new text end

new text begin (ii) the service plan, including the monthly authorized
hours, or flexible use plan;
new text end

new text begin (iii) the care plan, signed by the recipient and the
qualified professional, if required or designated, detailing the
personal care services to be provided;
new text end

new text begin (iv) documentation, on a form approved by the commissioner
and signed by the personal care assistant, specifying the day,
month, year, arrival, and departure times, with AM and PM
notation, for all services provided to the recipient. The form
must include a notice that it is a federal crime to provide
false information on personal care service billings for medical
assistance payment; and
new text end

new text begin (v) all notices to the recipient regarding personal care
service use exceeding authorized hours; and
new text end

new text begin (2) to communicate, by telephone if available, and in
writing, with the recipient or the responsible party about the
schedule for use of authorized hours and to notify the recipient
and the county public health nurse in advance and as soon as
possible, on a form approved by the commissioner, if the monthly
number of hours authorized is likely to be exceeded for the
month.
new text end

new text begin (g) The commissioner shall establish an ongoing audit
process for potential fraud and abuse for personal care
assistant services. The audit process must include, at a
minimum, a requirement that the documentation of hours of care
provided be on a form approved by the commissioner and include
the personal care assistant's signature attesting that the hours
shown on each bill were provided by the personal care assistant
on the dates and the times specified.
new text end

Sec. 14.

Minnesota Statutes 2004, section 256B.0627,
subdivision 5, is amended to read:

Subd. 5.

Limitation on payments.

Medical assistance
payments for home care services shall be limited according to
this subdivision.

(a) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A
recipient may receive the following home care services during a
calendar year:

(1) up to two face-to-face assessments to determine a
recipient's need for personal care assistant services;

(2) one service update done to determine a recipient's need
for personal care assistant services; and

(3) up to nine skilled nurse visits.

(b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care
services above the limits in paragraph (a) must receive the
commissioner's prior authorization, except when:

(1) the home care services were required to treat an
emergency medical condition that if not immediately treated
could cause a recipient serious physical or mental disability,
continuation of severe pain, or death. The provider must
request retroactive authorization no later than five working
days after giving the initial service. The provider must be
able to substantiate the emergency by documentation such as
reports, notes, and admission or discharge histories;

(2) the home care services were provided on or after the
date on which the recipient's eligibility began, but before the
date on which the recipient was notified that the case was
opened. Authorization will be considered if the request is
submitted by the provider within 20 working days of the date the
recipient was notified that the case was opened;

(3) a third-party payor for home care services has denied
or adjusted a payment. Authorization requests must be submitted
by the provider within 20 working days of the notice of denial
or adjustment. A copy of the notice must be included with the
request;

(4) the commissioner has determined that a county or state
human services agency has made an error; or

(5) the professional nurse determines an immediate need for
up to 40 skilled nursing or home health aide visits per calendar
year and submits a request for authorization within 20 working
days of the initial service date, and medical assistance is
determined to be the appropriate payer.

(c) [RETROACTIVE AUTHORIZATION.] A request for retroactive
authorization will be evaluated according to the same criteria
applied to prior authorization requests.

(d) [ASSESSMENT AND SERVICE PLAN.] Assessments under
section 256B.0627, subdivision 1, paragraph (a), shall be
conducted initially, and at least annually thereafter, in person
with the recipient and result in a completed service plan using
forms specified by the commissioner. Within 30 days of
recipient or responsible party request for home care services,
the assessment, the service plan, and other information
necessary to determine medical necessity such as diagnostic or
testing information, social or medical histories, and hospital
or facility discharge summaries shall be submitted to the
commissioner. Notwithstanding the provisions of section
256B.0627, subdivision 12, the commissioner shall maximize
federal financial participation to pay for public health nurse
assessments for personal care services. For personal care
assistant services:

(1) The amount and type of service authorized based upon
the assessment and service plan will follow the recipient if the
recipient chooses to change providers.

(2) If the recipient's deleted text begin medical deleted text end need changes, the
recipient's provider may assess the need for a change in service
authorization and request the change from the county public
health nurse. Within 30 days of the request, the public health
nurse will determine whether to request the change in services
based upon the provider assessment, or conduct a home visit to
assess the need and determine whether the change is
appropriate. new text begin If the change in service need is due to a change
in medical condition, a new physician's determination of medical
necessity, required by section 256B.0625, subdivision 19c, must
be obtained.
new text end

(3) To continue to receive personal care assistant services
after the first year, the recipient or the responsible party, in
conjunction with the public health nurse, may complete a service
update on forms developed by the commissioner according to
criteria and procedures in subdivision 1.

(e) [PRIOR AUTHORIZATION.] The commissioner, or the
commissioner's designee, shall review the assessment, service
update, request for temporary services, new text begin request for flexible use
option, new text end service plan, and any additional information that is
submitted. The commissioner shall, within 30 days after
receiving a complete request, assessment, and service plan,
authorize home care services as follows:

(1) [HOME HEALTH SERVICES.] All home health services
provided by a home health aide must be prior authorized by the
commissioner or the commissioner's designee. Prior
authorization must be based on medical necessity and
cost-effectiveness when compared with other care options. When
home health services are used in combination with personal care
and private duty nursing, the cost of all home care services
shall be considered for cost-effectiveness. The commissioner
shall limit home health aide visits to no more than one visit
each per day. The commissioner, or the commissioner's designee,
may authorize up to two skilled nurse visits per day.

(2) [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal
care assistant services and supervision by a qualified
professional, if requested by the recipient, must be prior
authorized by the commissioner or the commissioner's designee
except for the assessments established in paragraph (a). The
amount of personal care assistant services authorized must be
based on the recipient's home care rating. A child may not be
found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity
for the child or assist the child with the activity and the
amount of assistance needed is similar to the assistance
appropriate for a typical child of the same age. Based on
medical necessity, the commissioner may authorize:

(A) up to two times the average number of direct care hours
provided in nursing facilities for the recipient's comparable
case mix level; or

(B) up to three times the average number of direct care
hours provided in nursing facilities for recipients who have
complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with
eating or have a neurological diagnosis; or

(C) up to 60 percent of the average reimbursement rate, as
of July 1, 1991, for care provided in a regional treatment
center for recipients who have Level I behavior, plus any
inflation adjustment as provided by the legislature for personal
care service; or

(D) up to the amount the commissioner would pay, as of July
1, 1991, plus any inflation adjustment provided for home care
services, for care provided in a regional treatment center for
recipients referred to the commissioner by a regional treatment
center preadmission evaluation team. For purposes of this
clause, home care services means all services provided in the
home or community that would be included in the payment to a
regional treatment center; or

(E) up to the amount medical assistance would reimburse for
facility care for recipients referred to the commissioner by a
preadmission screening team established under section 256B.0911
or 256B.092; and

(F) a reasonable amount of time for the provision of
supervision by a qualified professional of personal care
assistant services, if a qualified professional is requested by
the recipient or responsible party.

(ii) The number of direct care hours shall be determined
according to the annual cost report submitted to the department
by nursing facilities. The average number of direct care hours,
as established by May 1, 1992, shall be calculated and
incorporated into the home care limits on July 1, 1992. These
limits shall be calculated to the nearest quarter hour.

(iii) The home care rating shall be determined by the
commissioner or the commissioner's designee based on information
submitted to the commissioner by the county public health nurse
on forms specified by the commissioner. The home care rating
shall be a combination of current assessment tools developed
under sections 256B.0911 and 256B.501 with an addition for
seizure activity that will assess the frequency and severity of
seizure activity and with adjustments, additions, and
clarifications that are necessary to reflect the needs and
conditions of recipients who need home care including children
and adults under 65 years of age. The commissioner shall
establish these forms and protocols under this section and shall
use an advisory group, including representatives of recipients,
providers, and counties, for consultation in establishing and
revising the forms and protocols.

(iv) A recipient shall qualify as having complex medical
needs if the care required is difficult to perform and because
of recipient's medical condition requires more time than
community-based standards allow or requires more skill than
would ordinarily be required and the recipient needs or has one
or more of the following:

(A) daily tube feedings;

(B) daily parenteral therapy;

(C) wound or decubiti care;

(D) postural drainage, percussion, nebulizer treatments,
suctioning, tracheotomy care, oxygen, mechanical ventilation;

(E) catheterization;

(F) ostomy care;

(G) quadriplegia; or

(H) other comparable medical conditions or treatments the
commissioner determines would otherwise require institutional
care.

(v) A recipient shall qualify as having Level I behavior if
there is reasonable supporting evidence that the recipient
exhibits, or that without supervision, observation, or
redirection would exhibit, one or more of the following
behaviors that cause, or have the potential to cause:

(A) injury to the recipient's own body;

(B) physical injury to other people; or

(C) destruction of property.

(vi) Time authorized for personal care relating to Level I
behavior in subclause (v), items (A) to (C), shall be based on
the predictability, frequency, and amount of intervention
required.

(vii) A recipient shall qualify as having Level II behavior
if the recipient exhibits on a daily basis one or more of the
following behaviors that interfere with the completion of
personal care assistant services under subdivision 4, paragraph
(a):

(A) unusual or repetitive habits;

(B) withdrawn behavior; or

(C) offensive behavior.

(viii) A recipient with a home care rating of Level II
behavior in subclause (vii), items (A) to (C), shall be rated as
comparable to a recipient with complex medical needs under
subclause (iv). If a recipient has both complex medical needs
and Level II behavior, the home care rating shall be the next
complex category up to the maximum rating under subclause (i),
item (B).

(3) [PRIVATE DUTY NURSING SERVICES.] All private duty
nursing services shall be prior authorized by the commissioner
or the commissioner's designee. Prior authorization for private
duty nursing services shall be based on medical necessity and
cost-effectiveness when compared with alternative care options.
The commissioner may authorize medically necessary private duty
nursing services in quarter-hour units when:

(i) the recipient requires more individual and continuous
care than can be provided during a nurse visit; or

(ii) the cares are outside of the scope of services that
can be provided by a home health aide or personal care assistant.

The commissioner may authorize:

(A) up to two times the average amount of direct care hours
provided in nursing facilities statewide for case mix
classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;

(B) private duty nursing in combination with other home
care services up to the total cost allowed under clause (2);

(C) up to 16 hours per day if the recipient requires more
nursing than the maximum number of direct care hours as
established in item (A) and the recipient meets the hospital
admission criteria established under Minnesota Rules, parts
9505.0501 to 9505.0540.

The commissioner may authorize up to 16 hours per day of
medically necessary private duty nursing services or up to 24
hours per day of medically necessary private duty nursing
services until such time as the commissioner is able to make a
determination of eligibility for recipients who are
cooperatively applying for home care services under the
community alternative care program developed under section
256B.49, or until it is determined by the appropriate regulatory
agency that a health benefit plan is or is not required to pay
for appropriate medically necessary health care services.
Recipients or their representatives must cooperatively assist
the commissioner in obtaining this determination. Recipients
who are eligible for the community alternative care program may
not receive more hours of nursing under this section than would
otherwise be authorized under section 256B.49.

(4) [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is
ventilator-dependent, the monthly medical assistance
authorization for home care services shall not exceed what the
commissioner would pay for care at the highest cost hospital
designated as a long-term hospital under the Medicare program.
For purposes of this clause, home care services means all
services provided in the home that would be included in the
payment for care at the long-term hospital.
"Ventilator-dependent" means an individual who receives
mechanical ventilation for life support at least six hours per
day and is expected to be or has been dependent for at least 30
consecutive days.

(f) [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner
or the commissioner's designee shall determine the time period
for which a prior authorization shall be effective new text begin and, if
flexible use has been requested, whether to allow the flexible
use option new text end . If the recipient continues to require home care
services beyond the duration of the prior authorization, the
home care provider must request a new prior authorization.
Under no circumstances, other than the exceptions in paragraph
(b), shall a prior authorization be valid prior to the date the
commissioner receives the request or for more than 12 months. A
recipient who appeals a reduction in previously authorized home
care services may continue previously authorized services, other
than temporary services under paragraph (h), pending an appeal
under section 256.045. The commissioner must provide a detailed
explanation of why the authorized services are reduced in amount
from those requested by the home care provider.

(g) [APPROVAL OF HOME CARE SERVICES.] The commissioner or
the commissioner's designee shall determine the medical
necessity of home care services, the level of caregiver
according to subdivision 2, and the institutional comparison
according to this subdivision, the cost-effectiveness of
services, and the amount, scope, and duration of home care
services reimbursable by medical assistance, based on the
assessment, primary payer coverage determination information as
required, the service plan, the recipient's age, the cost of
services, the recipient's medical condition, and diagnosis or
disability. The commissioner may publish additional criteria
for determining medical necessity according to section 256B.04.

(h) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.]
The agency nurse, the independently enrolled private duty nurse,
or county public health nurse may request a temporary
authorization for home care services by telephone. The
commissioner may approve a temporary level of home care services
based on the assessment, and service or care plan information,
and primary payer coverage determination information as required.
Authorization for a temporary level of home care services
including nurse supervision is limited to the time specified by
the commissioner, but shall not exceed 45 days, unless extended
because the county public health nurse has not completed the
required assessment and service plan, or the commissioner's
determination has not been made. The level of services
authorized under this provision shall have no bearing on a
future prior authorization.

(i) [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.]
Home care services provided in an adult or child foster care
setting must receive prior authorization by the department
according to the limits established in paragraph (a).

The commissioner may not authorize:

(1) home care services that are the responsibility of the
foster care provider under the terms of the foster care
placement agreement and administrative rules;

(2) personal care assistant services when the foster care
license holder is also the personal care provider or personal
care assistant unless the recipient can direct the recipient's
own care, or case management is provided as required in section
256B.0625, subdivision 19a;

(3) personal care assistant services when the responsible
party is an employee of, or under contract with, or has any
direct or indirect financial relationship with the personal care
provider or personal care assistant, unless case management is
provided as required in section 256B.0625, subdivision 19a; or

(4) personal care assistant and private duty nursing
services when the number of foster care residents is greater
than four unless the county responsible for the recipient's
foster placement made the placement prior to April 1, 1992,
requests that personal care assistant and private duty nursing
services be provided, and case management is provided as
required in section 256B.0625, subdivision 19a.

Sec. 15.

Minnesota Statutes 2004, section 256B.0627,
subdivision 9, is amended to read:

Subd. 9.

new text begin option for new text end flexible use of personal care
assistant hours.

(a) "Flexible use new text begin option new text end " means the scheduled
use of authorized hours of personal care assistant services,
which vary within deleted text begin the length of the deleted text end new text begin a new text end service authorization
new text begin period covering no more than six months, new text end in order to more
effectively meet the needs and schedule of the
recipient. new text begin Authorized hours not used within the six-month
period may not be carried over to another time period. The
flexible use of personal care assistant hours for a six-month
period must be prior authorized by the commissioner, based on a
request submitted on a form approved by the commissioner. The
request must include the assessment and the annual service plan
prepared by the county public health nurse.
new text end

new text begin (b) The recipient or responsible party, together with the
case manager, if the recipient has case management services, and
the county public health nurse, shall determine whether flexible
use is an appropriate option based on the needs, abilities,
preferences, and history of service use of the recipient or
responsible party, and if appropriate, must ensure that the
allocation of hours covers the ongoing needs of the recipient
over an entire year divided into two six-month periods of
flexible use.
new text end

new text begin (c) If prior authorized, new text end recipients may use their approved
hours flexibly within the service authorization period for
medically necessary covered services specified in the assessment
required in subdivision 1. The flexible use of authorized hours
does not increase the total amount of authorized hours available
to a recipient as determined under subdivision 5. The
commissioner shall not authorize additional personal care
assistant services to supplement a service authorization that is
exhausted before the end date under a flexible service use plan,
unless the county public health nurse determines a change in
condition and a need for increased services is established.

deleted text begin (b) deleted text end new text begin (d) new text end The new text begin personal care provider organization and the
new text end recipient or responsible party deleted text begin , together with the provider, deleted text end must
deleted text begin work to monitor and document the use of authorized hours and
ensure that a recipient is able to manage services effectively
throughout the authorized period. Upon request of the recipient
or responsible party, the provider must furnish regular updates
to the recipient or responsible party on the amount of personal
care assistant services used deleted text end new text begin develop a written month-to-month
plan of the projected use of personal care assistant services
that is part of the care plan and ensures:
new text end

new text begin (1) that the health and safety needs of the recipient will
be met;
new text end

new text begin (2) that the total annual authorization will not be used
before the end of the authorization period; and
new text end

new text begin (3) monthly monitoring will be conducted of hours used as a
percentage of the authorized amount new text end .

new text begin (e) The provider shall notify the recipient, the case
manager, if the recipient has case management services, and the
county public health nurse in advance and as soon as possible,
on a form approved by the commissioner, if the monthly amount of
hours authorized is likely to be exceeded for the month.
new text end

new text begin (f) The commissioner shall provide written notice to the
provider, the recipient or responsible party, the county case
manager, if the recipient has case management services, and the
county public health nurse, when a flexible use recipient
exceeds the personal care service authorization for the month by
an amount determined by the commissioner. If the use of hours
exceeds the monthly service authorization by the amount
determined by the commissioner for two months during any
three-month period, the commissioner shall notify the recipient
and the county public health nurse that the flexible use
authorization will be revoked beginning the following month.
The revocation will not become effective if, within ten working
days of the commissioner's notice of flexible use revocation,
the county public health nurse requests prior authorization for
an increase in the service authorization and continuation of the
flexible use option, or the recipient appeals and assistance
pending appeal is ordered. The commissioner shall determine
whether to approve the increase and continued flexible use.
new text end

new text begin (g) The recipient or responsible party may stop the
flexible use of hours by notifying the provider and county
public health nurse in writing.
new text end

new text begin (h) The recipient or responsible party may appeal the
commissioner's action according to section 256.045. The denial
or revocation of the flexible use option shall not affect the
recipient's authorized level of personal care assistant services
as determined under subdivision 5.
new text end

Sec. 16.

Minnesota Statutes 2004, section 256B.0627, is
amended by adding a subdivision to read:

new text begin Subd. 18. new text end

new text begin Oversight of enrolled personal care assistant
services providers. new text end

new text begin The commissioner may request from providers
documentation of compliance with laws, rules, and policies
governing the provision of personal care assistant services. A
personal care assistant service provider must provide the
requested documentation to the commissioner within ten business
days of the request. Failure to provide information to
demonstrate substantial compliance with laws, rules, or policies
may result in suspension, denial, or termination of the provider
agreement.
new text end

Sec. 17.

Minnesota Statutes 2004, section 256B.15,
subdivision 1, is amended to read:

Subdivision 1.

Policy, applicability, purpose, and
construction; definition.

(a) It is the policy of this state
that individuals or couples, either or both of whom participate
in the medical assistance program, use their own assets to pay
their share of the total cost of their care during or after
their enrollment in the program according to applicable federal
law and the laws of this state. The following provisions apply:

(1) subdivisions 1c to 1k shall not apply to claims arising
under this section which are presented under section 525.313;

(2) the provisions of subdivisions 1c to 1k expanding the
interests included in an estate for purposes of recovery under
this section give effect to the provisions of United States
Code, title 42, section 1396p, governing recoveries, but do not
give rise to any express or implied liens in favor of any other
parties not named in these provisions;

(3) the continuation of a recipient's life estate or joint
tenancy interest in real property after the recipient's death
for the purpose of recovering medical assistance under this
section modifies common law principles holding that these
interests terminate on the death of the holder;

(4) all laws, rules, and regulations governing or involved
with a recovery of medical assistance shall be liberally
construed to accomplish their intended purposes;

(5) a deceased recipient's life estate and joint tenancy
interests continued under this section shall be owned by the
remaindermen or surviving joint tenants as their interests may
appear on the date of the recipient's death. They shall not be
merged into the remainder interest or the interests of the
surviving joint tenants by reason of ownership. They shall be
subject to the provisions of this section. Any conveyance,
transfer, sale, assignment, or encumbrance by a remainderman, a
surviving joint tenant, or their heirs, successors, and assigns
shall be deemed to include all of their interest in the deceased
recipient's life estate or joint tenancy interest continued
under this section; deleted text begin and
deleted text end

(6) the provisions of subdivisions 1c to 1k continuing a
recipient's joint tenancy interests in real property after the
recipient's death do not apply to a homestead owned of record,
on the date the recipient dies, by the recipient and the
recipient's spouse as joint tenants with a right of
survivorship. Homestead means the real property occupied by the
surviving joint tenant spouse as their sole residence on the
date the recipient dies and classified and taxed to the
recipient and surviving joint tenant spouse as homestead
property for property tax purposes in the calendar year in which
the recipient dies. For purposes of this exemption, real
property the recipient and their surviving joint tenant spouse
purchase solely with the proceeds from the sale of their prior
homestead, own of record as joint tenants, and qualify as
homestead property under section 273.124 in the calendar year in
which the recipient dies and prior to the recipient's death
shall be deemed to be real property classified and taxed to the
recipient and their surviving joint tenant spouse as homestead
property in the calendar year in which the recipient dies. The
surviving spouse, or any person with personal knowledge of the
facts, may provide an affidavit describing the homestead
property affected by this clause and stating facts showing
compliance with this clause. The affidavit shall be prima facie
evidence of the facts it states new text begin ; and
new text end

new text begin (7) no action shall be taken to enforce or collect any lien
arising under this section or under sections 514.980 to 514.985
and sections 514.991 to 514.995 with respect to a homestead
owned of record, on the date the recipient dies, by the
recipient and a joint tenant with a right of survivorship, until
the joint tenant sells the homestead, ceases to reside in the
homestead, or dies. Homestead means the real property occupied
by the surviving joint tenant as the sole residence on the date
the recipient dies and classified and taxed to the recipient and
surviving joint tenant as homestead property for property tax
purposes in the calendar year in which the recipient dies. For
purposes of this exemption, real property the recipient and the
surviving joint tenant purchase solely with the proceeds from
the sale of the prior homestead, own of record as joint tenants,
and qualify as homestead property under section 273.124 in the
calendar year in which the recipient dies and prior to the
recipient's death shall be deemed to be real property classified
and taxed to the recipient and the surviving joint tenant as
homestead property in the calendar year in which the recipient
dies. The surviving joint tenant, or any person with personal
knowledge of the facts, may provide an affidavit describing the
homestead property affected by this clause and stating facts
showing compliance with this clause. The affidavit shall be
prima facie evidence of the facts it states. The estate, any
owner of an interest in the property that is or may be subject
to the lien, or any other interested party, may voluntarily pay
off, settle, or otherwise satisfy the claim secured or to be
secured by the lien at any time before or after the lien is
filed or recorded. Such payoffs, settlements, and satisfactions
shall be deemed to be voluntary repayments of past medical
assistance payments for the benefit of the deceased recipient,
and neither the process of settling the claim, the payment of
the claim, or the acceptance of a payment shall constitute an
adjustment or recovery that is prohibited under this section new text end .

(b) new text begin The commissioner shall release liens arising under
notices of potential claims under this section and medical
assistance liens under sections 514.980 to 514.985, against a
deceased recipient's life estates and jointly owned interests in
farm and income producing real property they own of record on
the date they die if their interest in the property ends at
their death, the surviving remainderman or surviving joint
tenant owns their interest in the property of record on that
date, and all of the following conditions apply with respect to
the surviving remainderman or the surviving joint tenant and
their interest in the property:
new text end

new text begin (1) the farm property is real property for which all of the
following apply continuously for a period beginning at least
three years before the calendar year in which the recipient
first received long-term care medical assistance through the
date of the recipient's death:
new text end

new text begin (i) the remainderman or surviving joint tenant is a farmer,
as defined in section 500.24, subdivision 2, paragraph (n), and
is engaged in farming, as defined in section 500.24, subdivision
2, paragraph (a);
new text end

new text begin (ii) all of the land is a family farm as defined in section
500.24, subdivision 2, paragraph (b); and
new text end

new text begin (iii) all of the land is classified and taxed as class 2a
agricultural land under section 273.13, subdivision 23,
paragraph (a), for property tax purposes; and
new text end

new text begin (2) the income-producing property is real property for
which all of the following apply continuously for a period
beginning at least three years before the calendar year in which
the recipient first received long-term care medical assistance
through the date of the recipient's death:
new text end

new text begin (i) no part of the property is classified or taxed as
homestead property for property tax purposes, provided that if
the property is classified and taxed as both homestead and
nonhomestead property, the portion of the property classified
and taxed as nonhomestead property shall be considered to
satisfy this requirement;
new text end

new text begin (ii) all of the property is classified and taxed as class
1c property under section 273.13, subdivision 22, paragraph (c),
except that part of the class 1c property that is a dwelling
occupied as a homestead; class 3a or 3b commercial or industrial
property under section 273.13, subdivision 24; or as class 4a or
4c property classified under section 273.13, subdivision 25,
paragraphs (a) and (d), for property tax purposes; and
new text end

new text begin (iii) the business, profession, or occupation in which the
real property is used is the primary business, profession, or
occupation of the remainderman or surviving joint tenant and the
real property is used solely for that business, profession, or
occupation. A primary business, profession, or occupation is
one the ongoing operation of which provides at least 65 percent
of a person's gross income for federal income tax purposes for
the calendar year.
new text end

new text begin (c) new text end For purposes of this section, "medical assistance"
includes the medical assistance program under this chapter and
the general assistance medical care program under chapter 256D
deleted text begin and deleted text end new text begin but does not include the new text end alternative care new text begin program new text end for
nonmedical assistance recipients under section 256B.0913.

new text begin EFFECTIVE DATE. new text end

new text begin The amendments in this section are
effective July 1, 2005, and apply to the estates of decedents
who die on or after that date.
new text end

Sec. 18.

Minnesota Statutes 2004, section 256B.15,
subdivision 1a, is amended to read:

Subd. 1a.

Estates subject to claims.

If a person
receives any medical assistance hereunder, on the person's
death, if single, or on the death of the survivor of a married
couple, either or both of whom received medical assistance, or
as otherwise provided for in this section, the total amount paid
for medical assistance rendered for the person and spouse shall
be filed as a claim against the estate of the person or the
estate of the surviving spouse in the court having jurisdiction
to probate the estate or to issue a decree of descent according
to sections 525.31 to 525.313.

A claim shall be filed if medical assistance was rendered
for either or both persons under one of the following
circumstances:

(a) the person was over 55 years of age, and received
services under this chapter new text begin , excluding alternative care new text end ;

(b) the person resided in a medical institution for six
months or longer, received services under this chapter new text begin ,
excluding alternative care new text end , and, at the time of
institutionalization or application for medical assistance,
whichever is later, the person could not have reasonably been
expected to be discharged and returned home, as certified in
writing by the person's treating physician. For purposes of
this section only, a "medical institution" means a skilled
nursing facility, intermediate care facility, intermediate care
facility for persons with mental retardation, nursing facility,
or inpatient hospital; or

(c) the person received general assistance medical care
services under chapter 256D.

The claim shall be considered an expense of the last
illness of the decedent for the purpose of section 524.3-805.
Any statute of limitations that purports to limit any county
agency or the state agency, or both, to recover for medical
assistance granted hereunder shall not apply to any claim made
hereunder for reimbursement for any medical assistance granted
hereunder. Notice of the claim shall be given to all heirs and
devisees of the decedent whose identity can be ascertained with
reasonable diligence. The notice must include procedures and
instructions for making an application for a hardship waiver
under subdivision 5; time frames for submitting an application
and determination; and information regarding appeal rights and
procedures. Counties are entitled to one-half of the nonfederal
share of medical assistance collections from estates that are
directly attributable to county effort. deleted text begin Counties are entitled
to ten percent of the collections for alternative care directly
attributable to county effort.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments in this section are
effective July 1, 2005, and apply to the estates of decedents
who die on or after that date.
new text end

Sec. 19.

Minnesota Statutes 2004, section 256B.15,
subdivision 2, is amended to read:

Subd. 2.

Limitations on claims.

The claim shall include
only the total amount of medical assistance rendered after age
55 or during a period of institutionalization described in
subdivision 1a, clause (b), and the total amount of general
assistance medical care rendered, and shall not include
interest. Claims that have been allowed but not paid shall bear
interest according to section 524.3-806, paragraph (d). A claim
against the estate of a surviving spouse who did not receive
medical assistance, for medical assistance rendered for the
predeceased spouse, is limited to the value of the assets of the
estate that were marital property or jointly owned property at
any time during the marriage. deleted text begin Claims for alternative care shall
be net of all premiums paid under section 256B.0913, subdivision
12, on or after July 1, 2003, and shall be limited to services
provided on or after July 1, 2003.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005,
for decedents dying on or after that date.
new text end

Sec. 20.

Minnesota Statutes 2004, section 256B.431, is
amended by adding a subdivision to read:

new text begin Subd. 41. new text end

new text begin Nursing facility rate increases for october 1,
2005, and july 1, 2006. new text end

new text begin (a) For the rate period beginning
October 1, 2005, and the rate year beginning July 1, 2006, the
commissioner shall make available to each nursing facility
reimbursed under this section or section 256B.434 an adjustment
equal to two percent of the total operating payment rate.
new text end

new text begin (b) Money resulting from the rate adjustment under
paragraph (a) must be used to increase wages and benefits and
pay associated costs for employees, except management fees, the
administrator, and central office staff. Except as provided in
paragraph (c), money received by a facility as a result of the
rate adjustment provided in paragraph (a) must be used only for
wage, benefit, and staff increases implemented on or after the
effective date of the rate increase each year, and must not be
used for increases implemented prior to that date.
new text end

new text begin (c) With respect only to the October 1, 2005, rate
increase, a hospital-attached nursing facility that incurred
costs for salary and employee benefit increases first provided
after July 1, 2003, may count those costs towards the amount
required to be spent on salaries and benefits under paragraph
(b). These costs must be reported to the commissioner in the
form and manner specified by the commissioner.
new text end

new text begin (d) Nursing facilities may apply for the rate adjustment
under paragraph (a). The application must be made to the
commissioner and contain a plan by which the nursing facility
will distribute the funds according to paragraph (b). For
nursing facilities in which the employees are represented by an
exclusive bargaining representative, an agreement negotiated and
agreed to by the employer and the exclusive bargaining
representative constitutes the plan. A negotiated agreement may
constitute the plan only if the agreement is finalized after the
date of enactment of all increases for the rate year and signed
by both parties prior to submission to the commissioner. The
commissioner shall review the plan to ensure that the rate
adjustments are used as provided in paragraph (b). To be
eligible, a facility must submit its distribution plan by March
31, 2006, and December 31, 2006, respectively. If a facility's
distribution plan is effective after the first day of the
applicable rate period that the funds are available, the rate
adjustments are effective the same date as the facility's plan.
new text end

new text begin (e) A copy of the approved distribution plan must be made
available to all employees by giving each employee a copy or by
posting a copy in an area of the nursing facility to which all
employees have access. If an employee does not receive the wage
and benefit adjustment described in the facility's approved plan
and is unable to resolve the problem with the facility's
management or through the employee's union representative, the
employee may contact the commissioner at an address or telephone
number provided by the commissioner and included in the approved
plan.
new text end

Sec. 21.

Minnesota Statutes 2004, section 256B.431, is
amended by adding a subdivision to read:

new text begin Subd. 42. new text end

new text begin Single-bed room payment rate. new text end

new text begin (a) Beginning
July 1, 2005, the operating payment rate for nursing facilities
reimbursed under this section or section 256B.434 shall be
increased by five percent multiplied by the ratio of the number
of new single-bed rooms created divided by the number of active
beds on July 1, 2005, for each bed closure that results in the
creation of a single-bed room after July 1, 2005.
new text end

new text begin (b) A nursing facility is prohibited from discharging
residents for purposes of establishing single-bed rooms. A
nursing facility must retain a statement from any resident
discharged to another nursing facility between July 1, 2005, and
December 31, 2007, signed by the resident or the resident's
designated responsible party, certifying the resident requests
to move and is under no coercion to be discharged. This signed
statement must be witnessed and signed by the local ombudsman.
The commissioner shall assess a monetary penalty of $5,000 per
occurrence against any nursing facility determined to have
discharged a resident for purposes of establishing single-bed
rooms.
new text end

new text begin (c) If after the date of enactment of this section and
before December 31, 2007, more than 4,000 nursing home beds are
removed from service, a portion of the appropriation for nursing
homes shall be transferred to the alternative care program. The
amount of this transfer shall equal the number of beds removed
from service less 4,000, multiplied by the average monthly
per-person cost for alternative care, multiplied by 12, and
further multiplied by 0.3.
new text end

new text begin (d) Savings that result from bed closures on or after July
1, 2005, that do not result in the establishment of single-bed
rooms and exceed the number of closures included in the February
2005 forecast shall not cancel to the general fund but shall be
deposited in the health care quality improvement account
established under section 256.957.
new text end

new text begin (e) For the rate year beginning July 1, 2005, the amount
nursing facilities receive for medically necessary single-bed
rooms under Minnesota Rules, part 9549.0070, subpart 3, shall be
up to 114.365 percent of the established total payment rate for
the resident. For the rate year beginning July 1, 2006, the
amount nursing facilities receive for medically necessary
single-bed rooms under Minnesota Rules, part 9549.0070, subpart
3, shall be up to 114.75 percent of the established total
payment rate for the resident. For the rate years beginning on
or after July 1, 2007, the single-bed payment rate shall be up
to 115 percent of the established total payment rate for the
resident.
new text end

Sec. 22.

Minnesota Statutes 2004, section 256B.434,
subdivision 4, is amended to read:

Subd. 4.

Alternate rates for nursing facilities.

(a) For
nursing facilities which have their payment rates determined
under this section rather than section 256B.431, the
commissioner shall establish a rate under this subdivision. The
nursing facility must enter into a written contract with the
commissioner.

(b) A nursing facility's case mix payment rate for the
first rate year of a facility's contract under this section is
the payment rate the facility would have received under section
256B.431.

(c) A nursing facility's case mix payment rates for the
second and subsequent years of a facility's contract under this
section are the previous rate year's contract payment rates plus
an inflation adjustment and, for facilities reimbursed under
this section or section 256B.431, an adjustment to include the
cost of any increase in Health Department licensing fees for the
facility taking effect on or after July 1, 2001. The index for
the inflation adjustment must be based on the change in the
Consumer Price Index-All Items (United States City average)
(CPI-U) forecasted by the commissioner of finance's national
economic consultant, as forecasted in the fourth quarter of the
calendar year preceding the rate year. The inflation adjustment
must be based on the 12-month period from the midpoint of the
previous rate year to the midpoint of the rate year for which
the rate is being determined. For the rate years beginning on
July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1,
2003, deleted text begin and deleted text end July 1, 2004 new text begin , July 1, 2005, and July 1, 2006 new text end , this
paragraph shall apply only to the property-related payment rate,
except that adjustments to include the cost of any increase in
Health Department licensing fees taking effect on or after July
1, 2001, shall be provided. In determining the amount of the
property-related payment rate adjustment under this paragraph,
the commissioner shall determine the proportion of the
facility's rates that are property-related based on the
facility's most recent cost report.

(d) The commissioner shall develop additional
incentive-based payments of up to five percent above the
standard contract rate for achieving outcomes specified in each
contract. The specified facility-specific outcomes must be
measurable and approved by the commissioner. The commissioner
may establish, for each contract, various levels of achievement
within an outcome. After the outcomes have been specified the
commissioner shall assign various levels of payment associated
with achieving the outcome. Any incentive-based payment cancels
if there is a termination of the contract. In establishing the
specified outcomes and related criteria the commissioner shall
consider the following state policy objectives:

(1) improved cost effectiveness and quality of life as
measured by improved clinical outcomes;

(2) successful diversion or discharge to community
alternatives;

(3) decreased acute care costs;

(4) improved consumer satisfaction;

(5) the achievement of quality; or

(6) any additional outcomes proposed by a nursing facility
that the commissioner finds desirable.

Sec. 23.

Minnesota Statutes 2004, section 256B.434, is
amended by adding a subdivision to read:

new text begin Subd. 4f. new text end

new text begin Rate increase effective july 1, 2005. new text end

new text begin For the
rate year beginning July 1, 2005, a facility in Ramsey County
licensed for 180 beds shall have its operating payment rate as
determined under this section and in effect on June 30, 2005,
increased by $2.49. The increase under this subdivision shall
be included in the facility's total payment rates for the
purposes of determining future rates under this section or any
other section.
new text end

Sec. 24.

Minnesota Statutes 2004, section 256B.440, is
amended by adding a subdivision to read:

new text begin Subd. 4. new text end

new text begin Continued system development. new text end

new text begin (a) The
commissioner shall continue developmental work on a new nursing
home reimbursement system and present recommendations for a new
system to the legislature by January 15, 2006. The new system
shall comply with subdivisions 1 and 2.
new text end

new text begin (b) Nursing facilities shall continue to file, and the
commissioner shall continue to collect and audit, annual cost
reports under the conditions specified in subdivision 3.
new text end

new text begin (c) Notwithstanding any contrary provisions of chapter 16C,
the commissioner may, within the limits of appropriations
specifically available for this purpose, extend contracts
previously negotiated for consulting work on development of the
new reimbursement system.
new text end

Sec. 25.

Minnesota Statutes 2004, section 256B.5012, is
amended by adding a subdivision to read:

new text begin Subd. 6. new text end

new text begin Icf/mr rate increases beginning october 1, 2005,
and july 1, 2006. new text end

new text begin (a) For the rate periods beginning October 1,
2005, and July 1, 2006, the commissioner shall make available to
each facility reimbursed under this section an adjustment to the
total operating payment rate of two percent.
new text end

new text begin (b) Money resulting from the rate adjustment under
paragraph (a) must be used to increase wages and benefits and
pay associated costs for employees, except for administrative
and central office employees. Money received by a facility as a
result of the rate adjustment provided in paragraph (a) must be
used only for wage, benefit, and staff increases implemented on
or after the effective date of the rate increase each year, and
must not be used for increases implemented prior to that date.
new text end

new text begin (c) For each facility, the commissioner shall make
available an adjustment using the percentage specified in
paragraph (a) multiplied by the total payment rate, excluding
the property-related payment rate, in effect on the preceding
day. The total payment rate shall include the adjustment
provided in section 256B.501, subdivision 12.
new text end

new text begin (d) A facility whose payment rates are governed by closure
agreements, receivership agreements, or Minnesota Rules, part
9553.0075, is not eligible for an adjustment otherwise granted
under this subdivision.
new text end

new text begin (e) A facility may apply for the payment rate adjustment
provided under paragraph (a). The application must be made to
the commissioner and contain a plan by which the facility will
distribute the funds according to paragraph (b). For facilities
in which the employees are represented by an exclusive
bargaining representative, an agreement negotiated and agreed to
by the employer and the exclusive bargaining representative
constitutes the plan. A negotiated agreement may constitute the
plan only if the agreement is finalized after the date of
enactment of all rate increases for the rate year. The
commissioner shall review the plan to ensure that the payment
rate adjustment per diem is used as provided in this
subdivision. To be eligible, a facility must submit its plan by
March 31, 2006, and December 31, 2006, respectively. If a
facility's plan is effective for its employees after the first
day of the applicable rate period that the funds are available,
the payment rate adjustment per diem is effective the same date
as its plan.
new text end

new text begin (f) A copy of the approved distribution plan must be made
available to all employees by giving each employee a copy or by
posting it in an area of the facility to which all employees
have access. If an employee does not receive the wage and
benefit adjustment described in the facility's approved plan and
is unable to resolve the problem with the facility's management
or through the employee's union representative, the employee may
contact the commissioner at an address or telephone number
provided by the commissioner and included in the approved plan.
new text end

Sec. 26.

Minnesota Statutes 2004, section 256B.69,
subdivision 23, is amended to read:

Subd. 23.

Alternative integrated long-term care services;
elderly and disabled persons.

(a) The commissioner may
implement demonstration projects to create alternative
integrated delivery systems for acute and long-term care
services to elderly persons and persons with disabilities as
defined in section 256B.77, subdivision 7a, that provide
increased coordination, improve access to quality services, and
mitigate future cost increases. The commissioner may seek
federal authority to combine Medicare and Medicaid capitation
payments for the purpose of such demonstrations. Medicare funds
and services shall be administered according to the terms and
conditions of the federal waiver and demonstration provisions.
For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to
subdivisions 1 to 22. The provisions of Minnesota Rules, parts
9500.1450 to 9500.1464, apply to these demonstrations, with the
exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457,
subpart 1, items B and C, which do not apply to persons
enrolling in demonstrations under this section. An initial open
enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to
Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is
enrolled in a health plan under these demonstrations and the
health plan's participation is subsequently terminated for any
reason, the person shall be provided an opportunity to select a
new health plan and shall have the right to change health plans
within the first 60 days of enrollment in the second health
plan. Persons required to participate in health plans under
this section who fail to make a choice of health plan shall not
be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota
Rules, part 9505.5220, subpart 1, item A, if adopted, for the
purpose of demonstrations under this subdivision, the
commissioner may contract with managed care organizations,
including counties, to serve only elderly persons eligible for
medical assistance, elderly and disabled persons, or disabled
persons only. For persons with primary diagnoses of mental
retardation or a related condition, serious and persistent
mental illness, or serious emotional disturbance, the
commissioner must ensure that the county authority has approved
the demonstration and contracting design. Enrollment in these
projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under
this subdivision for persons with primary diagnoses of mental
retardation or a related condition, serious and persistent
mental illness, or serious emotional disturbance, without
approval of the county board of the county in which the
demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to
252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules,
parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580,
and 9525.1800 to 9525.1930, the commissioner may implement under
this section projects for persons with developmental
disabilities. The commissioner may capitate payments for ICF/MR
services, waivered services for mental retardation or related
conditions, including case management services, day training and
habilitation and alternative active treatment services, and
other services as approved by the state and by the federal
government. Case management and active treatment must be
individualized and developed in accordance with a
person-centered plan. Costs under these projects may not exceed
costs that would have been incurred under fee-for-service.
Beginning July 1, 2003, and until two years after the pilot
project implementation date, subcontractor participation in the
long-term care developmental disability pilot is limited to a
nonprofit long-term care system providing ICF/MR services, home
and community-based waiver services, and in-home services to no
more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall
report to the legislature prior to expansion of the
developmental disability pilot project. This paragraph expires
two years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for
disabled persons, the commissioner must provide information to
appropriate committees of the house of representatives and
senate and must involve representatives of affected disability
groups in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative
reimbursement methodology in section 256B.434 may, in
collaboration with a hospital, clinic, or other health care
entity provide services under paragraph (a). The commissioner
shall amend the state plan and seek any federal waivers
necessary to implement this paragraph.

new text begin (e) Notwithstanding section 256B.0621, health plans
providing services under this section are responsible for home
care targeted case management and relocation targeted case
management. Services must be provided according to the terms of
the waivers and contracts approved by the federal government.
new text end

Sec. 27.

new text begin [501B.895] PUBLIC HEALTH CARE PROGRAMS AND
CERTAIN TRUSTS.
new text end

new text begin (a) It is the public policy of this state that individuals
use all available resources to pay for the cost of long-term
care services, as defined in section 256B.0595, before turning
to Minnesota health care program funds, and that trust
instruments should not be permitted to shield available
resources of an individual or an individual's spouse from such
use. Any irrevocable inter vivos trust or any legal instrument,
device, or arrangement similar to an irrevocable inter vivos
trust created on or after July 1, 2005, containing assets or
income of an individual or an individual's spouse, including
those created by a person, court, or administrative body with
legal authority to act in place of, at the direction of, upon
the request of, or on behalf of the individual or individual's
spouse, becomes revocable by operation of law for the sole
purpose of a state or local human services agency determination
on an application by the individual or the individual's spouse
for payment of long-term care services through a Minnesota
public health care program under chapter 256. For purposes of
this section, any inter vivos trust and any legal instrument,
device, or arrangement similar to an inter vivos trust:
new text end

new text begin (1) shall be deemed to be located in and subject to the
laws of this state; and
new text end

new text begin (2) is created as of the date it is fully executed by or on
behalf of all of the settlors or others.
new text end

new text begin (b) For purposes of this section, a legal instrument,
device, or arrangement similar to an irrevocable inter vivos
trust means any instrument, device, or arrangement which
involves a grantor who transfers or whose property is
transferred by another including, but not limited to, any court,
administrative body, or anyone else with authority to act on
their behalf or at their direction, to an individual or entity
with fiduciary, contractual, or legal obligations to the grantor
or others to be held, managed, or administered by the individual
or entity for the benefit of the grantor or others. These legal
instruments, devices, or other arrangements are irrevocable
inter vivos trusts for purposes of this section.
new text end

new text begin (c) In the event of a conflict between this section and the
provisions of an irrevocable trust created on or after July 1,
2005, this section shall control.
new text end

new text begin (d) This section does not apply to trusts that qualify as
supplemental needs trusts under section 501B.89 or to trusts
meeting the criteria of United States Code, title 42, section
1396p (d)(4)(a) and (c) for purposes of eligibility for medical
assistance.
new text end

new text begin (e) This section applies to all trusts first created on or
after July 1, 2005, and to all interests in real or personal
property regardless of the date on which the interest was
created, reserved, or acquired.
new text end

Sec. 28.

Minnesota Statutes 2004, section 514.981,
subdivision 6, is amended to read:

Subd. 6.

Time limits; claim limits; liens on life estates
and joint tenancies.

(a) A medical assistance lien is a lien on
the real property it describes for a period of ten years from
the date it attaches according to section 514.981, subdivision
2, paragraph (a), except as otherwise provided for in sections
514.980 to 514.985. The agency may renew a medical assistance
lien for an additional ten years from the date it would
otherwise expire by recording or filing a certificate of renewal
before the lien expires. The certificate shall be recorded or
filed in the office of the county recorder or registrar of
titles for the county in which the lien is recorded or filed.
The certificate must refer to the recording or filing data for
the medical assistance lien it renews. The certificate need not
be attested, certified, or acknowledged as a condition for
recording or filing. The registrar of titles or the recorder
shall file, record, index, and return the certificate of renewal
in the same manner as provided for medical assistance liens in
section 514.982, subdivision 2.

(b) A medical assistance lien is not enforceable against
the real property of an estate to the extent there is a
determination by a court of competent jurisdiction, or by an
officer of the court designated for that purpose, that there are
insufficient assets in the estate to satisfy the agency's
medical assistance lien in whole or in part because of the
homestead exemption under section 256B.15, subdivision 4, the
rights of the surviving spouse or minor children under section
524.2-403, paragraphs (a) and (b), or claims with a priority
under section 524.3-805, paragraph (a), clauses (1) to (4). For
purposes of this section, the rights of the decedent's adult
children to exempt property under section 524.2-403, paragraph
(b), shall not be considered costs of administration under
section 524.3-805, paragraph (a), clause (1).

(c) Notwithstanding any law or rule to the contrary, the
provisions in clauses (1) to (7) apply if a life estate subject
to a medical assistance lien ends according to its terms, or if
a medical assistance recipient who owns a life estate or any
interest in real property as a joint tenant that is subject to a
medical assistance lien dies.

(1) The medical assistance recipient's life estate or joint
tenancy interest in the real property shall not end upon the
recipient's death but shall merge into the remainder interest or
other interest in real property the medical assistance recipient
owned in joint tenancy with others. The medical assistance lien
shall attach to and run with the remainder or other interest in
the real property to the extent of the medical assistance
recipient's interest in the property at the time of the
recipient's death as determined under this section.

(2) If the medical assistance recipient's interest was a
life estate in real property, the lien shall be a lien against
the portion of the remainder equal to the percentage factor for
the life estate of a person the medical assistance recipient's
age on the date the life estate ended according to its terms or
the date of the medical assistance recipient's death as listed
in the Life Estate Mortality Table in the health care program's
manual.

(3) If the medical assistance recipient owned the interest
in real property in joint tenancy with others, the lien shall be
a lien against the portion of that interest equal to the
fractional interest the medical assistance recipient would have
owned in the jointly owned interest had the medical assistance
recipient and the other owners held title to that interest as
tenants in common on the date the medical assistance recipient
died.

(4) The medical assistance lien shall remain a lien against
the remainder or other jointly owned interest for the length of
time and be renewable as provided in paragraph (a).

(5) Subdivision 5, paragraph (a), clause (4), paragraph
(b), clauses (1) and (2); and subdivision 6, paragraph (b), do
not apply to medical assistance liens which attach to interests
in real property as provided under this subdivision.

(6) The continuation of a medical assistance recipient's
life estate or joint tenancy interest in real property after the
medical assistance recipient's death for the purpose of
recovering medical assistance provided for in sections 514.980
to 514.985 modifies common law principles holding that these
interests terminate on the death of the holder.

(7) Notwithstanding any law or rule to the contrary, no
release, satisfaction, discharge, or affidavit under section
256B.15 shall extinguish or terminate the life estate or joint
tenancy interest of a medical assistance recipient subject to a
lien under sections 514.980 to 514.985 on the date the recipient
dies.

(8) new text begin No action shall be taken to enforce or collect any lien
arising under section 256B.15 or under sections 514.980 to
514.985 and sections 514.991 to 514.995 with respect to a
homestead owned of record, on the date the recipient dies, by
the recipient and a joint tenant with a right of survivorship,
until the joint tenant sells the homestead, ceases to reside in
the homestead, or dies. Homestead means the real property
occupied by the surviving joint tenant as the sole residence on
the date the recipient dies and classified and taxed to the
recipient and surviving joint tenant as homestead property for
property tax purposes in the calendar year in which the
recipient dies. For purposes of this exemption, real property
the recipient and the surviving joint tenant purchase solely
with the proceeds from the sale of the prior homestead, own of
record as joint tenants, and qualify as homestead property under
section 273.124 in the calendar year in which the recipient dies
and prior to the recipient's death shall be deemed to be real
property classified and taxed to the recipient and the surviving
joint tenant as homestead property in the calendar year in which
the recipient dies. The surviving joint tenant, or any person
with personal knowledge of the facts, may provide an affidavit
describing the homestead property affected by this clause and
stating facts showing compliance with this clause. The
affidavit shall be prima facie evidence of the facts it states.
The estate, any owner of an interest in the property that is or
may be subject to the lien, or any other interested party, may
voluntarily pay off, settle, or otherwise satisfy the claim
secured or to be secured by the lien at any time before or after
the lien is filed or recorded. Such payoffs, settlements, and
satisfactions shall be deemed to be voluntary repayments of past
medical assistance payments for the benefit of the deceased
recipient, and neither the process of settling the claim, the
payment of the claim, or the acceptance of a payment shall
constitute an adjustment or recovery that is prohibited under
this section.
new text end

new text begin (9) new text end The provisions of clauses (1) to deleted text begin (7) deleted text end new text begin (8) new text end do not apply
to a homestead owned of record, on the date the recipient dies,
by the recipient and the recipient's spouse as joint tenants
with a right of survivorship. Homestead means the real property
occupied by the surviving joint tenant spouse as their sole
residence on the date the recipient dies and classified and
taxed to the recipient and surviving joint tenant spouse as
homestead property for property tax purposes in the calendar
year in which the recipient dies. For purposes of this
exemption, real property the recipient and their surviving joint
tenant spouse purchase solely with the proceeds from the sale of
their prior homestead, own of record as joint tenants, and
qualify as homestead property under section 273.124 in the
calendar year in which the recipient dies and prior to the
recipient's death shall be deemed to be real property classified
and taxed to the recipient and their surviving joint tenant
spouse as homestead property in the calendar year in which the
recipient dies. The surviving spouse, or any person with
personal knowledge of the facts, may provide an affidavit
describing the homestead property affected by this clause and
stating facts showing compliance with this clause. The
affidavit shall be prima facie evidence of the facts it states.

new text begin (d) The commissioner shall release liens arising under
notices of potential claims under section 256B.15 and medical
assistance liens under sections 514.980 to 514.985, against a
deceased recipient's life estates and jointly owned interests in
farm and income producing real property they own of record on
the date they die if their interest in the property ends at
their death, the surviving remainderman or surviving joint
tenant owns their interest in the property of record on that
date, and all of the following conditions apply with respect to
the surviving remainderman or surviving joint tenant and their
interest in the property:
new text end

new text begin (1) the farm property is real property for which all of the
following apply continuously for a period beginning at least
three years before the calendar year in which the recipient
first received long-term care medical assistance through the
date of the recipient's death:
new text end

new text begin (i) the remainderman or surviving joint tenant is a farmer,
as defined in section 500.24, subdivision 2, paragraph (n), and
is engaged in farming, as defined in section 500.24, subdivision
2, paragraph (a);
new text end

new text begin (ii) all of the land is a family farm as defined in section
500.24, subdivision 2, paragraph (b); and
new text end

new text begin (iii) all of the land is classified and taxed as class 2a
agricultural land under section 273.13, subdivision 23,
paragraph (a), for property tax purposes; and
new text end

new text begin (2) the income-producing property is real property for
which all of the following apply continuously for a period
beginning at least three years before the calendar year in which
the recipient first received long-term care medical assistance
through the date of the recipient's death:
new text end

new text begin (i) no part of the property is classified or taxed as
homestead property for property tax purposes, provided that if
the property is classified and taxed as both homestead and
nonhomestead property, the portion of the property classified
and taxed as nonhomestead property shall be considered to
satisfy this requirement;
new text end

new text begin (ii) all of the property is classified and taxed as class
1c property under section 273.13, subdivision 22, paragraph (c),
except that part of the class 1c property that is a dwelling
occupied as a homestead; class 3a or 3b commercial or industrial
property under section 273.13, subdivision 24; or as class 4a or
4c property classified under section 273.13, subdivision 25,
paragraphs (a) and (d), for property tax purposes; and
new text end

new text begin (iii) the business, profession, or occupation in which the
real property is used is the primary business, profession, or
occupation of the remainderman or surviving joint tenant and the
real property is used solely for that business, profession, or
occupation. A primary business, profession, or occupation is
one the ongoing operation of which provides at least 65 percent
of a person's gross income for federal income tax purposes for
the calendar year.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005,
and applies to the estates of decedents who die on or after that
date. new text end

Sec. 29.

Minnesota Statutes 2004, section 524.3-805, is
amended to read:

524.3-805 CLASSIFICATION OF CLAIMS.

(a) If the applicable assets of the estate are insufficient
to pay all claims in full, the personal representative shall
make payment in the following order:

(1) costs and expenses of administration;

(2) reasonable funeral expenses;

(3) debts and taxes with preference under federal law;

(4) reasonable and necessary medical, hospital, or nursing
home expenses of the last illness of the decedent, including
compensation of persons attending the decedent, deleted text begin a claim filed
under section 256B.15 for recovery of expenditures for
alternative care for nonmedical assistance recipients under
section 256B.0913, deleted text end and including a claim filed pursuant to
section 256B.15;

(5) reasonable and necessary medical, hospital, and nursing
home expenses for the care of the decedent during the year
immediately preceding death;

(6) debts with preference under other laws of this state,
and state taxes;

(7) all other claims.

(b) No preference shall be given in the payment of any
claim over any other claim of the same class, and a claim due
and payable shall not be entitled to a preference over claims
not due, except that if claims for expenses of the last illness
involve only claims filed under section deleted text begin 256B.15 for recovery of
expenditures for alternative care for nonmedical assistance
recipients under section 256B.0913, section deleted text end 246.53 for costs of
state hospital care and claims filed under section 256B.15 deleted text begin ,
claims filed to recover expenditures for alternative care for
nonmedical assistance recipients under section 256B.0913 shall
have preference over claims filed under both sections 246.53 and
other claims filed under section 256B.15, and deleted text end new text begin . new text end Claims filed
under section 246.53 have preference over claims filed under
section 256B.15 deleted text begin for recovery of amounts other than those for
expenditures for alternative care for nonmedical assistance
recipients under section 256B.0913 deleted text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005,
for decedents dying on or after that date.
new text end

Sec. 30. new text begin COMMUNITY SERVICES PROVIDER RATE INCREASES.
new text end

new text begin (a) The commissioner of human services shall increase
reimbursement rates by two percent for the rate period beginning
October 1, 2005, and the rate year beginning July 1, 2006,
effective for services rendered on or after those dates.
new text end

new text begin (b) The two percent annual rate increase described in this
section must be provided to:
new text end

new text begin (1) home and community-based waivered services for persons
with mental retardation or related conditions under Minnesota
Statutes, section 256B.501;
new text end

new text begin (2) home and community-based waivered services for the
elderly under Minnesota Statutes, section 256B.0915;
new text end

new text begin (3) waivered services under community alternatives for
disabled individuals under Minnesota Statutes, section 256B.49;
new text end

new text begin (4) community alternative care waivered services under
Minnesota Statutes, section 256B.49;
new text end

new text begin (5) traumatic brain injury waivered services under
Minnesota Statutes, section 256B.49;
new text end

new text begin (6) nursing services and home health services under
Minnesota Statutes, section 256B.0625, subdivision 6a;
new text end

new text begin (7) personal care services and nursing supervision of
personal care services under Minnesota Statutes, section
256B.0625, subdivision 19a;
new text end

new text begin (8) private duty nursing services under Minnesota Statutes,
section 256B.0625, subdivision 7;
new text end

new text begin (9) day training and habilitation services for adults with
mental retardation or related conditions under Minnesota
Statutes, sections 252.40 to 252.46;
new text end

new text begin (10) alternative care services under Minnesota Statutes,
section 256B.0913;
new text end

new text begin (11) adult residential program grants under Minnesota
Rules, parts 9535.2000 to 9535.3000;
new text end

new text begin (12) adult and family community support grants under
Minnesota Rules, parts 9535.1700 to 9535.1760;
new text end

new text begin (13) the group residential housing supplementary service
rate under Minnesota Statutes, section 256I.05, subdivision 1a;
new text end

new text begin (14) adult mental health integrated fund grants under
Minnesota Statutes, section 245.4661;
new text end

new text begin (15) semi-independent living services under Minnesota
Statutes, section 252.275, including SILS funding under county
social services grants formerly funded under Minnesota Statutes,
chapter 256I;
new text end

new text begin (16) community support services for deaf and
hard-of-hearing adults with mental illness who use or wish to
use sign language as their primary means of communication; and
new text end

new text begin (17) living skills training programs for persons with
intractable epilepsy who need assistance in the transition to
independent living.
new text end

new text begin (c) Providers that receive a rate increase under this
section shall use the additional revenue to increase wages and
benefits and pay associated costs for employees, except for
management fees, the administrator, and central office staffs.
new text end

new text begin (d) For public employees, the increase for wages and
benefits for certain staff is available and pay rates shall be
increased only to the extent that they comply with laws
governing public employees collective bargaining. Money
received by a provider for pay increases under this section may
be used only for increases implemented on or after the first day
of the rate period in which the increase is available and must
not be used for increases implemented prior to that date.
new text end

new text begin (e) A copy of the provider's plan for complying with
paragraph (c) must be made available to all employees by giving
each employee a copy or by posting a copy in an area of the
provider's operation to which all employees have access. If an
employee does not receive the adjustment, if any, described in
the plan and is unable to resolve the problem with the provider,
the employee may contact the employee's union representative.
If the employee is not covered by a collective bargaining
agreement, the employee may contact the commissioner at a
telephone number provided by the commissioner and included in
the provider's plan.
new text end

Sec. 31. new text begin CONSUMER-DIRECTED COMMUNITY SUPPORTS
METHODOLOGY.
new text end

new text begin For persons using the home and community-based waiver for
persons with developmental disabilities whose Consumer-Directed
Community Supports budgets were reduced by the October 2004,
state-set budget methodology, the commissioner of human services
must allow exceptions to exceed the state-set budget formula up
to the daily average cost during calendar year 2004 or for
persons who graduated from school during 2004, the average daily
cost during July through December 2004, less one-half of case
management and home modifications over $5,000 when the
individual's county of financial responsibility determines that:
new text end

new text begin (1) necessary alternative services will cost the same or
more than the person's current budget; and
new text end

new text begin (2) administrative expenses or provider rates will result
in fewer hours of needed staffing for the person than under the
Consumer-Directed Community Supports option. Any exceptions the
county grants must be within the county's allowable aggregate
amount for the home and community-based waiver for persons with
developmental disabilities.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal
approval of the waiver amendment in section 33.
new text end

Sec. 32. new text begin COSTS ASSOCIATED WITH PHYSICAL ACTIVITIES.
new text end

new text begin The expenses allowed for adults under the Consumer-Directed
Community Supports option shall include costs at the lowest rate
available, considering daily, monthly, semiannual, annual, or
membership rates, including transportation, associated with
physical exercise or other physical activities to maintain or
improve the person's health and functioning.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal
approval of the waiver amendment in section 33.
new text end

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

new text begin The commissioner of human services shall submit an
amendment to the Centers for Medicare and Medicaid Services
consistent with sections 31 and 32 by August 1, 2005.
new text end

Sec. 34. new text begin INDEPENDENT EVALUATION AND REVIEW OF UNALLOWABLE
ITEMS.
new text end

new text begin The commissioner of human services shall include in the
independent evaluation of the Consumer-Directed Community
Supports option provided through the home and community-based
services waivers for persons with disabilities under 65 years of
age:
new text end

new text begin (1) provision for ongoing, regular participation by
stakeholder representatives through June 30, 2007;
new text end

new text begin (2) recommendations on whether changes to the unallowable
items should be made to meet the health, safety, or welfare
needs of participants in the Consumer-Directed Community
Supports option within the allowed budget amounts. The
recommendations on allowable items shall be provided to the
senate and house of representatives committees with jurisdiction
over human services policy and finance issues by January 15,
2006; and
new text end

new text begin (3) a review of the statewide caseload changes for the
disability waiver programs for persons under 65 years of age
that occurred since the state-set budget methodology
implementation on October 1, 2004, and recommendations on the
fiscal impact of the budget methodology on use of the
Consumer-Directed Community Supports option.
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. 35. new text begin IMMUNITY; REFUNDS BARRED.
new text end

new text begin (a) The commissioner of human services, county agencies,
and elected officials and their employees are immune from all
liability for any action taken implementing those portions of
Laws 2003, First Special Session chapter 14, that extend medical
assistance lien and estate claims recovery policies to include
the alternative care program, as those laws existed at the time
the action was taken.
new text end

new text begin (b) The legislature expressly intends that none of the
recoveries of alternative care payments the state or a local
agency made under Minnesota Statutes, sections 256B.15 and
514.991 to 514.995, as they existed prior to the effective date
of this amendment, shall be refunded or repaid.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 36. new text begin SKILLED NURSING FACILITIES IN FARIBAULT COUNTY.
new text end

new text begin All skilled nursing facilities in Faribault County shall
have the inspection required under Minnesota Statutes, section
144A.10, conducted by the Department of Health's Mankato survey
team.
new text end

Sec. 37. new text begin EXPIRATION DATE.
new text end

new text begin Section 31 shall expire on the date the commissioner of
human services implements a new consumer-directed community
supports budget methodology that is based on reliable and
accurate information about the services and supports intensity
needs of persons using the option and that adequately accounts
for the increased costs of adults who graduate from school and
need services funded by the waiver during the day.
new text end

Sec. 38. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 514.991; 514.992;
514.993; 514.994; and 514.995, are repealed effective July 1,
2005. On and after the repeal date all alternative care liens
of record shall be of no force and effect, shall not be liens on
real property, and examiners of title shall disregard these
liens and shall not carry them forward to subsequent
certificates of title.
new text end

ARTICLE 5

MENTAL AND CHEMICAL HEALTH

Section 1.

Minnesota Statutes 2004, section 62J.692,
subdivision 3, is amended to read:

Subd. 3.

Application process.

(a) A clinical medical
education program conducted in Minnesota by a teaching
institution to train physicians, doctor of pharmacy
practitioners, dentists, chiropractors, or physician assistants
is eligible for funds under subdivision 4 if the program:

(1) is funded, in part, by patient care revenues;

(2) occurs in patient care settings that face increased
financial pressure as a result of competition with nonteaching
patient care entities; and

(3) emphasizes primary care or specialties that are in
undersupply in Minnesota.

new text begin A clinical medical education program that trains
pediatricians is requested to include in its program curriculum
training in case management and medication management for
children suffering from mental illness to be eligible for funds
under subdivision 4.
new text end

(b) A clinical medical education program for advanced
practice nursing is eligible for funds under subdivision 4 if
the program meets the eligibility requirements in paragraph (a),
clauses (1) to (3), and is sponsored by the University of
Minnesota Academic Health Center, the Mayo Foundation, or
institutions that are part of the Minnesota State Colleges and
Universities system or members of the Minnesota Private College
Council.

(c) Applications must be submitted to the commissioner by a
sponsoring institution on behalf of an eligible clinical medical
education program and must be received by October 31 of each
year for distribution in the following year. An application for
funds must contain the following information:

(1) the official name and address of the sponsoring
institution and the official name and site address of the
clinical medical education programs on whose behalf the
sponsoring institution is applying;

(2) the name, title, and business address of those persons
responsible for administering the funds;

(3) for each clinical medical education program for which
funds are being sought; the type and specialty orientation of
trainees in the program; the name, site address, and medical
assistance provider number of each training site used in the
program; the total number of trainees at each training site; and
the total number of eligible trainee FTEs at each site. Only
those training sites that host 0.5 FTE or more eligible trainees
for a program may be included in the program's application; and

(4) other supporting information the commissioner deems
necessary to determine program eligibility based on the criteria
in paragraphs (a) and (b) and to ensure the equitable
distribution of funds.

(d) An application must include the information specified
in clauses (1) to (3) for each clinical medical education
program on an annual basis for three consecutive years. After
that time, an application must include the information specified
in clauses (1) to (3) in the first year of each biennium:

(1) audited clinical training costs per trainee for each
clinical medical education program when available or estimates
of clinical training costs based on audited financial data;

(2) a description of current sources of funding for
clinical medical education costs, including a description and
dollar amount of all state and federal financial support,
including Medicare direct and indirect payments; and

(3) other revenue received for the purposes of clinical
training.

(e) An applicant that does not provide information
requested by the commissioner shall not be eligible for funds
for the current funding cycle.

Sec. 2.

Minnesota Statutes 2004, section 244.054, is
amended to read:

244.054 DISCHARGE PLANS; OFFENDERS WITH SERIOUS AND
PERSISTENT MENTAL ILLNESS.

Subdivision 1.

Offer to develop plan.

The commissioner
of human services, in collaboration with the commissioner of
corrections, shall offer to develop a discharge plan for
community-based services for every offender with serious and
persistent mental illness, as defined in section 245.462,
subdivision 20, paragraph (c), new text begin and every offender who has had a
diagnosis of mental illness and would otherwise be eligible for
case management services under section 245.462, subdivision 20,
paragraph (c), but for the requirement that the offender be
hospitalized or in residential treatment, new text end who is being released
from a correctional facility. If an offender is being released
pursuant to section 244.05, the offender may choose to have the
discharge plan made one of the conditions of the offender's
supervised release and shall follow the conditions to the extent
that services are available and offered to the offender.

Subd. 2.

Content of plan.

If an offender chooses to have
a discharge plan developed, the commissioner of human services
shall develop and implement a discharge plan, which must include
at least the following:

(1) at least 90 days before the offender is due to be
discharged, the commissioner of human services shall designate
deleted text begin an agent of the Department of Human Services deleted text end new text begin a discharge planner
new text end with mental health training to serve as the primary person
responsible for carrying out discharge planning activities;

(2) at least 75 days before the offender is due to be
discharged, the offender's deleted text begin designated agent deleted text end new text begin discharge planner
new text end shall:

(i) obtain informed consent and releases of information
from the offender that are needed for transition services new text begin , and
forward them to the appropriate local entity new text end ;

(ii) contact the county human services department in the
community where the offender expects to reside following
discharge, and inform the department of the offender's impending
discharge and the planned date of the offender's return to the
community; determine whether the county or a designated
contracted provider will provide case management services to the
offender; refer the offender to the case management services
provider; and confirm that the case management services provider
will have opened the offender's case prior to the offender's
discharge; and

(iii) deleted text begin refer the offender to appropriate staff in the county
human services department in the community where the offender
expects to reside following discharge, for enrollment of the
offender if eligible in medical assistance or general assistance
medical care, using special procedures established by process
and Department of Human Services bulletin deleted text end new text begin assist the offender in
filling out an application for medical assistance, general
assistance medical care, or MinnesotaCare and submit the
application for eligibility determination to the commissioner.
The commissioner shall determine an offender's eligibility no
more than 45 days, or no more than 60 days if the offender's
disability status must be determined, from the date that the
application is received by the department. The effective date
of eligibility for the health care program shall be no earlier
than the date of the offender's release. If eligibility is
approved, the commissioner shall mail a Minnesota health care
program membership card to the facility in which the offender
resides and transfer the offender's case to MinnesotaCare
operations within the department or the appropriate county human
services agency in the county where the offender expects to
reside following release for ongoing case management new text end ;

(3) at least 2-1/2 months before discharge, the offender's
deleted text begin designated agent deleted text end new text begin discharge planner new text end shall secure timely
appointments for the offender with a psychiatrist no later than
30 days following discharge, and with other program staff at a
community mental health provider that is able to serve former
offenders with serious and persistent mental illness;

(4) at least 30 days before discharge, the offender's
deleted text begin designated agent deleted text end new text begin discharge planner new text end shall convene a predischarge
assessment and planning meeting of key staff from the programs
in which the offender has participated while in the correctional
facility, the offender, the supervising agent, and the mental
health case management services provider assigned to the
offender. At the meeting, attendees shall provide background
information and continuing care recommendations for the
offender, including information on the offender's risk for
relapse; current medications, including dosage and frequency;
therapy and behavioral goals; diagnostic and assessment
information, including results of a chemical dependency
evaluation; confirmation of appointments with a psychiatrist and
other program staff in the community; a relapse prevention plan;
continuing care needs; needs for housing, employment, and
finance support and assistance; and recommendations for
successful community integration, including chemical dependency
treatment or support if chemical dependency is a risk factor.
Immediately following this meeting, the offender's deleted text begin designated
agent deleted text end new text begin discharge planner new text end shall summarize this background
information and continuing care recommendations in a written
report;

(5) immediately following the predischarge assessment and
planning meeting, the provider of mental health case management
services who will serve the offender following discharge shall
offer to make arrangements and referrals for housing, financial
support, benefits assistance, employment counseling, and other
services required in sections 245.461 to 245.486;

(6) at least ten days before the offender's first scheduled
postdischarge appointment with a mental health provider, the
offender's deleted text begin designated agent deleted text end new text begin discharge planner new text end shall transfer the
following records to the offender's case management services
provider and psychiatrist: the predischarge assessment and
planning report, medical records, and pharmacy records. These
records may be transferred only if the offender provides
informed consent for their release;

(7) upon discharge, the offender's deleted text begin designated agent
deleted text end new text begin discharge planner new text end shall ensure that the offender leaves the
correctional facility with at least a ten-day supply of all
necessary medications; and

(8) upon discharge, the prescribing authority at the
offender's correctional facility shall telephone in
prescriptions for all necessary medications to a pharmacy in the
community where the offender plans to reside. The prescriptions
must provide at least a deleted text begin 30-day deleted text end new text begin 60-day new text end supply of all necessary
medications, and must be able to be refilled once for one
additional 30-day supply.

new text begin EFFECTIVE DATE. new text end

new text begin Subdivision 2, clause (2), item (iii), is
effective August 1, 2006, or upon HealthMatch implementation,
whichever is later.
new text end

Sec. 3.

Minnesota Statutes 2004, section 245.4661, is
amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Supportive housing and other community services
for individuals transitioning from anoka-metro regional
treatment center. new text end

new text begin The commissioner, through agreements with
counties and in consultation with providers of supportive
housing with services and others, shall transition individuals
who are currently at Anoka-Metro Regional Treatment Center into
the community, who are ready to be discharged or who are at
imminent risk of admission. The commissioner shall expand the
adult mental health initiative pilot projects under section
245.4661 to provide appropriate, thorough, flexible, and
sufficient services that may include supportive housing with
services, assertive community treatment, case management, and
other community supports for individuals with a mental illness
who:
new text end

new text begin (1) are at imminent risk of being admitted to, or are ready
to be discharged or have recently been discharged from, a
regional treatment center, community hospital, or residential
treatment program; and
new text end

new text begin (2) have no appropriate housing available or lack the
resources necessary to access permanent housing.
new text end

Sec. 4.

Minnesota Statutes 2004, section 245.4661, is
amended by adding a subdivision to read:

new text begin Subd. 9. new text end

new text begin Bed closing. new text end

new text begin The commissioner shall close 25
beds at the Anoka-Metro Regional Treatment Center by July 1,
2007, and an additional 25 beds by July 1, 2008, or after
sufficient alternative services have been developed. The
commissioner shall transfer state savings resulting from these
bed closures into appropriate accounts according to subdivision
10 to pay for the ongoing provision of the alternative services
in subdivision 8 and for expansion of contract beds under
section 256.9693. No individual will be involuntarily
discharged under this subdivision if appropriate community
services are not available to support the individual.
new text end

Sec. 5.

Minnesota Statutes 2004, section 245.4661, is
amended by adding a subdivision to read:

new text begin Subd. 10. new text end

new text begin Budget flexibility. new text end

new text begin The commissioner may make
budget transfers that do not increase the state share of costs
to effectively implement the restructuring of adult mental
health services.
new text end

Sec. 6.

Minnesota Statutes 2004, section 245.4661, is
amended by adding a subdivision to read:

new text begin Subd. 11. new text end

new text begin County eligibility. new text end

new text begin The commissioner may
approve funding for services under subdivision 8 according to
subdivisions 9 and 10 for a county or group of counties that:
new text end

new text begin (1) agrees to outcome-based performance criteria that
includes a reduction in utilization of regional treatment center
inpatient services through provision of quality services that
meet individual needs;
new text end

new text begin (2) agrees to the collection and submission of data
necessary to measure progress towards the criteria in clause (1)
and measurement of any resulting state or county savings;
new text end

new text begin (3) agrees to reinvest in the services defined in
subdivision 8 an amount equal to the ten percent county share of
regional treatment center services for the fiscal year ending
June 30, 2004, applied against the bed utilization reduction in
clause (1); and
new text end

new text begin (4) agrees to develop a supportive housing program that
insures the delivery of employment services, supportive
services, housing and health care for eligible individuals, or
agrees to contract with an existing integrated program.
new text end

Sec. 7.

Minnesota Statutes 2004, section 245.4874, is
amended to read:

245.4874 DUTIES OF COUNTY BOARD.

new text begin (a) new text end The county board in each county shall use its share of
mental health and Community Social Services Act funds allocated
by the commissioner according to a biennial children's mental
health component of the community social services plan that is
approved by the commissioner. The county board must:

(1) develop a system of affordable and locally available
children's mental health services according to sections 245.487
to 245.4887;

(2) establish a mechanism providing for interagency
coordination as specified in section 245.4875, subdivision 6;

(3) develop a biennial children's mental health component
of the community social services plan which considers the
assessment of unmet needs in the county as reported by the local
children's mental health advisory council under section
245.4875, subdivision 5, paragraph (b), clause (3). The county
shall provide, upon request of the local children's mental
health advisory council, readily available data to assist in the
determination of unmet needs;

(4) assure that parents and providers in the county receive
information about how to gain access to services provided
according to sections 245.487 to 245.4887;

(5) coordinate the delivery of children's mental health
services with services provided by social services, education,
corrections, health, and vocational agencies to improve the
availability of mental health services to children and the
cost-effectiveness of their delivery;

(6) assure that mental health services delivered according
to sections 245.487 to 245.4887 are delivered expeditiously and
are appropriate to the child's diagnostic assessment and
individual treatment plan;

(7) provide the community with information about predictors
and symptoms of emotional disturbances and how to access
children's mental health services according to sections 245.4877
and 245.4878;

(8) provide for case management services to each child with
severe emotional disturbance according to sections 245.486;
245.4871, subdivisions 3 and 4; and 245.4881, subdivisions 1, 3,
and 5;

(9) provide for screening of each child under section
245.4885 upon admission to a residential treatment facility,
acute care hospital inpatient treatment, or informal admission
to a regional treatment center;

(10) prudently administer grants and purchase-of-service
contracts that the county board determines are necessary to
fulfill its responsibilities under sections 245.487 to 245.4887;

(11) assure that mental health professionals, mental health
practitioners, and case managers employed by or under contract
to the county to provide mental health services are qualified
under section 245.4871;

(12) assure that children's mental health services are
coordinated with adult mental health services specified in
sections 245.461 to 245.486 so that a continuum of mental health
services is available to serve persons with mental illness,
regardless of the person's age;

(13) assure that culturally informed mental health
consultants are used as necessary to assist the county board in
assessing and providing appropriate treatment for children of
cultural or racial minority heritage; and

(14) consistent with section 245.486, arrange for or
provide a children's mental health screening to a child
receiving child protective services or a child in out-of-home
placement, a child for whom parental rights have been
terminated, a child found to be delinquent, and a child found to
have committed a juvenile petty offense for the third or
subsequent time, unless a screening has been performed within
the previous 180 days, or the child is currently under the care
of a mental health professional. The court or county agency
must notify a parent or guardian whose parental rights have not
been terminated of the potential mental health screening and the
option to prevent the screening by notifying the court or county
agency in writing. The screening shall be conducted with a
screening instrument approved by the commissioner of human
services according to criteria that are updated and issued
annually to ensure that approved screening instruments are valid
and useful for child welfare and juvenile justice populations,
and shall be conducted by a mental health practitioner as
defined in section 245.4871, subdivision 26, or a probation
officer or local social services agency staff person who is
trained in the use of the screening instrument. Training in the
use of the instrument shall include training in the
administration of the instrument, the interpretation of its
validity given the child's current circumstances, the state and
federal data practices laws and confidentiality standards, the
parental consent requirement, and providing respect for families
and cultural values. If the screen indicates a need for
assessment, the child's family, or if the family lacks mental
health insurance, the local social services agency, in
consultation with the child's family, shall have conducted a
diagnostic assessment, including a functional assessment, as
defined in section 245.4871. The administration of the
screening shall safeguard the privacy of children receiving the
screening and their families and shall comply with the Minnesota
Government Data Practices Act, chapter 13, and the federal
Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191. Screening results shall be considered
private data and the commissioner shall not collect individual
screening results.

new text begin (b) When the county board refers clients to providers of
children's therapeutic services and supports under section
256B.0943, the county board must clearly identify the
nonchildren's therapeutic services and supports covered services
components and identify the reimbursement source for those
requested services, the method of payment, and the payment rate
to the provider.
new text end

Sec. 8.

Minnesota Statutes 2004, section 245.4885,
subdivision 1, is amended to read:

Subdivision 1.

deleted text begin screening required deleted text end new text begin admission criteria new text end .

The county board shall, prior to admission, except in the case
of emergency admission, deleted text begin screen deleted text end new text begin determine the needed level of
care for new text end all children referred for treatment of severe emotional
disturbance deleted text begin to deleted text end new text begin in new text end a new text begin treatment foster care setting, new text end residential
treatment facility new text begin , new text end or informally admitted to a regional
treatment center if public funds are used to pay for the
services. The county board shall also deleted text begin screen deleted text end new text begin determine the
needed level of care for new text end all children admitted to an acute care
hospital for treatment of severe emotional disturbance if public
funds other than reimbursement under chapters 256B and 256D are
used to pay for the services. deleted text begin If a child is admitted to a
residential treatment facility or acute care hospital for
emergency treatment or held for emergency care by a regional
treatment center under section 253B.05, subdivision 1, screening
must occur within three working days of admission.
Screening deleted text end new text begin The level of care determination new text end shall determine
whether the proposed treatment:

(1) is necessary;

(2) is appropriate to the child's individual treatment
needs;

(3) cannot be effectively provided in the child's home; and

(4) provides a length of stay as short as possible
consistent with the individual child's need.

When a deleted text begin screening deleted text end new text begin level of care determination new text end is conducted,
the county board may not determine that referral or admission to
a new text begin treatment foster care setting, new text end residential treatment facility new text begin ,
new text end or acute care hospital is not appropriate solely because
services were not first provided to the child in a less
restrictive setting and the child failed to make progress toward
or meet treatment goals in the less restrictive
setting. deleted text begin Screening shall include both deleted text end new text begin The level of care
determination must be based on new text end a diagnostic assessment deleted text begin and deleted text end new text begin that
includes new text end a functional assessment which evaluates family, school,
and community living situations new text begin ; and an assessment of the
child's need for care out of the home using a validated tool
which assesses a child's functional status and assigns an
appropriate level of care. The validated tool must be approved
by the commissioner of human services new text end . If a diagnostic
assessment deleted text begin or deleted text end new text begin including a new text end functional assessment has been
completed by a mental health professional within new text begin the past new text end 180
days, a new diagnostic deleted text begin or functional deleted text end assessment need not be
completed unless in the opinion of the current treating mental
health professional the child's mental health status has changed
markedly since the assessment was completed. The child's parent
shall be notified if an assessment will not be completed and of
the reasons. A copy of the notice shall be placed in the
child's file. Recommendations developed as part of
the deleted text begin screening deleted text end new text begin level of care determination new text end process shall include
specific community services needed by the child and, if
appropriate, the child's family, and shall indicate whether or
not these services are available and accessible to the child and
family.

During the deleted text begin screening deleted text end new text begin level of care determination new text end process,
the child, child's family, or child's legal representative, as
appropriate, must be informed of the child's eligibility for
case management services and family community support services
and that an individual family community support plan is being
developed by the case manager, if assigned.

deleted text begin Screening deleted text end new text begin The level of care determination new text end shall deleted text begin be in
compliance deleted text end new text begin comply new text end with section 260C.212. Wherever possible, the
parent shall be consulted in the deleted text begin screening deleted text end process, unless
clinically inappropriate.

The deleted text begin screening process deleted text end new text begin level of care determination new text end , and
placement decision, and recommendations for mental health
services must be documented in the child's record.

An alternate review process may be approved by the
commissioner if the county board demonstrates that an alternate
review process has been established by the county board and the
times of review, persons responsible for the review, and review
criteria are comparable to the standards in clauses (1) to (4).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 9.

Minnesota Statutes 2004, section 245.4885, is
amended by adding a subdivision to read:

new text begin Subd. 1a. new text end

new text begin Emergency admission. new text end

new text begin Effective July 1, 2006,
if a child is admitted to a treatment foster care setting,
residential treatment facility, or acute care hospital for
emergency treatment or held for emergency care by a regional
treatment center under section 253B.05, subdivision 1, the level
of care determination must occur within three working days of
admission.
new text end

Sec. 10.

Minnesota Statutes 2004, section 245.4885,
subdivision 2, is amended to read:

Subd. 2.

Qualifications.

deleted text begin No later than July 1, 1991,
Screening deleted text end new text begin Level of care determination new text end of children for new text begin treatment
foster care, new text end residential new text begin , new text end and inpatient services must be
conducted by a mental health professional. Where appropriate
and available, culturally informed mental health consultants
must participate in the deleted text begin screening deleted text end new text begin level of care determination new text end .
Mental health professionals providing deleted text begin screening deleted text end new text begin level of care
determination new text end for new text begin treatment foster care, new text end inpatient new text begin , new text end and
residential services must not be financially affiliated with any
deleted text begin acute care inpatient hospital, residential treatment facility,
or regional treatment center deleted text end new text begin nongovernment entity which may be
providing those services new text end . deleted text begin The commissioner may waive this
requirement for mental health professional participation after
July 1, 1991, if the county documents that:
deleted text end

deleted text begin (1) mental health professionals or mental health
practitioners are unavailable to provide this service; and
deleted text end

deleted text begin (2) services are provided by a designated person with
training in human services who receives clinical supervision
from a mental health professional.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 11.

Minnesota Statutes 2004, section 254B.03,
subdivision 4, is amended to read:

Subd. 4.

Division of costs.

Except for services provided
by a county under section 254B.09, subdivision 1, or services
provided under section 256B.69 or 256D.03, subdivision 4,
paragraph (b), new text begin or when the primary drug problem is amphetamine
or methamphetamine abuse or dependence, new text end the county shall, out of
local money, pay the state for 15 percent of the cost of
chemical dependency services, including those services provided
to persons eligible for medical assistance under chapter 256B
and general assistance medical care under chapter 256D.
Counties may use the indigent hospitalization levy for treatment
and hospital payments made under this section. Fifteen percent
of any state collections from private or third-party pay, less
15 percent of the cost of payment and collections, must be
distributed to the county that paid for a portion of the
treatment under this section. If all funds allocated according
to section 254B.02 are exhausted by a county and new text begin , except for
treatment provided for amphetamine or methamphetamine abuse or
dependence, new text end the county has met or exceeded the base level of
expenditures under section 254B.02, subdivision 3, the county
shall pay the state for 15 percent of the costs paid by the
state under this section new text begin , unless the payment is for treatment of
amphetamine or methamphetamine abuse of dependence new text end . The
commissioner may refuse to pay state funds for services to
persons not eligible under section 254B.04, subdivision 1, if
the county financially responsible for the persons has exhausted
its allocation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 12.

Minnesota Statutes 2004, section 256B.0622,
subdivision 2, is amended to read:

Subd. 2.

Definitions.

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

(a) "Intensive nonresidential rehabilitative mental health
services" means adult rehabilitative mental health services as
defined in section 256B.0623, subdivision 2, paragraph (a),
except that these services are provided by a multidisciplinary
staff using a total team approach consistent with assertive
community treatment, the Fairweather Lodge treatment model, new text begin as
defined by the standards established by the National Coalition
for Community Living, new text end and other evidence-based practices, and
directed to recipients with a serious mental illness who require
intensive services.

(b) "Intensive residential rehabilitative mental health
services" means short-term, time-limited services provided in a
residential setting to recipients who are in need of more
restrictive settings and are at risk of significant functional
deterioration if they do not receive these services. Services
are designed to develop and enhance psychiatric stability,
personal and emotional adjustment, self-sufficiency, and skills
to live in a more independent setting. Services must be
directed toward a targeted discharge date with specified client
outcomes and must be consistent with new text begin the Fairweather Lodge
treatment model as defined in paragraph (a), and other
new text end evidence-based practices.

(c) "Evidence-based practices" are nationally recognized
mental health services that are proven by substantial research
to be effective in helping individuals with serious mental
illness obtain specific treatment goals.

(d) "Overnight staff" means a member of the intensive
residential rehabilitative mental health treatment team who is
responsible during hours when recipients are typically asleep.

(e) "Treatment team" means all staff who provide services
under this section to recipients. At a minimum, this includes
the clinical supervisor, mental health professionals, mental
health practitioners, and mental health rehabilitation workers.

Sec. 13.

Minnesota Statutes 2004, section 256B.0625, is
amended by adding a subdivision to read:

new text begin Subd. 46. new text end

new text begin Mental health telemedicine. new text end

new text begin Effective January
1, 2006, and subject to federal approval, mental health services
that are otherwise covered by medical assistance as direct
face-to-face services may be provided via two-way interactive
video. Use of two-way interactive video must be medically
appropriate to the condition and needs of the person being
served. Reimbursement is at the same rates and under the same
conditions that would otherwise apply to the service. The
interactive video equipment and connection must comply with
Medicare standards in effect at the time the service is provided.
new text end

Sec. 14.

Minnesota Statutes 2004, section 256B.0625, is
amended by adding a subdivision to read:

new text begin Subd. 47. new text end

new text begin Treatment foster care services. new text end

new text begin Effective July
1, 2006, and subject to federal approval, medical assistance
covers treatment foster care services according to section
256B.0946.
new text end

Sec. 15.

Minnesota Statutes 2004, section 256B.0625, is
amended by adding a subdivision to read:

new text begin Subd. 48. new text end

new text begin Psychiatric consultation to primary care
practitioners. new text end

new text begin Effective January 1, 2006, medical assistance
covers consultation provided by a psychiatrist via telephone,
e-mail, facsimile, or other means of communication to primary
care practitioners, including pediatricians. The need for
consultation and the receipt of the consultation must be
documented in the patient record maintained by the primary care
practitioner. If the patient consents, and subject to federal
limitations and data privacy provisions, the consultation may be
provided without the patient present.
new text end

Sec. 16.

new text begin [256B.0946] TREATMENT FOSTER CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Covered service. new text end

new text begin (a) Effective July 1,
2006, and subject to federal approval, medical assistance covers
medically necessary services described under paragraph (b) that
are provided by a provider entity eligible under subdivision 3
to a client eligible under subdivision 2 who is placed in a
treatment foster home licensed under Minnesota Rules, parts
2960.3000 to 2960.3340.
new text end

new text begin (b) Services to children with severe emotional disturbance
residing in treatment foster care settings must meet the
relevant standards for mental health services under sections
245.487 to 245.4887. In addition, specific service components
reimbursed by medical assistance must meet the following
standards:
new text end

new text begin (1) case management service component must meet the
standards in Minnesota Rules, parts 9520.0900 to 9520.0926 and
9505.0322, excluding subparts 6 and 10;
new text end

new text begin (2) psychotherapy and skills training components must meet
the standards for children's therapeutic services and supports
in section 256B.0943; and
new text end

new text begin (3) family psychoeducation services under supervision of a
mental health professional.
new text end

new text begin Subd. 2. new text end

new text begin Determination of client eligibility. new text end

new text begin A client's
eligibility to receive treatment foster care under this section
shall be determined by a diagnostic assessment, an evaluation of
level of care needed, and development of an individual treatment
plan, as defined in paragraphs (a) to (c).
new text end

new text begin (a) The diagnostic assessment must:
new text end

new text begin (1) be conducted by a psychiatrist, licensed psychologist,
or licensed independent clinical social worker that is performed
within 180 days prior to the start of service;
new text end

new text begin (2) include current diagnoses on all five axes of the
client's current mental health status;
new text end

new text begin (3) determine whether or not a child meets the criteria for
severe emotional disturbance in section 245.4871, subdivision 6,
or for serious and persistent mental illness in section 245.462,
subdivision 20; and
new text end

new text begin (4) be completed annually until age 18. For individuals
between age 18 and 21, unless a client's mental health condition
has changed markedly since the client's most recent diagnostic
assessment, annual updating is necessary. For the purpose of
this section, "updating" means a written summary, including
current diagnoses on all five axes, by a mental health
professional of the client's current mental status and service
needs.
new text end

new text begin (b) The evaluation of level of care must be conducted by
the placing county with an instrument approved by the
commissioner of human services. The commissioner shall update
the list of approved level of care instruments annually.
new text end

new text begin (c) The individual treatment plan must be:
new text end

new text begin (1) based on the information in the client's diagnostic
assessment;
new text end

new text begin (2) developed through a child-centered, family driven
planning process that identifies service needs and
individualized, planned, and culturally appropriate
interventions that contain specific measurable treatment goals
and objectives for the client and treatment strategies for the
client's family and foster family;
new text end

new text begin (3) reviewed at least once every 90 days and revised; and
new text end

new text begin (4) signed by the client or, if appropriate, by the
client's parent or other person authorized by statute to consent
to mental health services for the client.
new text end

new text begin Subd. 3. new text end

new text begin Eligible providers. new text end

new text begin For purposes of this
section, a provider agency must have an individual placement
agreement for each recipient and must be a licensed child
placing agency, under Minnesota Rules, parts 9543.0010 to
9543.0150, and either:
new text end

new text begin (1) a county;
new text end

new text begin (2) an Indian Health Services facility operated by a tribe
or tribal organization under funding authorized by United States
Code, title 25, sections 450f to 450n, or title 3 of the Indian
Self-Determination Act, Public Law 93-638, section 638
(facilities or providers); or
new text end

new text begin (3) a noncounty entity under contract with a county board.
new text end

new text begin Subd. 4. new text end

new text begin Eligible provider responsibilities. new text end

new text begin (a) To be
an eligible provider under this section, a provider must develop
written policies and procedures for treatment foster care
services consistent with subdivision 1, paragraph (b), clauses
(1), (2), and (3).
new text end

new text begin (b) In delivering services under this section, a treatment
foster care provider must ensure that staff caseload size
reasonably enables the provider to play an active role in
service planning, monitoring, delivering, and reviewing for
discharge planning to meet the needs of the client, the client's
foster family, and the birth family, as specified in each
client's individual treatment plan.
new text end

new text begin Subd. 5. new text end

new text begin Service authorization. new text end

new text begin The commissioner will
administer authorizations for services under this section in
compliance with section 256B.0625, subdivision 25.
new text end

new text begin Subd. 6. new text end

new text begin Excluded services. new text end

new text begin (a) Services in clauses (1)
to (4) are not eligible as components of treatment foster care
services:
new text end

new text begin (1) treatment foster care services provided in violation of
medical assistance policy in Minnesota Rules, part 9505.0220;
new text end

new text begin (2) service components of children's therapeutic services
and supports simultaneously provided by more than one treatment
foster care provider;
new text end

new text begin (3) home and community-based waiver services; and
new text end

new text begin (4) treatment foster care services provided to a child
without a level of care determination according to section
245.4885, subdivision 1.
new text end

new text begin (b) Children receiving treatment foster care services are
not eligible for medical assistance reimbursement for the
following services while receiving treatment foster care:
new text end

new text begin (1) mental health case management services under section
256B.0625, subdivision 20; and
new text end

new text begin (2) psychotherapy and skill training components of
children's therapeutic services and supports under section
256B.0625, subdivision 35b.
new text end

Sec. 17.

new text begin [256B.0947] TRANSITIONAL YOUTH INTENSIVE
REHABILITATIVE MENTAL HEALTH SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin Subject to federal approval,
medical assistance covers medically necessary, intensive
nonresidential rehabilitative mental health services as defined
in subdivision 2, for recipients as defined in subdivision 3,
when the services are provided by an entity meeting the
standards in this section.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the
following terms have the meanings given them.
new text end

new text begin (a) "Intensive nonresidential rehabilitative mental health
services" means child rehabilitative mental health services as
defined in section 256B.0943, except that these services are
provided by a multidisciplinary staff using a total team
approach consistent with assertive community treatment, or other
evidence-based practices, and directed to recipients with a
serious mental illness who require intensive services.
new text end

new text begin (b) "Evidence-based practices" are nationally recognized
mental health services that are proven by substantial research
to be effective in helping individuals with serious mental
illness obtain specific treatment goals.
new text end

new text begin (c) "Treatment team" means all staff who provide services
to recipients under this section. At a minimum, this includes
the clinical supervisor, mental health professionals, mental
health practitioners, mental health behavioral aides, and a
school representative familiar with the recipient's individual
education plan (IEP) if applicable.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility for transitional youth. new text end

new text begin An eligible
recipient under the age of 18 is an individual who:
new text end

new text begin (1) is age 16 or 17;
new text end

new text begin (2) is diagnosed with a medical condition, such as an
emotional disturbance or traumatic brain injury, for which
intensive nonresidential rehabilitative mental health services
are needed;
new text end

new text begin (3) has substantial disability and functional impairment in
three or more of the areas listed in section 245.462,
subdivision 11a, so that self-sufficiency upon adulthood or
emancipation is unlikely; and
new text end

new text begin (4) has had a recent diagnostic assessment by a qualified
professional that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to
address identified disability and functional impairments and
individual recipient goals.
new text end

new text begin Subd. 4. new text end

new text begin Provider certification and contract
requirements. new text end

new text begin (a) The intensive nonresidential rehabilitative
mental health services provider must:
new text end

new text begin (1) have a contract with the host county to provide
intensive transition youth rehabilitative mental health
services; and
new text end

new text begin (2) be certified by the commissioner as being in compliance
with this section and section 256B.0943.
new text end

new text begin (b) The commissioner shall develop procedures for counties
and providers to submit contracts and other documentation as
needed to allow the commissioner to determine whether the
standards in this section are met.
new text end

new text begin Subd. 5. new text end

new text begin Standards applicable to nonresidential
providers. new text end

new text begin (a) Services must be provided by a certified
provider entity as defined in section 256B.0943, subdivision 4
that meets the requirements in section 245B.0943, subdivisions 5
and 6.
new text end

new text begin (b) The clinical supervisor must be an active member of the
treatment team. The treatment team must meet with the clinical
supervisor at least weekly to discuss recipients' progress and
make rapid adjustments to meet recipients' needs. The team
meeting shall include recipient-specific case reviews and
general treatment discussions among team members.
Recipient-specific case reviews and planning must be documented
in the individual recipient's treatment record.
new text end

new text begin (c) Treatment staff must have prompt access in person or by
telephone to a mental health practitioner or mental health
professional. The provider must have the capacity to promptly
and appropriately respond to emergent needs and make any
necessary staffing adjustments to assure the health and safety
of recipients.
new text end

new text begin (d) The initial functional assessment must be completed
within ten days of intake and updated at least every three
months or prior to discharge from the service, whichever comes
first.
new text end

new text begin (e) The initial individual treatment plan must be completed
within ten days of intake and reviewed and updated at least
monthly with the recipient.
new text end

new text begin Subd. 6. new text end

new text begin Additional standards for nonresidential
services. new text end

new text begin The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
new text end

new text begin (1) The treatment team must use team treatment, not an
individual treatment model.
new text end

new text begin (2) The clinical supervisor must function as a practicing
clinician at least on a part-time basis.
new text end

new text begin (3) The staffing ratio must not exceed ten recipients to
one full-time equivalent treatment team position.
new text end

new text begin (4) Services must be available at times that meet client
needs.
new text end

new text begin (5) The treatment team must actively and assertively engage
and reach out to the recipient's family members and significant
others, after obtaining the recipient's permission.
new text end

new text begin (6) The treatment team must establish ongoing communication
and collaboration between the team, family, and significant
others and educate the family and significant others about
mental illness, symptom management, and the family's role in
treatment.
new text end

new text begin (7) The treatment team must provide interventions to
promote positive interpersonal relationships.
new text end

new text begin Subd. 7. new text end

new text begin Medical assistance payment for intensive
rehabilitative mental health services. new text end

new text begin (a) Payment for
nonresidential services in this section shall be based on one
daily rate per provider inclusive of the following services
received by an eligible recipient in a given calendar day: all
rehabilitative services under this section, staff travel time to
provide rehabilitative services under this section, and
nonresidential crisis stabilization services under section
256B.0944.
new text end

new text begin (b) Except as indicated in paragraph (c), payment will not
be made to more than one entity for each recipient for services
provided under this section on a given day. If services under
this section are provided by a team that includes staff from
more than one entity, the team must determine how to distribute
the payment among the members.
new text end

new text begin (c) The host county shall recommend to the commissioner one
rate for each entity that will bill medical assistance for
nonresidential intensive rehabilitative mental health services.
In developing these rates, the host county shall consider and
document:
new text end

new text begin (1) the cost for similar services in the local trade area;
new text end

new text begin (2) actual costs incurred by entities providing the
services;
new text end

new text begin (3) the intensity and frequency of services to be provided
to each recipient;
new text end

new text begin (4) the degree to which recipients will receive services
other than services under this section; and
new text end

new text begin (5) the costs of other services that will be separately
reimbursed.
new text end

new text begin (d) The rate for intensive rehabilitative mental health
services must exclude medical assistance room and board rate, as
defined in section 256I.03, subdivision 6, and services not
covered under this section, such as partial hospitalization and
inpatient services. Physician services are not a component of
the treatment team and may be billed separately. The county's
recommendation shall specify the period for which the rate will
be applicable, not to exceed two years.
new text end

new text begin (e) When services under this section are provided by an
assertive community team, case management functions must be an
integral part of the team.
new text end

new text begin (f) The rate for a provider must not exceed the rate
charged by that provider for the same service to other payors.
new text end

new text begin (g) The commissioner shall approve or reject the county's
rate recommendation, based on the commissioner's own analysis of
the criteria in paragraph (c).
new text end

new text begin Subd. 9. new text end

new text begin Provider enrollment; rate setting for
county-operated entities. new text end

new text begin Counties that employ their own staff
to provide services under this section shall apply directly to
the commissioner for enrollment and rate setting. In this case,
a county contract is not required and the commissioner shall
perform the program review and rate setting duties which would
otherwise be required of counties under this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2006.
new text end

Sec. 18.

Minnesota Statutes 2004, section 256B.19,
subdivision 1, is amended to read:

Subdivision 1.

Division of cost.

The state and county
share of medical assistance costs not paid by federal funds
shall be as follows:

(1) beginning January 1, 1992, 50 percent state funds and
50 percent county funds for the cost of placement of severely
emotionally disturbed children in regional treatment centers;

(2) beginning January 1, 2003, 80 percent state funds and
20 percent county funds for the costs of nursing facility
placements of persons with disabilities under the age of 65 that
have exceeded 90 days. This clause shall be subject to chapter
256G and shall not apply to placements in facilities not
certified to participate in medical assistance;

(3) beginning July 1, 2004, 80 percent state funds and 20
percent county funds for the costs of placements that have
exceeded 90 days in intermediate care facilities for persons
with mental retardation or a related condition that have seven
or more beds. This provision includes pass-through payments
made under section 256B.5015; deleted text begin and
deleted text end

(4) beginning July 1, 2004, when state funds are used to
pay for a nursing facility placement due to the facility's
status as an institution for mental diseases (IMD), the county
shall pay 20 percent of the nonfederal share of costs that have
exceeded 90 days. This clause is subject to chapter 256G new text begin ; and
new text end

new text begin (5) beginning July 1, 2006, 50 percent state funds and 50
percent county funds for the cost of treatment foster care
services under section 256B.0946 new text end .

For counties that participate in a Medicaid demonstration
project under sections 256B.69 and 256B.71, the division of the
nonfederal share of medical assistance expenses for payments
made to prepaid health plans or for payments made to health
maintenance organizations in the form of prepaid capitation
payments, this division of medical assistance expenses shall be
95 percent by the state and five percent by the county of
financial responsibility.

In counties where prepaid health plans are under contract
to the commissioner to provide services to medical assistance
recipients, the cost of court ordered treatment ordered without
consulting the prepaid health plan that does not include
diagnostic evaluation, recommendation, and referral for
treatment by the prepaid health plan is the responsibility of
the county of financial responsibility.

Sec. 19.

Minnesota Statutes 2004, section 256D.03,
subdivision 4, is amended to read:

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation
agencies;

(4) prescription drugs and other products recommended
through the process established in section 256B.0625,
subdivision 13;

(5) equipment necessary to administer insulin and
diagnostic supplies and equipment for diabetics to monitor blood
sugar level;

(6) eyeglasses and eye examinations provided by a physician
or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical
assistance program;

(13) podiatric services;

(14) dental services and dentures, subject to the
limitations specified in section 256B.0625, subdivision 9;

(15) outpatient services provided by a mental health center
or clinic that is under contract with the county board and is
established under section 245.62;

(16) day treatment services for mental illness provided
under contract with the county board;

(17) prescribed medications for persons who have been
diagnosed as mentally ill as necessary to prevent more
restrictive institutionalization;

(18) psychological services, medical supplies and
equipment, and Medicare premiums, coinsurance and deductible
payments;

(19) medical equipment not specifically listed in this
paragraph when the use of the equipment will prevent the need
for costlier services that are reimbursable under this
subdivision;

(20) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified
adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or
a certified geriatric nurse practitioner in independent
practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an
inpatient basis is not included as part of the cost for
inpatient services included in the operating payment rate, and
(3) the service is within the scope of practice of the nurse
practitioner's license as a registered nurse, as defined in
section 148.171;

(21) services of a certified public health nurse or a
registered nurse practicing in a public health nursing clinic
that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the
scope of practice of the public health nurse's license as a
registered nurse, as defined in section 148.171; deleted text begin and
deleted text end

(22) telemedicine consultations, to the extent they are
covered under section 256B.0625, subdivision 3b new text begin ; and
new text end

new text begin (23) mental health telemedicine and psychiatric
consultation as covered under section 256B.0625, subdivisions 46
and 48 new text end .

(ii) Effective October 1, 2003, for a person who is
eligible under subdivision 3, paragraph (a), clause (2), item
(ii), general assistance medical care coverage is limited to
inpatient hospital services, including physician services
provided during the inpatient hospital stay. A $1,000
deductible is required for each inpatient hospitalization.

(b) Gender reassignment surgery and related services are
not covered services under this subdivision unless the
individual began receiving gender reassignment services prior to
July 1, 1995.

(c) In order to contain costs, the commissioner of human
services shall select vendors of medical care who can provide
the most economical care consistent with high medical standards
and shall where possible contract with organizations on a
prepaid capitation basis to provide these services. The
commissioner shall consider proposals by counties and vendors
for prepaid health plans, competitive bidding programs, block
grants, or other vendor payment mechanisms designed to provide
services in an economical manner or to control utilization, with
safeguards to ensure that necessary services are provided.
Before implementing prepaid programs in counties with a county
operated or affiliated public teaching hospital or a hospital or
clinic operated by the University of Minnesota, the commissioner
shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to
participate in the program in a manner that reflects the risk of
adverse selection and the nature of the patients served by the
hospital, provided the terms of participation in the program are
competitive with the terms of other participants considering the
nature of the population served. Payment for services provided
pursuant to this subdivision shall be as provided to medical
assistance vendors of these services under sections 256B.02,
subdivision 8, and 256B.0625. For payments made during fiscal
year 1990 and later years, the commissioner shall consult with
an independent actuary in establishing prepayment rates, but
shall retain final control over the rate methodology.

(d) Recipients eligible under subdivision 3, paragraph (a),
clause (2), item (i), shall pay the following co-payments for
services provided on or after October 1, 2003:

(1) $3 per nonpreventive visit. For purposes of this
subdivision, a visit means an episode of service which is
required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory
setting by a physician or physician ancillary, chiropractor,
podiatrist, nurse midwife, advanced practice nurse, audiologist,
optician, or optometrist;

(2) $25 for eyeglasses;

(3) $25 for nonemergency visits to a hospital-based
emergency room;

(4) $3 per brand-name drug prescription and $1 per generic
drug prescription, subject to a $20 per month maximum for
prescription drug co-payments. No co-payments shall apply to
antipsychotic drugs when used for the treatment of mental
illness; and

(5) 50 percent coinsurance on restorative dental services.

(e) Co-payments shall be limited to one per day per
provider for nonpreventive visits, eyeglasses, and nonemergency
visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all
co-payments in this subdivision. The general assistance medical
care reimbursement to the provider shall be reduced by the
amount of the co-payment, except that reimbursement for
prescription drugs shall not be reduced once a recipient has
reached the $20 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the
recipient. Providers may not deny services to recipients who
are unable to pay the co-payment, except as provided in
paragraph (f).

(f) If it is the routine business practice of a provider to
refuse service to an individual with uncollected debt, the
provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient
with uncollected debt before services can be denied.

(g) Any county may, from its own resources, provide medical
payments for which state payments are not made.

(h) Chemical dependency services that are reimbursed under
chapter 254B must not be reimbursed under general assistance
medical care.

(i) The maximum payment for new vendors enrolled in the
general assistance medical care program after the base year
shall be determined from the average usual and customary charge
of the same vendor type enrolled in the base year.

(j) The conditions of payment for services under this
subdivision are the same as the conditions specified in rules
adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.

(k) Inpatient and outpatient payments shall be reduced by
five percent, effective July 1, 2003. This reduction is in
addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).

(l) Payments for all other health services except
inpatient, outpatient, and pharmacy services shall be reduced by
five percent, effective July 1, 2003.

(m) Payments to managed care plans shall be reduced by five
percent for services provided on or after October 1, 2003.

(n) A hospital receiving a reduced payment as a result of
this section may apply the unpaid balance toward satisfaction of
the hospital's bad debts.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 20.

Minnesota Statutes 2004, section 256D.44,
subdivision 5, is amended to read:

Subd. 5.

Special needs.

In addition to the state
standards of assistance established in subdivisions 1 to 4,
payments are allowed for the following special needs of
recipients of Minnesota supplemental aid who are not residents
of a nursing home, a regional treatment center, or a group
residential housing facility.

(a) The county agency shall pay a monthly allowance for
medically prescribed diets if the cost of those additional
dietary needs cannot be met through some other maintenance
benefit. The need for special diets or dietary items must be
prescribed by a licensed physician. Costs for special diets
shall be determined as percentages of the allotment for a
one-person household under the thrifty food plan as defined by
the United States Department of Agriculture. The types of diets
and the percentages of the thrifty food plan that are covered
are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent
of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires
special products, 100 percent of thrifty food plan;

(3) controlled protein diet, less than 40 grams and
requires special products, 125 percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty
food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed
for necessary home repairs or necessary repairs or replacement
of household furniture and appliances using the payment standard
of the AFDC program in effect on July 16, 1996, for these
expenses, as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at
a reasonable rate negotiated by the county or approved by the
court. This rate shall not exceed five percent of the
assistance unit's gross monthly income up to a maximum of $100
per month. If the guardian or conservator is a member of the
county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly
allowance of $68 for restaurant meals for a person who was
receiving a restaurant meal allowance on June 1, 1990, and who
eats two or more meals in a restaurant daily. The allowance
must continue until the person has not received Minnesota
supplemental aid for one full calendar month or until the
person's living arrangement changes and the person no longer
meets the criteria for the restaurant meal allowance, whichever
occurs first.

(e) A fee of ten percent of the recipient's gross income or
$25, whichever is less, is allowed for representative payee
services provided by an agency that meets the requirements under
SSI regulations to charge a fee for representative payee
services. This special need is available to all recipients of
Minnesota supplemental aid regardless of their living
arrangement.

(f) Notwithstanding the language in this subdivision, an
amount equal to the maximum allotment authorized by the federal
Food Stamp Program for a single individual which is in effect on
the first day of January of the previous year will be added to
the standards of assistance established in subdivisions 1 to 4
for individuals under the age of 65 who are relocating from an
institution new text begin , or an adult mental health residential treatment
program under section 256B.0622, new text end and who are shelter needy. An
eligible individual who receives this benefit prior to age 65
may continue to receive the benefit after the age of 65.

"Shelter needy" means that the assistance unit incurs
monthly shelter costs that exceed 40 percent of the assistance
unit's gross income before the application of this special needs
standard. "Gross income" for the purposes of this section is
the applicant's or recipient's income as defined in section
256D.35, subdivision 10, or the standard specified in
subdivision 3, whichever is greater. A recipient of a federal
or state housing subsidy, that limits shelter costs to a
percentage of gross income, shall not be considered shelter
needy for purposes of this paragraph.

Sec. 21.

Minnesota Statutes 2004, section 256L.03,
subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

For individuals
under section 256L.04, subdivision 7, with income no greater
than 75 percent of the federal poverty guidelines or for
families with children under section 256L.04, subdivision 1, all
subdivisions of this section apply. "Covered health services"
means the health services reimbursed under chapter 256B, with
the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care
services other than services covered under section 256B.0625,
subdivision 9, paragraph (b), orthodontic services, nonemergency
medical transportation services, personal care assistant and
case management services, nursing home or intermediate care
facilities services, inpatient mental health services, and
chemical dependency services. Outpatient mental health services
covered under the MinnesotaCare program are limited to
diagnostic assessments, psychological testing, explanation of
findings, new text begin mental health telemedicine, psychiatric consultation,
new text end medication management by a physician, day treatment, partial
hospitalization, and individual, family, and group psychotherapy.

No public funds shall be used for coverage of abortion
under MinnesotaCare except where the life of the female would be
endangered or substantial and irreversible impairment of a major
bodily function would result if the fetus were carried to term;
or where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in
this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2006.
new text end

Sec. 22.

new text begin [641.155] DISCHARGE PLANS; OFFENDERS WITH
SERIOUS AND PERSISTENT MENTAL ILLNESS.
new text end

new text begin The commissioner of corrections shall develop a model
discharge planning process for every offender with a serious and
persistent mental illness, as defined in section 245.462,
subdivision 20, paragraph (c), who has been convicted and
sentenced to serve three or more months and is being released
from a county jail or county regional jail.
new text end

new text begin An offender with a serious and persistent mental illness,
as defined in section 245.462, subdivision 20, paragraph (c),
who has been convicted and sentenced to serve three or more
months and is being released from a county jail or county
regional jail shall be referred to the appropriate staff in the
county human services department at least 60 days before being
released. The county human services department may carry out
provisions of the model discharge planning process such as:
new text end

new text begin (1) providing assistance in filling out an application for
medical assistance, general assistance medical care, or
MinnesotaCare;
new text end

new text begin (2) making a referral for case management as outlined under
section 245.467, subdivision 4;
new text end

new text begin (3) providing assistance in obtaining a state photo
identification;
new text end

new text begin (4) securing a timely appointment with a psychiatrist or
other appropriate community mental health providers; and
new text end

new text begin (5) providing prescriptions for a 30-day supply of all
necessary medications.
new text end

Sec. 23. new text begin PRIORITY IN JANITORIAL CONTRACTS.
new text end

new text begin When awarding contracts to provide the janitorial services
for the new Department of Human Services and Department of
Health buildings, the commissioner of administration shall give
priority to supported work vendors.
new text end

ARTICLE 6

FAMILY SUPPORT

Section 1.

Minnesota Statutes 2004, section 119B.011, is
amended by adding a subdivision to read:

new text begin Subd. 23. new text end

new text begin Work participation rate enhancement
program. new text end

new text begin "Work participation rate enhancement program" means
the program established under section 256J.575.
new text end

Sec. 2.

Minnesota Statutes 2004, section 119B.05,
subdivision 1, is amended to read:

Subdivision 1.

Eligible participants.

Families eligible
for child care assistance under the MFIP child care program are:

(1) MFIP participants who are employed or in job search and
meet the requirements of section 119B.10;

(2) persons who are members of transition year families
under section 119B.011, subdivision 20, and meet the
requirements of section 119B.10;

(3) families who are participating in employment
orientation or job search, or other employment or training
activities that are included in an approved employability
development plan under section 256J.95;

(4) MFIP families who are participating in work job search,
job support, employment, or training activities as required in
their employment plan, or in appeals, hearings, assessments, or
orientations according to chapter 256J;

(5) MFIP families who are participating in social services
activities under chapter 256J as required in their employment
plan approved according to chapter 256J;

(6) new text begin families who are participating in services or
activities that are included in an approved family stabilization
plan under section 256J.575;
new text end

new text begin (7) new text end families who are participating in programs as required
in tribal contracts under section 119B.02, subdivision 2, or
256.01, subdivision 2; and

deleted text begin (7) deleted text end new text begin (8) new text end families who are participating in the transition
year extension under section 119B.011, subdivision 20a.

Sec. 3.

Minnesota Statutes 2004, 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 section 259.67 or through title IV-E of the Social
Security Act.

(b) For households with adjusted gross income equal to or
greater than 100 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 100 percent of federal poverty guidelines and less than 175
percent of federal poverty guidelines, the parental contribution
is $4 per month;

(2) new text begin if the adjusted gross income is equal to or greater
than 175 percent of the federal poverty guidelines and less than
or equal to 200 percent of the federal poverty guidelines, the
parental contribution shall be one percent of the adjusted gross
income;
new text end

new text begin (3) new text end if the adjusted gross income is equal to or greater
than deleted text begin 175 deleted text end new text begin 200 new text end percent of federal poverty guidelines and less than
or equal to deleted text begin 375 deleted text end new text begin 420 new text end 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 one percent of adjusted gross income at deleted text begin 175 deleted text end new text begin 200
new text end percent of federal poverty guidelines and increases to 7.5
percent of adjusted gross income for those with adjusted gross
income up to deleted text begin 375 deleted text end new text begin 420 new text end percent of federal poverty guidelines;

deleted text begin (3) deleted text end new text begin (4) new text end if the adjusted gross income is greater than deleted text begin 375
deleted text end new text begin 420 new text end percent of federal poverty guidelines and less than 675
percent of federal poverty guidelines, the parental contribution
shall be 7.5 percent of adjusted gross income;

deleted text begin (4) deleted text end new text begin (5) new text end 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 ten percent of adjusted gross income; and

deleted text begin (5) deleted text end new text begin (6) new text end if the adjusted gross income is equal to or greater
than 975 percent of federal poverty guidelines, the parental
contribution shall be 12.5 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 new text begin and funds from early withdrawn qualified retirement
accounts under the Internal Revenue Code new text end 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.

(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) deleted text begin . An amount equal to the annual deleted text end new text begin , except that a new text end court-ordered
child support payment actually paid on behalf of the child
receiving services shall be deducted from the deleted text begin adjusted gross
income deleted text end new text begin contribution new text end of the parent making the payment deleted text begin prior to
calculating the parental contribution under paragraph (b) deleted text end .

(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. 4.

Minnesota Statutes 2004, section 256.01, is
amended by adding a subdivision to read:

new text begin Subd. 14b. new text end

new text begin American indian child welfare projects. new text end

new text begin (a)
The commissioner of human services may authorize projects to
test 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. Notwithstanding section 626.556, the
commissioner may authorize projects to use alternative methods
of investigating and assessing reports of child maltreatment,
provided that the projects comply with the provisions of section
626.556 dealing with the rights of individuals who are subjects
of reports or investigations, including notice and appeal rights
and data practices requirements. 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.
new text end

new text begin (b) For the purposes of this section, "American Indian
child" means a person from birth to 18 years of age who is a
tribal member or eligible for membership in one of the tribes
chosen for the project under this subdivision and who is
residing on the reservation of that tribe.
new text end

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

new text begin (1) be one of the existing tribes with reservation land in
Minnesota;
new text end

new text begin (2) have a tribal court with jurisdiction over child
custody proceedings;
new text end

new text begin (3) have a substantial number of children for whom
determinations of maltreatment have occurred;
new text end

new text begin (4) have capacity to respond to reports of abuse and
neglect under section 626.556;
new text end

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

new text begin (6) have a tribal-state title IV-E agreement in effect.
new text end

new text begin (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:
new text end

new text begin (1) assessment and prevention of child abuse and neglect;
new text end

new text begin (2) family preservation;
new text end

new text begin (3) facilitative, supportive, and reunification services;
new text end

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

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

new text begin (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 the tribal project is in effect and receiving funding for
the project. The commissioner shall work with tribes and
affected counties to develop procedures for data collection,
evaluation, and clarification of the 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 changes the responsibilities of the county law
enforcement agency or court services.
new text end

new text begin (f) 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 deemed
acceptable by the state to meet state and federal reporting
requirements.
new text end

new text begin (g) For counties with tribes participating in the American
Indian Child Welfare Project, five percent of the total cost of
the nonfederal share is to be paid by the county.
new text end

Sec. 5.

Minnesota Statutes 2004, section 256J.021, is
amended to read:

256J.021 SEPARATE STATE deleted text begin PROGRAM deleted text end new text begin PROGRAMS new text end FOR USE OF STATE
MONEY.

new text begin (a) new text end Beginning October 1, 2001, and each year thereafter,
the commissioner of human services must treat MFIP expenditures
made to or on behalf of any minor child under section 256J.02,
subdivision 2, clause (1), who is a resident of this state under
section 256J.12, and who is part of a two-parent eligible
household as expenditures under a separately funded state
program and report those expenditures to the federal Department
of Health and Human Services as separate state program
expenditures under Code of Federal Regulations, title 45,
section 263.5.

new text begin (b) Beginning October 1, 2005, and each year thereafter,
the commissioner of human services must treat MFIP expenditures
made to or on behalf of any minor child under section 256J.02,
subdivision 2, clause (1), who is a resident of this state under
section 256J.12, and who is part of a household participating in
the work participation rate enhancement program under section
256J.575 as expenditures under a separately funded state program
and report those expenditures to the federal Department of
Health and Human Services as separate state program expenditures
under Code of Federal Regulations, title 45, section 263.5.
new text end

Sec. 6.

Minnesota Statutes 2004, section 256J.08,
subdivision 65, is amended to read:

Subd. 65.

Participant.

"Participant" means a person who
is currently receiving cash assistance or the food portion
available through MFIP. A person who fails to withdraw or
access electronically any portion of the person's cash and food
assistance payment by the end of the payment month, who makes a
written request for closure before the first of a payment month
and repays cash and food assistance electronically issued for
that payment month within that payment month, or who returns any
uncashed assistance check and food coupons and withdraws from
the program is not a participant. A person who withdraws a cash
or food assistance payment by electronic transfer or receives
and cashes an MFIP assistance check or food coupons and is
subsequently determined to be ineligible for assistance for that
period of time is a participant, regardless whether that
assistance is repaid. The term "participant" includes the
caregiver relative and the minor child whose needs are included
in the assistance payment. A person in an assistance unit who
does not receive a cash and food assistance payment because the
case has been suspended from MFIP is a participant. A person
who receives cash payments under the diversionary work program
under section 256J.95 is a participant. new text begin A person who receives
cash payments under the work participation rate enhancement
program under section 256J.575 is a participant.
new text end

Sec. 7.

Minnesota Statutes 2004, section 256J.21,
subdivision 2, is amended to read:

Subd. 2.

Income exclusions.

The following must be
excluded in determining a family's available income:

(1) payments for basic care, difficulty of care, and
clothing allowances received for providing family foster care to
children or adults under Minnesota Rules, parts 9545.0010 to
9545.0260 and 9555.5050 to 9555.6265, and payments received and
used for care and maintenance of a third-party beneficiary who
is not a household member;

(2) reimbursements for employment training received through
the Workforce Investment Act of 1998, United States Code, title
20, chapter 73, section 9201;

(3) reimbursement for out-of-pocket expenses incurred while
performing volunteer services, jury duty, employment, or
informal carpooling arrangements directly related to employment;

(4) all educational assistance, except the county agency
must count graduate student teaching assistantships,
fellowships, and other similar paid work as earned income and,
after allowing deductions for any unmet and necessary
educational expenses, shall count scholarships or grants awarded
to graduate students that do not require teaching or research as
unearned income;

(5) loans, regardless of purpose, from public or private
lending institutions, governmental lending institutions, or
governmental agencies;

(6) loans from private individuals, regardless of purpose,
provided an applicant or participant documents that the lender
expects repayment;

(7)(i) state income tax refunds; and

(ii) federal income tax refunds;

(8)(i) federal earned income credits;

(ii) Minnesota working family credits;

(iii) state homeowners and renters credits under chapter
290A; and

(iv) federal or state tax rebates;

(9) funds received for reimbursement, replacement, or
rebate of personal or real property when these payments are made
by public agencies, awarded by a court, solicited through public
appeal, or made as a grant by a federal agency, state or local
government, or disaster assistance organizations, subsequent to
a presidential declaration of disaster;

(10) the portion of an insurance settlement that is used to
pay medical, funeral, and burial expenses, or to repair or
replace insured property;

(11) reimbursements for medical expenses that cannot be
paid by medical assistance;

(12) payments by a vocational rehabilitation program
administered by the state under chapter 268A, except those
payments that are for current living expenses;

(13) in-kind income, including any payments directly made
by a third party to a provider of goods and services;

(14) assistance payments to correct underpayments, but only
for the month in which the payment is received;

(15) payments for short-term emergency needs under section
256J.626, subdivision 2;

(16) funeral and cemetery payments as provided by section
256.935;

(17) nonrecurring cash gifts of $30 or less, not exceeding
$30 per participant in a calendar month;

(18) any form of energy assistance payment made through
Public Law 97-35, Low-Income Home Energy Assistance Act of 1981,
payments made directly to energy providers by other public and
private agencies, and any form of credit or rebate payment
issued by energy providers;

(19) Supplemental Security Income (SSI), including
retroactive SSI payments and other income of an SSI recipient deleted text begin ,
except as described in section 256J.37, subdivision 3b deleted text end ;

(20) Minnesota supplemental aid, including retroactive
payments;

(21) proceeds from the sale of real or personal property;

(22) state adoption assistance payments under section
259.67, and up to an equal amount of county adoption assistance
payments;

(23) state-funded family subsidy program payments made
under section 252.32 to help families care for children with
mental retardation or related conditions, consumer support grant
funds under section 256.476, and resources and services for a
disabled household member under one of the home and
community-based waiver services programs under chapter 256B;

(24) interest payments and dividends from property that is
not excluded from and that does not exceed the asset limit;

(25) rent rebates;

(26) income earned by a minor caregiver, minor child
through age 6, or a minor child who is at least a half-time
student in an approved elementary or secondary education
program;

(27) income earned by a caregiver under age 20 who is at
least a half-time student in an approved elementary or secondary
education program;

(28) MFIP child care payments under section 119B.05;

(29) all other payments made through MFIP to support a
caregiver's pursuit of greater economic stability;

(30) income a participant receives related to shared living
expenses;

(31) reverse mortgages;

(32) benefits provided by the Child Nutrition Act of 1966,
United States Code, title 42, chapter 13A, sections 1771 to
1790;

(33) benefits provided by the women, infants, and children
(WIC) nutrition program, United States Code, title 42, chapter
13A, section 1786;

(34) benefits from the National School Lunch Act, United
States Code, title 42, chapter 13, sections 1751 to 1769e;

(35) relocation assistance for displaced persons under the
Uniform Relocation Assistance and Real Property Acquisition
Policies Act of 1970, United States Code, title 42, chapter 61,
subchapter II, section 4636, or the National Housing Act, United
States Code, title 12, chapter 13, sections 1701 to 1750jj;

(36) benefits from the Trade Act of 1974, United States
Code, title 19, chapter 12, part 2, sections 2271 to 2322;

(37) war reparations payments to Japanese Americans and
Aleuts under United States Code, title 50, sections 1989 to
1989d;

(38) payments to veterans or their dependents as a result
of legal settlements regarding Agent Orange or other chemical
exposure under Public Law 101-239, section 10405, paragraph
(a)(2)(E);

(39) income that is otherwise specifically excluded from
MFIP consideration in federal law, state law, or federal
regulation;

(40) security and utility deposit refunds;

(41) American Indian tribal land settlements excluded under
Public Laws 98-123, 98-124, and 99-377 to the Mississippi Band
Chippewa Indians of White Earth, Leech Lake, and Mille Lacs
reservations and payments to members of the White Earth Band,
under United States Code, title 25, chapter 9, section 331, and
chapter 16, section 1407;

(42) all income of the minor parent's parents and
stepparents when determining the grant for the minor parent in
households that include a minor parent living with parents or
stepparents on MFIP with other children;

(43) income of the minor parent's parents and stepparents
equal to 200 percent of the federal poverty guideline for a
family size not including the minor parent and the minor
parent's child in households that include a minor parent living
with parents or stepparents not on MFIP when determining the
grant for the minor parent. The remainder of income is deemed
as specified in section 256J.37, subdivision 1b;

(44) payments made to children eligible for relative
custody assistance under section 257.85;

(45) vendor payments for goods and services made on behalf
of a client unless the client has the option of receiving the
payment in cash; and

(46) the principal portion of a contract for deed payment.

Sec. 8.

Minnesota Statutes 2004, section 256J.39, is
amended by adding a subdivision to read:

new text begin Subd. 1a. new text end

new text begin Prohibited purchases. new text end

new text begin MFIP recipients are
prohibited from using MFIP monthly cash assistance payments
issued in the form of an electronic benefits transfer to
purchase tobacco products or alcohol.
new text end

Sec. 9.

Minnesota Statutes 2004, section 256J.521,
subdivision 1, is amended to read:

Subdivision 1.

Assessments.

(a) For purposes of MFIP
employment services, assessment is a continuing process of
gathering information related to employability for the purpose
of identifying both participant's strengths and strategies for
coping with issues that interfere with employment. The job
counselor must use information from the assessment process to
develop and update the employment plan under subdivision 2 or 3,
as appropriate, deleted text begin and deleted text end to determine whether the participant
qualifies for a family violence waiver including an employment
plan under subdivision 3 new text begin , and to determine whether the
participant should be referred to the work participation rate
enhancement program under section 256J.575 new text end .

(b) The scope of assessment must cover at least the
following areas:

(1) basic information about the participant's ability to
obtain and retain employment, including: a review of the
participant's education level; interests, skills, and abilities;
prior employment or work experience; transferable work skills;
child care and transportation needs;

(2) identification of personal and family circumstances
that impact the participant's ability to obtain and retain
employment, including: any special needs of the children, the
level of English proficiency, family violence issues, and any
involvement with social services or the legal system;

(3) the results of a mental and chemical health screening
tool designed by the commissioner and results of the brief
screening tool for special learning needs. Screening tools for
mental and chemical health and special learning needs must be
approved by the commissioner and may only be administered by job
counselors or county staff trained in using such screening
tools. The commissioner shall work with county agencies to
develop protocols for referrals and follow-up actions after
screens are administered to participants, including guidance on
how employment plans may be modified based upon outcomes of
certain screens. Participants must be told of the purpose of
the screens and how the information will be used to assist the
participant in identifying and overcoming barriers to
employment. Screening for mental and chemical health and
special learning needs must be completed by participants who are
unable to find suitable employment after six weeks of job search
under subdivision 2, paragraph (b), and participants who are
determined to have barriers to employment under subdivision 2,
paragraph (d). Failure to complete the screens will result in
sanction under section 256J.46; and

(4) a comprehensive review of participation and progress
for participants who have received MFIP assistance and have not
worked in unsubsidized employment during the past 12 months.
The purpose of the review is to determine the need for
additional services and supports, including placement in
subsidized employment or unpaid work experience under section
256J.49, subdivision 13 new text begin , or referral to the work participation
rate enhancement program under section 256J.575 new text end .

(c) Information gathered during a caregiver's participation
in the diversionary work program under section 256J.95 must be
incorporated into the assessment process.

(d) The job counselor may require the participant to
complete a professional chemical use assessment to be performed
according to the rules adopted under section 254A.03,
subdivision 3, including provisions in the administrative rules
which recognize the cultural background of the participant, or a
professional psychological assessment as a component of the
assessment process, when the job counselor has a reasonable
belief, based on objective evidence, that a participant's
ability to obtain and retain suitable employment is impaired by
a medical condition. The job counselor may assist the
participant with arranging services, including child care
assistance and transportation, necessary to meet needs
identified by the assessment. Data gathered as part of a
professional assessment must be classified and disclosed
according to the provisions in section 13.46.

Sec. 10.

Minnesota Statutes 2004, section 256J.53,
subdivision 2, is amended to read:

Subd. 2.

Approval of postsecondary education or
training.

(a) In order for a postsecondary education or
training program to be an approved activity in an employment
plan, the participant must be working in unsubsidized employment
at least deleted text begin 20 deleted text end new text begin ten new text end hours per week.

(b) Participants seeking approval of a postsecondary
education or training plan must provide documentation that:

(1) the employment goal can only be met with the additional
education or training;

(2) there are suitable employment opportunities that
require the specific education or training in the area in which
the participant resides or is willing to reside;

(3) the education or training will result in significantly
higher wages for the participant than the participant could earn
without the education or training;

(4) the participant can meet the requirements for admission
into the program; and

(5) there is a reasonable expectation that the participant
will complete the training program based on such factors as the
participant's MFIP assessment, previous education, training, and
work history; current motivation; and changes in previous
circumstances.

(c) The hourly unsubsidized employment requirement does not
apply for intensive education or training programs lasting 12
weeks or less when full-time attendance is required.

(d) Participants with an approved employment plan in place
on July 1, 2003, which includes more than 12 months of
postsecondary education or training shall be allowed to complete
that plan provided that hourly requirements in section 256J.55,
subdivision 1, and conditions specified in paragraph (b), and
subdivisions 3 and 5 are met. A participant whose case is
subsequently closed for three months or less for reasons other
than noncompliance with program requirements and who returns to
MFIP shall be allowed to complete that plan provided that hourly
requirements in section 256J.55, subdivision 1, and conditions
specified in paragraph (b) and subdivisions 3 and 5 are met.

Sec. 11.

new text begin [256J.575] WORK PARTICIPATION RATE ENHANCEMENT
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin (a) The work participation rate
enhancement program (WORK PREP) is Minnesota's TANF program to
serve families who are not making significant progress within
MFIP due to a variety of barriers to employment.
new text end

new text begin (b) The goal of this program is to stabilize and improve
the lives of families at risk of long-term welfare dependency or
family instability due to employment barriers such as physical
disability, mental disability, age, and caring for a disabled
household member. WORK PREP provides services to promote and
support families to achieve the greatest possible degree of
self-sufficiency. Counties may provide supportive and other
allowable services funded by the MFIP consolidated fund under
section 256J.626 to eligible participants.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin The terms used in this section
have the meanings given them in paragraphs (a) to (d).
new text end

new text begin (a) The "work participation rate enhancement program" means
the program established under this section.
new text end

new text begin (b) "Case management" means the services provided by or
through the county agency to participating families, including
assessment, information, referrals, and assistance in the
preparation and implementation of a family stabilization plan
under subdivision 5.
new text end

new text begin (c) "Family stabilization plan" means a plan developed by a
case manager and the participant, which identifies the
participant's most appropriate path to unsubsidized employment,
family stability, and barrier reduction, taking into account the
family's circumstances.
new text end

new text begin (d) "Family stabilization services" means programs,
activities, and services in this section that provide
participants and their family members with assistance regarding,
but not limited to:
new text end

new text begin (1) obtaining and retaining unsubsidized employment;
new text end

new text begin (2) family stability;
new text end

new text begin (3) economic stability; and
new text end

new text begin (4) barrier reduction.
new text end

new text begin The goal of the program is to achieve the greatest degree
of economic self-sufficiency and family well-being possible for
the family under the circumstances.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) The following MFIP or DWP
participants are eligible for the program under this section:
new text end

new text begin (1) a participant identified under section 256J.561,
subdivision 2, paragraph (d), who has or is eligible for an
employment plan developed under section 256J.521, subdivision 2,
paragraph (c);
new text end

new text begin (2) a participant identified under section 256J.95,
subdivision 12, paragraph (b), as unlikely to benefit from the
diversionary work program;
new text end

new text begin (3) a participant who meets the requirements for or has
been granted a hardship extension under section 256J.425,
subdivision 2 or 3; and
new text end

new text begin (4) a participant who is applying for supplemental security
income or Social Security disability insurance.
new text end

new text begin (b) Families must meet all other eligibility requirements
for MFIP established in this chapter. Families are eligible for
financial assistance to the same extent as if they were
participating in MFIP.
new text end

new text begin Subd. 4. new text end

new text begin Universal participation. new text end

new text begin All caregivers must
participate in family stabilization services as defined in
subdivision 2.
new text end

new text begin Subd. 5. new text end

new text begin Case management; family stabilization plans;
coordinated services. new text end

new text begin (a) The county agency shall provide
family stabilization services to families through a case
management model. A case manager shall be assigned to each
participating family within 30 days after the family begins to
receive financial assistance as a participant of the work
participation rate enhancement program. The case manager, with
the full involvement of the family, shall recommend, and the
county agency shall establish and modify as necessary, a family
stabilization plan for each participating family.
new text end

new text begin (b) The family stabilization plan shall include:
new text end

new text begin (1) each participant's plan for long-term self-sufficiency,
including an employment goal where applicable;
new text end

new text begin (2) an assessment of each participant's strengths and
barriers, and any special circumstances of the participant's
family that impact, or are likely to impact, the participant's
progress towards the goals in the plan; and
new text end

new text begin (3) an identification of the services, supports, education,
training, and accommodations needed to overcome any barriers to
enable the family to achieve self-sufficiency and to fulfill
each caregiver's personal and family responsibilities.
new text end

new text begin (c) The case manager and the participant must meet within
30 days of the family's referral to the case manager. The
initial family stabilization plan shall be completed within 30
days of the first meeting with the case manager. The case
manager shall establish a schedule for periodic review of the
family stabilization plan that includes personal contact with
the participant at least once per month. In addition, the case
manager shall review and modify if necessary the plan under the
following circumstances:
new text end

new text begin (1) there is a lack of satisfactory progress in achieving
the goals of the plan;
new text end

new text begin (2) the participant has lost unsubsidized or subsidized
employment;
new text end

new text begin (3) a family member has failed to comply with a family
stabilization plan requirement;
new text end

new text begin (4) services required by the plan are unavailable; or
new text end

new text begin (5) changes to the plan are needed to promote the
well-being of the children.
new text end

new text begin (d) Family stabilization plans under this section shall be
written for a period of time not to exceed six months.
new text end

new text begin Subd. 6. new text end

new text begin Cooperation with program requirements. new text end

new text begin (a) To
be eligible, a participant must comply with paragraphs (b) to
(f).
new text end

new text begin (b) Participants shall engage in family stabilization plan
activities listed in clause (1) or (2) for the number of hours
per week that the activities are scheduled and available, unless
good cause exists for not doing so, as defined in section
256J.57, subdivision 1:
new text end

new text begin (1) in single-parent families with no children under six
years of age, the case manager and the participant must develop
a family stabilization plan that includes 30 to 35 hours per
week of activities; and
new text end

new text begin (2) in single-parent families with a child under six years
of age, the case manager and the participant must develop a
family stabilization plan that includes 20 to 35 hours per week
of activities.
new text end

new text begin (c) The case manager shall review the participant's
progress toward the goals in the family stabilization plan every
six months to determine whether conditions have changed,
including whether revisions to the plan are needed.
new text end

new text begin (d) When the participant has increased participation in
work-related activities sufficient to meet the federal
participation requirements of TANF, the county agency shall
refer the participant to the MFIP program and assign the
participant to a job counselor. The participant and the job
counselor must meet within 15 days of referral to MFIP to
develop an employment plan under section 256J.521. No
reapplication is necessary and financial assistance shall
continue without interruption.
new text end

new text begin (e) Participants who have not increased their participation
in work activities sufficient to meet the federal participation
requirements of TANF may request a referral to the MFIP program
and assignment to a job counselor after 12 months in the program.
new text end

new text begin (f) A participant's requirement to comply with any or all
family stabilization plan requirements under this subdivision
shall be excused when the case management services, training and
educational services, and family support services identified in
the participant's family stabilization plan are unavailable for
reasons beyond the control of the participant, including when
money appropriated is not sufficient to provide the services.
new text end

new text begin Subd. 7. new text end

new text begin Sanctions. new text end

new text begin (a) The financial assistance grant
of a participating family shall be reduced, according to section
256J.46, if a participating adult fails without good cause to
comply or continue to comply with the family stabilization plan
requirements in this subdivision, unless compliance has been
excused under subdivision 6, paragraph (f).
new text end

new text begin (b) Given the purpose of the work participation rate
enhancement program in this section and the nature of the
underlying family circumstances that act as barriers to both
employment and full compliance with program requirements,
sanctions are appropriate only when it is clear that there is
both ability to comply and willful noncompliance on the part of
the participant.
new text end

new text begin (c) Prior to the imposition of a sanction, the county
agency must review the participant's case to determine if the
family stabilization plan is still appropriate and meet with the
participants face-to-face. The participant may bring an
advocate to the face-to-face meeting. If a face-to-face meeting
is not conducted, the county agency must send the participant a
written notice that includes the information required under
clause (1):
new text end

new text begin (1) during the face-to-face meeting, the county agency must:
new text end

new text begin (i) determine whether the continued noncompliance can be
explained and mitigated by providing a needed family
stabilization service, as defined in subdivision 2, paragraph
(d);
new text end

new text begin (ii) determine whether the participant qualifies for a good
cause exception under section 256J.57, or if the sanction is for
noncooperation with child support requirements, determine if the
participant qualifies for a good cause exemption under section
256.741, subdivision 10;
new text end

new text begin (iii) determine whether activities in the family
stabilization plan are appropriate based on the family's
circumstances;
new text end

new text begin (iv) explain the consequences of continuing noncompliance;
new text end

new text begin (v) identify other resources that may be available to the
participant to meet the needs of the family; and
new text end

new text begin (vi) inform the participant of the right to appeal under
section 256J.40; and
new text end

new text begin (2) if the lack of an identified activity or service can
explain the noncompliance, the county must work with the
participant to provide the identified activity.
new text end

new text begin (d) After the requirements of paragraph (c) are met and
prior to imposition of a sanction, the county agency shall
provide a notice of intent to sanction under section 256J.57,
subdivision 2, and, when applicable, a notice of adverse action
as provided in section 256J.31.
new text end

new text begin (e) Section 256J.57 applies to this section except to the
extent that it is modified by this subdivision.
new text end

Sec. 12.

new text begin [256J.621] WORK PARTICIPATION BONUS.
new text end

new text begin Upon exiting the diversionary work program (DWP) or upon
terminating MFIP cash assistance with earnings, a participant
who is employed and working 24 hours a week may be eligible for
transitional assistance of $50 per month to assist in meeting
the family's basic needs as the participant continues to move
toward self-sufficiency.
new text end

new text begin To be eligible for a transitional assistance payment, the
participant must not receive MFIP cash assistance or
diversionary work program assistance during the month and must
be employed an average of at least 24 hours a week.
Transitional assistance shall be available for a maximum of 12
months from the date the participant exited the diversionary
work program or terminated MFIP cash assistance.
new text end

new text begin The commissioner shall establish policies and develop forms
to verify eligibility for transitional assistance. The forms
must contain all data elements required to meet federal TANF
reporting requirements.
new text end

new text begin Expenditures on the transitional assistance program shall
be state-funded and treated as segregated funds under the
state's TANF maintenance of effort requirement. Months in which
a participant receives transitional assistance under this
section shall not count toward the participant's MFIP 60-month
time limit.
new text end

new text begin This section shall take effect if federal law changes the
TANF work participation rates that states must meet and the
commissioner determines that implementation of this program will
enhance Minnesota's TANF work participation rates.
new text end

Sec. 13.

Minnesota Statutes 2004, section 256J.626,
subdivision 1, is amended to read:

Subdivision 1.

Consolidated fund.

The consolidated fund
is established to support counties and tribes in meeting their
duties under this chapter. Counties and tribes must use funds
from the consolidated fund to develop programs and services that
are designed to improve participant outcomes as measured in
section 256J.751, subdivision 2 new text begin , and to provide case management
services to participants of the work participation rate
enhancement program new text end . Counties may use the funds for any
allowable expenditures under subdivision 2. Tribes may use the
funds for any allowable expenditures under subdivision 2, except
those in clauses (1) and (6).

Sec. 14.

Minnesota Statutes 2004, section 256J.626,
subdivision 2, is amended to read:

Subd. 2.

Allowable expenditures.

(a) The commissioner
must restrict expenditures under the consolidated fund to
benefits and services allowed under title IV-A of the federal
Social Security Act. Allowable expenditures under the
consolidated fund may include, but are not limited to:

(1) short-term, nonrecurring shelter and utility needs that
are excluded from the definition of assistance under Code of
Federal Regulations, title 45, section 260.31, for families who
meet the residency requirement in section 256J.12, subdivisions
1 and 1a. Payments under this subdivision are not considered
TANF cash assistance and are not counted towards the 60-month
time limit;

(2) transportation needed to obtain or retain employment or
to participate in other approved work activities new text begin or activities
under a family stabilization plan new text end ;

(3) direct and administrative costs of staff to deliver
employment services for MFIP deleted text begin or deleted text end new text begin , new text end the diversionary work
program, new text begin or the work participation rate enhancement program; new text end to
administer financial assistance deleted text begin , deleted text end new text begin ; new text end and to provide specialized
services intended to assist hard-to-employ participants to
transition to work new text begin or transition from the work participation
rate enhancement program to MFIP new text end ;

(4) costs of education and training including functional
work literacy and English as a second language;

(5) cost of work supports including tools, clothing, boots,
and other work-related expenses;

(6) county administrative expenses as defined in Code of
Federal Regulations, title 45, section 260(b);

(7) services to parenting and pregnant teens;

(8) supported work;

(9) wage subsidies;

(10) child care needed for MFIP deleted text begin or deleted text end new text begin , the new text end diversionary work
program new text begin , or the work participation rate enhancement program
new text end participants to participate in social services;

(11) child care to ensure that families leaving MFIP or
diversionary work program will continue to receive child care
assistance from the time the family no longer qualifies for
transition year child care until an opening occurs under the
basic sliding fee child care program; deleted text begin and
deleted text end

(12) services to help noncustodial parents who live in
Minnesota and have minor children receiving MFIP or DWP
assistance, but do not live in the same household as the child,
obtain or retain employment new text begin ; and
new text end

new text begin (13) services to help families participating in the work
participation rate enhancement program achieve the greatest
possible degree of self-sufficiency new text end .

(b) Administrative costs that are not matched with county
funds as provided in subdivision 8 may not exceed 7.5 percent of
a county's or 15 percent of a tribe's allocation under this
section. The commissioner shall define administrative costs for
purposes of this subdivision.

Sec. 15.

Minnesota Statutes 2004, section 256J.626,
subdivision 3, is amended to read:

Subd. 3.

Eligibility for services.

Families with a minor
child, a pregnant woman, or a noncustodial parent of a minor
child receiving assistance, with incomes below 200 percent of
the federal poverty guideline for a family of the applicable
size, are eligible for services funded under the consolidated
fund. Counties and tribes must give priority to families
currently receiving MFIP deleted text begin or deleted text end new text begin , the new text end diversionary work program, new text begin or
the work participation rate enhancement program, new text end and families at
risk of receiving MFIP or diversionary work program.

Sec. 16.

Minnesota Statutes 2004, section 256J.626,
subdivision 4, is amended to read:

Subd. 4.

County and tribal biennial service agreements.

(a) Effective January 1, 2004, and each two-year period
thereafter, each county and tribe must have in place an approved
biennial service agreement related to the services and programs
in this chapter. In counties with a city of the first class
with a population over 300,000, the county must consider a
service agreement that includes a jointly developed plan for the
delivery of employment services with the city. Counties may
collaborate to develop multicounty, multitribal, or regional
service agreements.

(b) The service agreements will be completed in a form
prescribed by the commissioner. The agreement must include:

(1) a statement of the needs of the service population and
strengths and resources in the community;

(2) numerical goals for participant outcomes measures to be
accomplished during the biennial period. The commissioner may
identify outcomes from section 256J.751, subdivision 2, as core
outcomes for all counties and tribes;

(3) strategies the county or tribe will pursue to achieve
the outcome targets. Strategies must include specification of
how funds under this section will be used and may include
community partnerships that will be established or strengthened;
deleted text begin and
deleted text end

(4) new text begin strategies the county or tribe will pursue under the
work participation rate enhancement program; and
new text end

new text begin (5) new text end other items prescribed by the commissioner in
consultation with counties and tribes.

(c) The commissioner shall provide each county and tribe
with information needed to complete an agreement, including:
(1) information on MFIP cases in the county or tribe; (2)
comparisons with the rest of the state; (3) baseline performance
on outcome measures; and (4) promising program practices.

(d) The service agreement must be submitted to the
commissioner by October 15, 2003, and October 15 of each second
year thereafter. The county or tribe must allow a period of not
less than 30 days prior to the submission of the agreement to
solicit comments from the public on the contents of the
agreement.

(e) The commissioner must, within 60 days of receiving each
county or tribal service agreement, inform the county or tribe
if the service agreement is approved. If the service agreement
is not approved, the commissioner must inform the county or
tribe of any revisions needed prior to approval.

(f) The service agreement in this subdivision supersedes
the plan requirements of section 116L.88.

Sec. 17.

Minnesota Statutes 2004, section 256J.626,
subdivision 7, is amended to read:

Subd. 7.

Performance base funds.

(a) Beginning calendar
year 2005, each county and tribe will be allocated deleted text begin 95 deleted text end new text begin 100
new text end percent of their initial calendar year allocation. Counties and
tribes will be allocated additional funds new text begin from federal TANF
bonus funds the state receives new text end based on performance as follows:

(1) for calendar year 2005, a county or tribe that achieves
a 30 percent rate or higher on the MFIP participation rate under
section 256J.751, subdivision 2, clause (8), as averaged across
the four quarterly measurements for the most recent year for
which the measurements are available, will receive an additional
allocation deleted text begin equal to 2.5 percent of its initial allocation deleted text end new text begin to be
determined by the commissioner based upon available funds new text end ; and

(2) for calendar year 2006, a county or tribe that achieves
a 40 percent rate or a five percentage point improvement over
the previous year's MFIP participation rate under section
256J.751, subdivision 2, clause (8), as averaged across the four
quarterly measurements for the most recent year for which the
measurements are available, will receive an additional
allocation deleted text begin equal to 2.5 percent of its initial allocation deleted text end new text begin to be
determined by the commissioner based upon available funds new text end ; and

(3) for calendar year 2007, a county or tribe that achieves
a 50 percent rate or a five percentage point improvement over
the previous year's MFIP participation rate under section
256J.751, subdivision 2, clause (8), as averaged across the four
quarterly measurements for the most recent year for which the
measurements are available, will receive an additional
allocation deleted text begin equal to 2.5 percent of its initial allocation deleted text end new text begin to be
determined by the commissioner based upon available funds new text end ; and

(4) for calendar year 2008 and yearly thereafter, a county
or tribe that achieves a 50 percent MFIP participation rate
under section 256J.751, subdivision 2, clause (8), as averaged
across the four quarterly measurements for the most recent year
for which the measurements are available, will receive an
additional allocation deleted text begin equal to 2.5 percent of its initial
allocation deleted text end new text begin to be determined by the commissioner based upon
available funds new text end ; and

(5) for calendar years 2005 and thereafter, a county or
tribe that performs above the top of its range of expected
performance on the three-year self-support index under section
256J.751, subdivision 2, clause (7), in both measurements in the
preceding year will receive an additional allocation deleted text begin equal to
five percent of its initial allocation deleted text end new text begin to be determined by the
commissioner based upon available funds new text end ; or

(6) for calendar years 2005 and thereafter, a county or
tribe that performs within its range of expected performance on
the three-year self-support index under section 256J.751,
subdivision 2, clause (7), in both measurements in the preceding
year, or above the top of its range of expected performance in
one measurement and within its expected range of performance in
the other measurement, will receive an additional allocation
deleted text begin equal to 2.5 percent of its initial allocation deleted text end new text begin to be determined
by the commissioner based upon available funds new text end .

(b) Funds remaining unallocated after the performance-based
allocations in paragraph (a) are available to the commissioner
for innovation projects under subdivision 5.

deleted text begin (c)(1) If available funds are insufficient to meet county
and tribal allocations under paragraph (a), the commissioner may
make available for allocation funds that are unobligated and
available from the innovation projects through the end of the
current biennium.
deleted text end

deleted text begin (2) If after the application of clause (1) funds remain
insufficient to meet county and tribal allocations under
paragraph (a), the commissioner must proportionally reduce the
allocation of each county and tribe with respect to their
maximum allocation available under paragraph (a).
deleted text end

Sec. 18.

Minnesota Statutes 2004, section 256J.95,
subdivision 3, is amended to read:

Subd. 3.

Eligibility for diversionary work program.

(a)
Except for the categories of family units listed below, all
family units who apply for cash benefits and who meet MFIP
eligibility as required in sections 256J.11 to 256J.15 are
eligible and must participate in the diversionary work program.
Family units that are not eligible for the diversionary work
program include:

(1) child only cases;

(2) a single-parent family unit that includes a child under
12 weeks of age. A parent is eligible for this exception once
in a parent's lifetime and is not eligible if the parent has
already used the previously allowed child under age one
exemption from MFIP employment services;

(3) a minor parent without a high school diploma or its
equivalent;

(4) an 18- or 19-year-old caregiver without a high school
diploma or its equivalent who chooses to have an employment plan
with an education option;

(5) a caregiver age 60 or over;

(6) family units with a caregiver who received DWP benefits
in the 12 months prior to the month the family applied for DWP,
except as provided in paragraph (c);

(7) family units with a caregiver who received MFIP within
the 12 months prior to the month the family unit applied for
DWP;

(8) a family unit with a caregiver who received 60 or more
months of TANF assistance; and

(9) a family unit with a caregiver who is disqualified from
DWP or MFIP due to fraud.

(b) A two-parent family must participate in DWP unless both
caregivers meet the criteria for an exception under paragraph
(a), clauses (1) through (5), or the family unit includes a
parent who meets the criteria in paragraph (a), clause (6), (7),
(8), or (9).

(c) Once DWP eligibility is determined, the four months run
consecutively. If a participant leaves the program for any
reason and reapplies during the four-month period, the county
must redetermine eligibility for DWP.

new text begin (d) Newly arrived refugees and asylees as defined in Code
of Federal Regulations, title 45, chapter IV, section 400.2, who
have arrived in the United States within the last two months
shall be exempt from mandatory participation in the diversionary
work program and may enroll directly into the MFIP 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. 19.

Minnesota Statutes 2004, section 256J.95,
subdivision 9, is amended to read:

Subd. 9.

Property and income limitations.

The asset
limits and exclusions in section 256J.20 apply to applicants and
recipients of DWP. All payments, unless excluded in section
256J.21, must be counted as income to determine eligibility for
the diversionary work program. The county shall treat income as
outlined in section 256J.37 deleted text begin , except for subdivision 3a deleted text end . The
initial income test and the disregards in section 256J.21,
subdivision 3, shall be followed for determining eligibility for
the diversionary work program.

Sec. 20. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, section 256J.37, subdivisions 3a
and 3b, are repealed effective the first day of the second month
after the date of approval by the United States Department of
Agriculture.
new text end

ARTICLE 7

MISCELLANEOUS

Section 1.

new text begin [151.52] MANUFACTURER PRICE REPORT.
new text end

new text begin Subdivision 1. new text end

new text begin Report. new text end

new text begin All drug manufacturers registered
or licensed to do business in this state shall, on a quarterly
basis, report by National Drug Code the following pharmaceutical
pricing criteria to the commissioner of human services for each
of their drugs: average wholesale price, wholesale acquisition
cost, average manufacturer price as defined in United States
Code, title 42, chapter 7, subchapter XIX, section 1396r-8(k),
and best price as defined in United States Code, title 42,
chapter 7, subchapter XIX, section 1396r-8(c)(1)(C). The
calculation of average wholesale price and wholesale acquisition
cost shall be the net of all volume discounts, prompt payment
discounts, chargebacks, short-dated product discounts, cash
discounts, free goods, rebates, and all other price concessions
or incentives provided to a purchaser that result in a reduction
in the ultimate cost to the purchaser. When reporting average
wholesale price, wholesale acquisition cost, average
manufacturer price, and best price, manufacturers shall also
include a detailed description of the methodology by which the
prices were calculated. When a manufacturer reports average
wholesale price, wholesale acquisition cost, average
manufacturer price, or best price, the president or chief
executive officer of the manufacturer shall certify on a form
provided by the commissioner of human services, that the
reported prices are accurate. Any information reported under
this section shall be classified as nonpublic data under section
13.02, subdivision 9. Notwithstanding the classification of
data in this section and subdivision 2, the Minnesota Attorney
General's Office, the federal Centers for Medicare and Medicaid
Services or another law enforcement agency may access and obtain
copies of the data required under this section and use that data
for law enforcement purposes.
new text end

new text begin Subd. 2. new text end

new text begin Penalties and remedies. new text end

new text begin The attorney general
may pursue the penalties and remedies available to the attorney
general under section 8.31 against any manufacturer who violates
this section.
new text end

Sec. 2.

new text begin [151.55] CANCER 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) "Board" means the Board of Pharmacy.
new text end

new text begin (c) "Cancer drug" means a prescription drug that is used to
treat:
new text end

new text begin (1) cancer or the side effects of cancer; or
new text end

new text begin (2) the side effects of any prescription drug that is used
to treat cancer or the side effects of cancer.
new text end

new text begin (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.
new text end

new text begin (e) "Cancer supply" or "supplies" means prescription and
nonprescription cancer supplies needed to administer a cancer
drug.
new text end

new text begin (f) "Dispense" has the meaning given in section 151.01,
subdivision 30.
new text end

new text begin (g) "Distribute" means to deliver, other than by
administering or dispensing.
new text end

new text begin (h) "Medical facility" means an institution defined in
section 144.50, subdivision 2.
new text end

new text begin (i) "Medical supplies" means any prescription and
nonprescription medical supply needed to administer a cancer
drug.
new text end

new text begin (j) "Pharmacist" has the meaning given in section 151.01,
subdivision 3.
new text end

new text begin (k) "Pharmacy" means any pharmacy registered with the Board
of Pharmacy according to section 151.19, subdivision 1.
new text end

new text begin (l) "Practitioner" has the meaning given in section 151.01,
subdivision 23.
new text end

new text begin (m) "Prescription drug" means a legend drug as defined in
section 151.01, subdivision 17.
new text end

new text begin (n) "Side effects of cancer" means symptoms of cancer.
new text end

new text begin (o) "Single-unit-dose packaging" means a single-unit
container for articles intended for administration as a single
dose, direct from the container.
new text end

new text begin (p) "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.
new text end

new text begin Subd. 2. new text end

new text begin Establishment. new text end

new text begin 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.
new text end

new text begin Subd. 3. new text end

new text begin Requirements for participation by pharmacies and
medical facilities. new text end

new text begin (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.
new text end

new text begin (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:
new text end

new text begin (1) the name, street address, and telephone number of the
pharmacy or medical facility;
new text end

new text begin (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
new text end

new text begin (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).
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 4. new text end

new text begin Individual eligibility requirements. new text end

new text begin 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).
new text end

new text begin Subd. 5. new text end

new text begin Donations of cancer drugs and supplies. new text end

new text begin (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:
new text end

new text begin (1) an individual who is 18 years old or older; or
new text end

new text begin (2) a pharmacy, medical facility, drug manufacturer, or
wholesale drug distributor, if the donated drugs have not been
previously dispensed.
new text end

new text begin (b) A cancer drug is eligible for donation under the cancer
drug repository program only if the following requirements are
met:
new text end

new text begin (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;
new text end

new text begin (2) the drug's expiration date is at least six months later
than the date that the drug was donated;
new text end

new text begin (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
new text end

new text begin (4) the drug is not adulterated or misbranded.
new text end

new text begin (c) Cancer supplies are eligible for donation under the
cancer drug repository program only if the following
requirements are met:
new text end

new text begin (1) the supplies are not adulterated or misbranded;
new text end

new text begin (2) the supplies are in their original, unopened, sealed
packaging; and
new text end

new text begin (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.
new text end

new text begin (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
Department of Health's Web site.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 6. new text end

new text begin Dispensing requirements. new text end

new text begin (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
chapter 151 and within the practitioner's scope of practice.
new text end

new text begin (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.
new text end

new text begin (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:
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 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 cancer drug repository, the
state Department of Health, 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.
new text end

new text begin The board shall make the cancer drug repository form available
on the Department of Health's Web site.
new text end

new text begin (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:
new text end

new text begin (1) individuals who are uninsured;
new text end

new text begin (2) individuals who are enrolled in medical assistance,
general assistance medical care, MinnesotaCare, Medicare, or
other public assistance health care; and
new text end

new text begin (3) all other individuals who are otherwise eligible under
subdivision 4 to receive drugs or supplies from a cancer drug
repository.
new text end

new text begin Subd. 7. new text end

new text begin Handling fees. new text end

new text begin 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.
new text end

new text begin Subd. 8. new text end

new text begin Distribution of donated cancer drugs and
supplies. new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 9. new text end

new text begin Resale of donated drugs or supplies. new text end

new text begin Donated
drugs and supplies may not be resold.
new text end

new text begin Subd. 10. new text end

new text begin Record-keeping requirements. new text end

new text begin (a) Cancer drug
repository donor and recipient forms shall be maintained for at
least five years.
new text end

new text begin (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:
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 cancer drug
destroyed;
new text end

new text begin (3) the name of the person or firm that destroyed the drug;
and
new text end

new text begin (4) the source of the drugs or supplies destroyed.
new text end

new text begin Subd. 11. new text end

new text begin Liability. new text end

new text begin 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 the
donor of a cancer drug or supply is immune from civil liability
for an act or omission relating to the quality of a cancer drug
or supply that causes injury to or the death of an individual to
whom the cancer drug or supply is dispensed or administered 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 or administered 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
donated cancer drug or supply.
new text end

Sec. 3.

Minnesota Statutes 2004, section 241.01, is
amended by adding a subdivision to read:

new text begin Subd. 10. new text end

new text begin Purchasing for prescription drugs. new text end

new text begin In
accordance with section 241.021, subdivision 4, the commissioner
may contract with a separate entity to purchase prescription
drugs for persons confined in institutions under the control of
the commissioner. Local governments may participate in this
purchasing pool in order to purchase prescription drugs for
those persons confined in local correctional facilities in which
the local government has responsibility for providing health
care. If any county participates, the commissioner shall
appoint a county representative to any committee convened by the
commissioner for the purpose of establishing a drug formulary to
be used for state and local correctional facilities.
new text end

Sec. 4.

Minnesota Statutes 2004, section 256.01,
subdivision 2, is amended to read:

Subd. 2.

Specific powers.

Subject to the provisions of
section 241.021, subdivision 2, the commissioner of human
services shall carry out the specific duties in paragraphs (a)
through deleted text begin (aa) deleted text end new text begin (bb) new text end :

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(r) Allocate federal fiscal disallowances or sanctions for
audit exceptions when federal fiscal disallowances or sanctions
are based on a statewide random sample for the foster care
program under title IV-E of the Social Security Act, United
States Code, title 42, in direct proportion to each county's
title IV-E foster care maintenance claim for that period.

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

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

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

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

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

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

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

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

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

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

Sec. 5.

Minnesota Statutes 2004, section 256.741,
subdivision 4, is amended to read:

Subd. 4.

Effect of assignment.

Assignments in this
section take effect upon a determination that the applicant is
eligible for public assistance. The amount of support assigned
under this subdivision may not exceed the total amount of public
assistance issued or the total support obligation, whichever is
less. Child care support collections made according to an
assignment under subdivision 2, paragraph (c), must be
deposited, subject to any limitations of federal law, deleted text begin by the
commissioner of human services in the child support collection
account in the special revenue fund and appropriated to the
commissioner of education for child care assistance under
section 119B.03. These collections are in addition to state and
federal funds appropriated to the child care deleted text end new text begin in the general new text end fund.

Sec. 6.

new text begin [256.957] HEALTH CARE QUALITY IMPROVEMENT
ACCOUNT.
new text end

new text begin A health care quality improvement account is established in
the general fund.
new text end

Sec. 7.

Minnesota Statutes 2004, 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 actual
acquisition costs of the drugs plus a fixed dispensing fee; the
maximum allowable cost set by the federal government or by the
commissioner plus the fixed dispensing fee; or the usual and
customary price charged to the public. The amount of payment
basis must be reduced to reflect all discount amounts applied to
the charge by any provider/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 pharmacy dispensing fee shall be $3.65,
except that the dispensing fee for intravenous solutions which
must be compounded by the pharmacist shall be $8 per bag, $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. 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 average
wholesale price minus 11.5 percent, except that where a drug has
had its wholesale price reduced as a result of the actions of
the National Association of Medicaid Fraud Control Units, the
estimated actual acquisition cost shall be the reduced average
wholesale price, without the 11.5 percent deduction. The
maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable to, but no higher than,
the maximum amount paid by other third-party payors in this
state who have maximum allowable cost programs. Establishment
of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) An 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. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available,
payment shall be on the basis of the actual acquisition cost of
the generic drug, or on the maximum allowable cost established
by the commissioner.

(d) 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, the
average wholesale price minus five percent, or the maximum
allowable cost set by the federal government under United States
Code, title 42, chapter 7, section 1396r-8(e), and Code of
Federal Regulations, title 42, section 447.332, or by the
commissioner under paragraphs (a) to (c).

new text begin (e) The commissioner may consider the prices reported under
section 151.52, when determining reimbursement payments under
this subdivision.
new text end

Sec. 8.

Minnesota Statutes 2004, section 295.582, is
amended to read:

295.582 AUTHORITY.

new text begin Subdivision 1. new text end

new text begin Wholesale drug distributor tax. new text end

(a) A
hospital, surgical center, or health care provider that is
subject to a tax under section 295.52, or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor, may transfer additional expense
generated by section 295.52 obligations on to all third-party
contracts for the purchase of health care services on behalf of
a patient or consumer. new text begin Nothing shall prohibit a pharmacy from
transferring the additional expense generated under section
295.52 to a pharmacy benefits manager. new text end The additional expense
transferred to the third-party purchaser new text begin or a pharmacy benefits
manager new text end must not exceed the tax percentage specified in section
295.52 multiplied against the gross revenues received under the
third-party contract, and the tax percentage specified in
section 295.52 multiplied against co-payments and deductibles
paid by the individual patient or consumer. The expense must
not be generated on revenues derived from payments that are
excluded from the tax under section 295.53. All third-party
purchasers of health care services including, but not limited
to, third-party purchasers regulated under chapter 60A, 62A,
62C, 62D, 62H, 62N, 64B, 65A, 65B, 79, or 79A, or under section
471.61 or 471.617, new text begin and pharmacy benefits managers new text end must pay the
transferred expense in addition to any payments due under
existing contracts with the hospital, surgical center, pharmacy,
or health care provider, to the extent allowed under federal
law. A third-party purchaser of health care services includes,
but is not limited to, a health carrier or community integrated
service network that pays for health care services on behalf of
patients or that reimburses, indemnifies, compensates, or
otherwise insures patients for health care services. new text begin For
purposes of this section, a pharmacy benefits manager means an
entity that performs pharmacy benefits management. new text end A
third-party purchaser new text begin or pharmacy benefits manager new text end shall comply
with this section regardless of whether the third-party
purchaser new text begin or pharmacy benefits manager new text end is a for-profit,
not-for-profit, or nonprofit entity. A wholesale drug
distributor may transfer additional expense generated by section
295.52 obligations to entities that purchase from the
wholesaler, and the entities must pay the additional expense.
Nothing in this section limits the ability of a hospital,
surgical center, pharmacy, wholesale drug distributor, or health
care provider to recover all or part of the section 295.52
obligation by other methods, including increasing fees or
charges.

(b) Each third-party purchaser regulated under any chapter
cited in paragraph (a) shall include with its annual renewal for
certification of authority or licensure documentation indicating
compliance with paragraph (a).

(c) Any hospital, surgical center, or health care provider
subject to a tax under section 295.52 or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor may file a complaint with the
commissioner responsible for regulating the third-party
purchaser if at any time the third-party purchaser fails to
comply with paragraph (a).

(d) If the commissioner responsible for regulating the
third-party purchaser finds at any time that the third-party
purchaser has not complied with paragraph (a), the commissioner
may take enforcement action against a third-party purchaser
which is subject to the commissioner's regulatory jurisdiction
and which does not allow a hospital, surgical center, pharmacy,
or provider to pass-through the tax. The commissioner may by
order fine or censure the third-party purchaser or revoke or
suspend the certificate of authority or license of the
third-party purchaser to do business in this state if the
commissioner finds that the third-party purchaser has not
complied with this section. The third-party purchaser may
appeal the commissioner's order through a contested case hearing
in accordance with chapter 14.

new text begin Subd. 2. new text end

new text begin Agreement. new text end

new text begin A contracting agreement between a
third-party purchaser or a pharmacy benefits manager and a
resident or nonresident pharmacy registered under chapter 151,
may not prohibit:
new text end

new text begin (1) a pharmacy that has paid additional expense transferred
under this section by a wholesale drug distributor from
exercising its option under this section to transfer such
additional expenses generated by the section 295.52 obligations
on to the third-party purchaser or pharmacy benefits manager; or
new text end

new text begin (2) a pharmacy that is subject to tax under section 295.52,
subdivision 4, from exercising its option under this section to
recover all or part of the section 295.52 obligations from the
third-party purchaser or a pharmacy benefits manager.
new text end

Sec. 9.

Minnesota Statutes 2004, section 641.15,
subdivision 2, is amended to read:

Subd. 2.

Medical aid.

Except as provided in section
466.101, the county board shall pay the costs of medical
services provided to prisoners. The amount paid by the Anoka
deleted text begin county board deleted text end new text begin and Dakota County boards new text end for a medical service
shall not exceed the maximum allowed medical assistance payment
rate for the service, as determined by the commissioner of human
services. The county is entitled to reimbursement from the
prisoner for payment of medical bills to the extent that the
prisoner to whom the medical aid was provided has the ability to
pay the bills. The prisoner shall, at a minimum, incur
co-payment obligations for health care services provided by a
county correctional facility. The county board shall determine
the co-payment amount. Notwithstanding any law to the contrary,
the co-payment shall be deducted from any of the prisoner's
funds held by the county, to the extent possible. If there is a
disagreement between the county and a prisoner concerning the
prisoner's ability to pay, the court with jurisdiction over the
defendant shall determine the extent, if any, of the prisoner's
ability to pay for the medical services. If a prisoner is
covered by health or medical insurance or other health plan when
medical services are provided, the county providing the medical
services has a right of subrogation to be reimbursed by the
insurance carrier for all sums spent by it for medical services
to the prisoner that are covered by the policy of insurance or
health plan, in accordance with the benefits, limitations,
exclusions, provider restrictions, and other provisions of the
policy or health plan. The county may maintain an action to
enforce this subrogation right. The county does not have a
right of subrogation against the medical assistance program or
the general assistance medical care program.

Sec. 10.

Laws 2003, First Special Session chapter 14,
article 13C, section 2, subdivision 6, is amended to read:

Sec. 2. COMMISSIONER OF
HUMAN SERVICES

Subd. 6.

Basic Health Care Grants

Summary by Fund

General 1,499,941,000 1,533,016,000

Health Care Access 268,151,000 282,605,000

[UPDATING FEDERAL POVERTY GUIDELINES.]
Annual updates to the federal poverty
guidelines are effective each July 1,
following publication by the United
States Department of Health and Human
Services for health care programs under
Minnesota Statutes, chapters 256, 256B,
256D, and 256L.

The amounts that may be spent from this
appropriation for each purpose are as
follows:

(a) MinnesotaCare Grants

Health Care Access 267,401,000 281,855,000

[MINNESOTACARE FEDERAL RECEIPTS.]
Receipts received as a result of
federal participation pertaining to
administrative costs of the Minnesota
health care reform waiver shall be
deposited as nondedicated revenue in
the health care access fund. Receipts
received as a result of federal
participation pertaining to grants
shall be deposited in the federal fund
and shall offset health care access
funds for payments to providers.

[MINNESOTACARE FUNDING.] The
commissioner may expend money
appropriated from the health care
access fund for MinnesotaCare in either
fiscal year of the biennium.

(b) MA Basic Health Care Grants -
Families and Children

General 568,254,000 582,161,000

[SERVICES TO PREGNANT WOMEN.] The
commissioner shall use available
federal money for the State-Children's
Health Insurance Program for medical
assistance services provided to
pregnant women who are not otherwise
eligible for federal financial
participation beginning in fiscal year
2003. This federal money shall be
deposited in the federal fund and shall
offset general funds for payments to
providers. Notwithstanding section 14,
this paragraph shall not expire.

[MANAGED CARE RATE INCREASE.] (a)
Effective January 1, 2004, the
commissioner of human services shall
increase the total payments to managed
care plans under Minnesota Statutes,
section 256B.69, by an amount equal to
the cost increases to the managed care
plans from by the elimination of: (1)
the exemption from the taxes imposed
under Minnesota Statutes, section
297I.05, subdivision 5, for premiums
paid by the state for medical
assistance, general assistance medical
care, and the MinnesotaCare program;
and (2) the exemption of gross revenues
subject to the taxes imposed under
Minnesota Statutes, sections 295.50 to
295.57, for payments paid by the state
for services provided under medical
assistance, general assistance medical
care, and the MinnesotaCare program.
Any increase based on clause (2) must
be reflected in provider rates paid by
the managed care plan unless the
managed care plan is a staff model
health plan company.

(b) The commissioner of human services
shall increase by deleted text begin two percent deleted text end new text begin the
applicable tax rate in effect under
Minnesota Statutes, section 295.52, new text end the
fee-for-service payments under medical
assistance, general assistance medical
care, and the MinnesotaCare program for
services subject to the hospital,
surgical center, or health care
provider taxes under Minnesota
Statutes, sections 295.50 to 295.57,
effective for services rendered on or
after January 1, 2004.

(c) The commissioner of finance shall
transfer from the health care access
fund to the general fund the following
amounts in the fiscal years indicated:
2004, $16,587,000; 2005, $46,322,000;
2006, $49,413,000; and 2007,
$52,659,000.

(d) For fiscal years after 2007, the
commissioner of finance shall transfer
from the health care access fund to the
general fund an amount equal to the
revenue collected by the commissioner
of revenue on the following:

(1) gross revenues received by
hospitals, surgical centers, and health
care providers as payments for services
provided under medical assistance,
general assistance medical care, and
the MinnesotaCare program, including
payments received directly from the
state or from a prepaid plan, under
Minnesota Statutes, sections 295.50 to
295.57; and

(2) premiums paid by the state under
medical assistance, general assistance
medical care, and the MinnesotaCare
program under Minnesota Statutes,
section 297I.05, subdivision 5.

The commissioner of finance shall
monitor and adjust if necessary the
amount transferred each fiscal year
from the health care access fund to the
general fund to ensure that the amount
transferred equals the tax revenue
collected for the items described in
clauses (1) and (2) for that fiscal
year.

(e) Notwithstanding section 14, these
provisions shall not expire.

(c) MA Basic Health Care Grants - Elderly
and Disabled

General 695,421,000 741,605,000

[DELAY MEDICAL ASSISTANCE
FEE-FOR-SERVICE - ACUTE CARE.] The
following payments in fiscal year 2005
from the Medicaid Management
Information System that would otherwise
have been made to providers for medical
assistance and general assistance
medical care services shall be delayed
and included in the first payment in
fiscal year 2006:

(1) for hospitals, the last two
payments; and

(2) for nonhospital providers, the last
payment.

This payment delay shall not include
payments to skilled nursing facilities,
intermediate care facilities for mental
retardation, prepaid health plans, home
health agencies, personal care nursing
providers, and providers of only waiver
services. The provisions of Minnesota
Statutes, section 16A.124, shall not
apply to these delayed payments.
Notwithstanding section 14, this
provision shall not expire.

[DEAF AND HARD-OF-HEARING SERVICES.]
If, after making reasonable efforts,
the service provider for mental health
services to persons who are deaf or
hearing impaired is not able to earn
$227,000 through participation in
medical assistance intensive
rehabilitation services in fiscal year
2005, the commissioner shall transfer
$227,000 minus medical assistance
earnings achieved by the grantee to
deaf and hard-of-hearing grants to
enable the provider to continue
providing services to eligible persons.

(d) General Assistance Medical Care
Grants

General 223,960,000 196,617,000

(e) Health Care Grants - Other
Assistance

General 3,067,000 3,407,000

Health Care Access 750,000 750,000

[MINNESOTA PRESCRIPTION DRUG DEDICATED
FUND.] Of the general fund
appropriation, $284,000 in fiscal year
2005 is appropriated to the
commissioner for the prescription drug
dedicated fund established under the
prescription drug discount program.

[DENTAL ACCESS GRANTS CARRYOVER
AUTHORITY.] Any unspent portion of the
appropriation from the health care
access fund in fiscal years 2002 and
2003 for dental access grants under
Minnesota Statutes, section 256B.53,
shall not cancel but shall be allowed
to carry forward to be spent in the
biennium beginning July 1, 2003, for
these purposes.

[STOP-LOSS FUND ACCOUNT.] The
appropriation to the purchasing
alliance stop-loss fund account
established under Minnesota Statutes,
section 256.956, subdivision 2, for
fiscal years 2004 and 2005 shall only
be available for claim reimbursements
for qualifying enrollees who are
members of purchasing alliances that
meet the requirements described under
Minnesota Statutes, section 256.956,
subdivision 1, paragraph (f), clauses
(1), (2), and (3).

(f) Prescription Drug Program

General 9,239,000 9,226,000

[PRESCRIPTION DRUG ASSISTANCE PROGRAM.]
Of the general fund appropriation,
$702,000 in fiscal year 2004 and
$887,000 in fiscal year 2005 are for
the commissioner to establish and
administer the prescription drug
assistance program through the
Minnesota board on aging.

[REBATE REVENUE RECAPTURE.] Any funds
received by the state from a drug
manufacturer due to errors in the
pharmaceutical pricing used by the
manufacturer in determining the
prescription drug rebate are
appropriated to the commissioner to
augment funding of the prescription
drug program established in Minnesota
Statutes, section 256.955.

Sec. 11. new text begin LANGUAGE INTERPRETER SERVICES STUDY.
new text end

new text begin The commissioner of commerce, in consultation with the
commissioners of health, human services, and employee relations,
and representatives of health plan companies, health care
providers, and limited-English-speaking communities, and
communities that communicate through sign language shall study
and make recommendations on providing language interpreter
services to limited-English-speaking patients and patients who
communicate through sign language in order to facilitate the
provision of health care services by health care providers and
health care facilities. The recommendations shall include:
new text end

new text begin (1) ways to address the needed availability of professional
interpreter services;
new text end

new text begin (2) an accreditation system for language interpreters,
including appropriate standards for education, training, and
credentialing; and
new text end

new text begin (3) criteria for determining financial responsibility for
providing interpreter services to patients, including the
responsible parties for arranging interpreter services and for
reimbursement for these services.
new text end

new text begin The commissioner of commerce shall submit these
recommendations to the legislature by January 15, 2006.
new text end

Sec. 12. new text begin REBATE REVENUE RECAPTURE.
new text end

new text begin Any money received by the state from a drug manufacturer
due to errors in the pharmaceutical pricing used by the
manufacturer in determining the prescription drug rebate shall
be deposited in the health care quality improvement account
established in Minnesota Statutes, section 256.957.
new text end

Sec. 13. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, section 119B.074, is repealed.
new text end

ARTICLE 8

APPROPRIATIONS

Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
new text end

The sums in the columns marked "APPROPRIATIONS" are added
to, or, if shown in parentheses, are subtracted from the
appropriations to the specified agencies in 2005 S.F. No. 1879,
article 11, if enacted. The appropriations are from the general
fund, unless another fund is named, and are available for the
fiscal year indicated for each purpose. The figures "2006" and
"2007," where used in this article, mean that the additions to
or subtractions from the appropriations listed under them are
for the fiscal year ending June 30, 2006, or June 30, 2007,
respectively. The "first year" is fiscal year 2006. The
"second year" is fiscal year 2007. The "biennium" is fiscal
years 2006 and 2007.
SUMMARY BY FUND

BIENNIAL
2006 2007 TOTAL

General $ 38,148,000 $ 63,783,000 $ 101,931,000

State Government
Special Revenue 7,151,000 12,625,000 19,776,000

Health Care
Access 42,451,000 65,060,000 107,511,000

Federal TANF (3,665,000) 11,064,000 7,399,000

Lottery Prize
Fund 400,000 400,000 800,000

TOTAL $ 84,485,000 $ 152,932,000 $ 237,417,000

APPROPRIATIONS
Available for the Year
Ending June 30
2006 2007

Sec. 2. COMMISSIONER OF
HUMAN SERVICES

Subdivision 1.

Total
Appropriation $ 75,897,000 $ 137,808,000

Summary by Fund

General 36,781,000 61,354,000

Health Care
Access 42,381,000 64,990,000

Federal TANF (3,665,000) 11,064,000

Lottery Cash
Flow 400,000 400,000

Subd. 2.

Agency Management

Summary by Fund

General (165,000) (231,000)

Health Care Access 1,623,000 1,701,000

The amounts that may be spent from the
appropriation for each purpose are as
follows:

(a) Financial Operations

General 424,000 424,000

Health Care Access 152,000 183,000

[ADMINISTRATIVE REDUCTION.] The general
fund appropriation in this section
includes a department-wide
administrative reduction of $6,885,000
the first year and $7,201,000 the
second year. The commissioner shall
ensure that any staff reductions made
under this paragraph comply with
Minnesota Statutes, section 43A.046.

(b) Legal and
Regulation Operations

General (5,208,000) (5,482,000)

Health Care Access 75,000 75,000

(c) Information Technology
Operations

General 4,619,000 4,827,000

Health Care Access 1,396,000 1,443,000

Subd. 3.

Revenue and Pass-Through

Federal TANF (16,956,000) (5,221,000)

[REDUCED TANF TRANSFER.]
Notwithstanding Laws 2000, chapter 488,
article 8, section 2, subdivision 6,
with respect to TANF funds used as
refinancing for the state share of the
child support pass-through under
Minnesota Statutes, section 256.741,
subdivision 15, and notwithstanding
Minnesota Statutes, section 290.0671,
subdivision 6a, with respect to the
TANF-funded expansion of the Minnesota
working family credit, the commissioner
shall reduce the combined amount of the
TANF funds transferred to the
commissioner of revenue for deposit in
the general fund by $11,020,000 in
fiscal year 2006, by $6,860,000 in
fiscal year 2007, and by $7,000,000 in
fiscal year 2008 and subsequent years.
Notwithstanding section 7, this
paragraph shall not expire.

[TANF TRANSFER TO FEDERAL CHILD CARE
AND DEVELOPMENT FUND.] The following
amounts are appropriated to the
commissioner for the purposes of MFIP
transition year child care under
Minnesota Statutes, section 119B.05;
$756,000 in fiscal year 2006;
$4,831,000 in fiscal year 2007;
$5,183,000 in fiscal year 2008; and
$1,127,000 in fiscal year 2009. The
commissioner shall authorize the
transfer of sufficient TANF funds to
the federal child care and development
fund to meet this appropriation and
shall ensure that all transferred funds
are expended according to the federal
child care and development fund
regulations. Notwithstanding section
7, this paragraph expires June 30, 2009.

Subd. 4. Economic Support Grants

Summary by Fund

General 1,722,000 7,109,000

Federal TANF 13,291,000 16,285,000

The amounts that may be spent from this
appropriation for each purpose are as
follows:

(a) Minnesota Family Investment Program

General -0- 3,740,000

Federal TANF 13,151,000 16,145,000

(b) MFIP Child Care Assistance Grants

-0- (3,740,000)

(c) Children Services Grants

1,119,000 6,074,000

(d) Children and Community Services
Grants

General Fund 3,000 11,000

Federal TANF 140,000 140,000

[NEW CHANCE PROGRAM.] Of the TANF
appropriation, $140,000 each year is to
the commissioner for a grant to the new
chance program. The new chance program
shall provide comprehensive services
through a private, nonprofit agency to
young parents in Hennepin County who
have dropped out of school and are
receiving public assistance. The
program administrator shall report
annually to the commissioner on skills
development, education, job training,
and job placement outcomes for program
participants.

(e) Minnesota Supplemental Aid Grants

118,000 363,000

(f) Group Residential Housing Grants

122,000 301,000

(g) Other Children's and Economic
Assistance Grants

360,000 360,000

[TRANSITIONAL HOUSING.] This
appropriation is to the commissioner
for the transitional housing program
established in the 2005 Environment,
Agriculture, and Economic Development
omnibus appropriations bill.

Subd. 5.

Children and Economic
Assistance Management

467,000 291,000

Subd. 6.

Basic Health Care Grants

Summary by Fund

General 190,000 6,424,000

Health Care Access 30,843,000 51,903,000

The amounts that may be spent from this
appropriation for each purpose are as
follows:

(a) MinnesotaCare Grants

Health Care Access 30,843,000 51,903,000

[HEALTHMATCH DELAY.] Of this
appropriation, $3,112,000 the first
year and $7,541,000 the second year is
for the MinnesotaCare program costs
related to a one-month delay in
implementation of the HealthMatch
program.

(b) MA Basic Health Care Grants -
Families and Children

516,000 3,326,000

[GREATER MINNESOTA HOSPITAL PAYMENT
ADJUSTMENT.] Of the general fund
appropriation for medical assistance
basic health care grants - families and
children, medical assistance basic
health care grants - elderly and
disabled, and general assistance
medical care, $400,000 each year is for
greater Minnesota payment adjustments
under Minnesota Statutes, section
256.969, subdivision 26, for admissions
occurring on or after July 1, 2005.

[PROVIDER RATES NOT TO INCREASE.]
Provider rates under medical assistance
and general assistance medical care,
except for rates paid for dental
services and pharmacy services, in
effect on June 30, 2005, shall not be
increased as a result of the repeal of
recipient co-payments effective July 1,
2005.

(c) MA Basic Health Care Grants - Elderly
and Disabled

1,146,000 727,000

(d) General Assistance Medical Care
Grants

1,029,000 4,349,000

(e) Health Care Grants - Other
Assistance

(2,500,000) (1,978,000)

[PRESCRIPTION DRUG DISCOUNT PROGRAM.]
Of the general fund appropriation for
the second year, $1,022,000 is to be
transferred to the Minnesota
prescription drug dedicated fund
established in Minnesota Statutes,
section 256.9545, subdivision 11. This
is a onetime appropriation and shall
not become part of base level funding
for the biennium beginning July 1, 2007.

Subd. 7.

Health Care Management

Summary by Fund

General 4,670,000 4,411,000

Health Care Access 9,915,000 11,386,000

The amounts that may be spent from this
appropriation for each purpose are as
follows:

(a) Health Care Administration

General 4,206,000 4,157,000

Health Care Access 7,465,000 10,693,000

[TICKET TO WORK.] Effective the day
following final enactment, supplemental
funding made available by the Centers
for Medicare and Medicaid Services
under the Ticket to Work Medicaid
Infrastructure Grant to support
outreach and education activities on
Medicare Part D for persons receiving
medical assistance for employed persons
with disabilities is appropriated to
the commissioner for required grant and
administrative activities.

(b) Health Care Operations

General 464,000 254,000

Health Care Access 2,450,000 693,000

Subd. 8.

Continuing Care Grants

Summary by Fund

General 6,616,000 36,090,000

Lottery Prize Fund 400,000 400,000

The amounts that may be spent from this
appropriation for each purpose are as
follows:

(a) Aging and Adult Service Grant

3,000 10,000

(b) Alternative Care Grants

10,468,000 19,442,000

(c) Medical Assistance Long-Term
Care Facilities Grants

(2,799,000) (12,569,000)

[RATE ADJUSTMENTS UNDER NEW NURSING
FACILITY REIMBURSEMENT SYSTEM.] Of this
appropriation, $12,992,000 the second
year is to adjust nursing facility
rates in order to facilitate the
transition from the current ratesetting
system to the system developed under
Minnesota Statutes, section 256B.440.

[NURSING HOME MORATORIUM EXCEPTIONS.]
During the first year, the commissioner
of health may approve moratorium
exception projects under Minnesota
Statutes, section 144A.073, for which
the full annualized state share of
medical assistance costs does not
exceed $3,000,000.

[ICF/MR DOWNSIZING.] Of this
appropriation, $300,000 each year is
for rate adjustments for intermediate
care facilities for persons with mental
retardation that are downsizing.

(d) Medical Assistance Long-Term
Care Waivers and Home Care Grants

(4,354,000) (3,279,000)

[LIMITING WAIVER GROWTH.] For each year
of the biennium ending June 30, 2007,
the commissioner of human services
shall make available additional
allocations for community alternatives
for disabled individuals waivered
services covered under Minnesota
Statutes, section 256B.49, at a rate of
105 per month or 1,260 per year, plus
any additional legislatively authorized
growth. Priorities for the allocation
of funds shall be for individuals
anticipated to be discharged from
institutional settings or who are at
imminent risk of a placement in an
institutional setting.

For each year of the biennium ending
June 30, 2007, the commissioner shall
make available additional allocations
for traumatic brain injury waivered
services covered under Minnesota
Statutes, section 256B.49, at a rate of
165 per year. Priorities for the
allocation of funds shall be for
individuals anticipated to be
discharged from institutional settings
or who are at imminent risk of a
placement in an institutional setting.

Notwithstanding 2005 S.F. No. 1879,
article 11, section 2, subdivision 8,
paragraph (d), if enacted, for each
year of the biennium ending June 30,
2007, the commissioner shall limit the
new diversion caseload growth in the
mental retardation and related
conditions waiver to 75 additional
allocations. Notwithstanding Minnesota
Statutes, section 256B.0916,
subdivision 5, paragraph (b), the
available diversion allocations shall
be awarded to support individuals whose
health and safety needs result in an
imminent risk of an institutional
placement at any time during the fiscal
year.

(e) Mental Health Grants

General 950,000 1,888,000

Lottery Prize Fund 400,000 400,000

[ALTERNATIVES TO ANOKA-METRO REGIONAL
TREATMENT CENTER.] Of this
appropriation, $350,000 the first year
and $145,000 the second year is to the
commissioner to develop community
alternatives to Anoka-Metro Regional
Treatment Center under Minnesota
Statutes, section 245.4661,
subdivisions 8 to 11. Any amount of
this appropriation that is unspent
shall not cancel but shall be available
until expended. Notwithstanding
section 7, this paragraph shall not
expire.

(f) Deaf and Hard-of-Hearing
Service Grants

9,000 33,000

(g) Chemical Dependency
Entitlement Grants

2,144,000 4,762,000

(h) Other Continuing Care

195,000 665,000

Subd. 9.

Continuing Care Management

599,000 465,000

[TASK FORCE ON COLLABORATIVE SERVICES.]
The commissioner, in collaboration with
the commissioner of education, shall
create a task force to discuss
collaboration between schools and
mental health providers to: promote
colocation and integrated services;
identify barriers to collaboration;
develop a model contract; and identify
examples of successful collaboration.
The task force shall also develop
recommendations on how to pay for
children's mental health screenings.
The task force shall include
representatives of school boards;
administrative personnel; special
education directors; counties; parent
advocacy organizations; school social
workers, counselors, nurses, and
psychologists; community mental health
professionals; health plans; and other
interested parties. The task force
shall present a report to the chairs of
the education and health policy
committees by February 1, 2006.

Of the general fund appropriation,
$5,000 the first year is to the
commissioner to contract with a
nonprofit organization that is
knowledgeable about children's mental
health issues to provide the research
necessary for the task force to make
recommendations and complete the report.

Subd. 10.

State-Operated Services

22,682,000 6,796,000

[EVIDENCE-BASED PRACTICE FOR
METHAMPHETAMINE TREATMENT.] Of the
general fund appropriation, $300,000
each year is to support development of
evidence-based practices for the
treatment of methamphetamine abuse at
the state-operated services chemical
dependency program in Willmar. These
funds shall be used to support research
on evidence-based practices for the
treatment of methamphetamine abuse,
dissemination of the results of the
evidence-based practice research
statewide, and creation of training for
addiction counselors specializing in
the treatment of methamphetamine abuse.

Sec. 3. COMMISSIONER OF HEALTH

Subdivision 1.

Total
Appropriation 6,271,000 13,118,000

Summary by Fund

General 1,367,000 2,429,000

State Government
Special Revenue 4,834,000 10,619,000

Health Care Access 70,000 70,000

[RENTAL COSTS, ADMINISTRATIVE
REDUCTIONS, FEE INCREASES, AND REVENUE
TRANSFER.] (a) Of this appropriation,
$1,208,000 the first year and
$3,069,000 the second year is for
rental costs in the new public health
laboratory building.

(b) The general fund appropriation in
this section includes a department-wide
administrative reduction of $242,000
the first year and $1,007,000 the
second year. The commissioner shall
ensure that any staff reductions made
under this paragraph comply with
Minnesota Statutes, section 43A.046.

(c) The commissioner shall increase all
fees levied by the commissioner a pro
rata amount in order to generate
revenue of $731,000 the first year and
$1,823,000 the second year. These
amounts shall be deposited in the
general fund. This paragraph shall not
apply to fees paid by occupational
therapists.

(d) $254,000 each year shall be
transferred from the state government
special revenue fund to the general
fund.

Subd. 2.

Community and Family
Health Improvement

Summary by Fund

General 159,000 (640,000)

State Government
Special Revenue 335,000 335,000

Health Care Access 70,000 70,000

[TANF CARRYFORWARD.] Any unexpended
balance of the TANF appropriation in
the first year of the biennium in this
section and 2005 S.F. No. 1879, article
11, section 3, if enacted, does not
cancel but is available for the second
year.

[WORK GROUP ON CHILDHOOD OBESITY.] (a)
Of the general fund appropriation,
$5,000 the first year and $1,000 the
second year is to the commissioner to
convene an interagency work group with
the commissioners of human services and
education to study and make
recommendations on reducing the rate of
obesity among the children in Minnesota.

(b) The work group shall determine the
number of children who are currently
obese and set a goal, including
measurable outcomes for the state in
terms of reducing the rate of childhood
obesity. The work group shall make
recommendations on how to achieve this
goal, including, but not limited to,
increasing physical activities;
exploring opportunities to promote
physical education and healthy eating
programs; improving the nutritional
offerings through breakfast and lunch
menus; and evaluating the availability
and choice of nutritional products
offered in public schools.

(c) The work group may include
representatives of the Minnesota
Medical Association; the Minnesota
Nurses Association; the Local Public
Health Association of Minnesota; the
Minnesota Dietetic Association; the
Minnesota School Food Service
Association; the Minnesota Association
of Health, Physical Education,
Recreation, and Dance; the Minnesota
School Boards Association; the
Minnesota School Administrators
Association; the Minnesota Secondary
Principals Association; the vending
industry; and consumers.

(d) The commissioner must submit the
recommendations of the work group to
the legislature by January 15, 2007.

Subd. 3.

Policy Quality and
Compliance

Summary by Fund

State Government
Special Revenue 770,000 770,000

[STATEWIDE TRAUMA SYSTEM.] (a) Of the
general fund appropriation, $382,000
the first year and $352,000 the second
year is for development of a statewide
trauma system.

(b) The commissioner shall increase
hospital licensing fees a pro rata
amount to increase fee revenue by
$382,000 the first year and $352,000
the second year. This revenue shall be
deposited in the general fund.

[AIDS PREVENTION FOR AFRICAN-BORN
RESIDENTS.] For fiscal year 2006 only,
the commissioner shall reallocate
$300,000 from the grant program under
Minnesota Statutes, section 145.928,
for grants in accordance with Minnesota
Statutes, section 145.924, paragraph
(b), for a public education and
awareness campaign targeting
communities of African-born Minnesota
residents. The grants shall be
designed to:

(1) promote knowledge and understanding
about HIV and to increase knowledge in
order to eliminate and reduce the risk
for HIV infection;

(2) encourage screening and testing for
HIV; and

(3) connect individuals to public
health and health care resources. The
grants must be awarded to collaborative
efforts that bring together nonprofit
community-based groups with
demonstrated experience in addressing
the public health, health care, and
social service needs of African-born
communities.

[FAMILY PLANNING GRANTS.] Of the
general fund appropriation, $500,000
each year is to the commissioner for
grants under Minnesota Statutes,
section 145.925, to family planning
clinics serving outstate Minnesota that
demonstrate financial need.

Subd. 4.

Health Protection

Summary by Fund

State Government
Special Revenue 3,729,000 9,514,000

Subd. 5.

Administrative Support
Services

1,208,000 3,069,000

Sec. 4. VETERANS NURSING HOMES BOARD

[VETERANS HOMES SPECIAL REVENUE
ACCOUNT.] The general fund
appropriations made to the board in
2005 S.F. No. 1879, if enacted, may be
transferred to a veterans homes special
revenue account in the special revenue
fund in the same manner as other
receipts are deposited according to
Minnesota Statutes, section 198.34, and
are appropriated to the board for the
operation of board facilities and
programs.

Sec. 5. HEALTH-RELATED BOARDS

Subdivision 1.

Total
Appropriation 2,317,000 2,006,000

Summary by Fund

State Government
Special Revenue 2,317,000 2,006,000

[STATE GOVERNMENT SPECIAL REVENUE
FUND.] The appropriations in this
section are from the state government
special revenue fund, except where
noted.

[NO SPENDING IN EXCESS OF REVENUES.]
The commissioner of finance shall not
permit the allotment, encumbrance, or
expenditure of money appropriated in
this section in excess of the
anticipated biennial revenues or
accumulated surplus revenues from fees
collected by the boards. Neither this
provision nor Minnesota Statutes,
section 214.06, applies to transfers
from the general contingent account.

Subd. 2.

Board of Dentistry

Summary by Fund

State Government
Special Revenue 150,000 -0-

[ORAL HEALTH PILOT PROJECT.] Of this
appropriation, $150,000 the first year
is to be transferred to the
commissioner of human services for an
oral health care system pilot project.

Subd. 3.

Board of Nursing

1,563,000 1,407,000

[MINNESOTA CENTER OF NURSING.] (a) Of
this appropriation, $500,000 in fiscal
year 2006 is to be used as start-up
funding to establish a Minnesota Center
of Nursing. The goals of the center
shall be to:

(1) maintain information on the current
and projected supply and demand of
nurses through the collection and
analysis of data on the nursing
workforce;

(2) develop a strategic statewide plan
for the nursing workforce;

(3) convene work groups of stakeholders
to examine issues and make
recommendations regarding factors
affecting nursing education,
recruitment, and retention;

(4) promote recognition, reward, and
renewal activities for nurses in
Minnesota; and

(5) provide consultation, technical
assistance, and data on the nursing
workforce to the legislature.

(b) The board shall report to the
legislature by January 15, 2007, on the
Center of Nursing's progress, the
center's collaboration efforts with
other organizations and governmental
entities, and the activities conducted
by the center in achieving the goals
outlined.

[TRANSFERS FROM SPECIAL REVENUE FUND.]
Of this appropriation, the following
transfers shall be made as directed
from the state government special
revenue fund:

(a) $938,000 the first year and
$1,207,000 the second year shall be
transferred to the commissioner of
human services for the long-term care
and home and community-based care
employee scholarship program. This
appropriation shall not become part of
base level funding for the biennium
beginning July 1, 2007.

(b) $125,000 the first year and
$200,000 the second year shall be
transferred to the health professional
education loan forgiveness program
account for loan forgiveness for nurses
under Minnesota Statutes, section
144.1501. This appropriation shall
become part of base level funding for
the commissioner for the biennium
beginning July 1, 2007, but shall not
be part of base level funding for the
biennium beginning July 1, 2009.
Notwithstanding section 7, this
paragraph expires on June 30, 2009.

Subd. 4.

Board of Pharmacy

499,000 499,000

[RURAL PHARMACY PROGRAM.] Of this
appropriation, $200,000 each year shall
be transferred to the commissioner of
health for the rural pharmacy planning
and transition grant program under
Minnesota Statutes, section 144.1476.
Of this transferred amount, $20,000
each year may be retained by the
commissioner for related administrative
costs. This appropriation shall become
part of base level funding for the
commissioner for the biennium beginning
July 1, 2007. Notwithstanding section
7, this paragraph expires on June 30,
2009.

[PHARMACIST LOAN FORGIVENESS.] $200,000
each year shall be transferred to the
health professional education loan
forgiveness program account for loan
forgiveness for pharmacists under
Minnesota Statutes, section 144.501.
This appropriation shall become part of
base level funding for the commissioner
for the biennium beginning July 1,
2007. Notwithstanding section 7, this
paragraph expires on June 30, 2009.

[DRUG MANUFACTURER PRICING DISCLOSURE.]
(a) The board shall increase the
licensing or registration fee for
wholesale drug distributors and drug
manufacturers required under Minnesota
Statutes, chapter 151, by $65 per year
beginning July 1, 2005.

(b) Of the appropriation in this
subdivision, $74,000 each year is to be
transferred to the commissioner of
human services for the data received
under Minnesota Statutes, section
151.52.

[CANCER DRUG REPOSITORY PROGRAM.] Of
this appropriation, $25,000 each year
is for the cancer drug repository
program under Minnesota Statutes,
section 151.55. This appropriation
shall become part of base level funding
for the board for the biennium
beginning July 1, 2007, but shall not
be part of the base for the biennium
beginning July 1, 2009.
Notwithstanding section 7, this
paragraph expires June 30, 2009.

Subd. 5.

Board of Social
Work

105,000 100,000

[ADMINISTRATIVE MANAGEMENT.] This
appropriation is to provide
administrative management under
Minnesota Statutes, section 148B.61,
subdivision 4. The following boards
shall be assessed a prorated amount
depending on the number of licensees
under the board's regulatory authority
providing mental health services within
their scope of practice: Board of
Medical Practice, the Board of Nursing,
the Board of Psychology, the Board of
Social Work, the Board of Marriage and
Family Therapy, and the Board of
Behavioral Health and Therapy.

Sec. 6. new text begin BASE LEVEL FUNDING ADJUSTMENTS.
new text end

new text begin Base level funding for the biennium beginning July 1, 2007,
for nonentitlement grants and administration appropriations in
this article shall be shown in legislative tracking documents.
Notwithstanding section 7, this section shall expire on June 30,
2009.
new text end

Sec. 7. new text begin SUNSET OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language in this article expires on June 30,
2007, unless a different expiration date is explicit.
new text end